1. HOW CAN PROVIDERS DEAL WITH ELDER ABUSE
Glen Sorensen
Age Communications 1

2. Definition of Elder Abuse
A single or repeated act, or lack of appropriate action, occurring in any relationship where there is an expectation of trust, which causes pain or distress to an older person
WHO, The Toronto Declaration on the Global Prevention of Elder Abuse 2002

3. Types of Elder Abuse Financial or Material Abuse Physical Abuse
Emotional or Psychological Abuse
Sexual Abuse
Neglect
Social Abuse
Spiritual Abuse

4. Extent of Abuse of Older People
Up to 5% of older Australians will become victims of abuse
This is consistent with international patterns
Abuse occurs in:
all socio-economic groups
all cultural groups
heterosexual and GLBTI relationships
metropolitan, regional, rural and remote areas
community and residential care settings

5. How Abuse of an Older Consumer May Be Detected
Observing signs or changes in behaviour or the situation that may indicate abuse
Witnessing an incident of abuse
Disclosure of abuse

6. What prevents people reporting abuse?

7. Barriers to Reporting by Older People
Fear of retaliation or punishment
Not realising they are being abused
Unaware of options/services that can help
Socially isolation
Cultural and language barriers
Impaired capacity to communicate abuse
Disempowerment
Dependence upon the perpetrator
Fear of abandonment or rejection by family members
Loyalty to family and/or desire to protect the abuser
Fear of not being believed

8. Common Barriers to Reporting by Staff
Dealing with elder abuse can be distressing and confronting
Uncertainty about whether it is elder abuse
Client does not want it reported
Concerned about confidentiality
Fear of betraying close relationships with the victim and the abuser
Worried about disruption to client’s life if they report
Unsure about the organisation’s policy and procedure
Fear about repercussions for them

9. Addressing Reporting Barriers

10. Is it mandatory to report abuse of older people?
Yes, in residential aged care
No, for people in the community however it must be reported internally to a supervisor. While there is no mandatory reporting of abuse of older people in Australia, it is expected that agencies will have policies and guidelines in place to guide workers when responding to abuse, whether or not it is criminal in nature.
Serious crimes must be reported (e.g. domestic violence, theft, fraud, stalking, kidnapping, neglect, physical assault and sexual assault are reportable crimes.

11. Mandatory Reporting
Under the Aged Care Amendment (Security and Protection) Bill 2007 it is mandatory for approved providers of residential care to report alleged or suspected unlawful sexual contact and unreasonable use of force to the Police and the Department of Health 1800 081 549 within 24 hours of the allegation or starting to suspect a reportable assault.
A reportable assault includes a range of assaults from deliberate and violent physical attacks to use of physical force with a resident.
It does not include minor assaults perpetrated by residents with a diagnosed mental impairment.

12. Other Considerations About Your Mandatory Response in Residential Care
As long as identifiers make the report in good faith, on reasonable grounds and are not the abuser, the Aged Care Amendment (Security and Protection) Bill 2007 offers them protection:
Of identity
From victimisation
Of civil or criminal liability
From termination of employment or contract

13. Is it okay to act on a suspicion?
Yes it is:
as neither victim nor abuser may disclose
as abuse is often hidden from outsiders
if the identifier has picked up signs and have formed a reasonable belief that abuse could be happening
as there is a duty of care to the alleged victim to take reasonable steps to prevent an older people coming to foreseeable harm

14. Privacy & Confidentiality Considerations
In responding to abuse of older people it is important that workers are aware of and respect the right of older people to privacy and confidentiality. However the promise of complete confidentiality cannot be given to any person who raises a concern about the abuse of an older person. This includes the older person themselves, a relative, a fellow worker or a member of the public.

15. Will I Breach Confidentiality by Reporting?
In cases of abuse, confidentiality exists between the client and the facility/agency
Duty of Care can override confidentiality when:
There is an obligation not to conceal a serious crime
There is a mandatory reporting requirement
Disclosure is in the person’s best interests (e.g. the person is at risk of harm, suicidal)
There is a serious threat to the life or health of the person
There is a duty to inform a third party who may be in danger

16. The Key Message for Frontline Staff
If you ever have any concerns about the health, wellbeing or safety of an older person, you have a duty of care to promptly report those concerns to a supervisor.

17. What should frontline staff do?

18. It is very important for your team to:
Know the types and signs of elder abuse
Understand duty of care responsibilities
Understand their responsibilities and what to do under your policy & procedure
Understand that it is mandatory for aged care facilities to report alleged or reported assaults
Understand that physical and sexual assaults, domestic violence, threats of violence, stalking, neglect, harassment, theft and fraud are criminal offences
Document the facts – what happened, what you noticed or were told and what you said or did
Ask for and receive support or debriefing

19. SETTING UP APPROPRIATE RESPONSES TO ELDER ABUSE ALLEGATIONS
What you need to have in place

20. The Essential Components
Clear set of intervention principles
Senior staff with allocated responsibilities for reporting and responding
A well broadcast policy
Procedures/guidelines for different situations
Referral pathways to response specialists
Informed and trained staff members who have direct contact with older people
Support structures for identifiers

21. Intervention Principles
• Older people at risk of or experiencing abuse are:
– Provided with information about options, including legal remedies
– Listened to with their views taken into account
– Supported to make their own decisions
– Respected in their choice to accept or reject support if competent to make that decision
Intervention is focused on:
the interests of the older person
ensuring their safety and ongoing protection from violence and abuse

22. Roles of Senior Staff
Ensure relevant policies & procedures are in place, known and followed
Ensure staff are trained in abuse recognition and responses
Identifying abuse
Follow-up on and respond to internal reports of alleged abuse
Ensure identifiers are protected and supported
Ensure documentation requirements are met

23. A 5 Step Response to Abuse

24. Determining the Response: Four Key Questions

25. Key Factors in Assessing Urgency & Risk
Victim’s vulnerability
Danger to the victim & others
Need for medical attention
Nature & extent of the abuse
Impact on the victim
Risk of repeated or increasing abuse
Risk of assets being permanently lost
Relationship between the victim & the abuser

26. Suggested Inclusions in an Elder Abuse Policy
Introduction – Overview & Rationale
Definitions of abuse
How abuse may be detected
Allocation of roles & responsibilities
Mandatory Reporting Requirements (Resi Care)
Referral principles (Community Care)
Duty of Care & confidentiality provisions
Commitment to supporting Identifiers

27. Suggested Procedural Considerations I
Residential Care Facilities
Mandatory reporting situations
Non–Mandatory reporting situations
Minor assaults by residents with a diagnosed mental impairment
What to do if the resident is not competent or if competency is uncertain

28. Non-mandatory reporting responses
Responses will be different in different situations. Actions to stop the abuse could include:
Further investigation by senior staff
Referral to the Police
Referral for competency assessment and/or guardianship
Case conference with staff, family, GP
Meeting with the primary carer/family
Staff misconduct procedures

29. Other Considerations for Procedures
Emergency responses
Non-emergency responses
If there is a question about mental capacity of the alleged victim
If intervention is refused by the victim
If the alleged abuser is a staff member
Seeking advice from specialist agencies
Referral protocols, pathways and options

30. Capacity, Consent and Intervention

31. Staff Support Strategies
Ensure all workers are informed and/or trained about the policy and procedure on responding to abuse
Offer support and protection from retribution to identifiers & reporters of abuse
Provide access to debriefing and, if needed, counseling to identifiers of and those affected by abuse

32. Contact Details
Glen Sorensen Age Communications Pty Ltd (02) (office) (mobile)