Professionals identified three key examples of factors that made decision easier, which are illustrated in Table 5.10 below. Appendix 5.6 shows the stages of analysis refinement including overall analysis by MD, followed by group level validation.
Table 5.10: Factors that can make decision making easier Category Quote
Effective line management
"But sometimes with the informal first strategy meeting with my manager to see how - is very much worthwhile because you’re given your instructions so to speak." (Assistant care manager - MS10. 345-346) Training to identify and act where abuse is suspected
“[I] Obviously oversee the training, making sure that all the carers are aware of anything from moving and handling to adult abuse.” (Domiciliary care manager - DS2. 7-8)
"So if people can relate to a little story, ‘oh there was a lady or a gentleman and this and this happened to them’ it makes it more real." (Supporting people manager - MS3. 369-370)
Clear and transparent procedures to respond to suspected abuse
"If we get legislation that would be great, about working together and giving it a bit more priority because without the legislation, without performance indicators etc. then it’s not afforded the same level of priority as child protection." (Safeguarding adult manager - MS1. 549-551)
"...it’s making people understand their role and their part of that, whether or not there’s legislation saying that if you’re part of this you’ve got to then be involved." (Supporting people manager - MS3. 446-447)
The next section presents the results of Phase I interviews with health professionals about their experiences of cases of financial elder abuse.
5.2.2 Health professionals
What are the cues that raise suspicions of financial elder abuse?
Factors that raised health professionals suspicions of financial elder abuse were classified into four cues, which included (1) the ‘identifier of abuse’, (2) the ‘financial problem suspected’, (3) the elder’s ‘physical capacity’ and (4) the elder’s ‘mental capacity’. Table 5.11 provides operational definitions of each cue-category.
Table 5.11: The cues of financial elder abuse for health professionals Cue Category Operational definition
Identifier of abuse
Directly observed Where the individual themselves noticed signs of financial abuse.
Reported Suspected abuse reported by third parties including the older persons family and friends.
Financial problem suspected
Stealing from the home or person
Possessions taken directly from the home or person, such as taking money from a cash point card, and giving incorrect change from shopping.
Anomalies between finances and living conditions
Poor provision of day-to-day necessities such as food, clothes or heating, regardless of an individual’s wealth.
Unknown befrienders or rogue traders
Individuals who seek out older people and develop a relationship (personal or
professional) for some form of financial gain.
Financial anomalies in accounts or bills
Where bank accounts show money missing, an unexpected overdraft or bills that have not been paid.
Wills changed or gifts given under duress or deception
Items given under duress or deception.
Misuse of power of attorney authority
Power of attorney authority obtained by deception or misused once in place.
Table 5.11 (Continued): The cues of financial elder abuse for health professionals Cue Category Operational definition
Financial problem suspected
Family members acting to protect their inheritance
Suspected financial abuse by an older
person’s family member motivated by a desire to protect financial or property assets seen as future inheritance. This included trying to hide an older customer’s assets.
Physical capacity
Health issues alerting the professional to concerns regarding financial elder abuse.
Mental capacity
The individuals mental capacity to make financial decisions increasing concerns regarding possible abuse.
This section provides quotations from the interviews to illustrate how each cue alerted professionals’ suspicions of financial elder abuse. Findings for this research question drawn from individual analysis by MD are presented in Appendix 5.7. At the end of this section, an additional cue relating to the person suspected of committing the financial abuse is considered (presence of learning disabilities). The cue was identified in individual analysis by PhD student MD. This cue was unique to one critical incident, and was therefore not considered a key cue of financial abuse.
(1) Identifier of abuse
In the majority of the critical incidents it was the health professional themselves who became suspicious that an older patient may be being financially abused, but some cases were reported by third parties. Table 5.12 provides examples of instances of abuse directly observed as well as a reported case.
Table 5.12: Financial abuse cue – Identifier of abuse Cue Category Quote
Identifier of abuse
Directly observed
"… I had gone to visit this lady and the minute I walked into her house it was…very cold … When I asked her about it she said she couldn’t afford to put the heating on. I asked her if she was alright financially and she said that her nephew took care of everything. That raised immediate concern with me because I thought well why is this lady sitting in a cold room … is he taking care of her?" (OT - DH6. 119-125)
"... we are sort of a holistic person …who knows an awful lot about them ... the combination of their physical and
psychological health, social things impact hugely and if you don’t have a picture … It’s difficult to know how to help …finances clearly come into that..." (GP - MH8. 310-313) Reported
"...the information I had was second hand, and information I had was from [someone who was] one of my patients already which was difficult." (GP - MH5. 181-182)
(2) Financial problem suspected
Health care professionals’ identified particular financial circumstances that made them suspect that abuse may be taking place. Instances of the different financial problems encountered by health care professionals are reviewed in Table 5.13.
Table 5.13: Financial elder abuse cue – Financial problem suspected Cue Category Quote
Financial problem suspected Stealing from the home or person
"…the client said that one of the drivers had visited her that day which was a day she wasn’t due to be here, and that he’d taken money from her purse … she believed he’d taken £40" (OT - LH11. 290-292)
Anomalies between finances and living
conditions
"...seeing a patient who clearly couldn’t cope, who clearly was becoming more and more demented, the place was filthy…" (GP - MH13. 40-41)
"...the fact that the family hadn’t been providing money for the person to use in the care home…" (OT - MH18. 42-43)
"...it became apparent to me that part of the limitations of the options was based on the fact that he didn’t want to use the finances." (GP - MH5. 42-43)
Unknown befrienders or rogue traders
“…I find it slightly unusual … because he’s been living with her for quite a long time. I’m not actually sure how he came to live with her... erm and he’s never paid her rent so I don’t think he’s ever contributed in the financial sense…” (GP - MH8. 174-176)
Table 5.13 (Continued): Financial elder abuse cue – Financial problem suspected Cue Category Quote
Financial problem suspected Unknown befrienders or rogue traders
“…that developed into loans, so she sort of knew that these people, these people were on first name terms with her, very pally, very friendly, moved out but the loans were still there…” (GP - MH5. 166-168)
“…I have had examples where people have known perfectly well that they are being slightly taken advantage of, but the benefit to them for having x around, is greater.” (GP - MH13. 283-285)
Financial anomalies in accounts or bills
“…there are occasions you know where people are reluctant to give you that information and that is of concern.” (OT - MH19. 274-275) Wills changed or gifts given under duress or deception
"...he wanted me to witness a new will that she was making… I refused to …" (GP - MH13. 201-202) "I was working with this lady … she’d given her granddaughter £2000 towards buying a new car because her granddaughter said that if she had a car she would take the lady out shopping and socialising regularly. And then the lady told us that her
granddaughter, of what she’d given her the money, took her car- rarely sort of took her anywhere and she wasn’t happy …" (OT - DH4. 43-48)
Misuse of Power of Attorney authority
"… her daughter in law had came with all this paperwork and asked her to sign documents…well no..she told her to sign documents and she didn’t fully understand what they were for. She was concerned that she had handed over control of her finances to her daughter in law and that she felt that she had been forced into the situation and didn’t know what to do about it." (Nurse - DH12. 25- 29) Family members acting to protect their inheritance
“A lot of the premises around here are worth an
absolute fortune… if you sell them and free up the funds for nursing homes then whoever is the beneficiary wouldn’t get it, and of course it would go on increasing in value as property has around here. So I suppose that’s one of the most prevalent problems actually.” (GP - MH13. 30-34)
"Her son … refused for her to go into care even though she was saying ‘look I just don’t feel I can cope’, but not being able to express herself; she was losing her language by this stage. So I would consider that abuse because you know, although clearly she wasn’t able to do things, her son wasn’t giving permission for her to go into care or for her home to be sold because it was his inheritance…" (OT - DH2.30-34)
Table 5.13 (Continued): Financial elder abuse cue – Financial problem suspected
Cue Category Quote
Financial problem suspected
Family members acting to protect their inheritance
"...the other sort of area where it can be difficult is when perhaps people have persuaded older people to sell their family houses, or their accommodation … and put in the money so that the family buys a nice big house
somewhere else really … I can understand the pressure on that, but it can be a disaster." (GP - MH13. 143-147)