Table of Contents
Type: Case Study | Subject: Social Work (Health and Social Care) | Level: Undergraduate | Word Count: ~2,900 words
This model case study was produced by an Essays UK specialist as reference material for learning purposes only. For support in this field, see our health and social care writers.
Overview: This model case study examines the safeguarding of a fictional older adult, Mrs Eleanor Davies, whose circumstances raise concerns of self-neglect and suspected financial abuse. It applies the Care Act 2014, the Mental Capacity Act 2005 and the Making Safeguarding Personal framework to show how a social worker would assess risk, respond proportionately and promote the service user’s wellbeing.
Safeguarding adults at risk is a central responsibility of adult social care in England, and the Care Act 2014 placed adult safeguarding on a statutory footing for the first time. For older people, the interaction between declining health, reduced social contact and dependency on others can create conditions in which abuse, neglect and self-neglect flourish, often unseen. This case study presents a fictional scenario in order to demonstrate how a newly qualified social worker, operating within a local authority adult social care team, would respond to a safeguarding concern involving an older adult. The names, locations and specific details used throughout are entirely illustrative and have been constructed for the purposes of learning; they do not represent any real individual or event. The discussion applies relevant legislation, statutory guidance, policy frameworks and social work theory to the scenario, with the aim of illustrating sound, defensible and person-centred practice. It should be read as a model example that explains the reasoning behind safeguarding decisions rather than as a template to be copied.
Mrs Eleanor Davies is a fictional 82-year-old woman who lives alone in a privately owned terraced house in a residential area of Greater Manchester. She was widowed four years ago and has no children. Mrs Davies has a diagnosis of early-stage vascular dementia, type 2 diabetes and reduced mobility following a fall six months ago that resulted in a fractured wrist. She previously managed independently with occasional help from neighbours, but her circumstances have gradually deteriorated. Her only regular visitor is her nephew, Mr Mark Davies, who holds no formal legal authority but has informally taken over the management of her bank account, bills and shopping.
The safeguarding concern was raised by Mrs Davies’ general practitioner following a home visit prompted by a missed diabetic review appointment. The GP observed that Mrs Davies had lost a noticeable amount of weight, that the house was cold and in disrepair, and that there was little food in the kitchen. Mrs Davies told the GP that she did not have enough money for heating, although her nephew reportedly controls a reasonable occupational pension and state pension. A red reminder letter for an unpaid utility bill was visible on the table. When the GP gently raised the possibility of additional support, Mrs Davies initially declined, stating that her nephew “sorts everything out” and that she did not want to cause trouble. The GP, mindful of the duty to share safeguarding concerns, made a referral to the local authority adult social care team under the local multi-agency safeguarding arrangements.
On reviewing the referral, the allocated social worker identified several overlapping concerns that required careful disentangling. The Care and Support Statutory Guidance recognises ten broad categories of abuse and neglect, and the practitioner’s task is to consider which, if any, apply, while avoiding premature conclusions. In this scenario, three principal concerns emerged, as summarised below.
| Concern | Possible Category | Observed Indicators |
|---|---|---|
| Unmet basic needs | Self-neglect | Weight loss, cold home, limited food, missed health appointment |
| Misuse of funds | Financial or material abuse | Unpaid bills despite available income; nephew controlling account without legal authority |
| Deteriorating property | Neglect and self-neglect | Disrepair, unsafe environment, reduced capacity to maintain home |
It is important to note that the presence of indicators does not establish that abuse is occurring. The nephew’s management of finances might be well intentioned and simply informal and disorganised, or it might be exploitative; the evidence at the point of referral is insufficient to decide. Equally, self-neglect may reflect Mrs Davies’ own long-standing lifestyle choices rather than a loss of ability to care for herself. The social worker therefore approached the situation with professional curiosity, holding these possibilities open while gathering further information through assessment.
The statutory foundation for the social worker’s response is the Care Act 2014, which consolidated and reformed adult social care law in England. Section 1 of the Act establishes the overarching wellbeing principle, requiring the local authority to promote the individual’s wellbeing in everything it does, including their personal dignity, physical and mental health, control over day-to-day life, and protection from abuse and neglect. This principle frames every subsequent decision in the case.
Section 42 of the Care Act 2014 imposes a duty on the local authority to make, or cause to be made, whatever enquiries it considers necessary where it has reasonable cause to suspect that an adult in its area meets three conditions: that the adult has needs for care and support, whether or not the authority is meeting them; that the adult is experiencing, or is at risk of, abuse or neglect; and that, as a result of their care and support needs, the adult is unable to protect themselves against the abuse or neglect or the risk of it. Applying this test to Mrs Davies, the first condition is clearly met given her dementia, diabetes and mobility needs. The second is arguably met in relation to both self-neglect and possible financial abuse. The third condition is the most finely balanced: the practitioner must consider whether Mrs Davies’ cognitive impairment and dependence on her nephew reduce her ability to protect herself. On the information available, the social worker concluded that there was reasonable cause to suspect all three conditions were satisfied, thereby triggering the Section 42 duty to enquire.
The Care and Support Statutory Guidance sets out six principles that should underpin all safeguarding activity: empowerment, prevention, proportionality, protection, partnership and accountability. These principles are not merely aspirational; they provide a practical test against which interventions can be judged. In particular, empowerment and proportionality guard against the risk that safeguarding becomes paternalistic and risk-averse, stripping older people of choice and control in the name of protection.
Because Mrs Davies has a diagnosis of dementia, the Mental Capacity Act 2005 is engaged. The Act establishes five statutory principles, including the presumption of capacity, the right to make unwise decisions, and the requirement that any decision taken on behalf of a person who lacks capacity be made in their best interests and be the least restrictive option. Crucially, capacity is both decision-specific and time-specific, meaning that the practitioner must assess Mrs Davies’ capacity in relation to each particular decision rather than making a global judgement about her competence.
Article 8 of the European Convention on Human Rights, incorporated through the Human Rights Act 1998, protects the right to respect for private and family life. Any intervention in Mrs Davies’ life must therefore be lawful, necessary and proportionate. In addition, Section 68 of the Care Act 2014 places a duty on the local authority to arrange an independent advocate where a person would otherwise experience substantial difficulty in being involved in the safeguarding process and there is no appropriate individual to support them. Given Mrs Davies’ cognitive impairment and the potential conflict of interest involving her nephew, the practitioner should consider whether an independent advocate is required.
Having established the legal framework, the analysis now considers how the social worker would translate these duties into skilled, ethical practice. Effective safeguarding is not a mechanical application of rules but a reflective process that integrates legislation, theory and relationship-based practice.
The practitioner’s first analytical task is to clarify Mrs Davies’ decision-making capacity, because this determines how the whole case proceeds. Under the two-stage test in the Mental Capacity Act 2005, the social worker must first establish whether there is an impairment of, or disturbance in the functioning of, the mind or brain, and then whether that impairment means the person is unable to understand, retain, use or weigh the relevant information, or to communicate their decision. Mrs Davies’ dementia satisfies the first stage, but the diagnosis alone does not determine the second. The social worker should assess capacity in relation to the specific decisions at hand, for example whether to accept a package of care, whether to allow her nephew to continue managing her money, and whether to remain in her own home. It is entirely possible that she has capacity for some of these decisions and not others, and that her capacity fluctuates. Importantly, the principle that a person is entitled to make unwise decisions means that if Mrs Davies has capacity and chooses to live with a degree of risk, that choice must be respected, even where professionals would prefer a safer alternative.
Making Safeguarding Personal (MSP) is a sector-led framework promoted by the Local Government Association that reorients safeguarding away from a process-driven, professionally defined model towards one centred on the outcomes the adult wishes to achieve. Rather than beginning with the question “what procedures must I follow?”, the MSP approach begins with “what does Mrs Davies want to happen, and how can we work with her to achieve it safely?”. This aligns directly with the wellbeing principle in Section 1 of the Care Act 2014 and with the empowerment principle in the statutory guidance. In practice, the social worker would seek a private conversation with Mrs Davies, away from her nephew, to understand her own view of her situation, her wishes and her desired outcomes. She may, for instance, wish to remain at home, maintain her relationship with her nephew, and simply have more money available for heating and food. Framing the intervention around these outcomes is more likely to secure her engagement than imposing a solution upon her.
Risk in this case is multi-dimensional and dynamic. The social worker must weigh the risk of harm from self-neglect and possible financial abuse against the risks associated with intervention itself, including the loss of Mrs Davies’ autonomy, the potential rupture of her only close relationship, and the distress that a heavy-handed response might cause. The proportionality principle requires that the response be the least intrusive consistent with managing the identified risk. A defensible risk assessment would therefore document the specific risks, their likelihood and potential severity, the service user’s own attitude to those risks, and the protective factors already in place, such as the involvement of the GP and attentive neighbours. Crucially, a proportionate response does not mean eliminating all risk; it means enabling Mrs Davies to live the life she chooses with risk managed to an acceptable level, a stance sometimes described as positive risk-taking.
The strengths perspective in social work encourages practitioners to identify and build upon the resources, capabilities and networks that a person already possesses, rather than defining them solely by their deficits and needs. Section 1 of the Care Act 2014 reinforces this orientation by requiring authorities to consider the individual’s own strengths and the support available from their wider network. In Mrs Davies’ case, relevant strengths include her clear wish to remain independent, her retained capacity for many decisions, her home ownership, her pension income, and her supportive neighbours. A strengths-based conversation might explore whether a befriending service, a telecare package, meals support, or assistance with budgeting could restore her independence without recourse to more restrictive measures. This approach is not naive optimism; it is balanced against the identified risks, but it ensures that the intervention enhances rather than diminishes Mrs Davies’ sense of control.
The suspicion of financial abuse requires particularly careful handling. The partnership principle and Section 6 of the Care Act 2014, which places duties of co-operation on relevant partners, underpin a multi-agency response. If Mrs Davies has capacity to manage her finances, the social worker’s role is to inform her of her options, which might include arranging for the Department for Work and Pensions appointeeship, a Lasting Power of Attorney for a trusted person, or support from her bank’s vulnerable customer service. If she lacks capacity for financial decisions, the matter may need referral to the Office of the Public Guardian, and the social worker should establish whether any Lasting Power of Attorney or deputyship exists. Where there is evidence of criminal exploitation, the police would be an essential partner, and the practitioner must balance the duty to protect with Mrs Davies’ wishes about police involvement, recognising that pursuing a criminal route against a relative she loves may not be the outcome she wants. Throughout, the accountability principle requires transparent, well-recorded decision-making so that the rationale for each step is clear and defensible.
Good practice also requires the social worker to consider the nephew’s own circumstances. Informal carers can experience significant strain, and what presents as abuse may sometimes reflect a carer who is overwhelmed, poorly informed or struggling to cope. Section 10 of the Care Act 2014 provides for a carer’s assessment where a carer appears to have needs for support. While the possibility of financial abuse must never be minimised, approaching the nephew with professional curiosity rather than accusation may both protect Mrs Davies more effectively and open the way to supporting the family relationship, provided this is consistent with her wishes and safety.
Drawing the analysis together, the following actions would represent a proportionate, person-centred and legally sound response to the safeguarding concern:
This model case study has demonstrated how a social worker would respond to a safeguarding concern involving a fictional older adult experiencing self-neglect and suspected financial abuse. The analysis has shown that effective safeguarding under the Care Act 2014 is far more than a procedural exercise; it is a balanced, reflective practice that holds together the duty to protect and the equally important duty to promote autonomy and wellbeing. The Section 42 duty provides the legal gateway to enquiry, but the quality of the response depends on the skilled integration of the Mental Capacity Act 2005, the six safeguarding principles, the Making Safeguarding Personal framework and a strengths-based orientation. By assessing capacity carefully, centring Mrs Davies’ own outcomes, acting proportionately and working in partnership, the social worker can manage risk without stripping away the independence and dignity that the legislation is designed to protect. As with all safeguarding work, the final test is whether the intervention leaves the person safer and more in control of their own life, and whether every decision taken on their behalf can be clearly and transparently justified.
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