1. 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

2. nda Financial Elder Abuse Project Grant Holders Prof Mary Gilhooly Brunel University Dr Priscilla Harries Brunel University Prof Ken GilhoolyHertfordshire University Prof Catherine Hennessy Plymouth University Dr Tony GilbertPlymouth University Prof David StanleyNorthumbria University Ms Bridget PenhaleUniversity of Sheffield Older Peoples Reference Group Teresa Lefort

3. nda Financial Elder Abuse Project Project Partners Action on Elder Abuse Gary Fitzgerald British Association of Social WorkersMs Ruth Cartwright Help the AgedMary Cox HSBCNeil Shadbolt North Tyneside CouncilAlison Tombs Relatives and Residents AssociationDr Gillian Dalley Peninsula Care Sector GroupMs Gill Fairhurst Peninsula Primary Care Research NetworkProf John Campbell

4. Content Overview of the study Progress to date Questions?

5. 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)

6. 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.

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

8. Phase I – Semi-structured interviews

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

10. 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?

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

12. Cues that raised suspicion of financial elder abuse Social care and Health professionals Banking professionals 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money

13. Cues that raised suspicion of financial elder abuse Social care and Health professionals Banking professionals 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money

14. Cues that raised suspicion of financial elder abuse Cue 1 – Identifier of abuseQuote 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)

15. Cues that raised suspicion of financial elder abuse Social care and Health professionals Banking professionals 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money

16. 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)

17. Cues that raised suspicion of financial elder abuse Social care and Health professionals Banking professionals 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money

18. Cues that raised suspicion of financial elder abuse Cue 3 – Physical capacityQuote 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)

19. Cues that raised suspicion of financial elder abuse Social care and Health professionals Banking professionals 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money

20. Cues that raised suspicion of financial elder abuse Cue 4 – Mental capacityQuote 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)

21. Cues that raised suspicion of financial elder abuse Social care and Health professionals Banking professionals 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Who is in charge of the money

22. 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)

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

24. Health & Social CareBanking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older personDetermine 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

25. Health & Social CareBanking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older personDetermine 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

26. Health & Social CareBanking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older personDetermine 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

27. Health & Social CareBanking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older personDetermine 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

28. Health & Social CareBanking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older personDetermine 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

29. Health & Social CareBanking 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

30. Health & Social CareBanking 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

31. Health & Social CareBanking Speak with older person Inform superior Monitor the situation If possible gather evidence Assess the mental capacity of older personDetermine 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

32. Phase II – Case scenarios Online Task

33. Phase II methodology Participants Target (n) Actual (n) Job-roles Social care professionals 70 60 Social workers, Care managers, Adult protection staff Health professionals 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

34. 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?

35. 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?

36. 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 cuesBanking cues 1. Identifier of abuse 2. Financial problem suspected 3. Physical capacity3. Physical Capacity 4. Mental capacity 5. Age of older person5. Who is in charge of the money 6. Gender of older person6.Age of older person 7. Gender of older person

37. 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.

38. Cue 1

39. 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

40. 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 Cue 3

41. 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 Cue 3 Cue 4

42. 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 Cue 3 Cue 4 Cue 5

43. 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 Cue 3 Cue 4 Cue 5 Cue 6

44. 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

45. 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

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

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

48. 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

49. 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)

50. Thank You