Detecting and Preventing
Financial Abuse of Older Adults
20th July 2010
Dr Deborah Cairns
Prof Mary Gilhooly, Dr Priscilla Harries, Mrs Miranda Davies,
Ms Elizabeth Notley
nda Financial Elder Abuse Project
Grant Holders
Prof Mary Gilhooly
Dr Priscilla Harries
Prof Ken Gilhooly
Prof Catherine Hennessy
Dr Tony Gilbert
Prof David Stanley
Ms Bridget Penhale
Brunel University
Brunel University
Hertfordshire University
Plymouth University
Plymouth University
Northumbria University
University of Sheffield
Older Peoples Reference Group
Teresa Lefort
nda Financial Elder Abuse Project
Project Partners
Action on Elder Abuse
British Association of Social Workers
Help the Aged
HSBC
North Tyneside Council
Relatives and Residents Association
Peninsula Care Sector Group
Peninsula Primary Care Research Network
Gary Fitzgerald
Ms Ruth Cartwright
Mary Cox
Neil Shadbolt
Alison Tombs
Dr Gillian Dalley
Ms Gill Fairhurst
Prof John Campbell
Content
• Overview of the study
• Progress to date
• Questions?
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)
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 design
PHASE I
Semi-structured
interviews
PHASE II
PHASE III
Experiments on Suspected Financial
Abuse
Decision Making
Detecting
Financial
Elder
Abuse
Policy analysis
Figure represents the NDA financial abuse grant
phases of study (Gilhooly et al., 2008).
Phase I – Semi-structured
interviews
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
20
Cashiers, Branch managers,
Financial advisers
Banking professionals
• Data collection
• Semi-structured interviews applying the Critical Incident
Technique (Flanagan, 1954) to learn about cases of financial
elder abuse.
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
1. Identifier of abuse
Banking professionals
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. Who is in charge of the
money
Cues that raised suspicion of financial elder abuse
Social care and Health
professionals
1. Identifier of abuse
Banking professionals
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. Who is in charge of the
money
Cues that raised suspicion of financial elder abuse
Cue 1 – Identifier of abuse
• Directly observed
• Another member of
staff
• Another professional
• Family
• Friend
• Older Person
Quote
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)
Cues that raised suspicion of financial elder abuse
Social care and Health
professionals
1. Identifier of abuse
Banking professionals
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. Who is in charge of the
money
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)
Cues that raised suspicion of financial elder abuse
Social care and Health
professionals
1. Identifier of abuse
Banking professionals
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. Who is in charge of the
money
Cues that raised suspicion of financial elder abuse
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)
Cues that raised suspicion of financial elder abuse
Social care and Health
professionals
1. Identifier of abuse
Banking professionals
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. Who is in charge of the
money
Cues that raised suspicion of financial elder abuse
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)
Cues that raised suspicion of financial elder abuse
Social care and Health
professionals
1. Identifier of abuse
Banking professionals
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. Who is in charge of the
money
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)
Q2. What are the types of decisions that have to
be made when financial abuse is suspected?
Overall summary of decision findings
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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
Health & Social Care
Banking
Speak 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)
Phase II – Case scenarios
Online Task
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
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 decisionmaking?
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?
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 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
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
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
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 3
Cue 1
Cue 2
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 3
Cue 4
Cue 5
Cue 1
Cue 2
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 3
Cue 4
Cue 5
Cue 2
Cue 6
Cue 1
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 3
Cue 4
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
Unlikely to take action
Certain abuse is occurring
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 Q1
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
Unlikely to take action
Certain abuse is occurring
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.
Analyses
from Q2
Make
informal
enquiries
Monitor
situation
Gather
evidence
Consult internally
with colleagues/
managers
Consult with
outside
organisations
Protect
customers
finances
Phase II research Questions
2. Which characteristics of the decision-maker help explain
decision-making?
Phase II research Questions
2. Which characteristics of the decision-maker help explain
decision-making?
•
•
•
•
•
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