Social care professionals viewed decision making in cases of suspected financial abuse as a challenge, as illustrated in the following quotation from an assistant team manager:
"So you would be liaising with their social workers and things, that bit works quite well. It’s when you get past that and the decisions have to be made, it becomes more difficult, not that the process itself is difficult." (MS8. 423-425)
Appendix 5.4 shows the stages of content analysis including overall analysis by researcher MD, followed by group level validation. Case features that were reported as making decision making difficult in cases of financial elder abuse were classified into seven categories. These included (1) the service user, (2) cultural context, (3) working with other agencies, (4) formal policy and procedure, (5) consequences of raising alarm, (6) identifying financial elder abuse, and (7) work environment. Collated quotations sorted under each of these categories and their component sub- categories are shown in Appendix 5.5. Table 5.8 below provides frequency counts of the number of times each category and sub-category was found within the data.
Table 5.8: Features that make decision making difficult – quote frequencies
Category Sub category Tally
The service user
Respecting the service user’s wishes 47 Compounding issues (age factors, learning disability,
language barriers, drug or alcohol abuse) 28
Cultural context Perceptions of money 11
Ageism 8 Working with other agencies Confidentiality 18 Differing priorities 18 Working practices 10
Not being kept informed 6
Table 5.8 (Continued): Features that make decision making difficult – quote frequencies
Category Sub category Tally
Formal policy and procedure
Proof of crime required and not always available 15
Hard to get a conviction 8
Lack of legislation 4
Rigid legislation / policy in other areas 4
Consequences of raising alarm
Impact on client's family relationships 19
Impact on working life 14
Impact on the older person 8
Impact on relationship with client or their family 5
Risk to personal safety 1
Identifying financial elder abuse
Identifying that abuse is occurring 16
Deciding what constitutes abuse 4
Work
environment
Lack of resources or support 25
Job role responsibility 11
In Table 5.9 below, further details regarding each of these categories and sub categories is provided.
Table 5.9: Features that can make decision making difficult Category Sub category Quote
The service user Respecting the service user’s wishes
"... they were going to pursue it but my client declined, she changed her mind, and she said ‘he’s still my son I don’t want it to be taken any further..." (Care manager assistant - LS18. 187-188)
"He was quite insistent that he wanted £250 … I said ‘well what about £100? What do you spend?’ and he said ‘but I might need it’ … I couldn’t say ‘well I think you should make it £100, that’s enough for anybody in the week’ …" (Social worker - MS11. 344-347)
Table 5.9 (Continued): Features that can make decision making difficult Category Sub category Quote
The service user Respecting the service user’s wishes
"...if somebody says, and they’re 89, ‘I’m happy giving my son £60 a week, I know it’s for drugs, it’s an unwise decision but he’s my son and I want to give it to him, it’s my money, I’m quite capable of doing that and I don’t see it as being abuse’ we have to respect that..." (Team manager - DS14. 267-270)
“… if there is reason to assume that actually they would have given their son… £20, out of their pension, that would have been their choice and just because they don’t have capacity to do that it’s really not fair for us to say ‘well you really can’t do that anymore’
because it’s something that they have always done." (Assistant team manager - MS8. 486-490)
Compounding issues. E.g. language barriers / memory problems
"...she was recently seen in November by a
psychiatrist, it is noted in the report that the daughter answered for her… I’m not sure that what was being said was a true reflection of what the lady was saying." (Assistant team manager - MS8. 96-98) "I think people find it very difficult if somebody’s got severe cognitive impairment and they say ‘I have £500 in that cupboard and it’s disappeared and 2 of my cups have been stolen as well and 6 eggs’…" (Team manager - DS14. 223-225)
Cultural context
Perceptions of money
"I think [for] older people living in the community [it] is much harder because often people don’t talk about finances, they’re private about it…" (Adult protection co-ordinator - DS15.187-188)
"... when you’re talking to clients … and maybe they were looking at residential care … and you talk about the fact they own their house and a family member will say ‘yes but they’ve willed it to me’ and you say ‘yes but that doesn’t count, the will only comes into its own when somebody’s actually died’" (Social worker - MS11. 437-441)
Table 5.9 (Continued): Features that can make decision making difficult Category Sub category Quote
Cultural
context Ageism
"I think there is certainly a feeling amongst social workers that work with older people, that actually, it’s seen that anybody can do, anybody can work with older people. You don’t have to be qualified to work with older people, whereas in fact, it’s almost the reverse because with children there is a lot of legislation behind you to back you up with what you do." (Assistant team manager - MS8. 367-371)
Working with other agencies
Confidentiality
"It’s always difficult, they won’t discuss anything with us because of data protection you know, you’ve got to have the client up there or the client’s permission." (Care manager - DS22. 324-325)
"It’s really very difficult to manage the confidentiality thing and I do feel it’s gone a bit it too far and people are a little hide bound around it." (Team manager - MS5. 246-247) Working with other agencies Differing priorities
"...the … obstruction I had was actually from the very slow response from the police, … when they came they said well they’ve got more high priority cases..." (Care manager - LS21. 355-358)
"...they were informed but they didn’t come to the meeting. Basically they regarded it as a civil matter that it wasn’t for them to be involved at all." (Social worker - MS11. 185-186) Formal policy and procedure Proof of crime required and not always available
"...they needed evidence, they needed bank statements, they needed all sorts of things and of course to get back dated bank statements takes a while…" (Assistant team manager - MS8. 237-238) "One of the biggest problems is when people give money freely, even though they’ve been under psychological abuse, they have given money freely, the police don’t see that as a criminal element but they’ve still been financially abused." (Safeguarding adults manager - MS1. 410-412)
Table 5.9 (Continued): Features that can make decision making difficult Category Sub category Quote
Formal policy and procedure
Hard to get a conviction
"We’ve never had a criminal conviction and so I think that that frustrates me but that’s more to do with the law probably than how they [police] feel but I know some of them get terribly frustrated themselves." (Team manager - DS14. 138-140)
Consequences of raising alarm
Impact on client’s family relationships
“…my client wouldn’t see anything wrong with her son…” (Care manager assistant - LS18. 248-249)
"So it’s difficult for anybody really I would say to be able to go in and make any judgement on that family even though you know it’s her family and she doesn’t want it so how would you put that in a policy?" (Client services manager - DS13.262-264)
Consequences of raising alarm
Impact on client’s family relationships
"... how can you guarantee … the safety of their finances? Because they still have to trust somebody … there’s never going any fool proof system especially if your own family members are abusing, what do you do?" (Care manager - LS21. 391-393)
Impact on working life
"A lot of homes say we have to be very careful like if one member of staff witnesses something against another often there could be bullying afterwards, often staff have to be separated out on different shifts stuff like that." (Adult protection co-ordinator - DS15. 267-270)
"...you don’t want to go ahead and report it because it is at first just a suspicion, but when it, because you know it will kind of …it will break up the unit of the team so you’ll feel that’ll be the last thing you’d want to do." (Senior support worker - DS23. 126-128)
Table 5.9 (Continued): Features that can make decision making difficult Category Sub category Quote
Identifying financial elder abuse Identifying that abuse is occurring
"...you can only identify if you’ve got any evidence. You know I mean how else would you know?" (Care manager - LS21. 377-378)
"...but I think in many ways it’s very difficult to prove financial abuse especially if the person that is being abused doesn’t use the word that it’s financial abuse." (Client services manager - DS13. 174-176)
Deciding what constitutes abuse
"...you’re not just asking what’s financial abuse, but you’re actually asking what’s abuse…"
(Safeguarding vulnerable adults co-ordinator - LS17. 69-70) Work environment Lack of resources and support
“Adult protection is urgent so you kind of have to drop everything else … you have to drop everything else to deal with so then people get very behind with their other work." (Adult protection co-ordinator - DS15.219-221)
"It used to be once every six months we used to out and review the clients and I think now it’s about once a year, so what is going on a day to day basis we rely on the carers you know…" (Care manager - LS21. 100-102)
Job role responsibility
"...there was confusion between the support worker, the support provider and the NHS trust staff really, the care manager." (Supporting people manager - MS3. 34-35)
“…if you’re a carer and you’re going in and you’re seeing that this neighbour is taking advantage erm, the younger carer might possibly mistake that as the neighbour being so helpful. A mature carer would look at it and I think ‘I don’t know’…” (Domiciliary care manager - DS2. 154-157)
The next section considers factors than can make decision making easier for social care professionals.