• Raina Summerson shares her company’s experience of dealing with a case of abuse
• Learning from abuse: the daughters’ story

I was prompted to write this as a reaction to yet another recent news story about the abuse of older people. It had the accompanying commentary about our homecare workforce, the wider social care sector and the age-old ‘profit vs not-for-profit or statutory’ provider. There were generalisations throughout.

Whilst, with the much-publicised health and social care workforce crisis, the language used is now somewhat moderated when talking about the independent social care sector and care workers, the bias that comes through is still pretty strong.

Unfortunately, abuse does happen. We have experienced it and learned from it. It is this learning that I want to share.

Last year, a worker previously employed by our company, Agincare, was successfully prosecuted and convicted for theft from an older couple in Bristol.

This prosecution was hard-fought for and would simply not have happened had it not been for the tenacity of the family members involved and the support and guidance they received from one police officer. The officer agreed to fight their corner within a system that thought the prosecution of someone who had clearly financially abused a vulnerable elderly couple was too difficult to pursue. Valuable advice was also given to the family at a later stage by Gary FitzGerald and the team at Action on Elder Abuse, as well as the Care Quality Commission.

Learning from abuse

As an organisation, we learned a great deal from that experience. We learned that no matter how much so many of us care deeply about what we do, there is an ever-present danger of rogue individuals taking advantage of their position and subjecting others to abuse.

We learned that our systems and structures can help to minimise the opportunity for such people, but cannot guarantee that things won’t happen. However, the system designed to protect can also lead to confusion, especially during investigatory stages and aftercare of all of the people involved.

We also learned that despite caring, our working lives are so busy and with such daily complexities, there is a risk that we move on too quickly from situations that really require much better reflection and learning from. Sometimes as a result, we stop fighting as hard as we should for what is right; in this case, fighting a system that doesn’t encourage collaboration, that doesn’t seem to want to pursue even seemingly clear abusive acts under a criminal process and that can effectively punish the victim.

In this case, the older couple were removed from their home as they were deemed too vulnerable and unsafe to remain. They were then separated as no care home could be found to accommodate them together. Instead, time should’ve been spent finding alternative solutions together, across multi-disciplinary teams.

In our reflections, the family along with us agreed that it is a great shame that the current system did not unite us as affected parties and encourage open, honest communication from the outset; in fact it actively prevented this, which actually could have jeopardised the successful prosecution. This made the process far more challenging, distressing and complex than it should have been.

Reviewing the case

Thanks to the determination of the family in this instance, I was lucky enough to be given the opportunity to meet with them to review the ‘case’ together. We were able to discuss our own internal case review, which had already led to some further improvements to our processes and training. But we wanted to do more.

The family kindly, and bravely, agreed to attend one of our national home care manager events. We agreed a format whereby we worked with the managers on a review of the incidents and honest appraisal of what we could have all done better to try to minimise the impact of even an unavoidable event by any rogue ‘care’ team member.

Then the family spoke about their perspective; leading from our provision of care (thankfully good in all other ways), through the journey of their parents’ increasing vulnerability and the discovery of what seemed a merciless exploitation of an older, kind and trusting couple by the worker involved.

I know that our managers would all agree that this was probably the most emotionally impactful session we have ever undertaken and certainly, I hope, one they will never forget. I certainly haven’t.

Reviewing in this way together was time-consuming for all involved, but it was meaningful and our team and the family agreed the value of it. Not all families or friends of victims will want this kind of independent contact and post-analysis.

However, we have changed our policy as a result, to ensure that people are asked if they want to meet to discuss the case and to ensure that better follow-up care is provided for all. In cases of abuse, not only the ‘victim’ is affected and the perpetrator, but those around them both.

Everyone wonders what more they could have done to prevent it, spot it or stop it sooner. All stakeholders should be focusing on how best to all work together, both to address issues and to prevent issues, not to divide and alienate.

Things will go wrong

When dealing with people, things are never easy or straightforward. Today, more than ever in the formal caring system, we are dealing with complexities and risks, and we are all under pressure with time and competing demands.

However, we must never forget that people are everything and we can never allow ourselves to become blasé about incidents. Equally, we must stop blaming and recognise that in such complexities things will go wrong, people will do wrong things, sometimes intentionally but more often accidentally.

Action on Elder Abuse has developed its campaign for elder abuse to be made a crime; to create a better prosecution pathway for abusers and I support the concept. There needs to be a deterrent and the fact that the system allows it to seem so easy is dangerous. However, we mustn’t let ourselves go too far and risk scaring off good staff or indeed scaring people who will need to rely on care and support services.

We must remember that whilst some older people may be more vulnerable, there is a fine line with risk-taking. On one hand, we promote choice and self-determination and on the other hand, we are surprised when they want to take risks or in some cases offer help to people, possibly in their attempts to take control over some aspect of their life.

We need to work with people on the subtleties. One case recently saw a client willingly loan money to a care worker, never to be repaid, but he didn’t want to prosecute as he said he had offered the money, she hadn’t stolen it or asked for it. As such, police didn’t want to, or couldn’t, pursue the case.

We considered what more we could do to make the people we support realise that professional boundaries are there to protect not just them but others. So, in this case, by accepting the behaviour and not acknowledging that they had in effect been stolen from, others would be at risk.

These are all fine lines. A worker tempted by or often actively offered presents or money. The lonely older person for whom a care assistant becomes like family and so they naturally want to give gifts or ‘help out’. The relationship that we expect to be so intimate and yet so professional. Add into this complexity of needs, confusion, isolation, dispersed family and lack of joined-up services and I wonder why we are so surprised and reactive to situations arising from this volatile mix of circumstances.

Understanding risks and judgements

We need to continue to advise and support our workforce, those we care for and their families about risks and judgement. We try to achieve this through values-based recruitment, Disclosure and Barring Service checks, solid training, clear professional boundaries and information and guidance to all. We need to implement simple, effective elements that can make a difference to awareness and prevention.

The current funding system and pressures mean that, if working with people funded by public services, we only deal with the most vulnerable and complex needs; therefore, we all need to support each other and the person within this, not turn and blame under some misguided act of self-preservation.

Let’s focus on better time, reflection and pursuit of justice for older and vulnerable adults. However, in the meantime, let’s not generalise about independent sector provision or our workforce. Also, let’s not think that the oft called-for registration of a care workforce is going to solve the situation, without the fundamental changes in the funding, commissioning and system structures.

Other professionals may be registered, and more importantly publicly-recognised, but in my experience this does not prevent rogue behaviour or automatic adherence to a higher professional accountability. It is more likely that the numbers of incidents of abuse are lower because these groups are not present to such scale in people’s homes.

Also, it should be noted that many allegations made against homecare workers are unsubstantiated. As a sector, we have got better at reporting things ‘just in case’ and that’s a good thing, unless it drives fear and loathing of a much-maligned, committed and caring workforce and stops people joining social and health care as a result.

Raina Summerson is Group Chief Executive of Agincare. Email: [email protected] Twitter: @Agincare

Learning from abuse: the daughters’ story

The daughters of the couple share their story of what happened to their parents, the impact this had on their lives and their advice for care providers.

Our parents were in their mid-eighties at the time they were abused. They had been married for 65 years and had a happy family life. Mum lived with Alzheimer’s and Dad was in and out of hospital with uncontrolled epilepsy. Their lives were chaotic at the time that the crime occurred and they were hanging on to their independence by their fingertips. They would not consider any other living option apart from the house they had owned since 1968. They were proud that they had planned financially for their old age and end of life.

They (and we) were totally dependent on the Agincare care workers to look after our parents at home to support them in their highly-vulnerable state. Mum and Dad had a strong bond with some of their long-term Agincare carers who they loved and trusted.

Mum started to talk about a ‘financial adviser’ who was helping her with money and we became suspicious. We found out that someone had been taking from their bank account the money that Mum and Dad had put aside for their funerals and we called the police. It was three months before the police identified the culprit as one of their Agincare carers who had financially groomed Mum and got her to hand over a debit card.

Impact

The impact of the crime on our parents and our family was devastating. Mum and Dad had to be removed from their home straight away and were kept in hospital as a place of safety. Mum spent a month on a noisy medical admissions ward, which must have been like environmental torture for someone with Alzheimer’s.

We were robbed of the opportunity to plan the last stage of their lives. They were moved several times over the next 18 months and ended their marriage living apart. The court experience (being cross-examined in a witness box in front of a jury) was also tough for us. Dad died in the middle of the court case and we had to return to court each day and hear the defendant (who pleaded not guilty) telling lies that defamed the memory of our father. We were heartbroken by the situation.

Silence

The police told us, and all others, not to talk to anyone about the investigation, so we had no contact with Agincare at all after we called the police. We didn’t speak to Agincare again until nearly 18 months later. We assumed that Agincare would get in touch with us after the court case was over but it didn’t happen.

As time went on we grew angrier and angrier about Agincare’s silence because we felt that our parents (and we as a family) had gone through so much as a result of the crimes of the carer that Agincare sent into their home. We got in touch with Action on Elder Abuse and the Care Quality Commission to find out what the situation was. We didn’t want to make a complaint or sue or anything like that. We just wanted to help make sure that no other family would have to go through what we had been through.

Involvement

We wrote an angry and accusatory letter to Raina Summerson and she came to meet us in Bristol. She talked us through Agincare’s position, actions taken and polices and systems; this created a completely different level of understanding of the situation for us. We wish that we had understood this before. We then felt really angry for a different reason; why hadn’t the local Agincare manager been called by the Crown Prosecution Service as a witness in the court case? It would have completely repudiated the lies of the defendant.

Raina and Agincare kept in touch with us after that. They went to a lot of trouble to involve us and show they were taking action across the company to do even more to make sure that what happened to our Mum and Dad didn’t happen to anyone else’s parents. We wanted to help. It isn’t a campaign against dishonest care workers who abuse their clients; most of the care workers we met did a fantastic job in keeping Mum and Dad well and safe. It is about having the systems and relationships in place to prevent it and sort it.

It was emotionally tough telling our story at the Agincare national domiciliary care managers meeting. It was almost a year to the day since Dad died whilst we were in court. But it was cathartic for us as a family and we are glad that we did it.

Advice

So, having had this experience, what is our advice to other care organisations? If something like this happens on your watch, reach out to the family. Create open communication and support them through the actions that follow. Unless there are very specific circumstances that make it a bad idea, insist on connecting with the family, whatever the police say. We are on the same side of wanting great care and no abuse for loved ones. We know that now but it was a painful journey to get there.

What have you learnt from incidents of abuse? How have you applied those to your social care services? Log-in to share your thoughts and read Action on Elder Abuse’s Briefing Paper about the need for a criminal offence of elder abuse. Subscription required.