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

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Page 1: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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

Page 2: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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

Page 3: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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%

Page 4: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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.

Page 5: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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.

Page 6: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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?

Page 7: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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

Page 8: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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.

Page 9: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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

Page 10: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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.

Page 11: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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.

Page 12: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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.

Page 13: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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)

Page 14: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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

Page 15: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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

Page 16: Safeguarding Vulnerable Adults Everyone’s Business Financial Abuse Patricia Trainor, Adult Safeguarding Lead, SHSCT Yvonne McKnight, Adult Safeguarding

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