Abuse

Abuse of the elderly is a topic which is not commonly aired in public. It is an uncomfortable thought that people are prepared to abuse those who are most vulnerable and often dependant on their abuser. Unfortunately, it is common and we should all be aware of the possibility, be able to identify some of the typical tell-tale signs, and know what steps should be taken to offer some protection against abuse.

Abuse comes in many forms - from financial or psychological to sexual abuse to plain neglect. The abuser can be a family member, friend, neighbour, partner, carer or stranger. There are no boundaries. As older people become more dependant on others, abuse becomes more common.
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