Aged care providers have been in the media spotlight in recent weeks. While some are alleged to have financially exploited the elderly others are alleged to have provided a substandard level of care. Research conducted by Curtin University in 2015 suggests that some 167,000 older Australians may be subject to abuse annually.
Like many other types of domestic or sexual violence, it is also likely that elder abuse is significantly under-reported, so the true scope of abuse may be far greater.
what is elder abuse?
According to the World Health Organisation, elder abuse is ‘a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.’ The perpetrators of elder abuse can include children, spouses, friends and neighbours, or staff at care facilities where the victims reside.
There are many different forms of elder abuse, including:
- Physical Abuse – Inflicting physical pain, injury or impairment. Can include forcibly restraining or inappropriately requiring the consumption of drugs.
- Emotional or Psychological Abuse – especially through intimidation, humiliation, mockery, isolating, ignoring, or menacing the elderly person. In a care facility, this could include repeatedly and intentionally ignoring calls for assistance.
- Sexual Abuse – apart from the obvious, this can include forcing the elderly to watch pornographic material, or even forcing them to take their clothes off without legitimate reasons.
- Neglect or Abandonment – failing to provide a requisite standard of care.
- Financial Abuse – includes outright theft, coercing elderly people into handing over funds or altering wills. Of particular concern are situations where carers are granted enduring powers of attorney, which enable the holder to undertake all legal actions that the person otherwise would be entitled to. Enduring guardianships relate to the right to make medical or health-related decisions on behalf of another person.
- Healthcare Fraud – such as billing for services which have not been provided, or intentionally over/under-medicating for a self-interested reason such as ‘kickbacks‘ from pharmaceutical providers.
what are the signs?
Potential signs of the various types of elder abuse include:
- A bad or unusual relationship between a care provider and recipient.
- Unexplained injuries
- Insistence by the caregiver that the victim is never attended to without them being present.
- Behaviour mimicking dementia (even when the victim does not suffer from this condition), which may suggest an emotional regression due to ongoing abuse.
- Ongoing poor hygiene and living conditions.
- Significant financial withdrawals being made from the victim’s accounts, or noticeable and inexplicable generosity by the suspected victim towards a specific caregiver.
Of course, this is not an exhaustive list. Care providers and employers should ensure that any behavioural or physical changes in their clients are observed and monitored, particularly sudden ones, which occur without explanation.
In terms of the Aged Care Act 1997, Section 63-1AA the definition of a mandatory reportable incident for persons in residential care include unlawful sexual contact and unreasonable use of force on a resident.
Providers are required to report to the Department of Health and the Police within 24 hours if they have any suspicion or allegation of reportable assault.
For person receiving home or flexible care, reportable incidents to the Department of Health include financial abuse. This does not extend to residents in aged care facilities, however, residents’ financial abuse still needs to be reported to the Police.
common risk factors for elder abuse
In the context of care facilities, the greatest risk factors for elder abuse include:
- Poor staff training or lack of awareness about what type of treatment is expected to be provided.
- Unhappy working conditions, contributing to staff feeling that they need to ‘lash out’ at clients.
- Excessive responsibilities and inadequate levels of support.
- Inappropriately vetted staff, including those with substance abuse issues.
- Inadequate policies and procedures related to the protection of vulnerable people and a lack of staff awareness of these policies.
- Inadequate complaint handling mechanisms.
Residents who may be particularly likely to become victims of elder abuse include those who are physically or mentally frail, or those who may be perceived as being very unpleasant to work with – causing care workers to demonstrate inappropriate frustration or aggression.
How to prevent the risk of ELDER ABUSE
Apart from remaining vigilant about the potential risk factors and apparent signs of elder abuse, care facilities must ensure that:
- All resident and staff concerns are appropriately listened to and noted.
- All staff have have undergone criminal checks.
- Intervention occurs immediately when elder abuse is suspected and workplace investigations are thorough and swift.
- All staff are appropriately trained in the relevant policies and procedures and how to recognise and prevent elder abuse.
COMPLICATIONS ARISING FROM THE AGEING MEMORY
Mild memory loss and a slowing down of thinking is a natural part of ageing. But while many elderly people are still capable of managing their own affairs, others who have serious conditions such as dementia may lose the capacity to do so.
In some cases, the simple fact that a person has an ageing memory may mean that they are treated as though they do not have any capacity to make decisions for themselves, and are thus at greater risk of elder abuse.
In the context of patients with dementia or other serious memory loss issues, any complaints they raise may be discounted out of hand as being fabricated. However, when coupled with other signs of potential elder abuse, they should be investigated.
Complications can also arise around eyewitness memory and conducting interviews in workplace investigations. In such cases, cognitive interviewing techniques can be helpful.
This may include allowing a witness to draw a sketch or use visualisation techniques, asking them to explain everything that occurred, taking them over events in reverse order, and asking them about how they were feeling at the time of the event can all assist in memory recall.
Conducting investigations into elder abuse in care contexts can be challenging. The WISE Workplace team is experienced in conducting independent, competent and unbiased investigations into reportable conduct and abuse complaints in care settings. Contact us to discuss your needs, and how we can help.