March 2020: This chapter was updated to add a link to Supporting Adult Carers published by NICE, as above.
The local authority’s responsibilities for prevention, reducing and delaying needs apply to all adults, including those who are caring for family or friends who have care and support needs.
As well as those who are currently carers, this also includes:
- those who may be about to take on a caring role;
- who do not currently have any needs for support; and
- those with needs for support which may not be being met by the local authority or other organisation.
It is essential that care and support systems actively promote wellbeing and independence, and do not just wait to respond when carers reach crisis point.
Prevention is not a one off activity. Prevention can sometimes be seen as something that happens primarily at the time of a diagnosis or assessment (or soon after), or when there has been a subsequent change in the person’s condition. Prevention services are, however, something that should always be considered. For example, for carers caring for a family member at the end of their life, prevention services could include the provision of pre-bereavement support.
2. Prevent, Reduce, Delay
‘Prevention’ is often broken down into three general approaches – primary, secondary and tertiary prevention – which are described in more detail below. These terms illustrate what type of services, facilities and resources could be considered, arranged and provided as part of a prevention service, as well as to whom and when such services could be provided or arranged. However, services can cut across any or all of these three approaches and so the examples provided are not to be seen as limited to that particular approach. Prevention should be seen as ongoing and is not a single activity or intervention.
2.1 Preventing needs
Prevention is aimed at individuals who have no current particular health or care and support needs. These are services, facilities or resources which are provided or arranged that may help an individual avoid developing needs for care and support. They may also help a carer avoid developing support needs by maintaining independence, good health and promoting wellbeing. They are generally universal services (that is, available to all), which may include – but are not limited to – interventions and advice that:
- provide universal access to good quality information;
- support safer neighbourhoods;
- promote healthy and active lifestyles (for example exercise classes);
- reduce loneliness or isolation (for example befriending schemes or community activities);
- encourage early discussions in families or groups about potential changes in the future (for example conversations about potential care arrangements or suitable accommodation should a family member become ill or disabled).
2.2 Reducing needs
These are more targeted interventions aimed at individuals who have an increased risk of developing needs. The provision of services, resources or facilities may help slow down or reduce any further deterioration, or prevent other needs from developing. Some early support can help stop a person’s life tip into crisis, for example a few hours support to help a family carer who is caring for their son or daughter with a learning disability and behaviour that challenges at home.
Targeted interventions should include approaches to identifying carers, including those who are taking on new caring responsibilities. Carers can also benefit from support to help them develop the knowledge and skills to care effectively and look after their own health and wellbeing.
2.3 Delaying needs
These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired.
Such services could also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through respite care, peer support groups like dementia cafés, or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others. This can help carers develop mechanisms to cope with stress associated with caring and help them develop an awareness of their own physical and mental health needs.
3. Carers and Adult Safeguarding
Carers can play a significant role in preventing and detecting abuse and neglect for the people they care for. The vast majority of carers strive to act in the best interests of the person they support.
There are times, however, when carers themselves experience abuse from the person to whom they are offering care and support or from the local community in which they live. Risk of harm to the supported person may also arise because of carer stress, tiredness, or lack of information, skills or support. Also, there are times where harm is intended.
Circumstances in which a carer could be involved in a situation that may require a safeguarding response from agencies include:
- a carer may witness or speak up about abuse or neglect in relation to the adult they care for, or another person;
- a 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;
- a carer may harm or neglect the adult they support on their own or with others. This may, or may not, be deliberate.
All staff and professionals should support a rights based approach to issues of abuse and neglect and to the recognition and support of carers.
3.1 Safeguarding enquiries
If a carer raises any issues about abuse or neglect, it is essential that they are listened to and that, where appropriate, a safeguarding enquiry is undertaken and other agencies are involved as required.
If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:
- removing or reducing risk – 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 reduces the risk of abuse. This may include, for example, the provision of training, information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy (see Independent Advocacy); in others, a carer may benefit from having such support if they are under great stress;
- involving other agencies – whether other agencies should be involved: in some circumstances where it is possible a criminal offence has been committed this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring the situation.
Other key considerations for carers should include:
- involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
- whether or not a joint assessment of the adult and the is appropriate in each individual circumstance;
- the risk factors that may increase the likelihood of abuse or neglect occurring;
- whether a change in circumstance changes the risk of abuse or neglect occurring.
A change in circumstance should also trigger the review of the adult’s care and support plan (see Care and Support Planning) and the carer’s support plan if they have one with their local authority. Further information about these considerations can be found in Carers and Safeguarding: Working Together to Improve Outcomes (ADASS).