Care workers are calling for more guidance around supporting service users during lockdown. Social Care Today reporter Laura O’Neill investigates how the proposed Coronavirus Bill will impact people with learning disabilities.
A support worker, who did not wish to be named, told Social Care Today that his employer instructed him to ‘leave service users in the street’ because he didn’t have the power to force them to lockdown under the Mental Capacity Act (MCA)
He did not wish to name his employer but said they were ‘amazing’ to work for before the coronavirus crisis.
However, following the outbreak, he said his team had been ‘abandoned’ by senior management, most of whom have gone into isolation without providing any guidance on enforcing the lockdown when service users have the right to make their own decisions under MCA.
‘We’ve heard a lot about protecting oldergcan people and rightly so, but 50 – 60% of the guys I support have underlying conditions.
‘There’s nothing in place to protect them. They’re expected to self-isolate but it’s difficult to communicate that to them.
‘80% of the people I support have the right to make their own decisions under MCA, so I can’t force them to stay in during the lockdown. I can’t force them to self-isolate if they are showing symptoms and I can’t make them practice social distancing.
‘We’ve been told that, if we are out with a service user who doesn’t want to come home, we should return to the house and leave them unsupported in the street. They don’t want us to risk being exposed for longer than we need to be, it puts the other vulnerable service users at risk.
‘What is the priority, is it their right to make their own choice? Or should we be able to restrict them?
‘It’s all well and good telling the vulnerable people to stay inside, but what if you don’t perceive yourself as vulnerable? What if you don’t understand the seriousness?
‘How can we protect them and continue to support them to keep living their best lives?’
A best interests decision
Hugh Constant, MCA lead at the Social Care Institute for Excellence (SCIE), said the Mental Capacity Act (MCA), and the related Deprivation of Liberty Safeguards (DoLS), has not been changed by the Emergency Coronavirus Act which came into force on March 31.
‘In essence, the MCA protects the rights of people with cognitive impairments to make their own decisions when they are able to, in the same way you and I can. It doesn’t give anyone the right to make decisions that are illegal.
‘Pre-corona, folk didn’t get to commit crimes, just because they happened to have a cognitive impairment, and they are not allowed to now.
‘The support worker needs to explain to the person in question what the risks and consequences of any decision they have to make are. If the person understands this, and understands the risks, then they take upon themselves the possible risk of being arrested/fined.
‘If the person doesn’t understand the consequences of the decision, then they would be deemed to lack capacity, and a best interests decision would need to be made on their behalf.
‘But best interests decisions can only be between what are the available, legal options; and so it would be very hard to justify, on best interests grounds, someone going out, because that person is probably not allowed to go out.
‘That said, Steve Broach, eminent social care lawyer, argues that if people are allowed to go out when necessary, then for some people, for whom exercise is necessary to a different degree to most (some people with autism, for example, where long walks may be a vital part of behaviour management) there is a defence for going out more often than once a day.
‘But a guy with learning disabilities who happens to fancy a trip to the shops can’t do it, MCA or no.
‘It would be tricky if a person became very distressed if they were not allowed out. The emphasis should be, wherever possible, on making staying in as interesting and fulfilling as possible.’
Zac Taylor, executive director of Quality at Mencap agreed that the best course of action is to help someone with a learning disability understand the coronavirus outbreak.
‘Daily routines can often be extremely important to people with a learning disability and the sudden changes we’re all experiencing can be particularly difficult for them and the people who support them.
‘However, we believe the best course of action is always to help someone with a learning disability understand the coronavirus outbreak, the government guidance and the consequences of not following it, and support them to make decisions in their best interest.
‘We have found accessible information, such as our easy-ready information on Coronavirus or stories about current changes, can help people with a learning disability understand what is going on and current government guidance.
‘While we are all having to make big changes to our lives, it can also be helpful for people with a learning disability, and for the public in general, to think about the things they like doing and how these activities can continue within the current limitations.’
Experts on their own lives
The support worker said his team has, so far, been managing to keep service users occupied during the lockdown, and is calling on social care providers to consult with staff and service users as the outbreak progresses.
‘I would like to see my concerns taken seriously, we should have started planning at stage one. We’re well into stage two now and it’s still business as usual, which seems odd.
‘Staff wellbeing is being affected, they’re not sure if they are putting their family in danger by coming into work. It all impact on their mental health.
‘We are going to end up with a lot of people off sick, which means there will be no one to support the service users.
‘No one is thinking ‘great, I don’t have to go to work’ they want to know how they are going to be able to keep this home ticking over in four, five, six months and what kind of support will be available if they need it.
‘I think care providers need to pool their resources. They should be talking and including people at all levels, not just management.
‘They should get the guys who live in the houses involved. They are the experts on their own lives and have got plenty of good ideas and important opinions. And it would really help improve their understanding of the situation.
‘We are all determined to keep going and do our best for the guys we support to ensure they are still able to live a happy and fulfilling life
The Department of Health and Social Care did not provide a comment. However, government has announced plans to release updated guidance on the practical issues affecting Deprivation of Liberty Safeguards.
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