Case study 1: Supporting a man with Down’s syndrome

Discuss about the Protection of children and vulnerable adults.

The case study here focuses upon Leo who is a 42 year old man with Down’s syndrome. Leo has been living in supported tenancy with another person. Leo has been receiving home based care and support services during the morning hours. However, there is a lack of any such services during the evening or night hours. Recently, Leo had been frequenting a pub where he had befriended a number of suspicious people. Leo had been delivering packages for them during the day which he believes to be washing machine spare parts. However, Leo’s support staffs doubt that he is getting involved in some wrong business and should immediately stop meeting these men.  However, Leo insists that these men are his friends and has the liberty to decide his course of actions.

In this context, Leo had been suffering from Down’s syndrome which   means that he had restricted decision making and intellectual abilities. Hence, it was necessary to guide or warn him regarding getting involved in illegal activities though the company of the suspicious men he befriended in a pub. It was very much possible that these men would have been drug dealers and had been using the innocence and trust of Leo to support their illegal objectives. Therefore, focusing upon some of these indicators I think serious monitoring of the activities undertaken by Leo needs to be done.

In my opinion, Leo had been suffering from Down’s syndrome which had limited his judgement skills or decision making abilities. In the current scenario, Leo had fallen prey to the malicious objectives of the men who he befriended in the pub.  Therefore, on repeated warning Leo still insisted that these men were his friends and he could handle his concerns. This resulted in a huge ethical dilemma on the part of the support carer.  As mentioned by Montgomery  et al. (2016), the  mental health capacity act allows  a person aged 16 and over to take their own decisions related to daily life situations . The mental health act had been implemented to provide sufficient freedom and empowerment to a person with restricted cognitive abilities (MacIntyre and Stewart 2017). As argued by Mackay (2017), a person may be lacking decision making abilities in one area but may possesses decision making abilities relevant to other areas. Therefore, as per the regulation Leo had to be given sufficient space and freedom in making effective decisions. However, the security concern often calls for the support carers to take harsh decisions.

Case study 2: Managing an elderly woman’s restricted mobility and decision-making abilities

In December 2014, the HSE had implemented some of the new regulations such as –safeguarding vulnerable persons at risk of abuse. It had been implemented in order to promote the welfare of vulnerable people and prevent them from any kind of abuse (Stewart and MacIntyre 2017). Here, Leo was in the danger of suffering from a number of abuses such as – psychological and material form of abuse. Therefore, in order to prevent Leo from any forms of victimization a safeguarding plan needs to be developed for the support carer.

Safeguarding plan:

• In this respect help will be taken by the support carer from the local government disability and special care agencies in dealing with the client.
• In dealing with the patient a support carer will ensure that the patient is not coerced or forced into abiding by the decisions of the support carer.
• Another alternative step which will be taken is accompanying Leo to the pub instead of pressurising him not to go and meet his friends. In case of any suspicions, the support carer will directly report the matter to the police. This has been further supported though the mental health capacities act, 2015, which allows a support carer to take decision on behalf of a patient, in case they lack the decision making capability.

The case study discusses regarding Mrs. B who is an 85 year old lady and had been living on her own with some help and support from her daughter. However, very recently she had suffered from a fall which had restricted her movement patterns. Recently, she had also been unable to manage some of her daily care activities effectively.  The patient here also suffers from mental confusion or dilemma at times. The physiotherapist visiting Mrs. B had suggested that she be better moved in a nursing home for better support and care. Though, the daughter of Mrs. B has supported the proposition of the doctor, Mrs. B refused and had rather expressed to receive the care and support services within the comfort of her home.

Some of the factors, which were of considerable importance over here, were the restricted mobility patterns of Mrs. B. Due to the fall. She had also been complaining of the inability to bear her weight which could be due to hip fracture, which had limited the activities of daily living of the patient. Additionally, the patient had also been experiencing mental confusions at times. It could be attributed to age related dementia or an effect of the fall, which may have caused damage to the cerebocortex region of the brain.  As commented by Stevens  et al. (2017), limited movements could be associated with the biggest risk of fall in the old age patients. Therefore, based upon these assessment and results the patient was in urgent need of being admitted to the hospital for support care activities.

I think one of the ethical dilemmas faced over here will be convincing the patient regarding the hospital stay and care. The physiotherapist attending to the patient was of the opinion that the patient should be moved into a hospital. However, he could not presumably force the patient, as the patient had the sufficient mental potential of making instrumental decisions pertaining to her life, health and care. This was in lieu of the Mental health capacity act, 2005, which had been implemented to provide sufficient support and empowerment to a patient into making effective decisions. Therefore, at no point of time the patient could be forcibly asked to agree to the decision of the attending physician, as this would be breach of the mental health capacity act (Flynn and Arstein-Kerslake 2017).

Case study 3: Preventing online victimization of a woman with moderate learning disabilities

One of the biggest concerns which were faced over here was that the patient was not provided with any social care worker. Therefore, in order to meet the care concerns of the patient within the premises of her home there was a need to recruit an efficient social care worker. Some of the steps have been further detailed though a safeguarding plan.

Safeguarding plan:

• In order to recruit an effective social care worker for the patient one could approach the local community services centre. The involvement of the community care agencies will help in the improvement of care and support services delivered to the patient.
• Additionally, the nursing professional looking after the care concerns of Mrs. B will need to provide a home visit to the patient at least three times a week. This will help in effectively monitoring the physical deterioration experienced by the patient effectively.
• The nursing professional will also stay in touch with the patient through telephonic mediums, which could be used to give reminders to the patient  regarding her next clinical visit
• The nursing professional entrusted in the care concern of the patient will also need to ensure that the patient has a safe drop till the clinic as Mrs. B experienced movement difficulties over here.

The current study focuses upon the case history of Susi who is a 45 year old female with moderate learning disability. She had been living in her own rented accommodation where she would be visited by a support worker at least few times a week. Susi had sufficient practical skills which helped here provide an effective account of her condition to the support carer. Susi had a history of dysfunctional family and had been sexually abused a couple of times in her life. She had been married twice and also divorced. The history of being subjected to violence has made her docile in nature and she rarely retaliated against the violent attitudes and behaviours inflicted upon her. She had also mentioned that she has a child who is in permanent care and Susi had lost all contacts with her child. She had also disclosed the facts to her support carer that she had been lately sending picture of herself to strangers online.

Therefore, based upon the account provided by Susi of her activities online, she was in the high risk of befriending treacherous men. Therefore, such online interaction with strangers could possess her severe risk in the future.  As commented by Stevens  et al. (2016), the one being subjected to abusive history often have tendency of keeping up secrets which could make management of the particular condition difficult. Hence, the support carer looking   after the concern of Susi needs to be careful and monitor her activities well.

Though, Susi had moderate learning disabilities she had effective practical skills which made managing mist of her daily life activities easy for here. Hence, Susi was in the best of mental capacities to make decisions. Therefore, the support carer attending to Susi could hardly prevent her from talking to strangers online. However as argued by Stewart and MacIntyre (2017), moderate learning disorders   have in many cases seen to affect decision making powers of an individual. For example, Susi felt passive or could hardly react against the abusive behaviours or violence inflicted upon her. As mentioned by Phelan (2014), counselling support sessions and moral counselling have been proved to be effective in bringing about changes in the insight or the behaviour of the patient.

From the  narrative  and detailed speculation into the condition of the patient  it could be ascertained that Susi was  prone to depression as she had been  living alone and  even lacked the  company of her  child . As suggested by Powell (2014), depressive bouts could cause an individual to react furiously in certain situations.

Safeguarding plan:

• Therefore, based upon the act of safeguarding vulnerable people at risk of abuse, one will need to ensure that sufficient protection measures are offered to the client.
• In this respect, the support carer will need to involve the various mental healthcare agencies to help Susi cope up with her loneliness and develop a more confident image about her own self.
• The support carer will empower her by helping her develop her skills around her activities of interest which will help her in making an independent living.

References

Flynn, E. and Arstein-Kerslake, A., 2017. State intervention in the lives of people with disabilities: the case for a disability-neutral framework. International Journal of Law in Context, 13(1), pp.39-57.

Graham, K., Norrie, C., Stevens, M., Moriarty, J., Manthorpe, J. and Hussein, S., 2016. Models of adult safeguarding in England: a review of the literature. Journal of Social Work, 16(1), pp.22-46.

MacIntyre, G. and Stewart, A., 2017. Safeguarding Adults With and Without Mental Capacity. Safeguarding Adults: Key Themes and Issues, p.53.

Mackay, K., 2017. The UK Policy Context for Safeguarding Adults: Rights-Based v Public Protection?. Safeguarding Adults: Key Themes and Issues, p.35.

Montgomery, L., Anand, J., Mackay, K., Taylor, B., Pearson, K.C. and Harper, C.M., 2016. Implications of divergences in adult protection legislation. The Journal of Adult Protection, 18(3), pp.149-160.

Phelan, A., 2014. Elder abuse: A review of progress in Ireland. Journal of elder abuse & neglect, 26(2), pp.172-188.

Powell, J.L., 2014. Governmentality, social policy and the social construction of old age in England. International Letters of Social and Humanistic Sciences, 16(2), pp.108-121.

Stevens, M., Martineau, S., Manthorpe, J. and Norrie, C., 2017. Social workers’ power of entry in adult safeguarding concerns: debates over autonomy, privacy and protection. The Journal of Adult Protection, 19(6), pp.312-322.

Stevens, M., Norrie, C., Manthorpe, J., Hussein, S., Moriarty, J. and Graham, K., 2016. Models of adult safeguarding in England: Findings from a study of costs and referral outcomes. British journal of social work, 47(4), pp.1224-1244.

Stewart, A. and MacIntyre, G., 2017. Safeguarding Adults: Key Issues and Concepts. Safeguarding Adults: Key Themes and Issues, p.13.