This chapter provides information for multi-agency practitioners about carers of adults with care and support needs in relation to adult safeguarding. Specifically, it outlines their role in preventing and detecting abuse or neglect of those for whom they care, but it also discusses potential harm that may be caused by carers. Multi-agency practitioners need to be aware of such possible risks to adults with care and support needs.
June 2020: This chapter has been amended to add a link to Supporting Adult Carers published by NICE, as above.
A carer, in this context, is usually a family member or a friend.
Carers can play a significant role in preventing and detecting abuse and neglect for the people they care for. The vast majority of carers strive to act in the best interests of the person they support. There are times, however, when carers themselves experience abuse from the person to whom they are offering care and support or from the local community in which they live.
Risk of harm to the supported person may also arise because of carer stress, tiredness, or lack of information, skills or support. Also, there are times where harm is intended.
Circumstances in which a carer could be involved in a situation that may require a safeguarding response from agencies include:
- a carer may witness or speak up about abuse or neglect in relation to the adult they care for, or another person;
- a carer may experience intentional or unintentional harm from the adult they are trying to support, or from professionals and organisations they are in contact with;
- a carer may harm or neglect the adult they support on their own or with others. This may, or may not, be deliberate.
All staff and professionals should support a rights based approach to issues of abuse and neglect and to the recognition and support of carers.
Assessment of both the carer and the adult they care for must include considering the wellbeing of both people. The Care Act includes protection from abuse and neglect as part of the definition of wellbeing (see Promoting Wellbeing). As such, a needs assessment for the adult or a carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information or support that prevents abuse or neglect from occurring. This may be for example, by providing training to the carer about the condition that the adult they care for has, or to support them to care more safely. Where that is necessary the local authority should make arrangements for providing such interventions.
A carer’s assessment should follow the legal requirements of the Care Act 2014 and also take into account the following factors:
- whether the adult for whom they care has a learning disability, mental health problems or a chronic progressive disabling illness that creates caring needs which exceed the carer’s ability to meet them;
- the emotional and / or social isolation of the carer and the adult;
- whether there is minimal or no communication between the adult and the carer either through choice, mental incapacity or poor relationship;
- whether the carer is or is not in receipt of any practical and/or emotional support from other family members or professionals;
- financial difficulties;
- whether the carer has an enduring or lasting power of attorney or appointeeship;
- whether there is a personal or family history of violent behaviour, alcoholism, substance misuse or mental illness;
- the physical and mental health and wellbeing of the carer.
3. Allegations against Carers who are Relatives or Friends
There is a clear difference between unintentional harm caused inadvertently and a deliberate act of either harm or omission. However, contact must be made with the police if a crime has been or may be committed
In cases where unintentional harm has occurred this may be due to lack of knowledge or due to the fact that the carer’s own physical or mental needs make them unable to care adequately for the adult. The carer may also be an adult experiencing or at risk of abuse or neglect. In this situation the aim of safeguarding adults work will be to help the carer to provide support and make changes in their behaviour in order to decrease the risk of further harm to the person they are caring for.
4. Safeguarding Enquiries
If a carer raises any issues about abuse or neglect, it is essential that they are listened to and that, where appropriate, a safeguarding enquiry is undertaken and other agencies are involved as required.
If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:
- removing or reducing risk – whether, as part of the assessment and support planning process for the carer and / or the adult they care for, support can be provided that removes or reduces the risk of abuse. This may include, for example, the provision of training, information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy (see Independent Advocacy); in others, a carer may benefit from having such support if they are under great stress;
- involving other agencies – whether other agencies should be involved: in some circumstances where it is possible a criminal offence has been committed this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring the situation.
Other key considerations for carers should include:
- involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
- whether or not a joint assessment of the adult and the is appropriate in each individual circumstance;
- the risk factors that may increase the likelihood of abuse or neglect occurring;
- whether a change in circumstance changes the risk of abuse or neglect occurring.
A change in circumstance should also trigger the review of the care and support plan and, or, support plan (see Care and Support Planning). Further information about these considerations can be found in Carers and Safeguarding: Working Together to Improve Outcomes (ADASS).