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Detecting and Preventing Financial Abuse of Older Adults 20 th July 2010 Dr Deborah Detecting and Preventing Financial Abuse of Older Adults 20 th July 2010 Dr Deborah Cairns Prof Mary Gilhooly, Dr Priscilla Harries, Mrs Miranda Davies, Ms Elizabeth Notley

nda Financial Elder Abuse Project Grant Holders Prof Mary Gilhooly Dr Priscilla Harries Prof nda Financial Elder Abuse Project Grant Holders Prof Mary Gilhooly Dr Priscilla Harries Prof Ken Gilhooly Prof Catherine Hennessy Dr Tony Gilbert Prof David Stanley Ms Bridget Penhale Brunel University Hertfordshire University Plymouth University Northumbria University of Sheffield Older Peoples Reference Group Teresa Lefort

nda Financial Elder Abuse Project Partners Action on Elder Abuse British Association of Social nda Financial Elder Abuse Project Partners Action on Elder Abuse British Association of Social Workers Help the Aged HSBC North Tyneside Council Relatives and Residents Association Peninsula Care Sector Group Peninsula Primary Care Research Network Gary Fitzgerald Ms Ruth Cartwright Mary Cox Neil Shadbolt Alison Tombs Dr Gillian Dalley Ms Gill Fairhurst Prof John Campbell

Content • Overview of the study • Progress to date • Questions? Content • Overview of the study • Progress to date • Questions?

Background Definition ‘Financial or material abuse, including theft, fraud, exploitation, pressure in connection with Background Definition ‘Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits’ (DH & Home Office, 2000, Pg. 9) Prevalence A Department of Health and Comic Relief study reported financial abuse as the second most common type of elder abuse, after neglect (O’Keefe et al. , 2007)

Aim What is the aim of this study? The aim is to investigate how Aim What is the aim of this study? The aim is to investigate how different professional groups make decisions when they suspect financial elder abuse is taking place.

Research design PHASE I Semistructured interviews PHASE II Experiments on Suspected Financial Abuse Decision Research design PHASE I Semistructured interviews PHASE II Experiments on Suspected Financial Abuse Decision Making Detecting Financial Elder Abuse PHASE III Policy analysis Figure represents the NDA financial abuse grant phases of study (Gilhooly et al. , 2008).

Phase I – Semi-structured interviews Phase I – Semi-structured interviews

Phase I methodology Participants n Job-roles Social care professionals 23 Social workers, Team managers, Phase I methodology Participants n Job-roles Social care professionals 23 Social workers, Team managers, Adult protection staff Health professionals 20 GP’s, OT’s, District nurses Banking professionals 20 Cashiers, Branch managers, Financial advisers • Data collection • Semi-structured interviews applying the Critical Incident Technique (Flanagan, 1954) to learn about cases of financial elder abuse.

Phase I research Questions Q 1. What are the cues that are perceived as Phase I research Questions Q 1. What are the cues that are perceived as raising suspicions of financial elder abuse?

Q 1. What are the cues that are perceived as raising suspicions of financial Q 1. What are the cues that are perceived as raising suspicions of financial elder abuse?

Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Identifier of abuse 2. Financial problem suspected Banking professionals 3. Physical capacity 4. Mental capacity 3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money 1. Identifier of abuse 2. Financial problem suspected

Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Identifier of abuse 2. Financial problem suspected Banking professionals 3. Physical capacity 4. Mental capacity 3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money 1. Identifier of abuse 2. Financial problem suspected

Cues that raised suspicion of financial elder abuse Cue 1 – Identifier of abuse Cues that raised suspicion of financial elder abuse Cue 1 – Identifier of abuse • Directly observed • Another member of staff • Another professional • Family • Friend • Older Person Quote e. g. Older person "on this occasion she said that her carer had come in to her house on that morning and had taken money from her purse” (Occupational Therapist)

Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Identifier of abuse 2. Financial problem suspected Banking professionals 3. Physical capacity 4. Mental capacity 3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money 1. Identifier of abuse 2. Financial problem suspected

Cues that raised suspicion of financial elder abuse Cue 2 – Financial problem suspected Cues that raised suspicion of financial elder abuse Cue 2 – Financial problem suspected Quote • Rogue trader • Anomalies between finances and living conditions • Unknown befrienders • Inheritance concerns • Change to Will • Stealing e. g. Stealing "…[the carer] went to the machine with the grandson who was supposed to get out £ 50, he got out £ 100; he gave the carer £ 50 and he went ‘she’ll never know’. The carer immediately reported it to me…” (Social Worker)

Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Identifier of abuse 2. Financial problem suspected Banking professionals 3. Physical capacity 4. Mental capacity 3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money 1. Identifier of abuse 2. Financial problem suspected

Cues that raised suspicion of financial elder abuse Cue 3 – Physical capacity • Cues that raised suspicion of financial elder abuse Cue 3 – Physical capacity • Minor physical health problems • Major physical health problems Quote e. g. Major physical health problem “he was unable to come in to the branch due to his poor mobility and was heavily reliant on others” (Cashier)

Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Identifier of abuse 2. Financial problem suspected Banking professionals 3. Physical capacity 4. Mental capacity 3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money 1. Identifier of abuse 2. Financial problem suspected

Cues that raised suspicion of financial elder abuse Cue 4 – Mental capacity • Cues that raised suspicion of financial elder abuse Cue 4 – Mental capacity • Slightly confused • Extremely confused and forgetful Quote e. g. Extremely confused and forgetful ". . . a gentleman who had Dementia told me that he had amended his will. ” (Occupational therapist)

Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Cues that raised suspicion of financial elder abuse Social care and Health professionals 1. Identifier of abuse 2. Financial problem suspected Banking professionals 3. Physical capacity 4. Mental capacity 3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money 1. Identifier of abuse 2. Financial problem suspected

Cues that raised suspicion of financial elder abuse Cue 5 – Who is in Cues that raised suspicion of financial elder abuse Cue 5 – Who is in charge of the money? (Banking) Quote • Independently manages their own money • Has a lasting power of attorney • Has a third party signatory e. g. has a third party signatory "her son had put a third party mandate on her account which means that he’s got certain controls over her finances” (Cashier)

Q 2. What are the types of decisions that have to be made when Q 2. What are the types of decisions that have to be made when financial abuse is suspected?

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Overall summary of decision findings Health & Social Care Banking Speak with older person Overall summary of decision findings Health & Social Care Banking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older person Determine whether individual’s immediate finances are at risk Determine whether individual’s immediate safety is at risk Take action (e. g. protect customers finances – freeze account/refuse request to withdraw money/stop card/contact outside organisations) Take action (e. g. call outside organisations, protect older person)

Phase II – Case scenarios Online Task Phase II – Case scenarios Online Task

Phase II methodology Participants Target Actua (n) l (n) Job-roles Social care professionals 70 Phase II methodology Participants Target Actua (n) l (n) Job-roles Social care professionals 70 60 Social workers, Care managers, Adult protection staff Health professionals 70 70 GP’s, OT’s, District nurses Banking professionals 70 0 Data Collection • Case scenarios created from Phase I analysis presented to participants on website • Same set of scenarios viewed by health and social care professionals • Separate set of scenarios for banking professionals

Phase II research Questions 1. Which cues from Phase I are most influential in Phase II research Questions 1. Which cues from Phase I are most influential in the decision making process in relation to the detection of financial elder abuse and the likelihood of intervention? 2. Which characteristics of the decision-maker help explain decisionmaking?

Phase II research Questions 1. Which cues from Phase I are most influential in Phase II research Questions 1. Which cues from Phase I are most influential in the decision making process in relation to the detection of financial elder abuse and the likelihood of intervention?

Phase II research Questions 1. Which cues from Phase I are most influential in Phase II research Questions 1. Which cues from Phase I are most influential in the decision making process in relation to the detection of financial elder abuse and the likelihood of intervention? Cues from Phase I varied in case scenarios Social care and Health cues Banking cues 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity 3. Physical Capacity 4. Mental capacity 5. Age of older person 5. Who is in charge of the money 6. Gender of older person 6. Age of older person 7. Gender of older person

Example of a case scenario for health & social care professionals This scenario is Example of a case scenario for health & social care professionals This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful.

Cue 1 This scenario is about a 66 year old male. Another professional tells Cue 1 This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful.

Cue 1 Cue 2 This scenario is about a 66 year old male. Another Cue 1 Cue 2 This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful.

Cue 1 Cue 2 This scenario is about a 66 year old male. Another Cue 1 Cue 2 This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful. Cue 3

Cue 1 Cue 2 This scenario is about a 66 year old male. Another Cue 1 Cue 2 This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful. Cue 3 Cue 4

Cue 5 Cue 1 Cue 2 This scenario is about a 66 year old Cue 5 Cue 1 Cue 2 This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful. Cue 3 Cue 4

Cue 5 Cue 2 Cue 6 Cue 1 This scenario is about a 66 Cue 5 Cue 2 Cue 6 Cue 1 This scenario is about a 66 year old male. Another professional tells you that recently a change to this older person’s will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful. Cue 3 Cue 4

Example of case scenario on Web This scenario is about a 66 year old Example of case scenario on Web This scenario is about a 66 year old male. Another professional tells you that recently a change to his Will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful. Having read the above scenario please move the sliders on the scales to indicate your judgement on this case: Certain abuse is not occurring Unlikely to take action Certain abuse is occurring Likely to take action If you were likely to take action, please tick those which you would choose. You can tick as many as you wish. Make informal enquiries Monitor situation Gather evidence Consult internally with colleagues/ managers Consult with outside organisations Protect customers finances

Example of case scenario on Web Analyses from Q 1 This scenario is about Example of case scenario on Web Analyses from Q 1 This scenario is about a 66 year old male. Another professional tells you that recently a change to his Will has been made, leaving all possessions to the cleaner. This older person has major physical health problems and is extremely confused and forgetful. Having read the above scenario please move the sliders on the scales to indicate your judgement on this case: Certain abuse is not occurring Unlikely to take action Certain abuse is occurring Likely to take action If you were likely to take action, please tick those which you would choose. You can tick as many as you wish. Analyses from Q 2 Make informal enquiries Monitor situation Gather evidence Consult internally with colleagues/ managers Consult with outside organisations Protect customers finances

Phase II research Questions 2. Which characteristics of the decision-maker help explain decision-making? Phase II research Questions 2. Which characteristics of the decision-maker help explain decision-making?

Phase II research Questions 2. Which characteristics of the decision-maker help explain decision-making? • Phase II research Questions 2. Which characteristics of the decision-maker help explain decision-making? • • • Gender Age Ethnicity Employer Years in current role / profession

What next? • Phase II completion • Phase III completion • Potential training for What next? • Phase II completion • Phase III completion • Potential training for health, social care and banking professionals • Guideline development for health, social care and banking professionals

The need for Guidelines and Training “It would be helpful if there was a The need for Guidelines and Training “It would be helpful if there was a list of things to look out for and identify what financial abuse is. How to spot the signs" (Cashier) "Physically, yes the system helps you to monitor the culprits but the financial one is difficult to detect. Unless somebody gives you some information about what to look for you have no idea” (Social Worker) "I’ve not been trained to pick up on signs of financial abuse, so I don’t go into a situation looking for it - I go in to treat the patient. I suppose we need to be better informed as to what to look for and how to deal with abuse in order for us to be more confident to come forward and say that we suspect it" (General Practitioner)

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