Who is responsible when a person with capacity causes sexual harm in a care setting?

Care homes and supported living environments increasingly face difficult questions about sexual relationships, particularly in terms of balancing safeguarding risks and promoting autonomy.

These cases become particularly complex in the following scenarios:

• some residents have capacity to engage in sexual relations, but others do not
• safeguarding concerns arise between vulnerable adults around sexual relations
• a resident poses sexual risks to others
• professionals disagree about appropriate restrictions

As Court of Protection specialists Holly Miéville-Hawkins and Sophia Withers discussed, the legal framework in this area is often highly fact-sensitive. The Court of Protection may determine whether a person has capacity to engage in sexual relations, but responsibility for managing risk within care settings often falls on care providers and those supporting the protected party.

This creates difficult practical and ethical questions for:

• care homes
• local authorities
• safeguarding professionals
• deputies and attorneys
• families
• healthcare teams

Capacity assessments are highly context-specific

The legal test for capacity to engage in sexual relations comes primarily from the Supreme Court decision in A Local Authority v JB [2021] UKSC 52 which highlights the relevant information which the person being assessed needs to be able to understand. This information includes the following:

• the nature of sexual activity
• the consequences of sexual activity, including the possibility of pregnancy and sexually transmitted infections (STIs)
• consent and the right to refuse to engage in sexual activity
• the ability to withdraw consent
• the need for the other person to consent and understanding that they also have the ability to withdraw consent at any time

However, as Sophia Withers explained, the courts have recognised that the “relevant information” can sometimes be tailored depending on the circumstances.

For example:

An elderly married couple in a long-term monogamous relationship may not necessarily need detailed understanding of STI risks in the same way as someone engaging in casual or multiple sexual relationships.

This reflects the important principle that capacity assessments must remain decision-specific and fact-sensitive.

That said, the courts have generally been cautious about departing too far from the established guidance developed through case law.

How sexual relationships are managed in care settings

In practice, there is no universal approach across care settings. Different care homes may take very different positions depending on:

• staffing levels
• safeguarding culture and policies
• management style
• local authority involvement
• risk assessments
• the vulnerability of other residents
• The specific circumstances of the residents in their care

Some care providers may:

As discussed in the interview, some care homes are far more proactive than others in supporting residents’ rights to relationships and intimacy.

The involvement of social workers and local authorities can also significantly influence how these situations are managed.

The role of Article 8 rights in care settings

One of the key legal principles underpinning these cases is Article 8 of the European Convention on Human Rights and Human Rights Act 1998.

Article 8 protects:

• private life
• personal relationships
• dignity
• autonomy
• sexual expression

Care providers must take steps to balance these rights against:

• safeguarding duties
• protection of vulnerable residents
• regulatory and legal obligations
• health and safety responsibilities

This balancing exercise can become particularly difficult where:

• one resident has capacity
• another resident lacks capacity
• sexual behaviour creates distress or risk
• there are allegations of inappropriate conduct

Complex disputes about autonomy and safeguarding may overlap with broader health and welfare authorisation issues within the Court of Protection framework.

Who holds responsibility when harm occurs?

One of the most difficult questions in these cases is where responsibility ultimately sits when a capacitous individual causes sexual harm in a care environment.

The answer is rarely straightforward.

Responsibility may involve:

Importantly, the Court of Protection does not generally act as a preventative public protection body.

If a person has capacity to engage in sexual relations:

• they retain significant autonomy rights
• restrictive interventions must remain proportionate and risk-based
• care providers must justify any limitations imposed

This creates difficult operational challenges for care settings attempting to manage competing rights and risks.

The tension between autonomy and safeguarding

Care providers often find themselves navigating competing legal duties. On one hand, residents have rights under Article 8, including the right to private relationships and intimacy. On the other, care providers must protect vulnerable individuals and mitigate the risk of abuse while complying with safeguarding and legal obligations.

These tensions are particularly acute where:

• cognitive impairment fluctuates
• consent may change over time
• residents have differing levels of capacity
• communication difficulties exist

There are rarely perfect solutions.

What most people do not realise about these cases

Many people assume care homes can simply prohibit relationships where safeguarding concerns exist. In reality, the legal position is far more complicated.

Care providers must avoid:

• unlawful restrictions
• disproportionate interference with Article 8 rights
• discriminatory practices
• overprotective approaches unsupported by law

At the same time, failure to manage foreseeable safeguarding risks can expose providers to:

• regulatory criticism
• safeguarding investigations
• civil liability
• reputational damage

This is why careful documentation, risk assessment, and legal advice are often essential.

Why local authority involvement can be critical

As Sophia Withers noted, outcomes in these cases often depend heavily on whether:

• social workers are actively involved
• safeguarding concerns are monitored
• regular reviews take place
• professionals advocate for the person’s rights

Where local authorities take an active role, care planning is often more structured and balanced.

This may include:

• capacity reassessments
• relationship support plans
• safeguarding meetings
• advocacy involvement
• multi-disciplinary reviews

Common mistakes in care setting cases

Assuming older adults do not have sexual relationships

Care providers must not ignore any residents’ rights to intimacy and relationships, regardless of their age or presentation.

Treating all safeguarding concerns as incapacity

Risk and capacity are separate legal concepts and must be addressed correctly.

Failing to document decision-making

Poor documentation can create major safeguarding and regulatory difficulties.

Overly restrictive care planning

Restrictions must remain proportionate and legally justified.

Ignoring fluctuating capacity

Capacity assessments may need regular review and must be decision specific.

When professional advice is essential

Specialist legal advice is often necessary where:

• residents form intimate relationships in care settings
• safeguarding concerns arise between residents
• there are disputes about consent
• providers consider restrictive interventions
• deprivation of liberty concerns arise
• families challenge care decisions

These cases often involve overlapping issues concerning:

• mental capacity
• safeguarding
• human rights
• care regulation
• deprivation of liberty
• negligence and liability

In complex disputes, specialist litigation support and expert witness services may assist with capacity evidence, safeguarding analysis, and care planning recommendations.

FAQ

Can someone in a care home have capacity to engage in sexual relations?

Yes. Living in a care setting does not automatically imply that a person does not have capacity for a specific decision.

Do all residents need to understand STI risks?

Not necessarily. In limited circumstances, courts may tailor the relevant information depending on the specific relationship and context.

Can care homes prevent relationships between residents?

Only where restrictions are lawful, proportionate, and justified by safeguarding concerns. The Court of Protection will likely need to be involved where a decision needs to be made about preventing contact.

Who manages safeguarding risks in care settings?

Typically care providers, local authorities, safeguarding teams, and healthcare professionals.

Does the Court of Protection manage day-to-day safeguarding?

Generally, no. The Court of Protection primarily determines issues of capacity and best interests.

Conclusion

Cases involving sexual relationships in care settings highlight the complex engagement between respecting and promoting autonomy while considering safeguarding risks and balancing legal responsibility.

The Court of Protection can make a best interests decision as to whether a person has capacity to engage in sexual relations, but the practical responsibility for managing risk often falls to care providers and safeguarding professionals.

As care settings increasingly encounter complex relationship dynamics between vulnerable adults, professionals must carefully balance:

• dignity
• autonomy
• best interests
• safeguarding
• proportionality
• human rights obligations

These situations remain among the most sensitive and legally challenging issues within modern health and social care practice.