APPENDIX 22
Memorandum by Sussex County Council Social
Services Department (EA29)
INTRODUCTION
This memorandum is prepared by Marion Johnson,
Head of Service—Adult Protection for East Sussex County
Council Social Services Department. In preparation for this response,
I have circulated your request for information to Operational
Managers responsible for the prevention, investigation and taking
action when an adult protection incident is reported. One point
made was that abuse is experienced by a number of vulnerable adults
and although older people are a significant number of those reported
other vulnerable adults, those with learning disabilities and
mental health difficulties also need to be taken into account.
It should also be noted that reporting is based on an awareness
of abusive issues and the visibility of service provision. Staff
awareness in Older People's Services and the number of that age
group in institutional care may result in a greater level of reporting
for that group.
RESPONSE TO
QUESTIONS POSED
How prevalent is elder abuse?
The present monitoring methods of adult abuse
require further development not only in the robust reporting of
incidents but, also, the absence of any cross referencing of information
between the National Care Standards Commission, Police and Social
Services Departments. East Sussex has multi-agency policy and
procedures in place, a multi-agency County Management Committee
and local groups, including representatives from the lead organisations
(as stated above), as well as Health and the voluntary and independent
sectors (care homes and domiciliary care services).
I am not aware of the level of research relating
to the research into the abuse of older people. Hilary Brown,
Salomans, Southborough, Tonbridge, Kent, is my link on this subject.
Causes of elder abuse
A significant number of the alerts of elder
abuse come from residential care settings as it is an observable
environment where almost everyone would be considered vulnerable.
I have a sense that vulnerability encourages abusive relationships.
Recent examples in East Sussex have identified care services falling
short in:
— reasonable levels of nutrition in
care homes;
— appropriate medication administration;
and
— adequate treatment of skin conditions.
Some issues in residential care settings appear
to emanate from a lack of effective assessment practice by the
home owner prior to admission by the service provider. Care needs
are not necessarily accurately recognised at this stage and may
result in inappropriate care practices, eg control and restraint
practices. The ability to offer adequate care and develop care
plans is an issue for some services.
For older people living independently in the
community, the risk of financial abuse (theft) from their formal
and informal carers is the highest form of reported abuse. There
are also risks of abuse for older people living in the community
where there is property ownership and people are maintained at
home beyond viable levels—huge home care packaged in order
to protect assets rather than ensure good care. Those with mental
health difficulties can exhibit evidence of physical and psychological
abuse where informal carers are struggling to cope with the care
of demented and challenging individuals in their own homes.
What are the causes of elder abuse?
We are still improving our monitoring systems
to establish hard evidence. The gut feeling is that vulnerable
adults living in the community are mostly abused by relatives
and carers as the opportunity exists and there may be considerable
stress and tension in the relationship. For those in regulated
settings, this may still be the case but employed care staff and
managers are also seen to be perpetrators.
What are the causes of elder abuse?
Some mental health conditions, including multi-infarct
dementia (dementia caused by mini strokes), or other personality
changing disorders often result in stressful and conflictual relationships
with carers. There may be no intention to harm; it may be the
intention to protect, however lack of awareness or inappropriate
control and restraint methods can result in abuse. I would expect
that some racial groups have different expectations within their
gender relationships and some cultures will accept different types
of behaviours to others as the norm.
The settings of elder abuse
The likelihood of physical abuse within institutional
settings may be higher due to the level of physical handling required.
In a domiciliary setting, abuse may be financial in line with
the type of service being offered. The number of staff within
an institutional setting would obviously contribute to the quality
of care practice, as well as the equipment which is available
to lift and handle, for example.
What can be done about it?
Greater awareness of what constitutes abuse
will inform staff as to whether their care practice is appropriate.
There is an enormous lack of understanding by the general public
of what constitutes abuse.
Informal carers
In East Sussex, the Care for the Carers counsel
takes a lead in representing issues for carers. It is a good voluntary
support group that can provide information and guidance in an
appropriate way.
Formal carers
Greater detail is needed in guidance for staff
on the care and handling of people in institutional settings.
What is the role of staff training?
There is definitely a need for the recording
of care staff who have been alleged as responsible for adult protection
incidents, in order to prevent them from transferring from one
care agency to another. Data needs to be gathered for staff working
in the independent sector, as well as within statutory bodies,
to ensure that people are not re-employed following the investigation
of an incident where they were found to be culpable. The vetting
of Direct Payments Personal Assistants is at the discretion of
the service user. Further information may need to be provided
to inform service users of potential risks. No Secrets requires
a multi-agency approach to be taken by Social Services Departments
for prevention, investigation and taking action and the multi-agency
policy and procedures to be monitored in the light of experience.
However, Social Services Departments do not have rights of access
into care settings, eg residential care homes, in order to undertake
an investigation so this needs to be carried out alongside the
National Care Standards Commission (NCSC). However, a discrepancy
highlighted in the draft NCSC protocols is that the Care Home
Regulations specify issues that must be reported to the NCSC but
the Domiciliary Care and Nursing Agency Regulations are less specific.
We would like to see further legislation to
support the investigation of adult protection incidents.
November 2003
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