1. Information for Professionals
Definition of a Carer (Carers Trust and as used in the Sunderland Carers’ Strategy).
Who is a carer?
A carer is someone who, without payment, provides help and support to a friend, neighbour or relative who could not manage otherwise because of frailty, illness, disability, mental ill health or addiction.
This may include helping with:
- Washing, bathing and dressing;
- Cooking and housework;
- Medication and injections;
- Emotional support and much more.
Paid care workers who are sometimes referred to as ‘carers’ and who work in places such as care homes and hospitals, as well as in individuals’ homes (such as home care staff) are excluded from this definition.
Within the Safeguarding Adults process the importance and value of the role of family members as carers is acknowledged. Unpaid care may also be undertaken by friends or neighbours of the person needing care and support. Carers often have a valuable contribution to make to the safety, welfare and quality of life of the individual they support and care for, and need to be considered as partners in the Safeguarding Adults process, wherever this is appropriate and applicable, because it is important that the wishes, feelings and needs of the carer are identified and taken into account, where appropriate. However, although caring for someone can be very rewarding, some people may find it can be stressful at times, and may have the potential to impact on their own physical and mental health. It is recognised that all carers are individuals who may need different levels of help and support at different times, and are entitled to an assessment of need (a Carer's Assessment), in their own right.
The Safeguarding Adults Procedures acknowledge that when abuse by a carer does occur, it is often un-intentional (although in a small number of cases, it is found to be intentional). The majority of family carers do their utmost to act in the best interests of the cared for person; however, in some situations, the carer will not be able to provide the usual level of support, and in a small amount of cases, situations will arise which would meet the definitions of abuse. Situations which might lead to a breakdown of the usual caring role might include:
- The carer needs a break from the caring routine;
- The carer is themselves physically or mentally unwell;
- The carer is experiencing high levels of stress, generated either from doing their best to undertake the caring role, or from external sources;
- The carer has financial problems which are impacting on their mental wellbeing;
- The carer and the cared-for have not been able to agree on the level of service and support that are needed, or on the acceptance of any, or additional, services and support.
Townsend (1992) identified a range of causal factors which sought to explain why ordinary people, such as those engaged in the role of carer, can sometimes fail to provide the correct level of support, leading to a situation which can be classified as abuse. These all focus on different aspects of the carer and cared-for’s relationship – external circumstances (such as issues with finances or housing, or the marginalisation of vulnerable people and their carers within society) or internal pressures (such as changes to the dynamics of the carer / cared-for relationship, or the breakdown of the support offered due to difficulties with the carers’ physical or mental health).
Situations where abuse occurs may range from a one-off act of frustration to systematic and premeditated abuse. In general terms, abuse is linked to the vulnerability or dependency of one adult and the actions or inactions of someone involved in their life, who may or may not be an unpaid carer. Vulnerability and dependency places people at risk.
There have been instances where abuse has occurred and where the perpetrator has not understood their actions as an infringement of a person's human rights – some of these cases have involved family carers. In these circumstances, although the Safeguarding Adults procedures will still need to be followed; as long as there is no criminal case, the timely arrangement of appropriate levels of support for the carer, to enable them to continue to fulfil their caring role (if they wish to continue to do so) should be instigated.
Carers are fundamental to the whole of Safeguarding Adults and are partners in the process but it is important to emphasise that the focus of the Safeguarding Adults Procedures is the safeguarding of an Adult at Risk and as such, carers are participants in the process but the wishes, views, safety and wellbeing of the Adult at Risk are of primary importance.
The Safeguarding Adults process aims to strike a balance between the appropriate involvement of carers in the Procedures and at the same time, responding to the wishes of the Adult at Risk and the needs of an investigation. As such therefore:
- If the adult does not want their carer to be informed of the process, their wishes will be respected and if carers do attend meetings, it is with that person's consent - if they are able to give it;
- If carers are involved in meetings, they may be asked to leave for parts of the discussion in the interests of confidentiality;
- Carers who do attend meetings can expect to receive minutes (but not minutes of any part of the discussion for which they were asked to leave). Equally, if carers do not attend meetings, then they will not receive minutes however, they can expect feedback as appropriate;
- An Independent Mental Capacity Advocate (IMCA) may however be involved (even when there are carers or family members who would ordinarily represent the Adult at Risk). The IMCA’s role, depending on the circumstances, could be to support the individual undergoing the Safeguarding Adults process, their carer(s), or both.
Please Note: It is the Chair of the Safeguarding Adults meeting, who makes the decision as to who should or should not attend meetings and if a carer is the alleged abuser, they would not ordinarily be invited to attend a Safeguarding Adults meeting. This applies to any alleged abuser.The ultimate aim of the Safeguarding Adults Procedures is to ensure that the person who is seen as vulnerable and at risk of abuse or neglect is supported, the situation is dealt with appropriately and efficiently and any safeguards are put in place through the Safeguarding Adults Procedures. It is also important to note that carers can sometimes be at risk of abuse or neglect as well, either as a result of their own physical or mental health difficulties, or because they are themselves at risk of abuse from the cared-for person, due to behaviours or actions arising from that individual’s physical or mental health condition, e.g. pain, confusion, challenging behaviour or due to domestic violence from the cared-for person (that is not a facet of the cared-for person’s illness). The potential for carers to be at risk of abuse or neglect in their own right would also be considered within the Procedures. A concern about the suspected or known abuse of a carer would need to be referred into the Safeguarding Adults process in the same way as for any other individual, via the referral form, and using the Safeguarding Threshold Risk Assessment Guidance.