What does safeguarding look like?

20 October 2016

With the shrinking Social Care budget it is difficult to know what to do for yourself or your loved ones when it comes to care in later life.

The study published jointly by the King’s Fund and Nuffield Trust, the UK’s leading health think-tanks, highlights how the number of people in England receiving state-funded care has slumped by just over a quarter since 2009 despite a surging elderly population.

– John Bingham (Telegraph 15th Sept, 2016, Elderly care shortages now the ‘burning injustice’ facing Theresa May’s Britain)

Care homes are closing every day, down from over 18,000 in 2009 to 15,299 as of the date of writing. The choices are becoming fewer and the pressure on services becoming greater. The Government has stated it wants a different approach to care for the elderly, but what is it?

Skills for Care is a national organisation that deals with creating tools and training for care providers. Under the guidance of sector experts such as Professor David Croisdale-Appleby OBE they have produced a series of resources such as the following regarding safeguarding.


(Image courtesy of Skills for Care)

Why is this applicable to the live-in care community? We have to adhere to the policies and recommendations outlined by CQC and government White Papers, so the diagram states the way in which we make care individualised. The following is a simplistic scenario of how it may be relevant to our potential clients. For the purpose of this article, let’s call her Dot…


Family: We haven’t seen you for a while and are shocked at your apparent self-neglect. We see a gradual decline in your ability to perform everyday things and you seem to be deteriorating. We are worried about your mental state or wonder if it could just be lack of socialisation and loneliness that causes your quirky behaviour. You have lost weight and don’t seem to be feeding yourself or keeping yourself clean. The house is a mess and the dog has ruined the kitchen. Maybe it’s time to put you in a care home. It’s seems the logical choice- we are sure you will be safe and happy.

Dot: You have not given me a choice. What about my wishes and needs? I don’t want to leave my home and my dog. I would still like to go for coffee with my friends and to church. I just need someone to help me in the home, I don’t see or talk to anyone anymore.

Referral and decision

Dot: I am scared. What will happen to me seems to have been taken out of my hands. I know I need help, but am worried it will take me away from the home where I raised my family. My garden was my pride and joy and now I need someone to help me grow the flowers I love so much. I feel useless and worthless; so much more now that others are going to decide my fate. Don’t I have a say in all this?

Local Authority Social Care Team: Yes! Government and NHS Trust policy is for individualised care, where the safety, dignity and wishes of client are paramount. We are moving away from care homes and more towards care in the home. It’s being rolled out, but there are large gaps in the coverage.

You need help to do some things and you’d like to have companionship, but you don’t want leave home. You have a nutritional deficit and need some good home-cooked meals and perhaps meal supplements to regain your strength and improve your mental wellbeing. You will be assessed now and again later to determine if there is more than poor nutrition that is the cause of your forgetfulness. At present you need some 1-to-1 help with feeding and food preparation. You need some help with house cleanliness and personal hygiene, as well as reminders to take medication. With a little help she could visit local friends and go on trips. There will be some risks involved compared to sitting in a chair in a care home- a risk assessment would have to be done to assess such threats as injury and further neglect. Without assistance your condition will probably worsen and could result in a lengthy hospital stay or worse. You cannot continue to stay in the home without considerable help; we just need to decide what level of care is appropriate.

Family and Dot: What options are available?

Strategy Discussion

Family and Social Care Team: You don’t want to go into a care home, it’s not personalised. You want to stay in your home. You were married here, raised your children and want to spend the rest of your life here. We can try some domiciliary care though it’s not personalised. You probably will not get specific help at the time of your choosing, but at the time they can fit you in their busy schedule. It may be the cheapest option, but it could leave you vulnerable at night and for extended periods during the day. The immediate need is to reduce the risk of injury, infection, malnutrition and overwhelming loneliness, maybe this is not the best way to resolve these issues. Live-in care is an approach that uses one or two carers who live with you full time and see to most of the issues domiciliary care cannot resolve alone.

Dot: I choose live-in care, though my relatives are worried about the cost. A single carer situation is up to 30 percent cheaper than a high end private care home, and a risk assessment will be done to minimise injury to both myself and carer. It will give me chance to enjoy my time in my own home, where I feel safe.
Assessment and Investigation

Live-in care provider: You need someone to help with cooking cleaning, walking the dog and driving you to church and coffee with friends. Perhaps the best alternative is live-in care. At present, you are able to be left for a couple of hours per day, as you watch your favourite TV programmes and are not especially restless at night. Your condition may improve with correct nutrition and constancy of medication. You agree to having Sundays set aside as time to visit family. These scenarios allow for a single carer and to allow them to have relaxation time to avoid overwork. You have a spare room in which the carer will stay. Your carer will become your companion as well as your 1-to-1 personal assistant. You have a car with insurance that the carer may use to go shopping and take you to visit friends etc. A risk assessment will be done to identify possible issues in the home and you will be regularly evaluated to check if the current package is suitable or if it needs upgrading. A live-in carer will help with most things, give you independence and ensure that the risk to your health and safety are minimised. You even have a choice of which carer would be best suited for you- even in terms of interests.

Dot: I feel this is a good choice for me.


Dot: I have one live-in carer staying in my spare room, who is a companion and live-in support for me. I now sleep through the night, as my restlessness was anxiety about being moved from my home and hence there is no need for a second night carer. Yulia, my carer does not need to assist me in standing or manually transferring me as I am getting stronger and more physically able with good food and constant medication. I am able to take my own medication merely with prompting at the correct time. I am able to feed myself as long as the food is prepared. I am less confused and stronger due to the constant care. I enjoy my time gardening with Yulia and now actually have a social life again with my friends and church. I have power over my own decisions and outcomes. I have been placed on the lowest need-level of live-in care, which is roughly 30 percent cheaper than a private care home. If I get worse, this can be reassessed and changed in the future.

Monitor and Review

Dot: I have just finished a course of antibiotics due to a chest infection. The doctor said that if Yulia had not seen the changes in my physical condition, I would have been in hospital and then more intensive home care. My condition has improved since starting live-in care and I am enjoying my life again.

This is only a scenario, but care homes are becoming bigger, fewer and more anonymous. With live-in care you always know who will be with you and that they will address all of your care needs. I know what I would prefer for myself, as live-in care fits all the safeguarding points required by government policy.

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