Manna Santokhee Action on Elder Abuse

1. Manna SantokheeAction on Elder Abuse

2. Action on Elder Abuse

3. Manna Santokhee MA (Business and Fundraising Manager) Background $ Experience

4. Action on Elder Abuseis a ‘Four Nations’ organisation based in London It was established in 1993 by practitioners from health and social care, academics and voluntary sector representatives, and is now one of the key Adult Protection agencies in the UK. We are an ABUSE charity focusing upon the needs of older people

5. ‘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….

6. A Vulnerable Adult is … An Adult at Risk is … a person who is (a) unable to safeguard his/her own well-being, property, rights or other interests, (b) is at risk of harm, and (c) is affected by disability, mental disorder, illness or physical or mental infirmity, and is therefore more vulnerable to being harmed than adults who are not so affected. a person who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.

7. Five types of abuse Time for Action (11 minutes DVD)

8. UK Study of Abuse and Neglect of Older People - 2007 The overall prevalence of abuse, defined by ‘expectation of trust’ in the year preceding the survey was 4% This equates to 342,000 people aged 66 and over, or 1 in every 25 of the population aged 66 and over

9. 6 4.3 3.9 England Wales 3 Scotland N Ireland UK Study of Abuse and Neglect of Older People - 2007 Nation Specific Prevalence Percentage of all respondents who experienced abuse 7 6 5 4 Percentages 3 2 1 0 England Wales Scotland N Ireland

10. Source: Hidden Voices 78% of abuse occurs after the age of 70 years 40 55-64 22 65-69 18 70-79 16 80-89 90+ 4 55-64 65-69 70-79 80-89 90+ Age of victim 45 40 35 30 25 20 15 10 5 0

11. Source: Hidden Voices Men 11 22 Women Both 67 Gender of victim

12. 33 33 35 9 3 Partner Other family Home Help Friend Neighbours and Acquaintances UK Study of Abuse and Neglect of Older People - 2007 Percentage of all respondents who had experienced abuse in the last year The Perpetrators 40 35 30 25 Percentage 20 15 10 5 0

13. Source: Hidden Voices 64 Sheltered housing Other Hospital 23 Care Home 4 4 5 At home Where abuse occurs 70 60 50 40 30 20 10 0

14. Factors that may lead to elder abuse: Social Isolation Poor quality long term relationships Patterns of family violence Dependency Alcohol, drug and mental health problems Minority status

15. Factors that may lead to elder abuse in institutional settings: Poor staffing levels and working conditions Lack of training, supervision and support No procedures or policies on abuse Poor communication

16. Reasons for the hidden nature of abuse Mis-diagnosis of abuse as something else Family matters are private and should stay that way I have no one to turn to who can help. The abuse is my fault. The consequences of speaking up are worse than keeping quiet. I love my partner/son/daughter don’t want them criticised or punished for what they did

17. Reasons for the hidden nature of abuse I am completely dependent on my abuser. I’m so ashamed and embarrassed that my own family member could be behaving in an abusive or neglectful way I’m afraid if I break the “family secret,” the person hurting me will get back at me in a way worse than what is happening now. Long term conditioning by the abuser Failings in the system.

18. Mrs Frances Hales

19. Mrs Frances Hales Died from neglect

20. Visitors were encouraged to ring ahead when they came to see relatives at the home in Oxford. It gave the staff time to hide the stench of urine and scrape faeces off the curtains Not that they would ever see the 89 year old man whose suppurating pressure sores had rotted the flesh down to his bones. He was locked away upstairs, in too much pain to move and too much confusion to cry out. For the last four months of his life Alec Taylor saw no one except the owner, who cleaned his wounds by hacking at the skin around the sores with office scissors and ripping out his rotting flesh, wearing gloves he had used to scoop faeces off the sheets.

21. Adult Safeguarding

22. Adult Safeguarding and Adult Protection are concepts that seem reasonably straightforward at face value; they involve protecting vulnerable adults from harm or abuse. But they are in fact complex and challenging constructs in reality - both in terms of practical implementation but also in terms of the ethical/moral dilemmas that can be inherent within them.

23. Background: No Secrets was issued in 2000, as guidance under section 7 of the Local Authority Social Services Act 1970, to respond to a growing concern about elder abuse in particular, and adult abuse in general. It was statutory guidance, and local authorities were consequently required to follow it unless they could demonstrate a clear reason why they should not do so. It created, for the first time, a framework for multi-agency action in response to the risk of abuse or harm.

24. Process: How it works Alert: by anybody Referral: Accepted into the system Decision: Is it Safeguarding? Assessment: Is it happening? What is it? Plan: How to respond Review: Is it working?

25. On 15 June 2007 the Minister of State for Care Services, Ivan Lewis, promised a review of No Secrets, with particular regard to the need for legislation. What’s going on: The consultation was eventually published 14 October 2008 and concluded on 31 January 2009. In February 2010 the Government announced a three-pronged approach: legislation to address the governance of Safeguarding Boards (but without a commitment to what that meant or when it would happen), an Inter-Ministerial Cross Government Group on safeguarding adults, and an updated version of No Secrets

26. Key points from the Law Commission: • a duty on social services to investigate or cause an investigation • into adult protection cases; and a duty on Government to • prescribe the process for such investigations; • a new definition of people at risk of abuse and of harm in order • to ensure those in need receive adequate protection; • a statutory basis for adult safeguarding boards which should as • a minimum comprise local social services, police and health; • the legal requirement to establish serious case reviews; and an • enhanced duty to cooperate between relevant organisations.

27. Government response: • Safeguarding Boards will be made statutory.  • A statement of principles for use by Local Authority Social • Services and housing, health, the police and other agencies for • both developing and assessing the effectiveness of their local • safeguarding arrangements. • Principles: Empowerment, Protection, Prevention, • Proportionality, Partnership, and Accountability • The outcomes for adult safeguarding, for both individuals and • agencies

28. Thinking about Outcomes: Lord Justice Munby Physical health and safety can sometimes be bought at too high a price in happiness and emotional welfare. The emphasis must be on sensible risk appraisal, not striving to avoid all risk, whatever the price, but instead seeking a proper balance and being willing to tolerate manageable or acceptable risks as the price appropriately to be paid in order to achieve some other good – in particular to achieve the vital good of the elderly or vulnerable person’s happiness. What good is it making someone safer if it merely makes them miserable .

29. Thinking about Outcomes: Lord Justice Munby Intervention which is proportionate to the harm, or real possibility of future harm, and which has the overall effect (outcome) of improving the life of the adult, including their safety, happiness and mental well-being. “If the State is to justify removing vulnerable adults from their relatives, partners, friends or carers it can only be on the basis that the State is going to provide a better quality of care than that which they have hitherto been receiving

30. Key Issues

31. Key issues: There is a poor level of co-ordination across all organisations/capable guardians within the public and private sectors, leading to inconsistent delivery of appropriate advice, support and intervention. Those organisations/capable guardians, who come into contact with vulnerable adults exhibiting high levels of independence, may not recognise their vulnerability.

32. Key issues: Where organisations see no immediate threat to a person’s well-being, they may fail to consider the long-term impact of victimisation. This lack of realisation or sense of urgency can lead to safeguarding procedures not being invoked, or organisations choosing not to share data. The social care element of the No Secrets definition has the potential to limit the response of Adult Social Care, leaving a group of people, who are unable to safeguard themselves against harm or exploitation, excluded from the provision of protection.

33. Key issues: ACPO found a lack of consistent understanding of financial crime across police services and several examples of victims being turned away at police front desks. This may be due to a lack of understanding of financial crime, or an assumption that the loss of monies or assets is of less importance than other forms of abuse or crime. There is also evidence that police officers are, on occasion, making their own judgements about capacity, in circumstances where referring the adult for an assessment may be more appropriate.

34. Key issues: Despite high levels of contact, GPs appear to generate disproportionately low numbers of referrals. The role of GPs is considered crucial to safeguarding, as they are: “In an ideal position to identify safeguarding concerns with their knowledge of patients, their families and situations.”These low volumes of referral could be due to a lack of ability to identify safeguarding problems, or a concern over breaching confidentiality.

35. Elder Abuse Helpline 080 8808 8141 Admin telephone: 020 8835 9280 Email: manna@elderabuse.org.uk WEBSITE: WWW.ELDERABUSE.ORG.UK

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