When vulnerable individuals in our society are subjected to abuse by their carers, our response as a community is understandably one of outrage. It seems beyond belief that this could happen. But the sad reality is that some individuals within aged care facilities, disability care contexts, at home or in childcare centres can face abuse from the very people with whom they should feel entirely safe.
It is clear to us that employers and individuals within the care and community space want to know the best ways to identify, prevent and deal swiftly with allegations of abuse by carers. Accordingly, we closely examine definitional issues, NDIS implications, criminal factors and ‘red flag’ phenomena such as unexplained injuries in care contexts. The often sinister and exploitative manifestations of financial abuse will also be placed under the spotlight.
As an organisation, Wise Workplace is passionate at about deploying our investigative, training and advisory resources for the purpose of enhancing work and community places. In this and upcoming articles, we’ll examine some of the complex challenges faced by investigators when allegations of abuse by carers arise.
Defining abuse, common offences and likely culprits
Physical abuse can certainly be one of the more visual and confronting forms of abuse by carers. However, other less-obvious forms of abuse can be just as damaging and terrifying for the client involved.
Psychological and emotional abuse by carers can include violent anger, emotional manipulation and control strategies. And when discussing financial abuse by carers, the murky waters of ‘gift versus theft’ can be extremely difficult to traverse. Sexual abuse and manipulation also casts a shadow over care environments and the carer/ client relationship. As we have seen with the Royal Commission into Institutional Responses to Child Sexual Abuse, Australian children have historically suffered terrible assaults at the hands of so-called carers.
In terms of the more common offences, these can include common physical assaults such as rough-handling or scalding, misuse of restricted practices, and excessive and humiliating discipline. Less visible yet still horrendous acts of omission can amount to criminal negligence by a carer, such as threatening or failing to provide fluids or food. Yet despite the subject matter, investigators must take care to remain objective and fair throughout the entire course of an abuse investigation.
NDIS complaints system
We certainly all hope that the National Disability Insurance Scheme (NDIS) will ease some of the financial suffering and lifestyle challenges for disabled individuals. The vision of the NDIS has always been strong and simple – to enable Australians with a disability to curate what we all aspire to: an ‘ordinary life’.
Complaints connected to the newly-fledged system were of course inevitable. The NDIS complaints system enables participants to voice concerns both with their individual situation and the broader scheme. Yet how effectively the NDIS complaints scheme works for individual situations is still somewhat uncertain. Certainly, those with a disability can lodge an NDIS complaint about a provider of care, but the most that can currently happen is the removal of the provider from the scheme list.
In NSW, reportable incidents affecting a person with a disability in a residential facility are required to be investigated and reported to the Ombudsman for oversight. The legislation does not cover in-home services and does not come with a national or even state-based ‘suitability to work with disability services’ checking system, like the sister child protection legislation now effective in NSW, the ACT and Victoria.
There are national reporting schemes in place for aged care service providers, but these have limited scope and there’s no effective mechanism for preventing a carer found to have been abusive from finding further employment as a carer.
Ultimately while the system is improving, protection will come from prevention through good governance and policy, and effective investigation of incidents when they come to light.
Criminal conduct – likely conviction in children’s services, aged and disability sector
Many relationships within the children’s services, aged care, and disability sectors can develop unique complexities that arise as a result of dealing with dependence. Stress and isolation are just two issues that can affect both people with this vulnerability, and their carers. Yet it hardly follows that criminal conduct on the part of a carer can be excused due to the stressful nature of the job. Assault, fraud and theft can and do arise.
Not only is abuse grossly under reported by vulnerable people due to the relative power imbalance of the carer/client relationship, fear of reprisal, not being believed and the very real possibility of the service being removed, but their reports are not treated as being equal to those of their non-dependent counterparts.
Significant challenges are faced by the young, elderly and disabled when trying to communicate their story, and in being believed.
When faced with a complaint from a client of abuse or abhorrent conduct by an employee or carer, employers are often forced to confront the unbelievable. The first reaction can be disbelief, and this is swiftly followed by the search for some rational acceptable explanation for the report, injury or loss.
When matters are reported to the police, the justice system is constrained by the requirement of a high standard of proof and convincing verbal evidence to be provided to support the physical evidence, if there is any.
While this approach can be very effective at conviction where serious criminal offences have left unquestionable physical evidence, the myriad offences where very little or no conclusive physical evidence is left leaves the criminal justice system rather lacking.
For the safeguarding of the vulnerable and the safety of carers, a skilled independent investigation of complaints by the service provider is paramount.
Grooming and sexual manipulation: identifying the warning signs
Recognising the hallmarks of grooming can radically increase the opportunity for service providers to eliminate sexual and financial abuse in care situations.
The inclusion of grooming as a set of behaviours in the NSW Reportable Conduct legislation is no accident.
Common behaviours of grooming include showing special attention to one client over others, buying gifts and establishing often secret private communication networks. Tapping into our most basic human need to be loved, adults and children alike are vulnerable to this tactic.
Common behaviours of grooming include showing special attention to one client over others, buying gifts and establishing often secret private communication networks. Tapping into our most basic human need to be loved, adults and children alike are vulnerable to this tactic.
The aim of the abuser is to establish a perception of a special relationship that facilitates the request of favours that would otherwise be denied. These favours may be sexual or financial.
Clear policy guidelines, recurrent education of carers about professional boundaries and the important role of bystander observation are all critical in preventing grooming in care situations. Often only possible in high trust relationships, grooming and abuse can flourish when alternate support and social systems are degraded through loneliness or isolation.
The investigation of breaches of professional boundaries or grooming behaviour requires an intimate knowledge of this behaviour and careful consideration of the communication systems in place.
Investigating unexplained injury in care facilities
It goes without saying that injuries occur in all workplaces, not just the community sector. Yet there are certain injuries that can arise in care environments that understandably cause warning bells to ring for employers and loved ones alike.
Bruising to the head and upper body can be a clear sign that all is not well. Unexpected bed sores, scalds or unusual abrasions can also indicate that the ‘care’ in care facility might need immediate attention.
Yet like the collection of any evidence, workplace investigators must be extremely careful not to jump to conclusions when an unexplained injury arises.
If we see a vulnerable individual with an injury, it is essential that facts be collated with a clear head. With the right investigation tools, careful and informed analysis of expert medical and other objective evidence, valuable decisions can be made.
Financial abuse: what does it look like?
For both professional and volunteer carers, there is no doubt that the task of caring can be rather thankless. As a result, the temptation to use power inappropriately for financial gain can be all too real. Minors can also be taken advantage of financially.
Financial abuse of those in a care situation can take on a number of forms. A Power of Attorney might be deployed in a manner that sees unexplained money disappear from a patient’s bank account. Aged, disabled and/or child clients can also be cajoled or tricked into signing documents that place their finances in peril. Sometimes a carer will suggest they ‘look after’ the patient’s sizeable home and then send them to live in poverty.
At a more basic level, we sometimes simply see valuables and cash removed from rooms, or heavy-handed tactics being used on pension day to allow ATM access. Emotional weapons are often deployed.
Abuse by carers – a fair investigation is crucial
Whether you need to inquire about the investigation of suspected abuse by a carer, want training around the issue, or are seeking advice on your safeguarding processes, Wise Workplace can provide a suite of solutions designed for your situation.
Abuse against vulnerable children, the elderly and/or people with a disability unfortunately persists across society. However, safeguarding and investigation of alleged abuse by carers is an area of strength for us – give us a call.
Content retrieved from: http://www.wiseworkplace.com.au/_blog/WISE_Blog/post/investigating-complaints-of-abuse-by-carers/.
