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A Glimpse into Adult Social Care: Roles and Responsibilities in an Age of Legislation

Introduction

My final placement setting was with an Adult Social Care team for a local authority. The department’s client base were adults over 18 who fit in the Care Act 2014 eligibility criteria. The criterion is any person with a physical, sight or hearing disability, mental health, people with a terminal illness and carers. Some of the legislations that my team work by are, The Care Act 2014, Mental Capacity Act 2005 and The statement of Government Policy on Adult Safeguarding 2013. The department’s aim is to specialise in the provision and support of older people to maintain independence, safeguard and provide support with any disability or mobility issues. My role within this team was to manage my own case load where I would assess, implement, manage and review clients care plans. Some of the multi-agency teams I worked with are Hospitals, Day Care Centre’s, GP’s, Safeguarding, Learning Disability, Occupational and Mental Health.

2.1. Industry Overview in the UK

The first critical analysis case I will be discussing is a referral I received from the Alzheimer’s Society. They raised concerns the client (S) was not complying with taking her medication and that she felt she had no cognitive issues, despite her diagnosis of dementia. The deterioration of her cognitive state caused her to hallucinate and forget things. The client was a 67-year-old, white British lady who lived alone. She was capable of looking after herself physically, however, due to her Cognitive impairment, there were concerns about the risk she posed to herself, the lack of insight into her condition and self-care. The second case I will be exploring is a safeguarding referral I received from a housing association for the service user (E). E was a 53-year-old white British woman who lived alone. They visited the client’s home where E informed them her purse had gone missing. E advised that she did have her suspicions in regards to who could have taken her purse. However, she also suggested that at this moment she did not want Police involvement and only wanted advice on the matter in order to discuss how to ensure it does not happen again. Within both critical analyses, I will be exploring the Legislation that guided my practice along with the policy that assisted me with my decisions. I will also be reflecting on my learning, knowledge and understanding. Looking into how this affected my professional conduct and duties.

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Critical Analysis

When reading the referrals for both cases, I acknowledged that there were not many similarities between myself and these service users. Other than the fact we were all women, we were quite different in age, culture and race. I was aware that this could affect the way the clients engaged with me. The large age difference could mean that both clients come from a generation where lack of racial understanding causes bias and segregation. Despite this, I went forward in both cases with an open mind. I had a positive outlook and aimed to find some common ground in order to help build a trusting and professional relationship.

Critical Analysis 1

The concerns raised in the referral were that the client was repeatedly reporting incidents, that once investigated were established to have not actually taken place. The client’s daughter in law (A) had also contacted the Social Care team with her own concerns. A stated that S was not complying with taking her medication, due to a combination of forgetfulness and feeling that she did not need to take them. A stated that the client was not maintaining her personal care and was not maintaining a habitable living environment. She also advised that due to the client’s forgetfulness, she was accusing different members of the family of stealing from her home. This resulted in the client isolating herself from her family members by banning them from the house to visit her. A advised that the family had not seen S in months and were unaware of her current well-being.

Reading the background of this case, I noticed that I did not have many similarities with S. Although we were both women, there was a significant age difference between us. I realised that this could affect S engaging with me, as she may feel I lack knowledge and understanding of her needs, culture or values. Due to her age, I was aware that our racial difference could have an impact on our professional relationship. S may come from a generation where there is a lack of understanding of different cultures which can sometimes cause conflict. Despite this I continued with the case with an open mind, making sure to consider both myself and S’s ‘Social GGRRAACCEESS’ but not allowing them to negatively affect or relationship

Critical Analysis

The aim of my visit was to assess the client’s presenting needs and assess if she poses any safeguarding risks to herself due to her cognitive impairment. In order to establish this, I completed a mental capacity assessment for the client in, order to identify if she was able to make rational decisions in regards to her health and welfare. All adult social care departments have to use a framework based on the common assessment framework for adults [1]. ‘Every locality should seek to have a single community-based support system focussed on the health and wellbeing of the local population’ (Common Assessment Framework, 2009. Pg.9). Following this policy, I also completed a self-supported needs assessment to identify if S needed any additional community care support. Before attending my visit, I made sure I contacted all professionals that were or had been involved with S. I felt that this helped to facilitate my learning and understanding of the benefits and need for multi-professional working. This also enabled me to meet the requirements of the legislation for the national framework, by information gathering and sharing of that information to all relevant professionals involved with S. This I felt enabled me to be able to provide a personalised support plan for S, as I had background information on the service user and her history with social care and community services.

The ‘Care Act 2014’ states that all local authorities have a duty to promote and support the well-being of an individual ““wellbeing”, in relation to an individual, means that the individual’s well-being so far as relating to any of the following: personal dignity, physical, mental and emotional wellbeing, protection from abuse and neglect…..” (Care Act 2014). Understanding my legal duty helped to guide my practice when dealing with S, I was able to assess, identify risk and provide services in order to promote her wellbeing. On assessing S I asked probing questions that required detailed answers In order for me to get a clearer picture of S’s mental capacity. The Mental Health Act 2005 (MCA) states that a person who lacks mental capacity “ will be unable to make a decision in relation to a matter if they are unable to: understand, retain, use or weigh information relevant to that decision” ( MCA,s 3(1)). S was unable to answer these questions

Critical Analysis

sufficiently as she would give different accounts or insufficient details. However, she was able to give some examples of what she would do if she ever felt she was at risk in some way. She showed knowledge and understanding of how to maintain her well-being to a level she thought best. Despite S having a cognitive impairment and making unwise decisions, I am required to still assume that the individual is still best placed to judge what’s best for

As this was one of my first allocated cases I had to do some literature reading of on Mental Health, for example, The Care Act Manual by Tim Spencer-Lane (2014p.g 25) and Good Practice in Law and Safeguarding Adults 2009 (chapter 12) which speaks on reflective practice. I utilised the local authorities training services and completed training on Understanding behaviours, mental capacity and mental health awareness. I contacted the Alzheimer’s Society and signed up to become a dementia champion. This helped me to gain an understanding of what dementia is, and the experiences service users have that are living with dementia. I felt this was necessary in order for me to be confident in my professional decision-making process. I felt that this was a difficult case to deal with as S was living with Dementia, which caused her to make unwise decisions such as not maintaining a habitable living environment, accumulating financial debt, not taking medication as well as driving under a medical ban. At the visit, S insisted that she has no cognitive issues and that although she forgot things from time to time, she was not concerned. This is where I felt the difficulty lies, as it was clear that S lacked insight into her cognitive state and the risks she could possibly bare to herself. Although concerns were raised in regards to her personal care, as it was not causing herself or others harm it was not a need we could force action on. Doing so would be depriving the client of her liberty.

On completion of the visit, the objectives were met. S’s current health and presenting needs were identified and discussed with her. This was done to ensure she felt involved in the process and that her voice was heard. I felt I had met the aim of this case to manage the service user with a person centred approach. It was apparent during the visit that she lacked insight in acknowledging exactly what her health needs were.

Critical Analysis

However, I still included her in the decision making process in regards to the recommendations for her support. Those services are to be met by the client’s daughter in law, the clients GP and a private organisation as S declined services and social care involvement.

During my research for this case, I understood that a person-centred social care system should always be used in one`s professional practice. When speaking with S I advised that we encourage independence and just because a person it diagnosed with dementia, we do not feel that they cannot live independently. Stevens Tee proposes in his book Person Centred Approaches in Healthcare (2016, p.g 221) “ A person-centred health system is one that supports people to make informed decisions about, and to successfully manage, their own health and are, able to make informed decisions ad choose when to invite others to act on their behalf”. As professionals, we cannot assume service users lack capability due to their disability. I understood that by trying to force the client to accept services could be ethically wrong and classed as a form of discrimination. Assessing the client as not being able to maintain her welfare solely due to her cognition, would have been discriminatory. The Equality Act 2010 talks about making sure that people with disabilities are treated the equally and offered the same opportunities in life (within reason) as an abled bodied person. Based on this I felt that there should be a lot more support in place for clients such as S, who are diagnosed with dementia and live independently. It was not clear whether her non-compliance was due to her dementia, fear of the label of having dementia or fear of losing her independence. I personally felt that it was a combination of them all as on Dementia Champion training I was advised that Dementia tends to come with a negative social stigma that sufferers often avoid association with. I felt that this client would benefit from longer person-centred intervention method that gives the client a task centred approach to her needs. My practice educator shadowed my management of this case. She advised that I treated SS with respect and equality despite my knowledge of her disability. She advised that I demonstrated good person-centred, outcome focused practice when managing this case. She stated I also showed accountability for my own learning by seeking out relevant research in order to manage my case with confidence and understanding.

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References

Atkinson, J. (2006) Private and Public Protection: Civil Mental Health Legislation, Edinburgh, Dunedin Academic Press

Department of health. (2015). knowledge and skills statement for social workers working with adults. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/411957/KSS.pdf. Last accessed 24th April 2016

Department of Health 2013, Statement of Government Policy on Adult Safeguarding, Crown, United Kingdom. Last accessed 14th August 2016. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/197402/Statement_of_Gov_Policy.pdf

Jackie Pritchard. (2009 ). Reflections on practice. In: Jackie Pritchard Good practice in the Law and Safeguarding Adults. London: Jessic Kingsley publishers. p.g 209-2012.

The Care Act 2014. Availabe: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted. Last accessed 21st January 2017.

The Mental Capacity Act 2005. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf. Last accessed 14th August 2016.

The British Association of Social Workers. (2016). Professional capabilities Framework. Available: https://www.basw.co.uk/pcf/. Last accessed 25th April 2016.

Tim Spencer-Lane (2014). The Care Act Manuel. London: Thomson Reutera (professional) UK limited. p.g 25.

Statement of Government Policy on Adult Safeguarding 2013. (2016)

Stephen Tee (2016). Person Centred Approaches in Healthcare. London: Open University press. p.g221.

Critical analysis

Critical analysis 2

As this was my first safeguarding investigation, I thought it best to research up to date literature on safeguarding adults. There was a law commission on social care in 2011, and it called for a reform of safeguarding adults at risk to be changed to safeguarding vulnerable people. One of the recommendations was that all local authorities should have a legal obligation to take a lead role in investigating suspected cases of abuse with adults. “The draft Care and Support Bill (DH,2012b) proposes a duty on local authorities to make enquiries where there is a safeguarding concern (Gray and Birrell, 2013, p195). This has led to the current safeguarding adult’s legislation today that provides social workers working with adult’s, guidance on how to conduct safeguarding assessments and protect venerable people from the risk of abuse, neglect or self-harm. The Care Act 2014 makes reference to local authorities and safeguarding adults. When I first started my placement, I conducted training on safeguarding adults as well as the Care Act 2014. This legislation helped me to understand my role whilst conducting my investigation. As the local authority has a duty to “lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens” (Skills for Care 2015), It was my role to input a system around SE that safeguarded her against financial abuse. When reading the initial referral, I acknowledged that there were not many similarities with E and myself. We were quite different in age and shared no cultural similarities. Despite this, I made an effort to find common ground between us in order to try and build a relationship. I felt this was useful and important given the nature of the safeguarding referral. I felt the client was likely to be quite withdrawn and distrusting due

Critical Analysis

to the incident within her home. My first aim was to make sure I built a trusting relationship with E, making sure I created an environment for her where she felt safe and comfortable. Prior to meeting with E, I made sure to recap on my knowledge and understanding of working with vulnerable victims of abuse. This involved revisiting some of the readings about working with vulnerable abuse victims. One of these readings is the “Adult Safeguarding and Domestic Abuse: A Guide to Support Practitioners and Managers” (2014). This guide highlights about making connections between adult safeguarding and domestic abuse while providing definitions for these terms. Primarily, making connections between adult safeguarding and domestic abuse has been described to involve following the local policies, procedures and protocols for adult and children safeguarding from domestic abuse. Safeguarding has been defined as the act of protecting an individual`s right to safety hence keeping them free from neglect and ill-treatment. Further, the reading discusses the findings of research in this area and looks at how to work with people needing support and care. Some of the results of studies in this area include that a majority of domestic abuse reported are of women and have men as the principal perpetrators. Also, research has found that women are at a higher domestic abuse risk than men. This guide also has other useful information such as working with specific groups, mental capacity, adult safeguarding and domestic use, among others. Another key source of information for my recap was a report on “Guidance on Safeguarding and investigating the Abuse of Vulnerable Adults” (2012). This reading contained relevant information about the context of adult safeguarding, roles and responsibilities in safeguarding vulnerable adults as well as the Mental Capacity Act 2005. I also looked at “Protecting against harm: safeguarding adults” (Boland, Burnage & Chowhan, 2013). The authors of this article use different case studies to put the issues related to vulnerable abuse victims to perspective. The first case study focuses on abuse in a hospital setting and involves a 50-year-old man. The second case looks at investigating and preventing abuse and involves a diabetic 83-year-old woman. Although the client in my second analysis was not referred to social care for physical abuse, at this point, it was not clear the depth of her circumstances. Due to this, I felt it was ethical for me to make sure I was prepared. I conducted my own research on the different types of financial abuse and triggers to look out for.

Critical Analysis

Such abuse includes another person controlling one`s access to their own bank account or household money, the other person refusing to make a financial contribution to one or their family or the provision of money that is not enough to adequately cater for one's living expenses, taking out loans in someone’s name as well as being asked to account for how one spends their money. Other types of financial abuse include selling someone`s property, hiding money away from them or making someone to feel like they are not competent with money( Bond, et al., 2000). There were also financial abuse and triggers that are mainly experienced by the elderly. Such include being forced to change one`s will, being denied the right to control one bank accounts or credit cards, forging one’s signature and unauthorised possession of an individual`s property (Reeves & Wysong, 2010). I also researched on the effects financial abuse could have on a client. Some of the key findings of the study included; that financial abuse is the primary reason why more than 80 percent of customers, especially women, stay or keep returning to the abusive relationships. Since the perpetrators of this type of abuse destroy the victim's access to money, they remain without their own resources, which makes it difficult for them to take care of themselves and hence have to stick to the abusive relationship. I was also able to identify some of the short-term effects of financial abuse on a victim whereby they are unable to access assets that make life safe such as affordable housing and being able to provide for their children. On the long term basis, the victims are exposed to long-term safety and security issues. From a psychological point of view, I was able to find that financial abuse may result in other forms of emotional abuse which and can further have a consequence of the individual`s health by reducing their access to proper medication, healthy activities and good nutrition. Based on these findings, I made sure to keep an open mind when visiting the client. At this point, no persons had been identified as the culprit, and it was important not to give SE any false hope or make any accusations. Prior to the home visit, I established all care staff’s names that had access to the client’s home during the period in question. This enabled me to reduce the suspect list making it clearer as to who exactly had access to the property when the incident occurred. This practice was guided by the Care Act 2014 which states that a consideration of other things that could lead to the desired outcome should be done. As such, establishing the names of all care staff that accessed the

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Critical Analysis

client`s home during the period in question was a fundamental consideration that helped in the reduction of the suspect list hence increasing the probability of achieving the desired outcomes including who could have been the culprit. In order to prepare for this case, I made sure that all case notes, previous safeguarding’s and capacity assessments were analysed. By doing so, I would be establishing the facts and contributing factors leading up to the referral. From this, I came to understand the fundamental role that is played by assessing prior knowledge before carrying out an investigation on a client. The practice sheds light on various aspects of the case that may not have been clear hence putting one in a better position to conduct the investigation. Applying this knowledge along with what I had learnt through research and training, I felt that I now had the ability to carry out a safeguarding investigation independently. However, I also had the knowledge and understanding to be able to identify areas I would need superior support and guidance on. Looking into all possible outlooks as to how the purse could have gone missing and also looking into all possible suspects. My aim on this visit was also to identify and manage any risks and ensure the safety of SE. During my visit, I made sure to demonstrate compassion towards the E’s experience, showing understanding of how this incident could have done E feel disempowered and venerable within her own home. I made sure to demonstrate my professional understanding as to what my role is whilst investigating the safeguarding matter, showing my ability to communicate what my aims and outcomes are to her. I kept in mind that I needed to demonstrate all of this without giving E a false sense of hope in terms of results. However, making sure that despite the outcome of the investigation of theft, E is safeguarded to reduce the risk of another such incident happening again.

During this safeguarding investigation, I was able to maintain my professional conduct. I was able to demonstrate these by explaining my role as the social worker in relation to the safeguarding risk assessment. I was also able to prove some knowledge and understanding of the knowledge and skills statements for social workers in adult services relating to safeguarding. Where it states “Social workers must be able to recognise the risk indicators of different forms of abuse and neglect and their impact on individuals, their

Critical Analysis

families or their support networks and should prioritise the protection of children and adults in vulnerable situations whenever necessary”. I was able to identify the risk in this case without causing family dysfunctions or discomforts. With this case, the client’s grandson was one of the suspects. However, on assessing the client’s relationship with her grandson it was clear she was very close with him so was unlikely to want to accept him as a possible perpetrator. According to Lachs and Pillemer (2004), it would require some nerve to take or report a family member suspect in financial abuse. The author adds that it is evident that many family members are not willing to expose or subject their members to shame or embarrassment despite being aware of the ongoing financial abuse. In support of this Bond and Butler (2013) in their research on financial abuse and family member suspects, they explained that though the victims may be aware of their family members being suspects, they still admit that they would not like to see them subjected to punishment. Further, a study by Rabiner, Brown and O'Keeffe (2005) found that out of one thousand financial abuse cases that occur, in which the abusers are family members, only forty-four are reported to the relevant authorities. This also supports the common notion that family members are often unwilling to embarrass one of their own (Bond & Butler, 2013), hence always hesitate to take action when a family member becomes the key suspect in abuse. I was able to demonstrate a holistic approach to the identification of needs, circumstances, rights, strengths and risk. I was also able to meet this professional standard by my information gathering and multi-agency working practice. The professional standard was demonstrated by my ability to gather the necessary information as well as being able to provide an appropriate analysis regarding the information in order to deliver a suitable solution for the case. By looking at the available literature related to financial abuse before the investigation, I was able to equip myself with the necessary background knowledge about the subject that served as a professional guide. Making sure to use and demonstrate my critical, logical and reflective reasoning in my actions. This was depicted, for instance, by my demonstration of compassion towards the E’s experience, keeping an open mind when visiting the client as well as not giving SE any false hope or making any accusations.

Critical Analysis

The new reformed Care Act 2014 now states “The individual should be supported to participate as fully as possible in decisions, perhaps by family, friends or carer, or by an independent advocate if the local authority thinks the person has substantial difficulty in involvement and the person has no one else available to help them” (Guide to the Care Act 2014 and the implications for providers, 2014). Due to this, I had to make sure that I approached the case with a person-centred approach (Moyle, et al., 2011) making sure that my aim was to have solution focused outcomes that included the client’s involvement giving her choice and control. I demonstrated this by giving the customer's options on how she would like to reduce the risk of this happening again. In response, she accepted the options that I suggested to her such as not allowing financial pressure by any of those around her as well as ensuring that she is the only one with access to her money or her trusted family member. I discussed with her the options on how she manages her cash when it is in her possession. I highlighted to her that her condition of being bed bound and her current care package of many carers having access to her home does put her at a higher risk. This is because by having many carers accessing her home increases the probability that one among the many carers may engage in inappropriate behaviours that could translate to financial abuse of the old lady. This is supported by Reed`s, (2005) findings that reducing the number of people accessing an individual`s home can significantly bring down the risk of theft. However, I also highlighted to her that this does not mean measures cannot be put in place to protect herself and her personal items. I encouraged her to acknowledge that she has many strengths that she can pull on in order to monitor what goes on more within her home.

Although I was not able to identify who the culprit was, I feel that the aim of the visit was achieved. I was able to successfully assess the risks that are facing the client in light of their financial abuse. As stated earlier, one of the key risks that the client was exposed to is the abuse from her family members, particularly, her grandson. Besides, I was able to provide the client with a number of options to help her out of the challenging experience. I was able to identify the risk in this case without causing family dysfunctions or discomforts. When leaving SE`s home, I observed her seem a lot more assured and secured. How did I know this? This was evident from the client`s facial expression that depicted more happiness compared to what

Critical Analysis

was the case at the start of the investigation. There was also a reduction in the client`s signs of anxiety such as being unable to stay calm and still. SE was reassured that although we may not be able to identify who took the purse, all suspects were informed of our duty to safeguard and investigate. This may have informed the culprit that the client’s welfare and best interests are always being monitored by her local authority and the multi-agency professionals working with her. Informing family members and reminding professionals of the legal duty we have to protect our clients, may give the culprit a picture of a united front on behalf of the client. This is in fulfilment of one of the critical stages of safeguarding investigation, which is raising an alert. According to the safeguarding adults process, acting to protect adult at risk is one of the fundamental elements of the first stage of the safeguarding process (Graham, et al., 2016). I also felt it empowered SE and demonstrated the level of duty of care we have towards her as professionals. I felt it was important to make sure SE was aware of this in order to rebuild her self-confidence. Payne (1995 p.179) states that “empowerment examines the direct influence on social situations that we take part in…” If this is true, then it was important for me to make sure that although SE had a bad experience, she was still able to gain new strengths and understanding of her support systems around her and within her community.

My practice educator completed my final direct observation on this investigation. She provided me with feedback, advising that I was acutely aware of my professional capabilities, duty and boundaries when managing this case. She also suggested that I made sure never to make false promises to clients and to try and stay positive, focusing on solutions to move forward. I felt that this was accurate feedback which gave me the confidence to trust my developing capabilities as a professional.

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Boland, B., Burnage, J. and Scott, A., 2014. Protecting against harm: safeguarding adults in general medicine. Clinical Medicine, 14(4), pp.345-348.

Bond, M.C. and Butler, K.H., 2013. Elder abuse and neglect: definitions, epidemiology, and approaches to emergency department screening. Clinics in geriatric medicine, 29(1), pp.257-273.

Department of health. (2015). knowledge and skills statement for social workers working with adults. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/411957/KSS.pdf. Last accessed 24th April 2016

Graham, K., Norrie, C., Stevens, M., Moriarty, J., Manthorpe, J. and Hussein, S., 2016. Models of adult safeguarding in England: A review of the literature. Journal of Social Work, 16(1), pp.22-46.

Gray, A and Birrell, D (2013). Transforming adult social care. 3rd ed. Great Britain: The Policy Press. 195.

Jr, J.B., Cuddy, R., Dixon, G.L., Duncan, K.A. and Smith, D.L., 2000. The financial abuse of mentally incompetent older adults: A Canadian study. Journal of Elder Abuse & Neglect, 11(4), pp.23-38. Lachs, M.S. and Pillemer, K., 2004. Elder abuse. The Lancet, 364(9441), pp.1263-1272.

Local Government Association and Association Directors of Adult Social Services, 2014. Adult Safeguarding and Domestic Abuse: A Guide to Support Practitioners and Managers.

local government association. (2015). a guide to the care act 2014 and the implications for providers. Available: http://www.local.gov.uk/documents/10180/6869714/L14-759+Guide+to+the+Care+Act.pdf/d6f0e84c-1a58-4eaf-ac34-a730f743818d. Last accessed 25th April 2016.

Moyle, W., Murfield, J.E., Griffiths, S.G. and Venturato, L., 2011. Care staff attitudes and experiences of working with older people with dementia. Australasian Journal on Ageing, 30(4), pp.186-190. Payne, M (1995). Social Work and Community Care. New York: PALGRAVE. 179.

Rabiner, D.J., Brown, D. and O'Keeffe, J., 2005. Financial exploitation of older persons: policy issues and recommendations for addressing them. Journal of Elder Abuse & Neglect, 16(1), pp.65-84. Reed, K., 2005. When elders lose their cents: financial abuse of the elderly. Clinics in Geriatric medicine, 21(2), pp.365-382.

Reeves, S. and Wysong, J., 2010. Strategies to address financial abuse. Journal of elder abuse & neglect, 22(3-4), pp.328-334.

Reeves, S. and Wysong, J., 2010. Strategies to address financial abuse. Journal of elder abuse & neglect, 22(3-4), pp.328-334.

The British Association of Social Workers. (2016). Professional capabilities Framework. Available: https://www.basw.co.uk/pcf/. Last accessed 25th April 2016.

Critical Analysis


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