Is not effectively shielding a person with dementia a safeguarding issue?

[Zwerty]

The title sums it up really, is putting someone at potential risk of catching coronavirus because they’re not properly being shielded by family/the person they live with a safeguarding issue?

The context being, that the person is shielded because of dementia (and other conditions) but isn’t able to understand what shielding means so can’t advocate for themselves to say “we shouldn’t be doing that!” Or “visiting this place is putting me at more risk”.

Hope it makes sense - would just really appreciate opinions. It’s divisive subject so trying to look at it rationally I suppose.

I appreciate you don't want to say too much but could you give a little more detail? You've said 'visiting this place is putting me at more risk' as an example - do you mean the shielded person is being taken out somewhere and they don't have the capacity to say no, it's not safe? If that's the case, I'd definitely say it's a safeguarding concern.

Yes I would say it would be a safeguarding concern and you should contact social services in your area.

Tough one.
If it's a once weekly visit to the supermarket, as online is difficult, and said person isnt safe at home alone, its bit different to popping round to visit a friend, then coming home via the garden centre. First one, I think id leave well alone. Second one I'm not sure what Id do.
It also depends on what the other conditions are. Dementia (plus, I assume age) aren't sufficient to require shielding.

Dementia isn't in itself a shielding condition. I think it depends on where they are being taken and is there a good reason for it.

I was maybe overcautious about not posting too much and too vague in my first post.

@BamboozledandBefuddled the example you’ve given fits what’s happening completely. The person understands there is a virus and that people have died, and understands that normal life is somewhat on hold (eg. Regular activities have stopped). However they are being exposed with unnecessary trips out and aren’t good with personal hygiene so not washing hands regularly. The person is safe at home alone.

@KittenVsBox there are weekly trips to supermarket, other shops that have remained open, garden visits, people going into the home. Person living with them has been in close physical contact with relatives outside the home - that sort of thing.

@Sleepyblueocean All I know is that they have been told to shield by GP. How GP came to that decision I don’t know!

Has the person been told to shield?

I think if they have been told to shield then there might be safeguarding concerns.

You need to find out why they've been told to shield if it is indeed true. Dementia isn't a reason for shielding in itself and shielding is only guidance in any case, it's not enforceable in any way.

Being in a household with someone shielding doesn't mean the other person has to. If the person with dementia could not he left on their own for even short periods, I think you should acknowledge how incredibly difficult it would be for the other person and seek to find them more support rather than report them for anything.

It would be perfectly within guidelines for other family members to help out for instance.

I would say it's nigh on impossible to shield someone with dementia, without completely removing whatever minor freedoms they may still have. We have an elderly neighbour with dementia, who is still just about managing to live alone (with some support). He just doesn't get that he's supposed to be staying at home, and short of locking him in there's not much that can be done. He loves to be out and about walking and chatting to people, needs constant reminding not to get too close when he's chatting. He's putting himself at some risk of contracting Coronavirus, but what's the alternative? No quality of life at all for however long he has left?

If it is a safeguarding issue, what are you hoping to achieve? For them to move somewhere they can be more effectively shielded (with you? a care home?) or are you hoping to force the person they currently live with to shield them better? If they’re otherwise happy and well cared for, I’d be careful that in achieving better shielding you don’t hugely decrease their quality of life by forcing them to be moved. But then I think if I was elderly (I assume they are elderly) with dementia my focus would be quality not quantity of life. Others may have a different view.

I think it can be a safeguarding issuing and, from what you have explained, then it does sound as if they may not be being protected enough.

However, dementia doesn't always require shielding. A colleague of my DH has a father with dementia but it is in the fairly early stages. He does understand about the virus. It depends what stage of dementia they are at as to whether there is or could be a safeguarding issue.

What bubble said.

Based on what you’ve said, I don’t think I’d be reporting that as a safeguarding risk. As bubble said, I guess the question is what outcome do you want? Being the primary carer of someone with dementia is beyond tough and perhaps they need to get out and don’t feel safe leaving the person by themselves? Or simply need to get out for practical reasons, i.e. eat or get medicines.

Or as a PP has said, are they putting quality of life over quantity? Dementia can deteriorate quickly so you might make a judgement that in 3/6/12 months or whatever , that person may not have the faculties left to enjoy e.g a trip to the garden centre or distanced cup of tea in the garden with a friend. So has decided to do it now while it’s possible. Shielding is advice not law.

If the person with dementia is otherwise well cared for, I would personally leave well alone. If you are concerned this is part of a wider pattern of neglect, then perhaps it is worth an informal chat.

Actually reading back I’d agree with the more recent posters.

Now you’ve given more detail it does not seem like the person living with them is putting them at great risk.

And it also depends on if the person has specifically been given a shielding letter by a GP.

Nobody is legally obligated to take care of anyone. The most social services can do is put the person with dementia in a home.

They cannot force the carer not to go out or not to take the person with dementia out as it is not illegal to do so.

So it friend won what outcome you want.

Is there a reason you can’t simply talk to the carer and ask them why they are taking them out to non essential places?

But I mean if you are not willing to take care of the person with dementia yourself then you don’t really have a leg to stand on when it comes to dictating what the carer can or cannot do.

Thanks for responses. To clarify - GP has told person explicitly to shield and that the person is at greater risk of being seriously ill/dying if they contract covid. However after reading posts it’s less about following shielding to the letter (no fun trips to Barnard castle then..) it’s more about keeping that person safe from the virus, much like you would keep someone safe by not letting them come to harm in other ways.

I suppose in posting I was wanting to gauge opinion and seek advice - to help inform my response to the situation. Like most posters have said, it’s tricky and very dependent on the circumstances. I work with shielded patients so maybe feel a bit to “close” to the matter so other perspectives have been welcomed.

For other people asking about a wider pattern of neglect - not to my knowledge. I believe the person is very well cared for.

For the quality of life type questions - I agree the quality of life and mental health of Carer should be taken into account. I think what bothers me is the person with dementias lack of capacity to choose - quality of life or shielding (or where a balance in between is struck).

Yes it’s a safeguarding issue. The letter clearly says you or the person you care for should not leave their home. A person can choose to ignore the advice, but if they don’t have capacity the advice should not be ignored or their behalf.

Being a main carer for someone with dementia means different things and brings different issues for different people. I'd say that universally, people on the outside have very little idea just how badly dementia really affects the person, and how safe or unsafe the person with dementia is in this particular circumstance right now (yesterday they were fine with x but they've reached their limit today) .
I have no idea whether the person you care about should be better shielded, hopefully the main carer knows you are available to help and provide support. They may well be pleased to talk to you about what support they need.

@TheQueenOfTheNight you are right, the person caring has been offered support, but your post has made me think I and people around me need to do a better job of offering more support. While I do have insight into how incredibly tough living with someone with dementia is, I’ll never fully “know” - and even if I ever find myself in that position, the impact will undoubtedly be different.
Support for Carers is incredibly important, particularly at the moment.

@ToothFairyNemesis
That is very clear. I feel like maybe the issue here could that the message in your post (the whole household shielding) hasn’t got through to the Carer as clearly as you’ve put it.

Another issue is that as restrictions have been lifted for others (e.g. garden centres reopening and socially distanced meetings with one person) the Carer has thought “fantastic, we can all go out a bit more!” And not taking into account that (sadly) those slightly eased restrictions don’t necessarily apply to them.

Do they have capacity?

What is your object here? If this is someone who lacks capacity then how much good quality of life do they have left? I think there is a great argument that quality is more important than quantity of life for people with degenerative neurological diseases. I wouldn’t intentionally expose an elderly parent with dementia to the virus but would not be shutting them away as I’d hope they could enjoy their life whilst they still had the ability.

@Bartlet there is a difference though between some who is elderly as someone who is on the shielding list. If they don’t have capacity it is the responsibility of the person caring for them to follow medical advice.
It is no different than a carer withholding prescribed medication due to unwanted side affects.

@toothfairynemesis. My view on it is that I don’t agree with locking old people (and I’m just assuming that they’re old as they’ve got dementia) up to protect them from COVID when they may live for longer shielded in the house but with a worse quality of life. Same way that I don’t agree with artificially keeping people alive with agressive medical treatment if they have poor quality of life with no hope of getting better.

@Bartlet

Upthread I mentioned that yes quality of life is very important - as much for the person with dementia as it is for their Carer. My devils advocate to your point is that going to the rubbish tip or B&Q doesn’t offer greater quality of life - I may be wrong there if there are any B&Q/tip enthusiasts out there. In my view, those activities exposing them unnecessarily when they’ve been told to shield.

It depends if they have capacity. If they have capacity then they are responsible for their own decisions, if not then it us up to the person who cares for them to protect them.