Definition of an Adult (Vulnerable) at Risk

1. Introduction

With the guidance taken from The Care Act 2014 (England) (and interpreted for the Isle of Man context), the definition of an adult (vulnerable) at risk applies in respect of any person aged 18 or over who:

Everyone working to support people with care and support needs has a responsibility within these multi-agency adult safeguarding procedures to identify and respond to concerns about possible abuse and neglect.

An adult with care and support needs may be:

• A person with a physical disability, a learning difficulty or a sensory impairment;
• Someone with mental health needs, including dementia or a personality disorder;
• A person with a long-term health condition;
• Someone who misuses alcohol or substances to the extent that it affects their ability to manage day-to-day living;
• Someone who is unable to demonstrate the capacity to make a decision relating to their safety and is in need of care and support.

2. Safeguarding Responsibilities also Apply in Respect of Informal Carers

• An informal carer may witness or speak up about abuse or neglect;
• An informal 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; or
• An informal carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others.

Carers play a significant role in preventing the need for services and it is important that professionals consider preventing carers from developing needs for care and support themselves. There is a plethora of research which finds that people who act as long-time carers have poorer physical and mental health. Strategies that support carers to continue to care should take carer resilience into account.

If a carer experiences harm from the adult they are supporting, or if a carer harms or neglects the adult they support, consideration should be given to 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 mitigates the risk of abuse.

Where there is an allegation of domestic abuse and the alleged victim is an Adult at Risk, a concern should be raised to the Safeguarding Adults Team. Other agencies may need to be involved; in circumstances where a criminal offence is suspected this may include alerting the Police, or for other issues a combination of others may be required to assist e.g. GP, healthcare services or other providers may need to be involved.

It is however, necessary to exercise professional judgment to discern where alleged Abuse or Neglect by an informal carer may be due to lack of knowledge or where the carer's own needs make them unable to care adequately for the person at risk.

A distinction should be made between harm caused inadvertently; and abuse caused deliberately or in reaction to the adult at risk.

In certain situations, offering support for the carer may safeguard the adult.

3. Assessment

Assessment of both the carer and the adult they care for must include consideration of both their well-being. We consider protection from abuse and neglect to be essential to a person’s well-being. As such, a needs or 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 could include giving specific advice or providing training to the carer to enable them to provide care or support more safely. Alternatively, this may also mean enabling them to take regular breaks from direct care, or whatever they may define as their own desired outcome, measured alongside the outcomes defined by the person (adult at risk) who is cared for.

4. Speaking Up/Disclosure

If a carer speaks up about abuse or neglect, it is essential that they are listened to and that where appropriate a safeguarding enquiry is sensitively undertaken, and other agencies are involved as appropriate.

Other key considerations in relation to carers should include:

• Involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
• Whether or not joint assessment is appropriate, or separate assessments of the carer and cared for person is preferable;
• Gaining an understanding of the impact of the caring role on the carer themselves; including their health, their well-being;
• Thinking of whether an independent advocate or another person may be of help and guidance.

5. Safeguarding Responsibilities – Not Limited to How Care Needs are Funded or Met

It is important to affirm that Safeguarding responsibilities apply regardless of whether a person's care and support needs are being met, whether by benefit entitlement or any other arrangement. The responsibilities also apply to people who pay for their own care provision.

6. Historic Abuse and Deceased Adults

These policy & procedures apply to abuse or a risk of abuse or neglect that is current; and therefore allegations of historic abuse will not become the subject of a safeguarding enquiry.

Where a concern is received for an adult who has died, the same approach will apply and an enquiry will only be made where there is a clear belief that other adults are, or may be, at risk of harm.

Where there is any level of concern about the circumstances of a service user's death, this must be reported to the Coroner of Inquests or the Isle of Man Constabulary. Where there appears to be a current risk to other adults then appropriate steps must be taken to clarify this and to identify the adults who may be at risk. Enquiries can then be considered in respect of those other identified individuals.

In cases where an adult with care and support needs has died after experiencing abuse or neglect and where there is a concern about how agencies worked together to safeguard the adult there is a responsibility to consider raising a Serious Case Management Review with the Safeguarding Board.