Mrs E is an 85 year old woman who has been married for the past forty years. She lives at home with her husband who is also in his eighties. Mrs E is partially sighted, hard of hearing, and suffers from hydrocephalous, causing poor mobility, aggressive behaviour and lack of insight into her difficulties.

A care assessment revealed that Mr E provided care to his wife as she became more dependent. Various services were offered to the couple, sitting service, day care, domiciliary care and respite, all of which ere ultimately refused or cancelled. Flash points occurred when Mr E provided personal care for his wife or after she had fallen. Mr E became increasingly stressed by the home situation, but loathed paying for input via Social Services.

It was noticed that there was bruising on Mrs E’s Chest and on her upper and lower arms. Mrs E was lucid and able to confirm to the Care Manager that her husband had caused the injuries and that he had also threatened to smother her.

The couple’s marital situation had always been volatile but Mrs E had always been the prime aggressor, her husband however had never retaliated physically in the past.

Mr and Mrs E wanted to stay at home, but it was thought tat Mrs E lacked the insight to appreciate the risks of her situation, so a strategy meeting was put together.

The following actions were agreed at the meeting:

• Police to visit Mr E to speak to him about hitting his wife as it was thought that a man of Mr E’s age would listen to what the police had to say, in fact the situation did calm down for about two weeks, but then started again.
• GP to visit on a regular basis
• District nurses to visit on a regular basis to dress Mrs E’s legs and to keep a watching brief
• Mr E persuaded to accept home care three times per day.
• Advice to be obtained from the County Council’s legal section on the type of order we could use to move Mrs E to safety if needed.

 

A further incident occurred and a further strategy meeting was called, following which:

• an assessment of Mrs Es mental health was arranged
• continued support was provided by the GP and district nurses
• a decision was made to admit Mrs E to hospital under the mental health act
• decisions were made regarding guardianship

 

Central to this case was the need to all services to work closely together to support Mr & Mrs E in the community for as long as possible.

This example clearly demonstrates how in Cambridgeshire we have created a “framework for action” (No Secrets 2000) in which all agencies work together effectively to protect vulnerable adults from abuse.