Fighting Monsters

One of the key policies that I’ve worked a lot with over the past few years, has been the introduction of the ‘new’ Protection of Vulnerable Adults (POVA) scheme and the Safeguarding Adults procedure - when there is a suspicion of abuse of a vulnerable adult.

And it’s usually a frustrating process.

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There is little legislation in place to allow for any action even where there is - in some cases quite open - evidence that abuse is taking place.

Even after the forms have been filled, the strategy meetings have been convened, the police have confirmed that the CPS will not be able to take any further action because the victim of the abuse has dementia and therefore will not make a reliable witness - there is little that you can be left with.

The frustrating part is that you can have a very strong idea of what is going on through allegations, people saying things, but as long as the Crown Prosecution Service see people with dementia being unable to serve as witnesses, prosecutions will not be forthcoming.

Taking an elderly adult into residential care when they wish to stay in their own home is a draconian (and expensive) measure to take because the process of moving can be more permanent when someone is older. In fact, this article confirms that although there is no long term impact on elderly people who move into residential accommodation, when it is an imposed move, a higher morbidity rate can result.

Sometimes, people are left in situations that compromise their safety, dignity and financial position because the alternatives are not feasible.

I have been involved in two cases recently and without too many details, one is a standard (because unfortunately, it is probably the most common) financial abuse situation.

Someone who has dementia has a family member who feels they can use the income, savings and benefits of their parent as ‘free money’. Is this enough reason to move someone out of the property? No charges can be brought because although there is no capacity, according to the law, she is giving the money willingly (of course, this doesn’t account for the distress that is expressed through lack of being able to visit the local shops and buy a paper).

Another is a more tricky issue of possible physical and sexual abuse. Witness statements based on hearsay but fairly substantial - although not enough for criminal investigations.

That did involve a move - but it was no thanks to the Safeguarding Adults ’strategy’ meeting which seemed to consist of policemen apologising for what they were not able to do after consulting with the Crown Prosecution Service (no criticism of the police involved, they were equally if not more frustrated by this).

And I shouldn’t even start on trying to get civil injunctions when someone lacks capacity. Civil injunctions are geared towards domestic violence and they have a part to play but when the person who wants to apply for the injunction is deemed to ‘lack capacity’ - there is a more convoluted and extensive procedure involving the Official Solicitor - none of which can be done in a reasonable time-frame.

I think civil injunctions could potentially go part of the way in some circumstances although the need for proof is still there. I’m not sure what the answer is, but I wish the procedures had more teeth.

I read in Community Care, well, on their website, that Ealing won a case to remove an adult from the care of her family who were ‘unsafe carers’. The article makes the point that

‘Vulnerable adult protective litigation is a relatively new legal area and many teams will not have the budgets in place to run a case such as this. Difficult financial choices will arise and it is to be hoped that, overall, a means can be found of taking necessary protective legal action without having to cut frontline services.

The solution may lie in the new Court of Protection established under the Mental Capacity Act 2005. Future cases of this sort are likely to be heard by that court whose specialism and relative informality may make vulnerable adult cases easier to manage.’

So perhaps the Court of Protection will provide a greater level of protection in the long run.

One can only hope.

But in the meantime Action on Elder Abuse have launched a survivors network for victims of abuse.

I’m trying my hardest not to be cynical about this because any opportunities to help the victims of abuse has to be positive.

But what I’d really like to see is an additional bump to the legislation and particularly the means of obtaining civil injunctions to cover more of the issues of adults who do not have capacity and a more streamlining (and quick) process.

Just when I thought I was pretty hot on all the acronyms that are flung around the workplace, I have been hit with a few more. It came as a result of a conversation with one of the managers (there are whole swathes of different levels of managers in the local authority that become very difficult to unravel ) who informed me I would need to go to Dols training to be a BI assessor early next year.

I couldn’t actually understand what she was saying at first and then she explained that she was talking about Deprivation of Liberty Safeguards (which, apparently are known in the circles as DoLs) and being a Best Interest Assessor.

Of course, I had expected it would be something I’d be doing, as I work generally with older people and have just come off the ASW training so tick the boxes.

It certainly sounds, at least initially, less troubling morally than being actively responsible for detention of people.

I have though, become acutely more aware of it and the need for a robust Human Rights Act since working with compulsory admissions to hospital - and with the Deprivation of Liberty safeguards due to be implemented in April 2009, it’s an interesting development to turn back to.

The implementation is the DoL safeguards is very overdue as the Bournewood decision was handed down by the European Court of Human Rights in 2004.

It has been a long time coming but a few years later, there will be some kind of recognition that people who lack mental capacity need additional safeguards if they are held in hospitals, residential care and other ‘care’ facilities, without being able to give their consent.

Currently, as far as I know anyway, the plan is to train up some people who work within mental health teams to reassess people who have been placed in residential/nursing care or long term care without being able to give their consent and assess their Best Interests in respect to this and ensure that the placements have been made in their best interests.

As well as assessing best interest, a number of other criteria are specified including a separate assessment of mental health by a different person (a doctor) to verify that there is a mental disorder that warrants the level of care that is provided.

It has the potential to provide a more formal advocacy role and the hope of being to put into practice one of those wooly goals of ’speaking up for those without a voice’ ideals that drew me to social work in the first place.

Although well overdue it has the potential to provide some kind of voice for people who might not otherwise be heard and although there is the usual heart-sinking response to anything that seems to involve more paperwork/assessment and administration anyway, I am hoping that in this case, it will be able to affect a better standard of decision-making all round.

MENCAP reported yesterday that funding for learning disabled athletes is struggling following the ban on these athletes after some reported shifty behaviour regarding eligibility of some athletes who apparently faked having learning disabilities, in the Sydney Games of 2000.

The British Paralympic Association are pushing for the London 2012 games to re-introduce learning disabled events.

I honestly hope that the campaign is supported broadly and extensively. If ever there was a case of a few ruining the party for many by trying to take advantage, this seems to be a case in point.

 It makes one wonder what can be gained by lying about eligibility just to win prizes.

This tragic story about a man with learning disabilities and his mother who were both found dead left me with a couple of thoughts.

Obviously it is an enormous tragedy and apart from speculation there are few facts available.

My thought though was on the comment that he had stopped going to his day centre about a year ago and this had not been picked up by Social Workers or at least not followed up.

Firstly, it must be awful to carry any kind of feeling of responsibility in those circumstances and there will always be things that one can have wished to have done retrospectively.

To me, it highlights the importance of regular reviews of carers, even if, and especially if no paid packages of care are involved. Often the focus from the councils is on reviewing to save money or to ensure that money is appropriately spent - but it is the carers without services who do, perhaps, need the most support.

Judging from media reports, this man needed considerable support and although it is an individual case and not everyone can know the circumstances - I think it paints a tragic but exceptionally important picture of the role and support that must be offered to carers.

I remember from some of my own work, some of more satisfying moments have been being able to provide carers support. Sometimes it is just a matter of going in and talking to someone who is taking a lot on themselves because they don’t want to discharge any kind of responsibility for caring for their loved one. But sometimes, it is about preventing burn-out and checking that there is no abuse of vulnerable adults.

All I can say, and say with sadness, is that I’m glad I’m not in the Redditch Learning Disabilities Team at the moment.