Show them some respect

Case study

Situation: Belinda Stephenson is a 28-year-old woman with learning difficulties. She lived with her mother who was her sole carer until her death from cancer two years ago. Belinda’s brother, Jamie, who had moved away, inherited the house and chose to sell it. He was unwilling to take Belinda so she was moved into residential care – a small home in the community. 

Problem: On one of his occasional visits to see his sister, Jamie was shocked to find her still in bed at midday. A member of staff told him that “Belinda chooses to stay in bed and we respect her choice.” Jamie is worried that Belinda has put on three stones in weight in the past year – possibly because she is doing nothing. He also noticed that another female resident who was helping herself to breakfast was naked. Again he was told that it this was a matter of personal choice. Jamie questioned the appropriateness of such behaviour – not least because the two staff on duty that day were male. He was told: “It’s no problem – it’s not as if she’s attractive or anything.” Jamie also believes that because the staff at the home dislike him, as they believe he “turfed” Belinda out of her house to make money and hardly bothers with her, that they take little notice of his complaints. For her part, Belinda says she is happy at the home.

Panel responses

Mike MacCallam
The most striking aspect of this case is the apparent lack of respect and regard that the home has for its residents. Indeed, this is almost to the point that one questions whether or not the staff recognise them as fellow human beings. There is clearly no effort made to promote any sense of equality between staff and residents nor is there any attempt to develop the self-esteem and self-worth of the people living at the home.

It is one thing to say that you are respecting a person’s choice, but that has to be balanced against the responsibility of duty of care. In this instance, rather than respecting an individual’s choice, one might argue that the staff are in fact abusing the residents of the home through their failure to assist individuals to make informed choices and to provide appropriate alternatives.

There may be several reasons why Belinda is staying in bed. It might be due to her being bored or depressed or because she is physically unwell. There may be an underlying physical cause to Belinda’s weight gain, apart from as a lack of exercise or activity. Staff appear to have a lack of concern or even an awareness for Belinda’s health and well being, all of which should be fully investigated.

As Jamie feels that his complaints are dismissed by the home, he has the option of reporting his concerns to the Commission for Social Care Inspection. Details can be obtained from his local social services departments or through the commission’s website.1

He should also bring these matters to the attention of the local social services department, particularly if they are responsible for funding Belinda’s placement at the home, which in turn should consider whether or not Belinda (and her fellow residents) are victims of any abusive practice that warrants investigation under local vulnerable adults procedures.

Agencies should also consider immediately engaging advocates for the residents of the home to help protect them from further abusive practice and allow them to have a voice in changing the ways in which they are supported within their own home.

1 Commission for Social Care Inspection at

Sheena Jones
From a health practitioner’s perspective, Belinda’s increase in weight and the fact that she is staying in bed would be causes for concern.

The questions that come to mind are:

  • Does Belinda have regular access to a GP practice or a community nurse or both?
  • Does she have a current health action plan and is there a health component to her residential care plan?

l In the preparation of these plans, has any health screening been carried out and if so what issues were identified?

It may be that Belinda’s weight gain is associated with reduced activities or connected to an underlying medical condition that could be making Belinda feel tired. This could be a physical or a mental health problem.

Belinda’s mother died two years ago and consequently Belinda had to move out of the family house which had presumably been her long-term home. There might be issues around bereavement that have not been resolved and Belinda could be feeling rejected and depressed.

Her carers do not appear to understand the relationship between people’s choice and a duty of care. People need to have opportunities and experiences to inform their choices and thorough risk assessments should be carried out to ensure that a person’s health and safety is not being jeopardised.

From an occupational therapy perspective, as well as considering Belinda’s general physical and mental health, it would be important to find out about her interests and preferences: what she enjoys doing, how she feels about herself and where she is living, her general level of mobility and level of independence in daily living activities. It would also be important to look at the balance between social, leisure, employment, education and self-care activities while considering social and physical environments.

Jamie could contact the local social services department to report his concerns and to find out if Belinda was allocated a social worker. Alternatively, he could request that social services carry out a community care assessment. If he did not feel able to advocate on Belinda’s behalf, he could explore the possibility of finding an independent advocate for her.

User view

It seems Belinda was not given any support to figure out what she might want to do with her life if her ill mother passed away. Without this support, Belinda ended up in a her current situation. But whether she likes her life or not, we would say her wishes and rights must be respected at the same time as telling her about different options. But her brother might have some real worries, write Kathleen Franklin and Sue Morant.

Now, we are sure all of us would like to stay in bed until noon. We might like to after we have been working hard or have had something upsetting happen. However, after a few weeks most of us would get bored with this. We want to know was Belinda her mother’s carer? If she was her mother’s carer, she might still be tired. Or, she might be sad that her mother died and she had to leave her home. Someone should check to see if Belinda is depressed or ill. While the staff tell Jamie it is Belinda’s right to stay in bed, we can’t help but wonder if the staff are being lazy. Has anyone talked to Belinda about what she could do in the day?

We also don’t like what the staff said about Belinda’s housemate. It was insulting and also doesn’t make sense because what you look like doesn’t necessarily make you more or less safe from being abused. Would other staff who might find her pretty abuse her? Why are there two men working with these women? Did Belinda and her friend pick their own staff? They should have.

Also, we think someone should talk to the housemate about going around naked. We agree it’s her right to do this, but it’s not always safe to do so.

Finally, Jamie is not being taken seriously. While what happens to Belinda should be up to her, her brother should be listened to because people with learning difficulties do tend to get abused a lot. Jamie should not be blamed for Belinda having to move into a home. Just because he is her brother, doesn’t mean he should have to be her carer or that she would want him to be so. Her local council should be supporting her and figure out what she wants to do in her life. It’s not the staff’s business whether her brother sold the house.

We think Belinda should be offered an advocate, encouraged to get a check up with her doctor, and some support from her council to find out about what she could do with all of her life.

Kathleen Franklin and Sue Morant are members of Milton Keynes People First, a self-advocacy group for people with learning difficulties.

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