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

Detecting and Preventing Financial Abuse of Older Adults

Dr Deborah Cairns Prof Mary Gilhooly, Dr Priscilla Harries, Mrs Miranda Davies,

Ms Elizabeth Notley

20th July 2010

nda Financial Elder Abuse Project

Grant HoldersProf Mary Gilhooly Brunel UniversityDr Priscilla Harries Brunel UniversityProf Ken Gilhooly Hertfordshire UniversityProf Catherine Hennessy Plymouth UniversityDr Tony Gilbert Plymouth UniversityProf David Stanley Northumbria UniversityMs Bridget Penhale University of Sheffield

Older Peoples Reference GroupTeresa Lefort

nda Financial Elder Abuse Project

Project PartnersAction on Elder Abuse Gary FitzgeraldBritish Association of Social Workers Ms Ruth CartwrightHelp the Aged Mary CoxHSBC Neil ShadboltNorth Tyneside Council Alison TombsRelatives and Residents Association Dr Gillian DalleyPeninsula Care Sector Group Ms Gill FairhurstPeninsula Primary Care Research Network Prof John Campbell

Content• Overview of the study

• Progress to date

• Questions?

BackgroundDefinition

‘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)

PrevalenceA 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 different professional groups

make decisions when they suspect financial elder abuse is

taking place.

Research designPHASE I

Semi-structured interviews

PHASE IIIPolicy analysis

PHASE IIExperiments on Suspected Financial

Abuse Decision Making

Detecting Financial

Elder Abuse

Figure represents the NDA financial abuse grant phases of study (Gilhooly et al., 2008).

Phase I – Semi-structured interviews

•Data collection• Semi-structured interviews applying the Critical Incident Technique (Flanagan,

1954) to learn about cases of financial elder abuse.

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

Phase I research Questions

Q1. What are the cues that are perceived as raising suspicions of financial elder abuse?

Q2. What are the types of decisions that have to be made when financial abuse is suspected?

Q1. 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

Banking professionals

1. Identifier of abuse 1. Identifier of abuse2. Financial problem suspected 2. Financial problem suspected3. Physical capacity 3. Physical Capacity4. Mental capacity 4. Mental capacity

5. Who is in charge of the money







Cue 1 – Identifier of abuse Quote

• Directly observed• Another member of

staff• Another professional• Family• Friend• Older Person

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)







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)







Cue 3 – Physical capacity Quote

• Minor physical health problems

• Major physical health problems

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)







Cue 4 – Mental capacity Quote

• Slightly confused• Extremely confused

and forgetful

e.g. Extremely confused and forgetful"...a gentleman who had Dementia told me that he had amended his will.”

(Occupational therapist)







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)

Q2. What are the types of decisions that have to be made when financial abuse is suspected?

Health & Social Care BankingSpeak with older person Speak with older person

Inform superior Inform superior

Monitor the situation Monitor the situation

If possible gather evidence 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










person)











person)











person)











person)






Assess the mental capacity of older person

Determine whether individual’s immediate finances are at risk





person)











person)









account/refuse request to withdraw money/stop card/contact outside

organisations)

Take action(e.g. call outside organisations, protect

older person)


Phase II – Case scenariosOnline Task

Phase II methodology

ParticipantsTarget

(n)Actual

(n)Job-roles

Social care professionals 70 60Social 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 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 decision-making?





Cues from Phase I varied in case scenarios Social care and Health cues Banking cues

1. Identifier of abuse 1. Identifier of abuse

2. Financial problem suspected 2. Financial problem suspected

3. Physical capacity 3. Physical Capacity

4. Mental 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 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 1

Cue 2


Cue 1

Cue 2

Cue 3


Cue 1

Cue 2

Cue 3 Cue 4


Cue 1

Cue 2

Cue 3 Cue 4

Cue 5


Cue 1

Cue 2

Cue 3 Cue 4

Cue 5Cue 6

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 Certain abuse is occurring

Unlikely to take action 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

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 Certain abuse is occurring

Unlikely to take action 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 Q2

Analyses from Q1





• Gender• Age• Ethnicity• Employer• Years in current role / profession

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 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)

Thank You

Documents

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