Abuse
is defined by Action on Elder Abuse 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'.
Abuse can happen to someone who is living in their own house,
in hospital or in an institution. It can be perpetrated by those
employed as professionals as well as by volunteers. Abuse can
be deliberate and premeditated, or caused by accident or ignorance.
What
are the different types of abuse?
PHYSICAL ABUSE
This would include hitting, burning, pushing, restraining, misuse
of medication, deprivation of care, or general rough handling.
There can be abuse by neglect as well as deliberate physical
action. A family member such as an elderly husband or wife may
not appreciate the needs of the older person or how they should
be lifted or handled.
It may be more convenient for a carer or nursing home to keep
an elderly person over sedated or even physically restrained
to prevent the necessity of one to one supervision. Neglect
by an institution may result in that person suffering injuries
which require hospital attention. Pressure sores or respiratory
infections may cause grave illness if not noticed and treated.
What therefore should we look out for? Whilst it is often difficult
or inappropriate physically to examine an older person, arms,
legs, neck and face should be visible for bruising or other
signs of abuse. If we notice an unusual lack of mobility or
source of pain, questions be asked which may reveal that someone
is using an inappropriate amount of force.
PSYCHOLOGICAL ABUSE
This
would include verbal abuse, shouting, bullying, ignoring or
humiliating a person, causing loss of dignity to that person,
showing a lack of respect, enforcing isolation on that person
or exercising any form of coercion or making threats of harm
or abandonment.
This area of abuse covers an enormous variety of actions and
is more difficult to spot. It is common for the abused person
to hide the abuse because they are frightened or ashamed, or
they do not want to lose the only support they have. It can
arise where a family member refuses to allow anyone to help
the older person by denying entry to carers, Social Services
or other family members.
How can we spot it? We can look out for someone who is taking
a controlling role in the affairs of the older person and typically
refusing to take or listen to professional advice. Family members
are often excluded from the affairs of the older person by someone
taking such a role. A regular caller who is not appropriate
may take such a role, and the undue influence of a carer or
employee in areas which are unexpected or inappropriate may
also arouse suspicions.
FINANCIAL ABUSE
This would include theft, fraud, exploitation, pressure in connection
with wills, property or inheritance or financial transactions,
or misappropriation of property and benefits.
Unfortunately financial abuse of the elderly is rife. An older
person may start to lose touch with the value of money in their
purse and the cost of goods and services. A neighbour may offer
to collect the older person's pension and do a small amount
of shopping, but not give any change. A carer may ask a blind
person to sign a cheque ostensibly to pay a bill, but it is
in fact a large cheque in the carer's favour. A builder may
put pressure on an older person to allow small repair jobs to
be completed for increasingly large sums. A relative may put
pressure on an elderly person to give or lend them money on
a regular basis or to give them their house, only then to force
out the older person.
A check on bank accounts can establish any inappropriate payments.
Bank staff should be alert to older people being brought into
the branch by another person or regularly withdrawing money
which is more than they should reasonably require for their
own needs.
What can be done to reduce the risks?
It is difficult to insist on checking on an older person's finances
without risking an infringement of their privacy. Being alert
to unusual visitors, purchases and mail will help. Ideally,
we should all complete an Enduring Power of Attorney to enable
the responsibility of looking after financial affairs to be
passed to a trusted friend, relative or a professional person.
Should capacity be lost before an Enduring Power of Attorney
is made, an application can be made to the Court for the appointment
of a Receiver to look after all legal and financial matters.
SEXUAL ABUSE
This would include forcing a person to take part in any sexual
activity without his or her consent or where there is pressure
to consent. This can be in a person's own home, or in an institutional
setting where there are carers and residents mixing freely.
This can happen in any relationship. It is a difficult subject
to broach in any circumstances and particularly so if an older
person is clearly distressed and is not willing to do into details.
NEGLECT
This arises where a person is deprived of care or medication,
necessities of shelter or spiritual needs.
INSTITUTIONAL ABUSE
All types of abuse can be found in institutions, hospitals,
public homes and private homes. Poor practice can become acceptable
and so be perpetuated. Abuse can arise particularly when procedures
are designed to meet the needs of the staff and the organisation
and not the elderly people being looked after.
MENTAL CAPACITY ACT
Issues of elder abuse have been debated for many, many years.
A report entitled "No Secrets", made recommendations,
and some of them have been incorporated in to the Mental Capacity
Act which received Royal Assent just before parliament adjourned
for the election.
The Act introduces a new legal presumption that everybody
has capacity to make their own decisions unless it can be
proved otherwise. It has also introduced some rules for those
who make decisions on behalf of others, principally that they
must act in the best interests of the person for whom they
are making a decision and they must choose the option which
is the least restrictive of that persons' rights and freedom.
The Act gives guidance for those who have to decide whether
someone lacks capacity. It also provides authority for carers,
family and medical workers to give help and care to someone
without capacity where no formal authority exists.
Examples of such formal authority are:
Advance Directive - a written statement refusing certain medical
treatment
Lasting Power of Attorney - similar to the existing Enduring
Power of Attorney giving someone else the authority to deal
with legal and financial decisions
Court of Protection - decisions by the Court on application
Appointment of a Deputy - by the Court to make decisions
CONCLUSION
The examples of abuse described in this article are not fictional.
They have all happened to clients of ours where, fortunately,
we have been able to help them protect themselves from further
abuse and where appropriate, recover money and property taken
from them by financial abusers.
Relatively few cases have resulted in a police prosecution
as sadly an older person may be frightened of being a witness
at a trial. The police may also feel that an older person
may not be a reliable witness. It is hoped that this position
will improve when the effect of the Mental Capacity Act is
seen in practice.
For any further information please contact Sara Rogers, Beth
Carey or Clare Bishop.
We provide a comprehensive legal service to elderly people.
If
you would like further information about any of the matters
raised here or would like advice about any of these issues
or generally,
please contact Sara Rogers (s.rogers@mccormicks-solicitors.com)
of the McCormicks Wills & Trusts Department or telephone
0113 2460622.
McCormicks Solicitors Leeds 0113 246 0622 - Harrogate 01423
530630
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