Real life example of balancing rights - interested in opinions

[Azureal]

I have a sister who has a severe learning disability (non-verbal, developmental age of about 15 months) and has lived very happily in a small group care home for 15+ years. Some of the staff at her home have been with her from the beginning, both male and female, and are very good with her. 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. Indeed her favourite staff members are probably male.

A new person has moved into the house, also with a severe disability, and her family insist that only female staff undertake her personal care.

As a result there is a new house rule that a female staff member always has to be on overnights.

Historically it was mostly the male staff who took the overnights and many of them rely on the overtime to support their families.

The longstanding male members of staff are now thinking of leaving as they can't afford the pay drop. So the parents of the other person's right to request staff of a specific sex is negatively impacting my sister who may lose longstanding relationships with staff she is accustomed to and very close to. She is epileptic and has had 2 seizures since the change when she hadn't had any in 6 years. We are worried it's a reaction to stress as it's usually bank staff now if she wakes in the night as the female staff don't want the nights and the male staff aren't allowed.

I understand both points of view, that of the other family and of ours. But I'm worried for my sister. Would this come under sex discrimination or not? And any suggestions for resolving?

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'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.

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.

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.

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.

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.

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’

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.

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.

If we can't get them to allow mixed overnight staffing we may have to look at moving her, which would be very sad. I understand in any case we may not be able to move her as her social worker is the decision maker, not us.

Given that you attribute your sister's unhappiness to changes in staffing during the night shifts, I am unsure that the key will be to move her to a totally new facility. Her staff at night would still be unknown to her, and then she'd also be coping with a complete change of physical environment and totally new day staff as well.

You said that the overnight shifts are being filled by bank staff. Where I work, bank staff are people who have been interviewed and employed by the same manager as me, but who couldn't commit to fixed hour contracts, e.g. because of their own caring responsibilities at home. Our long-term bank staff are as familiar to our service users as full-time employees with similar lengths of employment.

Can you clarify whether the facility is using regular bank staff or agency staff? If it is regular bank staff, then the staff should be gradually building trust with all the service users, including your sister. That would re-establish stability.

I think you need to ask to meet with the manager, and explain that you're concerned about the emotional impact of unfamiliar staff in the night. Ask them what plans they have to recruit permanent staff for the nights, and ask them how long the current bank staff have been working there.

I'm not going to go into detail as to how I'm confident my sister has not been abused but there is a lot of technology and other systems in place that I, and my family, who know her and her capacity, believe to be sufficient to keep her safe without requiring that both staff on overnight duty are female. This had never been questioned as unsafe before.

I don't mind if they pass a rule only women can do her personal care. I do mind them exposing her to unfamiliar women if she wakes at night, and I do mind that she is distressed and upset by the changed atmosphere and levels of stress in her longstanding home and that this is putting her health at risk by causing seizures which could kill her, a concern just as real and just as serious as potential abuse.

And yes if she continues to be distressed and have seizures, we will look to move her somewhere calmer. Whether or not there are sex based rules for intimate care will not be a deciding factor in that.

Thank you to those who have shown understanding and given advice. To those accusing me of being complicit in abuse or not caring if my sister is abused, well done, I won't be back to this thread.

If you move her somewhere else, do make sure to ask about the alternate provider's staff turnover rate. Ask how many of the staff have been working for the service for under a year.

OP, if you want practical advice on this situation and since you say the single-sex care point isn’t the main issue, you might want to post on the Special Needs boards for advice.

I think the reason posters picked up on the sex-based rights point was because of the way your OP was framed and the fact you posted in FWR asking for opinions.

Good luck with it all, and I hope you manage to find a workable solution for your sister - staffing is such a huge issue in this sector and, regardless of our differing opinions on some issues, I think we can all agree that it’s a travesty that so many disabled people receive such shockingly inadequate care for their needs as a result of underfunding.

To clarify what you're saying here: new resident mist accept itiate care from a man, against her will, because... why?

Literally the only reason why same-sex intimate care is an urgent consideration, is because too many men in positions of "care" have taken advantage of vulnerable women when they're naked. It's all on record and women know this (cough -Jimmy Savile -uncough ) .

It's up to care providers to provide safe care. It's not up to women to request it.

No. New resident's family should meet existing residents' families and frank conversations about the consequences of their request should be possible. At the moment they are making a request without full knowledge of the consequences.

The 'consequences' are making all of the female residents safer and protecting both the male staff and the company from allegations of abuse.

No woman, or person acting on behalf of a vulnerable woman, should have to justify or prove to others why she needs and deserves the protection of same sex care. It's profoundly depressing that you think they should.

Neither you nor I are privy to enough detail to make such a claim. This is a specialist unit for such profoundly disabled people that they are unlikely to express any opinion on the matter of same sex care at all, but the OP is of the view that, to the extent that her daughter can express an opinion, her favourite staff are men. She is worried that one new patient will result in policy changes that cause her daughter’s favourite staff to leave. Open and transparent communication is always the best way of laying everything out and resolving problems to everyone’s satisfaction.

I’m sorry but are we really going down the route of no male health and social care professionals allowed anywhere? These aren’t Tom, Dick or Harry off the street, these are qualified members of staff with DBS’s. I work with men day in and day out in social care and they are just doing a job. If we don’t trust men to do their job then where does it end? No male nursery staff? No male nurses?
Of course the other resident is allowed to request personal care from same sex staff, but at the same time the care home can say they can’t meet need. In the same way that if I ask for a package of care for a sexually inappropriate man with dementia and ask for male only staff, 80% of care agencies will say they can’t meet that need as they have mostly female staff on their books.
This isn’t hospital, these are small care homes working with the limited staff they employ. Maybe the care home were greedy and didn’t fully consider the impact on the other residents? You’re allowed to be sad, OP, if your sister has built up relationships with the male staff. I have seen some beautiful professional relationships between male staff and female clients. They’re not all predators.

@Circumferences Jimmy Saville was NOT a healthcare professional, he was a celebrity given unrestricted access due to his celebrity. Please don’t use him as an example of someone abusing vulnerable patients when he was not working in a health and social care setting. It’s not the same.

The OP has left, so won't be clarifying exactly what's going on with staffing, but I have the idea that the home has no staff on permanent nights, and just relied on daystaff taking overtime?

If so, then the male day staff are presumably still getting their contracted hours, so I'm not sure where protecting their income comes into it. There's no right to overtime. (The fact that wages in the care sector are so low that people are willing to take overtime is another issue.)

If the nights are being staffed by bank staff, as opposed to agency, I'd ask if the rotas are being done so that one long-term staff member is on shift with the newer staff member. I'd also ask if these staff were being given day shift opportunities so they could get to know the service users then.

And if it's agency instead of bank, I'd want to know the plans to reduce their reliance on agency!

@DuchessofReality it’s a good question re the right to same sex care. I think it would come under the patient being treated with dignity and respect guidelines or something like that. It absolutely should be a ‘right’ in my opinion. Would like to know the answer.

Gandalfatemyhamster

A DBS just means not-caught-yet. It's not a certificate of sainthood. I mean, I have one.

Also, I hate to say this, but some care providers do basically employ anyone off the street...

That's horrifying, but sadly doesn't surprise me.

Disability News Service, run by John Pring, used to do a lot of research into this, though I haven't kept up with it.

Thanks for that report, @busybusybusy2015

Grim reading.