National Plan to Address Elder Abuse

Following the recommendations of the Australian Law Reform Commission Report on Elder Abuse handed down in June 2017 a national plan to offset elder abuse is currently being developed by federal and state governments.  Nationally consistent laws to respond to elder abuse are among the key goals that also include:

  • promoting the autonomy and agency of older people;
  • addressing ageism and promoting community understanding of elder abuse;
  • safeguarding at-risk older people and improving responses;
  • building the evidence basis.

I have spoken about elder abuse in past blogs.  Due to my role as an Aged Care Placement Consultant I work closely with elderly people and their families and have, at times, been aware of this taking place. so I was pleased to see the ALRC report and recommendations delivered last year.  The development of a national plan from these recommendations, that is expected in draft version by the end of this year, will be very welcome.

Attorney-General Christian Porter stated at the recent National Elder Abuse Conference in Sydney that the national plan would bring government, business and community stakeholders together to properly address this critical issue. He told the audience that addressing elder abuse was not just a legal issue so attorneys-general would work together with ministers from health, community services and other portfolios to develop the plan; in consultation with the community sector, seniors, business and financial sectors.

Meanwhile Victoria is the first state to develop its own action plan, launched this February. The Elder Abuse Community Action Plan for Victoria was developed by the National Ageing Research Institute, supported by Seniors Rights Victoria, the Office of Public Advocate and community service providers. It sets out 10 priorities to address elder abuse:

  • Clarify the relationship between family violence and elder abuse.
  • Raise community awareness of elder abuse and promote a positive image of older people to reduce ageism.
  • Increase availability of “older person centred” alternatives to disclosing elder abuse.
  • Standardise tools for recognising abuse and develop and implement a common framework for responding to elder abuse.
  • Increase availability of family (elder) mediation services including for people living in rural areas and CALD communities.
  • Provide education and training on elder abuse for all health professionals in health and aged care services.
  • Improve data and increase evaluation.
  • Clarify whether carer stress is a risk factor for elder abuse.
  • Improve understanding and response to elder abuse in CALD and Aboriginal and Torres Strait Islander communities.
  • Improve housing options for both perpetrators and victims of elder abuse.

It’s Time to Examine Attitudes to The Elderly To Stop Abuse

“Every time we impose our will on another, it is an act of violence.”-  Mahatma Gandhi

Mahatma Ghandi

This statement from someone considered as very wise within our society, when applied to the subject of elder abuse, makes one stop and think very deeply about our own behaviour and the acceptance of societal attitudes today.

We need to consider carefully the normalisation of abusive and dehumanising practices. How does this come about? Through the removal of rights, freedom and liberties that are generally afforded to all members of our society, which are often socially condoned. Removing an elderly person’s rights can often be justified under the guise of ‘duty of care’ and this removal of rights can often be found in institutional settings, like a Residential Aged Care Facility.

Some of the beliefs that can contribute to covert abuse are that older people are incapable of protecting themselves or making sound and rational decisions and that the way to protect them is to impose controls and restrictions on their behaviour. There is also a fear that allowing an older person to take risks means that the care provider is being negligent.

Some questions that should be asked that help us to understand our behaviour with regards to elder abuse are:
• How might this belief help or hinder my reaction and response to elder abuse?
• Would I be comfortable if this policy, practice or procedure was applied to me?
• If I encountered these restrictions in the community or in my own home would be I be comfortable with complying with them?
• If this policy, procedure or practice was applied to younger people would I be confident that they would consider it to be fair and reasonable?
• If this policy was applied generally to a group of people based on their race or gender alone would it be considered appropriate and acceptable?

Unfortunately, I do see examples of elder abuse in my role as an advocate and consultant to elderly people, assisting them to find a suitable aged care residence. This abuse can be in their own home, amongst family members or within facilities. A change in attitude to ageism is essential to stop this sort of behaviour in our society.

 

Enquiry Into Elder Abuse Recommendations for Aged Care

The Australian Law Reform Commission on the Enquiry into Elder Abuse with regard to Aged Care found that two of the areas highlighted by stakeholders needing improvement were transparency and accountability. As an Aged Care Placement Specialist these recommendations are especially critical to my clients, who are moving into aged care facilities.  The Commission is recommending that aged care providers be required to report certain types of abusive conduct, which become ‘reportable incidents’, to the Aged Care Complaints Commissioner with the Commissioner’s office taking on an oversight and monitoring role of the aged care provider’s response to the incidents of abuse. This complements existing functions of the Aged Care Commissioner and enhances safeguards, improving responses by the aged care providers.

Stakeholders also wanted enhanced employment screening for people working in aged care and looked to the working with children checks as an example. Currently aged care workers are required to have a police check, but the Commission noted that not all workplace conduct that could be of concern will be identified in a police check. The Commission proposes that any findings made against a worker from the ‘reportable incident’ scheme and other disciplinary findings, would be ‘flagged’ when a person applies to work in aged care. It also proposed that unregistered aged care workers, such as assistants in nursing and personal care workers, be subject to a code of conduct, bringing them into line with professionals such as Doctors and Nurses already subject to codes of conduct.

Another area for reform that was raised by stakeholders was in relation to restrictive practices or interventions that restrict the rights and freedoms of movement of a person. The primary purpose of using these practices is to protect the person or other people they are around from harm. Some of the practices reported were people being locked in a room or ward, physical restraint like clasping or holding a person’s hands or feet together, mechanical restraints such as being tied to beds or chairs and chemical restraints such as sedatives. Of concern was that restrictive practices are sometimes used as a means of coercion, discipline, convenience or retaliation by staff or other support people. They are most often used on people with an intellectual disability or cognitive impairment who exhibit what has been described as ‘challenging behaviours’ (eg: striking themselves or others or wandering). The Commission concluded that the use of these practices can be abusive at times.

The Commission proposes that these practices be regulated through a legislative framework that would apply to residential aged care. They should only be used to prevent physical harm, and only to the extent necessary to prevent the harm and before enacted require the approval of an independent decision maker, such as a senior clinician, and that the practice only be used as prescribed in a person’s behaviour management plan.

The Commission is now taking responses to its recommendations and final proposals will be published in August 2017.  In my role I inspect many aged care facilities and most are well run with the residents’ best interests at heart, so I look forward to seeing these reforms that will help to ensure that all facilities treat their elderly residents with the utmost care and respect.