Elder Abuse

1. Elder Abuse • Claire Elton • Senior Solicitor, Southampton City Council • claire.elton@southampton.gov.uk • July 2015

2. Purpose of this session- headlines • What do we mean by elder abuse • How can abuse be detected/what are the warning signs • What to do if you suspect elder abuse • Support services available-voluntary sector • Statutory bodies responsibility and powers including a summary of the safeguarding principles in the Care Act 2014 • Winterbourne view and care/hospital abuse

3. What is elder abuse • I will concentrate on abuse that affects the more older vulnerable people, but will also mention Winterbourne view report, which affected younger adults • Elder abuse includes, Physical, emotional, sexual, neglect, abandonment, healthcare fraud, financial abuse , cold calling fraud, internet fraud, oppression and duress • Action on elder abuse (charity) describe it as • 'A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person'.

4. Prevalence of elder abuse Southampton City Council received 1355 “concerns” in 2014-15, an increase of 38% from 2013-14 .   Of those concerns raised, the Safeguarding Adult Team investigated and completed 123 enquiries during that period   only 5% of concerns were raised by service users, carers or family members (why such a low number of referrals from individuals) The 2011 Census reports the proportion of Southampton’s population aged over 65 is reducing (13% compared with 14.5% in 2001 and a 2011 England average of 16.3%). Yet the number of safeguarding enquiries raised in respect of this age group continues to rise and they are disproportionately represented within safeguarding enquiries undertaken in 2014-15, in that 63% of all enquiries related to adults aged 65 or above. Concerns over financial abuse have risen. (This data is currently being checked by LSAB and will form part of the completed annual report)

5. Prevalence of elder abuse BBC reported in October 2013 Analysis of data from the Health and Social Care Information Centre (HSCIC) showed a 4% rise in the number of cases of alleged abuse referred for investigation in the past year HSCIC figures showed that the number of cases referred for investigation by councils in England rose from 108,000 in 2011/2012, to 112,000 in 2012/2013. Of these, 38% of the alleged abuse took place in the older person's home, while 45% took place in a care home. Physical abuse and neglect were the most common types of abuse reported. In 6% of cases the alleged abuser was the older person's partner, in 16% it was another family member and in 37% a social care worker.

6. Types of abuse • Physical-is non-accidental use of force against a elderly person that results in physical pain, injury or impairment. It included physical assaults and hitting or shoving but also the inappropriate use of drugs, restraints or confinement, • Emotional abuse-where people treat or speak to elderly people in ways that cause them emotional pain or distress • Includes verbal forms such as intimidation, humiliation and ridicule habitual blaming or scapegoating, non verbal is ignoring the person, isolating them from their friends or activities, terrorising or menacing behaviour • Sexual abuse is contact of a sexual nature without the persons consent which can include rape and other sex acts but also showing pornographic material, forcing them to watch sex acts, undress or to perform sex acts on others.

7. Financial Abuse - stealing or defrauding someone of goods and/or property. Sometimes straightforward, for example a care worker stealing from an older person's purse, but at other times it is more difficult to address as the perpetrator can be someone's relative, or age prejudice means that other people assume it is not happening or that the older person is to blame. Examples:- • Taking elderly person’s money /property or using the same without consent • Forging signatures on documents, including legal documents • Coercing individual to alter deeds/will/power of attorney • Telemarketing scams – bogus charity calls/ life insurance asking for payment card details, using scare tactics • Cold calling – bogus workmen spotting external “defects” to property “by chance” when none exist and demanding money to put right

8. Abuse cont. • Incidents can be one-off, multiple and effect more than one person • Patterns of abuse may vary and include: • Serial abusing-perpetrator seeks out and grooms individuals ( current investigation into builders conspiracy), • Long/short term abuse within long term family relationship or within residential settings • Opportunistic abuse • Stats from OPG-beware of sons and daughters!

9. Spotting signs of abuse and neglect • Statutory guidance confirms workers across a wide range of organisations need to be vigilant about adult safeguarding- GP’s housing officers, pharmacy • Noticing changes that may indicate abuse or neglect and act on their concerns and seek information to prevent harm • Person has unpaid bills including utility, care home, rent • Unexplained withdrawals from bank accounts by cheque/ATM

10. What are the warning signs • Additional names appearing on bank accounts • Belongings missing from home • Refusal by a 3rd party to let people into home e.g carers, family- current cases in SCC • Deliberate isolation of elderly person – stopping them attending events, speaking on behalf of person to decline visits or outings • Appearance of new “best friends” or “relatives” • Home is lacking in amenities which previously elderly person has enjoyed- toiletries run out, clothes worn out, TV packages cancelled, food running low, no heating

11. What action can you take- voluntary sector support • There are a number of charities and voluntary groups who can offer support • Action on elder abuse- tel 0808 808 8141 Set up in 1993 by practitioners, academics and volunteers who focus exclusively on elder abuse. They provide helplines and give out advice to individuals empowering they to protect themselves. They also act in trying to alter public policy and help shape the new safeguarding passages in the Care Act. Also assisted in doing BBC & panorama programmes to raise awareness. Webpage: http://www.elderabuse.org.uk/index.html • Age UK: state they are “the country's largest charity dedicated to helping everyone make the most of later life” The Age UK network comprises around 170 local Age UKs reaching most of England. The provide information and advice, run campaigns, provide commercial products and training. Webpage http://www.ageuk.org.uk/ Tel 0800 169 6565

12. What action can you take statutory bodies and other organisation • If abuse is suspected then you need to act – “Safeguarding is Everybody’s Business” and achieved by Working Together • Local Authority • Care Act 2014 The Care Act 2014 was given Royal Assent on 14th May 2014 and the majority of the Act came into force on 1st April 2015 • Norman Lamb MP, Care & Support Minister described the Act as being the most significant reform of care and support in more than 60 years. • One of the key principles: • Promoting well being, including preventing abuse and neglect (safeguarding)

13. For additional information Safeguarding sections 42-46 CA 2014 and mainly in Chapter 14 statutory guidance In addition to the CA2014 itself you can access the Statutory guidance, fact sheets and regulations at: https://www.gov.uk/government/publications/care-act-2014-statutory-guidance-for-implementation https://www.gov.uk/government/publications/care-act-2014-part-1-factsheets https://www.gov.uk/government/consultations/updating-our-care-and-support-system-draft-regulations-and-guidance

14. Section 1 Promoting individual well-being The Act has a number of core values which shape the specific duties and powers The first key principle is the general duty of a local authority “in exercising a function” under Part 1 of the Act “is to promote that individual’s well- being”. Function- includes individual service provision decisions in addition to policy decisions and also includes service provision and contact with individuals whose needs are not eligible.

15. Well-being principle • Well- being broad concept but includes: • Personal dignity (including treatment with respect) • Physical and mental health and emotional well-being • Protection from abuse and neglect, including safeguarding • Control of the individual over day-to-day life( including over care and support) • Participation in work, education training or recreation • Social and economic well-being • Domestic, family and personal relationships • Suitability of living accommodation • The individuals contribution to society

16. When discharging any obligation under the Act LA MUST “have regard to”: • The principle that the individual is best placed to judge their well-being, outcomes and goals • The individual’s views, wishes, feelings and beliefs, • The need to prevent/delay the development of needs for care and support and reducing existing needs • The need to make decisions that are not based on stereotyping of individuals,

17. Additional key principles and standards • Individual being able to participate as fully as possible • Achieving a balance between the individual’s well-being and that of any friends or relatives who are involved in the care • The need to protect people from abuse and neglect • The need to ensure any restrictions on individuals rights/freedoms to be kept to an absolute minimum

18. “Having regard” is the same as “due regard” under the Equality Act 2010. • proper and appropriate regard in all the circumstances • requires a conscious directing of the mind to the obligations- with rigour and an open mind. • Need for an audit trail of all significant decisions

19. Prevention of abuse and neglect and safeguarding Safeguarding was contained in “No secrets” guidance. The CA statutory guidance replaces this and gives this a new statutory basis. Where a person is at risk of harm or abuse LA must act swiftly and put in place an effective response When carrying out an assessment LA must consider if person is at risk of abuse/neglect and if believe so they must carry out a safeguarding enquiry and decide with the adult what if any actions are appropriate

20. Safeguarding framework of support National Multi Agency Safeguarding Roles and Responsibilities Concordat Six statutory Safeguarding Principles Care Act 2014 Chapter 14 (replaces ‘No Secrets’). Provides a new legal framework adult safeguarding. Responsibilities apply to LAs, Police and NHS Support based on capacity, consent, self determination, person centred Prevention and early intervention activities backed up by robust risk management Adult at risk Local Multi-Agency Safeguarding policy and Procedures Community Safety (Safer Neighbourhoods, ASB, Hate Crime, Domestic Abuse)

21. Six key safeguarding principles • Empowerment-being supported and encouraged to make own decisions • Prevention-Take action before harm occurs • Proportionality-Least intrusive response appropriate to the risk • Protection-support and representation to those in greatest need • Partnership-local solutions and working with commutes • Accountability- Transparency

22. Safeguarding S42 enquires • Where LA has reasonable cause to suspect that an adult in its area • has needs for care and support • is experiencing, or is at risk of, abuse and neglect, and, • as a result of those needs is unable to protect themselves against the abuse or neglect. • LA must make whatever enquiries it thinks necessary to enable it to decide what action should be taken

23. Section 42 Enquiries • A duty on local authorities to make enquiries, or to ask others to make enquiries • Purpose of the enquiry is to establish with the individual and/or their representatives, what (if any) action is needed in relation to the situation and to establish who should take such action • The section 42 duty will apply when a person with care and support needs whether or not: • ordinarily resident in the local authority area and • the local authority is meeting any of those needs

24. Abuse • Statutory guidance give some illustrations: • Physical abuse • Sexual abuse • Psychological abuse • Financial or material abuse • Modern slavery • Discriminatory abuse • Organisational abuse • Neglect and acts of omission • Self-neglect

25. Carers • Carers could be involved in safeguarding situations: • The carer may witness or complain about suspected abuse or neglect • The carer may experience intentional or unintentional harm from the adult or other professionals or organisations in touch with the adult, • The carer may intentionally or unintentionally harm or neglect the adult • Any assessment must include consideration of the carers and adults well being

26. Carers Support carers by offering a needs or carer’s assessment and use this as an opportunity to explore the individuals’ circumstances Considering whether it would be possible to provide information, or support that prevents abuse or neglect from occurring, for example, by providing training to the carer about the condition that the adult they care for has or to support them to care more safely. Recognising that abuse or neglect may be unintentional and may arise because a carer is struggling to care for another person. This makes the need to take action no less important, but in such circumstances, an appropriate response could be a carer assessment and support package for the carer and monitor.

27. LA role in carrying out S42 enquires • LA must make enquiries, or cause others to do so, if they reasonably suspect an adult meets the criteria or is at risk of, • The enquiry could range from a conversation with the adult right through to a multi-agency formal plan or course of action, depending on the individual circumstances, • The professional must record the concern, the adults views and wishes, any immediate action taken and reasons for the action, • The purpose of the enquiry is to decide whether someone/organisation should do something to help and protect the adult

28. LA role in carrying out S42 enquires • If LA decides another organisations should carry out the enquiry it must set out timescales and need to know outcomes and what action to take if this is not done, • The adult should always be involved unless there are exceptional circumstances that would increase the risk of abuse & what happens should reflect the adults wishes if possible, • All enquires should be handled in a sensitive and skilled way to ensure distress to the adult is minimised.

29. Independent advocacy The local authority MUST arrange for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or a safeguarding adult review if: They need help to understand and take part in the enquiry or review and to express their views, wishes, or feelings.

30. Independent advocacy • This provision relates to people with capacity. People lacking capacity will access advocacy support (e.g. an IMCA) via existing provisions under the Mental Capacity Act 2005. • 3 routes to advocacy: • Independent advocate (Care Act duty) • IMCA (MCA duty) • IMHA (MHA Act duty)

31. Integration and Co-operation Duty to co-operate not new. There are many examples of how LA and others have to co-operate e.g. homelessness enquiries, MAPPA, Children Act enquiries CA introduces 2 new provisions dealing with co-operation Section 6-general duty to co-operate Section 7 specific duty unless consider it would be incompatible with own duties or have an adverse effect on the exercise of its functions

32. Safeguarding is not a substitute for: Providers’ responsibilities to provide safe and high quality care and support; Commissioners regularly assuring themselves of the safety and effectiveness of commissioned services; Clinical and care governance to respond to pressure points CQC ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action; and Core duties of the police to prevent and detect crime and protect life and property

33. Local Safeguarding Adults Board under Section 43 of the CA each LA had to establish a LSAB. The object was to help and protect adults I its area, co-ordinate and ensure effectiveness of each of its members, to undertake Serious Adult Reviews in the event of serious harm or death where abuse is known or suspected. • Other LA Departments • Involvement of Trading Standards in cases of fraudulent tradesmen/ cold callers and to prosecute those guilty of offences, • Housing to work with Adults to secure alternative accommodation where need to move a person temporary to give respite so assessment/enquires can be carried out. • Community Safety- investigate ASB

34. Criminal offences-the police • CA stat guidance “ everyone is entitled to the protection of the law and access to justice. Behaviour which amounts to abuse and neglect …often constitute specific criminal offences”. • Early involvement of the police in many cases is very beneficial as they may be able to assist in getting forensic evidence and considerable skill in investigating and interviewing adults. Police investigations should be co-ordinated with health and social care enquiries and will often take priority over all over enquiries. • Police can gain access to properties under section 17 (1) (e) of PACE- to enter and search premises without a warrant in order to “save life or limb” • Can enter to deal with a breach of the peace in emergencies • ASBPCA 2014 new community remedy-letters of apology, repayment of stolen money, community work

35. Land Registry • Government body which is responsible for registering property titles in England and Wales. Offer advice line but also useful webpage on protecting property https://www.gov.uk/protect-land-property-from-fraud • Includes “property alerts” Property Alert is an award winning free property monitoring service aimed at anyone who feels a registered property could be at risk from fraud. propertyalert@landregistry.gsi.gov.uk • Tel0300 006 0478

36. Abuse in care/home/hospital setting Winterbourne view Report published December 2012 Like many, I have felt shock, anger, dismay and deep regret that vulnerable people were able to be treated in such an unacceptable way, and that the serious concerns raised by their families were ignored by the authorities for so long. As much as Winterbourne View fills us all with sorrow and anger, it should also fire us up to pursue real change and improvement in the future. It is a national imperative that there is a fundamental culture change so that those with learning disabilities or autism have exactly the same rights as anyone else to the best possible care and support. NORMAN LAMB Minister of State for Care and Support

37. The abuse revealed at Winterbourne View hospital was criminal. Staff whose job was to care for and help people instead routinely mistreated and abused them. Its management allowed a culture of abuse to flourish. Warning signs were not picked up or acted on by health or local authorities, and concerns raised by a whistleblower went unheeded. The fact that it took a television documentary to raise the alarm was itself a mark of failings in the system. This report sets out steps to respond to those failings, including tightening up the accountability of management and corporate boards for what goes on in their organisations. Though individual members of staff at Winterbourne View have been convicted, this case has revealed weaknesses in the system’s ability to hold the leaders of care organisations to account. This is a gap in the care regulatory framework which the Government is committed to address.

38. We expect to see a fundamental change. This requires actions by many organisations including government. In summary, this means: • all current placements will be reviewed by 1 June 2013, and everyone inappropriately in hospital will move to community-based support as quickly as possible, and no later than 1 June 2014; • by April 2014 each area will have a locally agreed joint plan to ensure high quality care and support services for all children, young people and adults with learning disabilities or autism and mental health conditions or behaviour described as challenging, in line with the model of good care; • as a consequence, there will be a dramatic reduction in hospital placements for this group of people and the closure of large hospitals;

39. a new NHS and local government-led joint improvement team, with funding from the Department of Health, will be created to lead and support this transformation; • we will strengthen accountability of Boards of Directors and Managers for the safety and quality of care which their organisations provide, setting out proposals during Spring 2013 to close this gap; • CQC will strengthen inspections and regulation of hospitals and care homes for this group of people. This will include unannounced inspections involving people who use services and their families, and steps to ensure that services are in line with the agreed model of care; and • with the improvement team we will monitor and report on progress nationally • Alongside the report, they also published a Concordat agreed with key external partners. It sets out a shared commitment to transform services, and specific actions which individual partners will deliver to make real change