The following article provides an outline of different forms of abusive behaviour so that you can recognise the signs and take action.
Statistics on Elder Abuse
A 2020 report from the Royal Commission into Aged Care Quality and Safety estimates that almost 40% of aged care residents experience neglect, emotional abuse or physical abuse:
30.8% of aged care residents are estimated to experience neglect;
22.6% of aged care residents are estimated to experience emotional abuse; and
5% of aged care residents are estimated to experience physical abuse.
(The Royal Commission into Aged Care Quality and Safety 2020)
According to the report, the abuse being experienced by aged care residents includes:
Neglect related to assistance with showering, eating, using the toilet, moving about, grooming and using continence aids
Neglect related to medicine management
Neglect related to wound care
Neglect related to catheter management
Neglect related to pain management
Neglect related to accessing general practitioners, dentists, mental health services and other allied health services
Staff not spending enough time attending to care needs
Being made to feel dependent on staff
Being treated like a child
Being forced to wear continence pads
Being shouted at
Not having care needs considered or listened to
Not being allowed to leave the bed/chair/room or go outside
Being treated roughly
(The Royal Commission into Aged Care Quality and Safety 2020)
Violence (Physical Abuse)
Violence is defined as the use of physical force with the intention to hurt, damage or kill somebody else (Better Health Channel 2016). This might include:
Striking (with or without a weapon);
Almost one in two (47%) of adults with a disability have experienced violence after the age of 15, which is 11% more than people without a disability (AIHW 2019).
Women with disabilities are especially likely to experience violence (Better Health Channel 2016).
Abuse is a violation of rights that involves the exploitation of power. There are several types of abuse that may be experienced by clients:
Sexual abuse refers to any sexual activity that takes place without the client’s consent. It does not necessarily involve penetration or physical contact and may take the form of indecent exposure or other sexually inappropriate actions that are not consented to.
For clients who are minors, sexual abuse also includes enticing the client into performing sexual activities, watching/viewing sexual activities or engaging in sexual behaviour, regardless of whether the client is aware of what is happening.
Emotional abuse is behaviour that scares or terrorises the client, potentially causing them to lose confidence, self-esteem or self-determination. It includes:
Verbal abuse (subtle or overt);
Suicide threats; or
Stalking and harassment (in-person or through technology).
Social abuse is the intentional isolation of the client from their family, friends and other contacts.
Systems abuse is the mistreatment of clients related to how the service is run (e.g. Clients being made to eat meals at a certain time to fit in with staff changeover).
(RACGP 2014; NSW Ombudsman 2017)
Statistics regarding the prevalence of abuse against older Australians is limited, however, it is estimated that between 2-14% of the older adult population has suffered abuse (AIFS 2016).
Neglect is the failure to fulfil the client’s basic physical or psychological needs (RACGP 2014). It includes:
Failure to provide the client with adequate food, shelter, clothing or protection; or
Allowing the client to be placed at risk through unsafe environments or practices.
Passive neglect (withholding or failing to provide the client with life necessities).
Wilful deprivation (intentionally denying the client assistance, putting them at risk of physical, mental or emotional harm).
Social neglect (limiting the client’s social, intellectual and emotional growth or wellbeing).
(Better Health Channel 2016)
Exploitation (Financial Abuse)
Exploitation is the intentional misuse of a client’s money or assets for personal gain (RACGP 2014). It includes:
Restricting the client’s access to (or information about) their money;
Fraudulently using the client’s money;
Stealing from the client;
Forcing the client to surrender their money or assets through coercion or deception;
Taking, misusing or concealing the client’s funds, property or assets.
(RACGP 2014; CDC 2019)
Discrimination is the mistreatment or bullying of a client based on their personal characteristics (or presumed characteristics). These characteristics can include (but are not limited to) gender, age, sexual orientation, disability, employment, race or religious belief (Victorian Equal Opportunity & Human Rights Commission n.d.).
Policies, Legislation and Services for Preventing Abuse
Your organisation must have clear policies and procedures established to protect clients from abusive behaviour. It is also important to maintain a workplace culture that promotes positive values, experience and attitudes and is transparent about its processes (NDS 2017).
It is also essential for your organisation to have a code of practice stating expectations and values (DSQ 2008).
In addition to individual organisations’ policies and procedures, there is federal and state legislation designed to protect the rights of clients. These include, but are not limited to:
The Disability Act 2006, which outlines the rights of people with disabilities. It contains provisions regarding disability services, including a mandatory explanation of rights to the client when they begin to use a service.
The Aged Care Act 1997, which has compulsory reporting provisions for aged care residents (in certain circumstances).
There are a number of Australian advocacy groups for both disability and aged care. The NDIS (2020) standards state that clients should be provided with information about advocacy services and given access to advocacy in the case of an incident.
Mandatory reporting is a legally-enforced requirement for designated service providers (‘mandatory reporters’) to report the suspected abuse or neglect of children (and in some incidences of assault, aged care residents) to government authorities (NSW Government 2017; Seniors Rights Victoria 2018).
Some healthcare professionals including registered medical practitioners, registered nurses and midwives are mandatory reporters who are obligated to report abuse (NSW Government 2017).
Recognising the Signs of Abusive Behaviour
Clients who suffer from abusive behaviour in healthcare may not seek help due to fear, guilt, shame, lack of capacity or lack of knowledge about resources (Better Health Channel 2018).
Therefore, it is important to be able to recognise the signs of abuse in case it is not being disclosed by the client. Signs may include, but are not limited to:
Malnutrition or dehydration;
Poor personal hygiene or dirty clothes;
Untreated medical issues;
Fearful, anxious or withdrawn behaviour;
Unexplained and frequent injuries;
Unexplained cuts or bruises on the genitals or anus;
Unexplained sexually transmitted infections; and
Sudden and unexpected changes in financial status.
Your organisation should have clear policies and procedures for responding to abuse. All staff should be familiar with these frameworks, as well as their duty of care to clients (Seniors Rights Victoria n.d.).
Healthcare workers may be the first people to notice or suspect abuse. If you suspect abuse:
Do not ignore the situation.
Be respectful of the client’s rights and wishes.
Contact emergency services if there is an immediate threat of harm.
Gather information by asking the client non-judgmental, direct and open questions in a sensitive manner.
Record details in writing, including anything you may have seen or heard. This must be confidential.
Notify your supervisor.
(Seniors Rights Victoria n.d.)
Mandatory reporting exists for a number of offences and it is not only part of your duty of care as a healthcare professional to report these, but also your legal responsibility. In other cases, you must gain the client's (or their substitute decision maker's) consent before reporting abuse to a third party (NSW DoH 2020).
If a client chooses not to report abuse, you should respect their wishes but provide them with resources and helplines in case they change their mind (NSW DoH 2020).
You should also be mindful of the client’s decision-making capacity. Always adhere to the capacity assessment principles (NSW DoH 2020).
All clients have the right to receive care without abuse or fear of abuse. Abuse is never acceptable in the workplace. Ensure you can recognise the signs of abuse and always take action if you suspect a client is being harmed.