Elder Abuse

Elder Abuse

Question 1 What is elder abuse? The International Network for the Prevention of Abuse of Older People (INPEA) and the World Health Organisation (WHO) define Elder Abuse as: “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 t an older person. Abuse of older people can be of various forms such as physical, psychological/emotional, sexual and financial. It also reflects intentional or unintentional neglect. (ACT Government Community Services, June 2012) Question 2 List five types of abuse. Give a brief description of each of elder abuse and an example of sign’s that could indicate abuse is occurring. Forms of Abuse of Older People: Physical Abuse: the infliction of pain or injury. This can include hitting, pushing, punching, kicking, biting, scratching, shaking, slapping, dragging, burning, inappropriately restraining or confining, inappropriately medicating, and damage to property.

Psychological Abuse: inflicting mental anguish through actions that cause fear of violence, isolation or deprivation, and feelings of shame and powerlessness. It may nclude verbal intimidation, humiliation or embarrassment, shouting, bullying, threats of physical harm, threats of institutionalisation, withdrawal of affection (e. g. refusing access to grandchildren), emotional blackmail, damage to, or removal of property and possessions, removal of decision-making powers, or preventing access to services.

Sexual Abuse: unwanted sexual behaviour including rape, indecent assault, sexual harassment or inappropriate touching. Financial Abuse: the illegal or improper use of an older person’s finances or property. It may include stealing, misappropriating money, forcing changes to a will or other egal documents, denying access to personal funds, forging signatures or misusing Power of Attorney. Neglect: the failure of a carer to provide the necessities of life to a person for whom they are caring.

Neglect can be intentional or unintentional. Intentional neglect is when an older person is abandoned or not provided with adequate food, clothing, shelter, medical or dental care, or where their spiritual needs are not met. It also includes improper use of medication, poor hygiene or personal care, or the refusal to allow other people to provide adequate care. Unintentional neglect occurs when a ay not be aware of the types of support available, or may be ill and unable to meet the person’s needs.

Social Abuse: preventing a person from having contact with friends or family, or access to social activities. It includes intrusion, isolation, and preventing independence using threats, manipulation and control. (Advocare 2012) Signs that would indicate that abuse is occurring would be: Physical – Behavioural Showing signs of being afraid of a particular person/people Appearing worried and/or anxious for no obvious reason Becoming irritable or easily upset Appearing depressed or withdrawn

Losing interest Sleep disturbances Changed eating habits Having thoughts of suicide Frequent shaking, trembling and/or crying attacks Rigid posture Presenting as helpless, hopeless or sad Making contradictory statements not resulting from mental confusion Reluctance or hesitation to talk openly, waiting for the carer to answer Avoiding physical, eye or verbal contact with carer or service provider. Psychological Abuse The person may be huddled when sitting and nervous with the family members or carer nearby Insomnia, sleep deprivation and loss of interest in self or environment

Fearfulness, helplessness, passivity, apathy, resignation, withdrawal Sexual Abuse It can be very difficult to identify, as embarrassment and shame may prevent the subject from being raised. Medical or nursing staff should examine the genital areas for bruising, bleeding, and painful areas. Check for torn, stained or blood stained underwear. Look for evidence of sexually transmitted disease. Watch for difficulty in walking or sitting. Any of these signs may be indicative of sexual abuse.

Financial Abuse This is the improper use of a person’s money, property, or assets by someone else. Money can be a very sensitive subject. Gear of not having enough money for future care, or feeling obligated to others can leave a person vulnerable. These feelings can be reinforced and used as a threat. Material or financial abuse may be more easily detected when clients are visited in their own homes. Neglect This is where a person is deprived by the carer, or the carer is unable to provide the necessities of life.

If food or drinks are being withheld, there is malnutrition, weight constipation or faecal impaction Isolation, lack of mental, physical, social or cultural contact Inadequate supervision, the person is abandoned/unattended for long eriods or locked in the house with any supervision There may be evidence of inadequate or inappropriate use of medication, for instance, the person may be over- sedated in the middle of the day There may be evidence of unmet physical needs such as decaying teeth or overgrown nails The person may be lacking necessary aids such as spectacles, dentures, hearing aids or walking frame Clothing may be poor hygiene or inadequate skin care. The victim may be very dirty, smell strongly or urine or be infested with lice. There may be a urine rash with abrasions and chafing Hypothermia, recent colds, bronchitis or pneumonia Department of Human Services September 1997) Question 3 Who is vulnerable to abuse? Abuse of older people crosses gender, social-economic, religious and cultural boundaries. Abuse is more likely to be inflicted by family members, especially an older person’s adult children.

Older people are at increased risk of abuse when they: Have a disability or poor health; Are in dependent caring relationships, particularly where a carer is experiencing carer burden or carer stress; Are isolated and/or without personal supports Have a past history of violence or conflict within the family Exhibit particularly ifficult and/or inappropriate behaviour, and/or confusion or memory loss; or Exhibit signs and symptoms of dementia. Question 4 What reporting mechanisms/systems are in place in residential care to address elder abuse? Recent amendments to the Aged Care Act 1997 (the Act) are designed to increase safeguards for residents of Aged Care homes. The Act requires approved Aged Care providers to report allegations or suspicions of unlawful sexual contact, or unreasonable use of force on a resident of an Australian Government subsidised Aged Care home. From 1 July 2007 Aged Care providers must have systems and protocols in place that nable compulsory reporting of such incidents.

If the approved provider receives an allegation of, or starts to suspect on reasonable grounds that unreasonable use of force or unlawful sexual contact on a resident has taken place, they must report the allegation or suspicion as soon as reasonably practicable and within 24 hours to the Police and the Department via the Aged Care Complaints Scheme. They must also provide protections for staff who report abuse. (Aged Rights Advocacy Service 2012) Question 5. are no mandatory reporting laws for elder abuse anywhere in Australia. As from 1 July 2007 Compulsory Reporting of certain assaults, inflected on a recipient of residential care was imposed on providers of Australian Government subsidised Aged Care homes.

Amendments to the Aged Care Act 1997 (the Act) are designed to Aged Care providers to report unlawful sexual contact or unreasonable use of force on a resident of an Australian Government subsidised Aged Care home. (Aged Care Act 1997) Question 6 Who is primarily responsible for services relating to abuse of the older person in the wider community? List the range of responses Elder Abuse and the Law – Mandatory Reporting There are no mandatory reporting laws for elder abuse anywhere in Australia. As from the 1st July 2007 Compulsory Reporting of certain assaults, inflicted on a recipient of residential care was imposed on providers of Australian Government subsidised Aged Care homes.

Amendments to the Aged Care Act 1997 (the Act) are designed to increase safeguards for residents of Aged Care homes. The Act requires approved Aged Care providers to report unlawful sexual contact or unreasonable use of force on a resident of an Australian Government subsidised Aged Care home. Suggested interventions include: Crisis care Provision of community support services Provision of respite care Counselling Alternative accommodation Legal interventions including police involvement, restraining orders, and applications for guardianship and financial management. At this time the evidence in support of mandatory reporting is not convincing. The consensus of government reports and researchers has been to oppose the introduction of mandatory reporting.

Workers and agencies are encouraged to seek advice from specialist services whenever required (e. g. Aged Care Assessment Teams, legal services, Police, mental ealth services, sexual assault services). All agencies that provide services to older people have the following roles in responding to the abuse of older people: Refer suspected, disclosed or established cases of abuse to appropriate services Identify possible abuse of older people (Australian Society for Geriatric Medicine Position Statement No. 1 Elder Abuse) Are older people with Dementia at higher risk of elder abuse? Support your answer Older people with dementia are more likely to be abused than those who are cognitively intact.

This may be related to increased dependence on carers or to a ower likelihood of seeking help. Mistreatment occurs when C6s (referred to hereafter as care givers) cause harm to persons with dementia (referred to hereafter as care recipients (CRs) through their actions or failure to act. Risk factors can be characteristics of the CR, the CG, their relationship, and the environment. These formed the design of the current study. Some CG factors associated with mistreatment of CR include poor health, social isolation, and mental health problems such as depressive symptoms and anxiety. The CG’S perception of caregiving burden has been associated with multiple types of abuse.

Similarly, being a spouse CG, duration of caregiving, and a shared living arrangement have been associated with mistreatment. A poor pre-morbid relationship was associated with CG physical aggression, whereas a good pre-morbid relationship and the use of formal services were associated with lower likelihood of mistreatment. CR factors significantly related to elder abuse included poor functional status and more-severe cognitive impairment. Several studies have associated CR behavioural problems with mistreatment, and CR physical aggression specifically with physical abuse. (Wiglesworth A, Mosqueda L et al Journal of American Geriatric oc. 2010) Question 8 List the key strategies for prevention/early intervention of Elder Abuse.

Key strategies for preventing abuse include: ??? Encouraging and supporting older people to stay active and socially connected ??? Ensuring that older people have access to independent information and advice prior to making decisions about financial and housing matters ??? Educating older people to assert their rights and gain support where necessary ??? Facilitating older people’s use of powers of attorney and guardianship which can enable them to plan for and have choice over who will have control over their affairs f they lose capacity in the future ??? Educating professionals to identify and respond to abuse Community care agencies and workers have an important role to play in implementing these strategies. Strategies to provide easier access to information and advice through ‘helplines’ and specialised abuse services can be effective. Queensland, Victoria and the ACT have implemented ‘helplines’ with positive feedback from a Queensland evaluation (Procopis 2007). The Victorian, WA and ACT Governments have developed state wide policy frameworks addressing the abuse of older people. The Victorian Government’s Elder Abuse Prevention Strategy, for example, includes a financial literacy program, an education and training package for professionals, specialist legal and advocacy services and community education (Office of Senior Victorians 2009).

Page Research to Practice Briefing 3 ??? February 2010 REFERENCES ACT Government Community Services, June 2012, ACT Elder Abuse Program Policy, viewed 30 May, 2013 http://ACT (ACT Elder Abuse Program Policy). Advocare – viewed 30 May 2013: http://www. Advocare. org. au 2012. Aged Care Act 1997, Australian Government Department of Health & Ageing 4 May, 2013. Aged Rights Advocacy Service (ARAS) 2012, viewed 24/5/13. – viewed Australian Society for Geriatric Medicine Position Statement No. 1 Elder Abuse Department of Human Services – Southern Metropolitan Region, (Dealing with Elder Abuse – September 1997). Government Community Services, June 2012, Government Community Services, June Government Practice Guidelines for Health Services and Community Agencies for the Prevention of Elder Abuse – viewed 30/5/13. ervices and community agencies Wiglesworth A, Mosqueda L, Mulnard R, Liao S, Gibbs L, Fitzgerald W. Screening for Abuse and Neglect of People with Dementia – Viewed 4 June, 2013, http:// Medscape. com/viewpublication 2010 (American Geriatric Soc. 2010. ) PART B – case study Your grandmother lives in an aged care facility and overall seems happy with the care that she receives. However, recently the staff seems to be very busy and do not attend to her toileting needs. When you speak to the staff they are too busy to attend for some time. Your grandmother finds this very distressing. You are her representative and she has indicated that she wants you to intervene on her behalf. What rights does your grandmother have?

My grandmother has the right o full and effective use of her personal, civil, legal and consumer rights to quality care appropriate to her needs to have full information about her own state of health and about available treatments neglect to live without discrimination or victimisation, and without being obliged to feel grateful to those providing her care and accommodation to personal privacy to live in a safe, secure and homelike environment, and to move freely both within and outside the residential care service without undue restriction to be treated and accepted as an individual, and to have her individual preferences taken into account nd treated with respect to continue her cultural and religious practices, and to keep the language of her choice, without discrimination to select and maintain social and personal relationships with anyone else without fear, criticism or restriction to freedom of speech to maintain her personal independence to accept personal responsibility for her own actions and choices, even though these may involve an element of risk, because she has the right to accept the risk and not to have the risk used as a ground for preventing or restricting her actions and choices to maintain control over, and to continue making decisions about, the ersonal aspects of her daily life, financial affairs and possessions to be involved in the activities, associations and friendships of her choice, both within and outside the residential care service to have access to services and activities available generally in the community to be consulted on, and to choose to have input into, decisions about the living arrangements of the residential care service to have access to information about her rights, care, accommodation and any other information that relates to her personally to complain and to take action to resolve disputes o have access to advocates and other avenues of redress to be free from reprisal, or a well-founded fear of reprisal, in any form for taking action to enforce her rights. (User Rights Principles 1997) Question 2 What is the Act that protects residents against abuse in Aged Care Facilities? The Charter of Residents Rights and Responsibilities under the Aged Care Act 1997 explicitly states that people living in aged care homes have the right to be treated with dignity and respect, and to live without exploitation, abuse or neglect. A process for reporting allegations of suspicions of physical assault and unlawful exual contact to the Victorian Department of Health was established in 2007. The reporting is consistent with accountability principles that underpin funding to all Victorian public health services.

All Public Sector Residential Aged Care Services (PSRACS) must notify the department of these reports, at the same time or within 24 hours of advising the Scheme, Victoria Police and resident’s family. Question 3 How can you advocate on behalf of your grandmother? Outline your approach. If I did feel a complaint was warranted I would bring it up to a staff member that I was comfortable dealing with. If this was a serious complaint I would take it up with the home’s administration. If I was uncertain I would ask, talk it over, perhaps have a chat to someone that I trusted who was not emotionally involved to get a clear picture of my grandmother’s situation and another opinion.

Approach staff- Talk to the staff finger at tired or uneducated nursing staff. A phrase that has a negotiatory tone is much more likely to get the response required. It should be put in the ‘l’ sense such as “I’m concerned that such as such is happening”. Talk to management- If no action is taken talk to the next person up the ladder. Use your support person to record events from a less emotional position. Using a back up person also shows you are less likely to back off. Record events- Start taking notes of the situation including the sequence of events and any relevant dates, names and staff responses. Nursing homes should have a complaints process in place, don’t wait too long to lodge a complaint.

Making an official complaint- If things are still unsatisfactory, it is now time to use the official complaints mechanism of the organisation or aged care system. This is where having kept a record is imperative. A well documented difficulty nd the sequence of events is much more likely to be corrected than one that is hazy. (Aged Carer) I would be sure that my Grandmother was kept informed that everyone was working on the complaint and giving her status reports. Your grandmother asked you to advocate on her behalf. What type of advocate would you be? Advocacy is about someone’s life. The aim would be to keep the focus of any discussion on my grandmother. Something that might be a good idea for one person, might not be a good idea for another.

I would need to discuss with the residential care home my grandmother’s individual needs and expectations. I would represent my grandmother who I was advocating for what she values and her communication, temperament, methods and style, what brings on a smile, etc. I would avoid avid direct confrontation and go for a win/win situation. Question 5 What outside agencies would you approach on behalf of your grandmother if your complaint is not dealt with effectively? I could contact the Public Sector Residential Aged Care Services (PSRACS) and I could report to the Commonwealth Government and Victoria Police (this would have to be done within 24 hours of the incident).

I would need to record my contact details; including my email address and telephone umber so that the Victorian Department of Health could contact me immediately if and to make complaints about health service providers. The Health Services Commissioner (HSC) is an independent statutory authority established to receive and resolve complaints about health service providers. The HSC also handles complaints about disclosure of health information and access to health information and ageing. Aged Carer viewed 3 June, 2013 http://www. agedcarer. com. au Australian Government Department of Health & Ageing Charter of Residents Rights & Responsibilities 1997. Schedule 1 of the User Rights Principles 1997