Safeguarding Vulnerable Adults
Everyone’s Business
Financial AbusePatricia Trainor, Adult Safeguarding Lead, SHSCT
Yvonne McKnight, Adult Safeguarding Specialist, BHSCT
Safeguarding Vulnerable Adults
Everyone’s Business
Financial AbusePatricia Trainor, Adult Safeguarding Lead, SHSCT
Yvonne McKnight, Adult Safeguarding Specialist, BHSCT
Definition of Financial AbuseDefinition of Financial Abuse
“Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or misuse or misappropriation of property, possessions or benefits.”
No Secrets. DHH 2000
No of SHSCT Financial Abuse Alerts in 2012/13
No of SHSCT Financial Abuse Alerts in 2012/13
ALL POCsAlerts/Referrals by Type of Abuse
PhysicalPsychological/
EmotionalSexual Financial Neglect Multiple
Institutional
Total
2011/12 479 108 69 117 60 26 12 8712012/13 798 205 134 193 109 0 37 1476
Variance 67% 90% 94% 65% 82% N/A N/A 69%
National Research FindingsNational Research Findings
Mansell et al (2009) Older people and people with a learning disability most at risk.
Davis et al (2011) Older people most at risk- identification involves complex judgements.
Action on Elder Abuse (2006) Financial abuse 2nd most reported type of abuse amongst older people. Paid carers followed by family members.
SHSCT ResearchSHSCT Research
Financial abuse 2nd most recorded form of abuse in the sample.
Frequency of financial abuse both isolated and repeat incidents.
Featured in 45% of multiple abuse referrals Financial abuse likely to be screened out at
early stage.
Learning Arising from Recent Case Examples
–Strategic/Policy Issues
Learning Arising from Recent Case Examples
–Strategic/Policy Issues
Regulations & Standards/ Guidance/Regional Contracts.
Lack of clarity around “reasonableness” of charges within residential/nursing care & supported living facilities.
Who decides?
Learning Arising from Recent Case Examples –Operational
Issues
Learning Arising from Recent Case Examples –Operational
Issues
Lack of Professional Scrutiny/Scepticism - necessary assessments need to be in place that can either support or challenge the validity of a care provider’s views/requests
Learning Arising from Recent Case Examples – Operational
Issues
Learning Arising from Recent Case Examples – Operational
Issues
Absent or incomplete assessments on service user files
Lack of standardisation in relation to recording practices led to a situation in which service providers became the “experts” in determining the needs of residents.
Poor Interface Arrangements Between Care Management, Contracts and Finance Staff within the Trust – “silo culture”
Communication Failures between Key Agencies – lack of understanding of one another’s roles leading to false assumptions
Learning Arising from Recent Case Examples – Operational
Issues
Learning Arising from Recent Case Examples – Operational
Issues
Learning Arising from Recent Case Examples – Operational
Issues
Learning Arising from Recent Case Examples – Operational
Issues
Poor Understanding of Adult Safeguarding Procedures - assumption that financial abuse is linked to physical and emotional abuse and therefore does not exist if the other 2 forms of abuse are not present.
Remedial Action by SHSCTRemedial Action by SHSCT
Action Plan developed on the back of the Trust research.
Review of Care Management procedures initiated as a result of safeguarding investigation into financial abuse.
New Care Management guidance developed – assessment and recording standardised across Directorates.
Remedial Action by SHSCTRemedial Action by SHSCT
Care Management Implementation Project Group established.
Care Management Implementation Officer post agreed.
Job Description Agreed Proceeding to recruit.
Financial AbuseFinancial Abuse
Older people, particularly with dementia, are among those who are at greatest risk of financial abuse.
60 – 80% of financial abuse against older people takes place in the home.
15 – 20% in Residential Care.–(Help the Aged 2008)
Miss L is over 95 years of ageLives alone with no known familyPhysically frail and has severely impaired hearing and visionBasically houseboundSupported at home with a care packageDay to day finances managed by a male friend Mr A who had formerly acted as her care workerMr A is stated to be an important person in Miss L’s life
Referred under Adult Safeguarding as a result of concerns raised by care staff about irregular activity in Miss L’s bank account. Approximately £3,000 missing from account
Miss L’s bank stated that they could not discuss concerns due to data protection
Miss L was physically unable to go to the bank and could not engage in a telephone interview due to level of hearing impairment
A further £11,000 withdrawn from account over next two weeks
GP’s initial opinion was that Miss L had capacity to make informed decisions and had an understanding of her finances
However, Miss L appeared to lack awareness of her finances and was of the view that Mr A and Social Services could address the issue for her
Action
Report to PSNI with Miss L’s agreement
Miss L’s bank informs that case had been referred to the fraud department for investigation and indicated that until this was completed they could not clarify if Miss L’s account would be refunded. If this was the case Miss L would no longer be the victim and the bank would make the decision as to whether to make a complaint to the PSNI
Interim protection plan agreed with Miss L and Mr A. Mr A agreed to withdraw from direct management of Miss L’s finances until Adult Safeguarding and potential Police investigations resolved
Following Miss L being referred to the Psychiatry of Old Age Team by GP, she was subsequently assessed as not having capacity to manage her financial affairs
Referral to the Office of Care and Protection (OCP) was completed
Mr A and another long-standing friend of Miss L have been appointed as joint Controllers by the OCP
Learning from Case Study
Capacity Issues• Professional staff need to be aware of the key indicators in relation to potential financial abuse
and they also need to be more alert to the need for differing levels of capacity assessments• In this case the service user did not have a significant cognitive impairment. However the
consequence of her level of impairment, linked to her sensory impairment, advanced age and isolation, meant that she was not capable of managing major finances
Professional Scepticism• In this situation the professionals involved did not question the appropriateness of the relationship
between Miss L and Mr A (i.e. from care worker to best friend/next-of-kin). This is particularly relevant when the service user is very isolated with no family contact. Professionals need to be more alert to the potential risks within these situations for both service user and employee
• Professional boundaries for care staff – clear guidance and direction needs to be provided in terms of appropriate boundaries between care staff and service users
Communication and Partnership Working• Communication between agencies is critical, particularly in this situation between Bank, Trust,
OCP and PSNI. In this case a criminal investigation could not be progressed as the PSNI did not have a complainant and there was insufficient information from other agencies to progress a Police investigation. The OCP also had difficulty acquiring information from the Bank and this led to a delay in making arrangements for funding of Miss L’s daily living needs and also delays in appointment of Controller
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