Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding Specialist, BHSCT Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding Specialist, BHSCT

Definition 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 ALL POCs Alerts/Referrals by Type of Abuse Physical Psychological/ Emotional Sexual Financial NeglectMultiple Institution al Total 2011/ / Variance 67%90%94% 65% 82%N/A 69%

National 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 2 nd most reported type of abuse amongst older people. Paid carers followed by family members.

SHSCT Research Financial abuse 2 nd 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 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 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 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

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 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 SHSCT Care Management Implementation Project Group established. Care Management Implementation Officer post agreed. Job Description Agreed Proceeding to recruit.

Financial 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 age Lives alone with no known family Physically frail and has severely impaired hearing and vision Basically housebound Supported at home with a care package Day to day finances managed by a male friend Mr A who had formerly acted as her care worker Mr 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