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.

Panel responses:

Samantha Robinson

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 time frame.

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 abuse.

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 assessment.

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 employee.

Jane Butler

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 ignored.

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.

User view:

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 translator.  

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