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’m going to assume this is a family member of yours. I’d tread carefully before using words like safeguarding. By all means have a conversation about shielding and what that means and how it can be supported. But if the alternative is they go into a care home I’d probably think they were actually safer where they are at the moment.

I am aware though that substitute “child” for “elderly person with dementia” and my view of safeguarding in these circumstances is completely different, so perhaps I should be ignored...

@Bartlet and sorry, didn’t fully reply with my objective - i suppose using Mumsnet as a discussion forum and to gauge the views of others to inform my approach. It’s something I’ve been feeling quite uneasy and uncomfortable about, others who are aware of the situation are less worried, and I suppose discussing it here is helping me to gain much needed perspective.

On the face of it a trip to a DIY store is not worth dying for but it’s the combination of seeing different places, people and feeling part of the community which is what elderly people really enjoy. Being out and about may be the highlight of the elderly persons day and be the one thing that prevents the carer from crumbling.

I don’t know the specific people and situation that you’re describing but I’m pretty sure that I’d do the same as them.

@Bartlet Absolutely. I had a trip to the garden centre last week that genuinely was the highlight of my week. So I take your point entirely!

If you are talking about a couple, then that impacts the conversation as well- I do think the boundaries are in a different place. It becomes a questions of what is best for the couple, not just the two individuals.

When my dad was very ill I had grave safeguarding concerns, but I know he would have been scandalised at any suggestion of criticising my mother. He'd prefer to suffer than have outside interference undermining her.

I deal with safeguarding referrals- it would depend on a lot of factors. The carer should be making decisions in their best interests and that would include weighing up a whole bunch of information we don't have here. It could be a safeguarding issue, it might not .
You can call the council for advice without taking it further.

You seem like you’re coming from a good place with this. If you can work with the carer to minimise potential risk without impacting on their quality of life too much then I think you’ll have a good balance.

This is something that will need to be talked about more as we move into the business as usual phase with this disease. Shielding for the sake of preventing death is all very noble but at what cost? Is it in the best interests of someone with dementia to be shut away whilst their last months of good quality of life ebb away from them.

@picklemewalnuts thanks for sharing your experience. I think the point about undermining the Carer who is the husband or wife is a good point. I think I’ve trod very lightly with it thus far for that exact reason. Thank you for sharing your experience, it has really helped.

I am shielding.

I'm not in the over 70 age group.

Trust me, a trip to B and Q or the tip would be as welcome as a 5star holiday break just now.

It could be that the trips out, while carrying some risk for the vulnerable person, are helping to keep the carer sane.

A stressed out, at the end of their rope carer may be a bigger risk to the vulnerable individual than the trips.

@Bubbletwix you’re correct, the person is a family member. I think possibly why the opinions on this thread have been so useful as it is quite emotionally sensitive for our family and I have found the kind of discussion that Mumsnet offers really helpful!

The person going into a care home wouldn’t be a good outcome in this situation for anyone. Exposure would be much greater - in the care homes in their area, anyway. But that feels a bit like the person with dementia is in between a rock and a hard place, as either way they’re exposed, and if they had the choice and capacity to decide they wouldn’t be. Pre-dementia he would have followed shielding to the letter.

Your point about replacing adult with child is one that’s gone through my head when -over- thinking this situation. I feel like I don’t know enough about it, but I should.

@Wingedharpy you make a very very good point, and I hadn’t considered it from that angle. I’d taken into account the carers mental health and needs into the mix as really important, but not with the approach that also poses a risk to the person being cared for. Thank you. And I really do empathise with your shielding situation and the B&Q/5 star hol comparison. I speak to people who are shielding (and really struggling) on the phone 8 hours a day, and even after 8/9 weeks of these conversations I still don’t think I could comprehend how it would impact me if I were in their position.

My patients being shielded have been nowhere! They have gone into the garden and that is it.
They have dementia.

If you rang my team we would put it through to safeguarding yes as the carer is not acting in the dementia patient's best interests by taking them to the tip and B&Q.

It's very difficult as I imagine the person they live with wants to help them with some kind of routine/normality as well.

How can you possibly say that @Friendsofmine? You have no idea whether this is a good thing or not for the person. It’s fine to say that it may be a safeguarding issue but unless you have got all the information then that is just a officious and unhelpful thing to say.

Say the person spend the next 6 months shielding inside whilst their dementia gets considerably worse and the person who is living with them can no longer cope so they need to go in a home. How is that in the persons best interests?

Playing devils advocate here though, yes he’s between a rock and a hard place, if you assume he would have made the same decision about shielding as he would pre dementia (only you can gauge if that’s a reasonable assumption, though I wouldn’t personally be able to guess for either of my parents, it’s not ever been a situation we ever thought we’d face or have discussed!) But his carer is in a pretty tight spot too, especially if he’s no longer as easily left (got used to carer always being around during lockdown?) and carer is arguably under no obligation to shield themselves for his sake. So even if he’s at home, if his carer is going to all these places, then I presume still being pretty close to him (personal care?) he’s at risk from the trips anyway even if he doesn’t go on them.

It’s a tough place to be, but only you can judge it, we don’t have all the facts here.

I have a family member who cannot work from home and the elderly relative they live has dementia with carers visiting multiple times a day who cannot socially distance due to the care they provide. My family member has decided to continue going to work, shops, having their children over, etc... even though family member with dementia has been advised to shield due to other health problems. This decision was made on the fact that a) elderly relative cannot be made to stay inside without a lot of distress, b) carers are coming in and out anyway and c) carers are paid for privately, and if family member doesn’t work they can’t afford the carers anymore. So, no shielding is happening as it reduces elderly relatives quality of life to almost nothing. My relatives children do not go within 2m’s either.

Relative also stays away from elderly relative with dementia, he does not provide physical care. He just cooks and cleans, etc, so they manage to maintain 2m’s distance.

And elderly relative only goes for short walks, which they are capable of. They do not go to busy public places or the shops themselves.

Can I ask if the carer is caring on their own?

I'm in the shielding group and my mental health has suffered greatly without the added pressure of caring for someone. If I didn't get out occasionally I would be in an even worse place mentally.

My mother has severe dementia, is doubly incontinent so needs full personal care and is clueless about the virus. She can't be left alone for a moment, as she wanders. It's exhausting and deeply upsetting for my dad, who is her main carer, and if he wanted to invite in a neighbour for company, or take mum to a garden centre I wouldn't dream of criticising him. The alternatives, that she goes to a care home or that I take over her care, aren't at all palatable.

To be honest a trip to b&q/the tip could easily be the difference between the carer being able to carry on and carer burn out resulting in the cared for person ending up in a care home.

Could you go and sit with them while their carer goes out for a bit?

I think there are a lot of factors at play here. If my nan was still alive (who had dementia) and was advised to shield I think she would have followed the advice but not strictly, if we had offered to take her to the supermarket a cafe etc she would have jumped at the chance.
If I was caring for my nan during a pandemic I would have still taken her to the supermarket etc because for her she liked to get out and have a change of scenery. The quality of life people with advanced dementia have is terrible for them but my nan always knew what a supermarket was and would often ask to go. She would have looked forward to a trip to B&Q all week (even if she wasn’t going to buy anything, just to look) I really think if my nan was alive during this pandemic her dementia would have accelerated quicker because who wants to have to stay inside 24/7 and not really understand Or forget why they have to.
If I was receiving this referral I would be having a chat with the career and seeing how they are doing? how is lockdown affecting their mental health? How are they managing looking after a relative under these circumstances?
If the adult is unable to safely look after themselves and no other family members are able to take over the care of the adult the only other option is a Care home And I would avoid that at all costs. People deteriorate a lot quicker in Care homes than in their own homes.

As someone who’s mother has advanced dementia I know how difficult caring for people with this condition is (in my mother’s case vascular dementia and extremely agitated all the time).

Through lockdown all support networks for my father have been removed, as well as possibility of getting out for change of scenery/for a coffee just to break up the day.

I was be extremely wary of reporting someone in this position. Getting out of the house might be the only thing keeping them going and allowing them to continue to care for the person with dementia - this is certainly not a good time for someone to feel overwhelmed and feel they cannot continue to do this and need it rely on a care home.

I think reporting this would be disgusting.

There’s a reason why residents in care homes have such short life spans. I would avoid one at all costs.

I don’t mean this to sound rude, but unless you are the person who is living with and caring for the relative with dementia you have no idea on how gruelling and exhausting it is. To resent the carer a luxurious trip to somewhere like B&Q is abhorrent.

If the carer can’t leave the person with dementia home alone safely perhaps you’d like to offer to sit at home to give them some respite?