Real life example of balancing rights - interested in opinions

Agree with others that this isn't really a balancing of rights issue. While continuity of care is desirable it's not a right and not something that could ever be promised given staff cannot be compelled to stay.

Stability is important for many individuals with significant support needs, but unfortunately it’s not something that’s a ‘protected right’

Stability can never be a protected right, because it would be impossible for any care home to guarantee a certain member of staff will always work there, or a specific care home will always be open. Change is inevitable. Its sad that people who have the least control over their own lives are the ones who can find it the most stressful.
The best that care homes can do is offer continuity of care, and to prepare & support residents through change as much as possible.

Yes, exactly - it’s the same reason teachers never put themselves in a situation where they’re alone with a child - to protect themselves from allegations.

Stability is important for many individuals with significant support needs, but unfortunately it’s not something that’s a ‘protected right’ in the same way same sex care it.

This doesn’t change my opinion on the consent issue in this case, but it’s incorrect to say that people who suffer disproportionate detriment from a decision as a result of their specific disability aren’t protected under the EA 2010 - disability is a protected characteristic too, just as sex is.

OP, I work in this area, and honestly, I am shocked that your sister's home didn't already have that policy in place.

What kind of management have they had? Even if the manager is incredibly naive and clueless about all the previous abuse scandals in the care sector, how come CQC haven't noticed the staffing rotas?

I entirely agree that continuity of care is essential, but the situation of having only male staff on shift to do personal care should never have been allowed to arise, short of a one-off emergency. Non-verbal disabled women are targeted for sexual abuse at truly sickening rates. Everyone in the sector with management responsibilities should be aware of this. In my experience, decent male carers are fully aware of this, and they are the first to request a female colleague's assistance with personal care to protect themselves.

You may ask why. It's because they know that if evidence is found that a service user has been sexually abused, everyone who was alone with that service user will come under investigation. The service that allows, for example, John (lovely guy, saint on earth) to do personal care for ladies will let its other male employees do personal care for ladies.

The current male employees may all be lovely, but the service management cannot give John a guarantee that the management will never ever accidentally employ a sexual abuser. If they do, and the abuse is discovered, John's life will be upturned in the investigation while the police and the management try to identify who actually committed the abuse.

The safest thing for everyone is safeguarding: safeguard service users from sexual abuse, and safeguard staff from being placed under suspicion.

OP,

I think you’re getting a really hard time from
people who have very little understanding of the topic, and seem to think that you can take a siloed approach to safeguarding and welfare. Whereas in reality, anyone with knowledge of the situation will realise that there are benefits and drawbacks of any arrangements and that it’s a tricky balancing game.

It sounds like unfortunately in this situation a management teams reaction to a valid request has had a totally disproportionate impact on your sisters welfare. Stability is important for many individuals with significant support needs, but unfortunately it’s not something that’s a ‘protected right’ in the same way same sex care it.

I’m glad to hear that you and others are pushing for best interest assessments. It’s difficult to see how one could conclude that regular bank staff, and no male overnight staff for the male residents is an appropriate conclusion.

Wishing you and your sister a positive outcome.

As the new resident is joining an existing small community that operates a bit like an extended family I think you should be allowed to discuss your concerns with their relatives and a comodations for your daughter should be prioritised, to provide her with stability, as well as to protect male caters from discrimination and lost income.

I'm quite surprised that other male carers do agree to be a lone carer on duty overnight doing personal care for a female, and that the service allows it.

My partner is a male support worker. He provides care for severely learning disabled people. He would never agree to be the lone worker doing personal care on a female client (this includes e.g. toileting, changing sanitary protection). He believes that for privacy and dignity women should have female carers.

And even if a family says it's ok, he'd worry about whether the client was really able to understand and weigh up the options.

I don't like to go through life distrusting everyone, it's not who I am.

So wonderful that you don't let the possibility of your sister being abused affect your peace of mind. Well done you.

You're going to move your sister to another care home if you can't get the current one to agree to have male staff on duty overnight providing her intimate care?
Is this a wind up?

You say the longstanding male staff members are thinking of leaving because of the drop in pay. That may be true. Or it may be what they are telling people. How do you know it isn’t because their easy access to highly vulnerable women has now been stopped?

Exactly my point - you weren’t allowed to consent on her behalf to optional medical intervention, because the doctors can’t be sure as to whether or not she’d consent to that, and under circumstances you describe, it sounds like it was something the doctors didn’t deem medically necessary but merely something that some patients can consent to, so they must be absolutely sure that the patient definitely consents to it. And they couldn’t be.

You say she’s non-verbal but capable of expressing her opinions and emotions - how much does she understand about sex, abuse, the prevalence of the abuse of vulnerable disabled people in the care system, whether other women are receiving intimate care from male staff or whether it’s reasonable for a woman to request intimate care from females only?

Presumably, the main opinions she is exposed to are those of you and your family and the care staff, who all agree that her receiving intimate care from men is fine, so it seems likely that she hasn’t been exposed to sufficient information to be able to freely consent to the situation she has been placed in by others.

The problem with stating that you’re fine with these particular male workers providing intimate care is the same argument used about women-only changing rooms - if you allow men in, you can’t only let the nice men in - you have to let all men in, regardless of how unsavoury or lacking in self-awareness or creepy they are.

So if you do move her to another facility that allows men to provide intimate care to vulnerable women, you might find that the male staff there aren’t as nice as the current ones, and you can’t pick and choose which men can touch her intimately based on how nice you think they are.

We as a family have never had a problem with the male staff giving her personal care and she doesn't appear to mind either.

How would she let you know if she did mind?

Lack of protest is not consent.

Agreed. OP abusers will groom their colleagues and their target's family members at first or alongside their grooming of their victims, surely you know this? They don't wear a sign, they look like everyone else and seem nice like everyone else but you've no idea what's happening when you're not watching.

Possibly outing but I had a colleague for over 6 years who it transpired was sexually abusing the children who were our clients. I trusted him, I liked him, if a member of my family had needed the service I'd have requested him to care for them because he was so kind and caring and the clients and families all loved him, as we his colleagues did.

Do not kid yourself that abusers all have a vibe, that you'd know if something was off,or that your sister would be able to express discomfort as an abuser could easily groom her to not complain, how would she even understand that what's happening isn't ok? Not one of us ever suspected my colleague and no clients raised concerns for years until a child told his relative he was uncomfortable about something that this person has done, and it all came out. He'd been sexually abusing children for years, many victims were uncovered and there were likely many more. Unchaperoned males should never have had access to your sister and you should be pleased that the coming of the new resident is going to mean safer care for your sister.

I don't like to go through life distrusting everyone, it's not who I am. I trust the longstanding staff members, both male and female and I trust the systems the home previously had in place.

And this is how the abusers carry on abusing in plain sight.

This. The rule of same sex care should be the default - not that women have to request it. I would be willing to consider exceptions but only where the patient or their person with power of attorney has specifically said it would be OK and where a careful assessment of consent and reasons has been done.

This is why balancing rights is hard. Anyone who has given the impression it's always easy has misled people. I am grateful that the Supreme Court were so clear in explaining their decision, and in acknowledging that it's always a question of balancing rights, which are sometimes in competition.

It’s not a balancing of rights conflicts if it is just poor management though? Put a male and female staff on overnight- I’d suggest ask them why they aren’t doing that. Mixed school camps would never go ahead without male and female staff for overnight, sounds like it should be the same here.

How regularly do you see her?

How would you know if someone on the staff was slowly, quietly grooming her by getting her trust, then using the opportunity of changing her incontinence pads and cleaning her up to accustom her to sexual stimulation and activity? She's an adult now: she will have adult physical responses to stimulation. Why do you think you'd know if she'd been raped or assaulted?

My MiL was in a care home and visited every 3-4 days by family. She had moments of lucidity and when she did, she was often unhappy. It took us, and the families of other victims, the best part of a year to work out what a couple of the male staff were doing.

And that's probably because female staff probably have to look after children or their own dependent elderly in the evenings and overnight, while men aren't expected to be the primary carers.

It sounds like the ideal solution would be for one male carer and one female carer to be working the nights. Plus that instead of bank staff, that they should be people who fit well with the clients and are regular employees that the clients get to know and are comfortable with.

I understand that it is finding a good, female carer that will work nights that is the issue, as male staff to fill this role are available and willing.

My relative's care home was really changed by a new female client - all others were male. It was a poor decision all round due to difference in new client's needs and current ones - not relating to personal care at all by the way. I imagine this can happen a lot in smaller places where there is a rhythm to life for long stay, regular clients. The new lady moved on eventually and all settled down, but one client massively struggled during and for a good while afterwards. It is very sad, and I agree the needs of the majority should be catered for, but this is only where possible.
Re the personal care, firstly in this instance I think this it is a bit of a by product in a way of how existing residents should be treated - as in everything ideally should be a good fit for them and instead everything has had to change - sadly, resourcing will never allow beyond getting care at all for everyone. I imagine all this isn't helping the new lady settle in either when really she's just receiving normal care.
Secondly, with personal care the safe practice is same sex care and this should be always available. This doesn't seem to apply to men so much though - and whilst it's less likely a female abuses a male some men get very distressed having to have a female help their personal care, which seems unfair. My Mum preferred male care, unusual I know, but alongside this some of the men were just that bit warmer than the women, one sang with her and held her hand occasionally - she really, really appreciated that small contact.
I hope all is resolved OP, it is so difficult to get a good care place/care where people can settle and have a decent life but this is no more than they deserve.

I believe we would see the signs if anything untoward had ever happened

You'd be seeing signs after the fact. Safeguarding is about prevention. And it's to safeguard the carer, as well as the person they are caring for.

I hope you're right. I hope you've been lucky. But safeguarding shouldn’t rely on luck.

They should give you an answer to your questions, though