* The names of all service users mentioned in this article have been changed.
Practitioner: Amanda Wollam, team manager, older people; Jill Marks, social worker; Karen Brogan, social worker; and Irene White, principal officer, adult protection.
Field: Older people.
Location: Telford, Shropshire.
Client: Florence Redshaw, 71, was not previously known to social services.
Case history: Florence lived alone in a council house with her 17-year-old grandson Marcus McManus, whose aggressive and threatening behaviour had not only alienated him from the rest of his family but had resulted in his arrest. A neighbour contacted the council expressing concern about Marcus who had been verbally threatening towards Florence and had been demanding money. It was also reported that Florence had told the neighbour that she couldn’t take any more from Marcus – and was feeling suicidal. It transpired that Florence had been previously bankrupted through financial abuse by her daughter, Emma – Marcus’s mother.
Dilemma: While frightened and stressed by Marcus’s behaviour, Florence didn’t want to involve police and still wanted to see Marcus to make sure he was OK.
Risk factor: Not only might Marcus physically, psychologically and financially abuse Florence, but there were also risks to the safety of the neighbour and to staff.
Outcome: Bail conditions kept Marcus out of Florence’s house, allowing her to re-take control of the situation. Sadly, she died following a heart attack weeks later.
Mention “abuse” and most people will prefix the word with “sexual” or “physical”. However, abuse can take many forms, including emotional or financial. Indeed, the charity Action on Elder Abuse estimated that 20 per cent of calls to its helplines are about financial abuse.
Florence Redshaw, 71, knew all about financial abuse. Her daughter bankrupted her some years ago. And now it seemed her grandson, Marcus McManus, was following suit. His demands for money had pushed Florence to confide in a neighbour that she felt suicidal. The neighbour, who overheard Marcus’s regular verbal threats, decided to inform social services.
“We made an appointment to visit Florence when we thought the grandson wasn’t going to be there,” says social worker, Jill Marks. “But he answered the door to us and was very hostile. He said she was ill in bed. We said we would return at a more convenient time but he said she wouldn’t talk to us if we did and slammed the door on us.”
Various attempts to set up a meeting failed but finally one was set up through the neighbour, whose involvement, although crucial in bringing the case to light, also posed problems. “There were safety concerns for the neighbour as we knew how violent Marcus could be. He smashed up furniture and had physically attacked animals. So we knew there was a risk,” says team manager Amanda Wollam.
Florence was lucid but extremely stressed. “She wanted Marcus to leave but didn’t want him arrested. He was family and she had brought him up,” says Marks. “We looked at legal options – possibly an injunction or an antisocial behaviour order, while continuing to build up a relationship with Florence.”
This was a critical time for the team. “It was difficult because she did have the capacity to make decisions, but was intimidated so could not effectively protect herself. So it was a fine line that social workers were treading, providing a protective shell around Florence without her feeling it was too intrusive and shutting the door on social services,” says Irene White, principal officer, adult protection. “Our adult protection meetings facilitated a wider group of people to be involved in the decision-making – including housing who were already concerned because of the structural damage to the property caused by the grandson. We also involved the youth offending service, the domestic violence unit (because although it wasn’t a husband-wife situation it was still domestic violence), and police.” Florence didn’t want to attend the meetings but was informed that they had taken place and of decisions made. But events overtook plans following Marcus’s arrest after threatening to kill his uncle (his mum’s brother). “On release his bail conditions included keeping away from Florence. He moved out but continued to visit regularly – although asking for forgiveness rather than money,” says Marks.
Marcus’s departure restored control to Florence. “She would see him at the door but keep him there and say, ‘You’re not allowed to cross my door’. She didn’t want him in the house but still wanted to see him,” says Marks. “You have to acknowledge in these situations that people are not just going to say goodbye to members of their family just because they are abusing them,” adds Wollam.
Florence, who had diabetes, also began to accept some help with meals. “Following Marcus’s arrest her stress had calmed. However, her medication increased and carers had to help her manage the dosette box (a pill container),” says Marks.
According to Wollam, Marcus’s departure also signalled a return to normality: “Florence hadn’t been able to wash or dress herself for ages, mainly because she had been so frightened of not being able to see what Marcus was doing. Now she began to do simple things – like have a bath. It demonstrated just how trapped she had been.”
Importantly, the team also sought ways to help Marcus. “Although we didn’t work directly with him we did a lot of work in the background – to enable him to have the help he needed. He confessed to the neighbour that all his problems were drug-related,” says Wollam, who referred him onto the community substance misuse team.
Sadly, just as things were improving, Florence died. “It took several weeks for us to establish the cause of her death – a heart attack. At first we were concerned – as with all unexpected deaths – that we might have in some way not protected Florence,” says Wollam.
She adds: “It was interesting that Florence didn’t have any contact with the family apart from Marcus – perhaps because everyone was angry with him or frightened of him. But when he moved off the scene Florence was able to re-establish contact with other family members, including her daughter. In view of how soon after she died, it was good that this reconciliation took place.”
Arguments for risk
- There were risks to several people in this case: Florence, staff and the neighbour. However, staff visited in pairs (Marks worked closely with co-worker Karen Brogan) and carried sophisticated personal alarms. With social services involved the neighbour did take a back seat but, helpfully, made herself available in an emergency. The workers visited Florence regularly (even at the end they were visiting weekly) and carers were going in to help with meals and medication. There was also the wide variety of people involved through the adult protection meetings who were aware of and monitoring Florence’s situation.
- Even with all this in place, the team were considering other avenues of protection, as White says: “Because we were concerned about Marcus’s aggression and potentially violent behaviour we did discuss running a multi-agency risk conference (Marc) under the public protection arrangements. As it happened he was arrested and so we didn’t need to go down that path.”
Arguments against risk
It was worrying that Marcus’s aggressive nature had alienated all family members except Florence who permitted him to live in her home. Florence had, we are told, practically brought Marcus up – and thus had a strong bond with him despite the deteriorating relationship. Marcus’s mother (and Florence’s daughter) was not involved – her current partner would have nothing to do with Marcus because Marcus had been violent towards her in the past. So Marcus had Florence all to himself. Isolating an older person from friends and family to gain control of the situation is a strong indicator that abuse might be happening.
If Marcus’s behaviour was drug-related (it transpired that he was dealing drugs and owed a drug-dealer in the area some money) it seemed fortunate in hindsight that he was arrested before something even more drastic happened. l Although banned from seeing Florence, Marcus regularly visited her. The police, who were informed, seemed to do little to prevent this.
By the standards of financial abuse of older people, Florence Redshaw’s story may be thought straightforward, writes Jef Smith. She was lucid, the abuser was obviously a villain, and the abuse was more or less public. More difficult to deal with are the cases where family members are covertly filching the money or possessions of highly dependent relatives.
Nevertheless, Florence’s plight presented serious dilemmas. Her grandson was violent and unpredictable, as well as financially unscrupulous. A bad situation for Florence could easily have got much worse if Marcus had – as seemed quite possible – attacked her. And the social workers’ “wait and see” policy would then have been open to criticism. But the cautious process of obtaining an entry, building a working relationship, and discreetly helping Marcus into treatment led to a position from which the workers could monitor events fairly closely, thereby enhancing Florence’s safety.
It may seem just luck that Marcus’s arrest brought things to a head, but given his history of offending this was always quite a likely development. The team’s courage in waiting on events rather than themselves precipitating a crisis – though they were prepared for quick action if necessary – soon paid off. They retained Florence’s trust and were able to access other useful services and to support her in maintaining a (more controlled) contact with her grandson. Perhaps most importantly of all, Florence was enabled, through what proved sadly to be the last months of her life, to remain in control of her own actions and relationships.
Jef Smith is a writer, trainer and consultant in care for older people.