Situation: Forty-eight-year-old Alex
Terreskinas lives alone in the north Midlands. English-born but
with Lithuanian parents (both of whom died in a car crash that Alex
survived), he is a wheelchair user who receives intensive home
support. He lives in and owns his parents’ house. His speech is
very slurred and his English is more limited than his Lithuanian.
His only surviving family – his sister Tonia – lives in a Suffolk
coastal town. She tries to visit as often as she can but the
demands of her own family keep her away. Her husband refuses to
have Alex move in with them.
Problem: On a recent visit to Alex, Tonia was
shocked to discover that Alex claimed to have been abused by his
home carer. He says that when they are alone she has spat at,
punched and kicked him. Contacting the local authority, she was
further shocked by the home care service manager’s decision not to
investigate the case any further as the home carer in question was
due to retire in three weeks after 35 years of service. Tonia also
claims to have been told “off the record” that this worker has “not
been the best” and it is good news for everyone that she is going.
She has been Alex’s carer for 12 years. When Tonia asks how long
she has been acting like this, Alex asks her not to make trouble
adding that if she (Tonia) cared she would not leave him alone.
Given the seriousness of these allegations, the social worker
receiving this information should immediately bring this to the
attention of their line manager. In keeping with the Department of
Health No Secrets guidance, the local authority should have a
policy and procedure for suspected abuse of vulnerable adults.
Actions that follow would need to take place within a prescribed
As a home care manager and a local authority home care assistant
have been implicated, senior managers should be consulted about the
allegations. There is also a duty on the local authority to notify
the local police’s community safety unit of the suspected
The welfare of the vulnerable adult should be of paramount
importance. At Kingston Council, the joint policy and procedure
states that there should be an allocated worker dealing with the
case. This worker would safeguard Alex’s safety while investigating
the situation to substantiate the facts as far as is possible. It
would be necessary to talk to all the people involved, including
Alex, Tonia, the home care manager and the carer. However, the home
care staff would be interviewed by senior managers of that
department who would liaise with the allocated worker.
As this carer could be working with others, it is essential to make
sure that other service users are not being exposed to the same
risk. Indeed, in Kingston, the home care assistant would be
suspended while the investigation was taking place.
A strategy discussion should take place to decide the actions to be
followed. A lead person ought to be identified as should those who
could assist in the process. The discussion should also decide who
is going to be visited, in order to undertake the investigation and
The action taken following this investigation would depend upon the
outcome of our discussions with all those involved. The facts may
be difficult to substantiate for varied reasons – it might be a
situation of one person’s word against another. However, the
importance of investigating thoroughly and openly must be
emphasised, particularly as this involves a local authority
During the discussions with Alex we would need to be mindful of the
possibility that Alex is deeply unhappy with his present lifestyle.
While it is entirely possible that Alex’s experience has indeed
taken place as he has reported, we need to be aware that Alex may,
in fact, not be the victim of abuse. He could have exaggerated the
incident to gain attention to feelings that he believed were being
Alex might be feeling very isolated and estranged from his cultural
roots. The problem may give us the opportunity to discuss
alternative arrangements with Alex and his sister, which would not
necessarily mean moving in with her family. For instance, the
possibility of supported housing in Suffolk could be investigated.
This would mean Alex would be living in his own home with the type
of assistance which would promote his independence.
His sister could be offered a carer’s assessment. This would
provide Tonia with an opportunity for her to consider the whole
family situation and to express her wishes or concerns about Alex.
It would be an opportunity to explore the possibility of him moving
closer to her. If she felt a move to her area would place greater
responsibility on her shoulders, then we could consider regular
contact throughout the year. This could be either by arranging
respite to an appropriate facility near to her, or providing
funding for her to travel to him.
If Alex were to remain in his present home his isolation, which is
seemingly at the root of his poor quality of life, needs to be
addressed, taking into consideration his cultural needs.
Investigations should be made to establish whether there are any
Lithuanian contacts in his area. There may be a known society who
could help with this, or be able to provide other support like
transport to a group. It is also clear that disability and language
difficulties contribute to Alex’s isolation. Perhaps speech and
language therapy as well as day care could be revisited.
It should be borne in mind that both Alex and Tonia have
experienced a huge bereavement and it is not known whether this was
addressed at the time. The time may now be opportune to introduce
the idea of bereavement counselling.
When one is as dependent as Alex and I, much of your quality of
life depends upon the relationship with carers, writes
Simon Heng. If this is good, based upon a mutual
agreement about not only what needs to be done but how it should be
done, then life can be made relatively comfortable. But we realise
that without the efforts of carers, even if contact isn’t abusive
but merely perfunctory, comfort and degrees of freedom are easily
compromised. We are vulnerable to our helpers’ moods at the best of
times, let alone when that person (obviously poorly supervised)
feels that they have the right to abuse their client.
I can understand that Alex has not wanted to confront this
problem. If you are as physically helpless as he is, all you want
is for the abuse to stop. You are frightened to speak out, because
your abuser will be walking through your door the next day, and you
are frightened of retaliation. Hoping that things will be
different, that your helper will be more caring next time, you
pretend that things are OK. You try to be friends with your abuser,
hoping that this will make a difference. You might even convince
yourself that they have your best interests at heart.
Not only is the worker at fault, so too is the whole social
services department. They have not only failed in their duty to
care adequately for their client, but they have consciously allowed
him to be abused and psychologically damaged. Senior management
needs to take responsibility for instituting disciplinary
proceedings against the care worker and her immediate manager: they
also need to implement some form of inquiry.
Alex needs independent professional help. He needs help to come
to terms with his experiences and recover from them, so that he can
feel that he is entitled to assert his human rights. He needs
professional advice about taking legal action against his abuser
and those who colluded with her. He also needs an advocate to help
him negotiate an appropriate, well-supervised care package that he
can trust. And the social services department should provide a
Perhaps Alex could be helped to explore the possibility of
selling his house and moving to the same locality as his sister and
her family. Even if it is not possible for them to share
accommodation, maybe he would see more of his family if his sister
did not have to travel so far to see him.
Simon Heng is a disabled service user