Recognising and Responding to Elder Abuse

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Published: 22 August 2021

Content warning: Please be aware that this Article contains graphics and information relating to abuse, which some people may find distressing.

Any person receiving care - regardless of age, gender or disability - should be able to access support without experiencing (or fearing) violence, abuse, neglect, exploitation or discrimination.

Abusive behaviour of any kind towards older adults (from staff, residents or others) is a violation of basic human rights and unacceptable in any setting (Better Health Channel 2016).

An older person’s right to access care without suffering abuse is set out in Aged Care Quality Standard 8: Organisational Governance.

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
  • 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
Emotional abuse
  • 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
Physical abuse
  • Restraint
  • Not being allowed to leave the bed/chair/room or go outside
  • Being hurt
  • Being treated roughly

(The Royal Commission into Aged Care Quality and Safety 2020)

Types of Elder Abuse

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)
  • Hitting
  • Beating
  • Scratching
  • Biting
  • Choking
  • Suffocation
  • Pushing
  • Shoving
  • Shaking
  • Slapping
  • Kicking
  • Stomping
  • Pinching
  • Burning
  • Force-feeding
  • Inappropriate use of medicines or physical restraint
  • Physical punishment
  • Hair pulling
  • Pinning in place
  • Arm twisting.

(Hall, Karch & Crosby 2016)

abuse violence
Violence is defined as the use of physical force with the intention to hurt, damage or kill somebody else.

Abuse

Abuse is a violation of rights that involves the exploitation of power. There are several types of abuse that may be experienced by older adults:

Sexual Abuse

Sexual abuse refers to any sexual activity that takes place without 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 (RACGP 2014; NSW Ombudsman 2017).

Emotional Abuse

Emotional abuse is behaviour that scares or terrorises someone, potentially causing them to lose confidence, self-esteem or self-determination. It includes:

  • Verbal abuse (subtle or overt)
  • Humiliation
  • Threats
  • Extreme jealousy
  • Suicide threats
  • Stalking and harassment (in-person or through technology).

(RACGP 2014; NSW Ombudsman 2017)

Social Abuse

Social abuse is the intentional isolation of a person from their family, friends and other contacts (RACGP 2014; NSW Ombudsman 2017).

Systems Abuse

Systems abuse is mistreatment related to how the organisation’s 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

Neglect is failure to fulfil a client’s basic physical or psychological needs (RACGP 2014). It includes:

  • Physical neglect;
    • 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, also known as financial abuse or economic abuse, 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
  • Forgery
  • Taking, misusing or concealing the client’s funds, property or assets.

(RACGP 2014; CDC 2016)

abuse exploitation
Exploitation is the intentional misuse of a client’s money or assets for personal gain.

Discrimination

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).

Disability Services Queensland (pp. 18-21) outlines key features of abuse prevention that should inform policies and procedures.

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:

There are a number of Australian advocacy groups for aged care. The Older Persons Advocacy Network (OPAN), which is contracted by the Australian Government, provides free, independent and confidential advocacy services to aged care clients (ACQSC 2020).

Each Australian state and territory also has its own elder abuse service.

The Serious Incident Response Scheme (SIRS)

Read: What is the Serious Incident Response Scheme (SIRS)?

The Serious Incident Response Scheme (SIRS), which commenced in April 2021, is a federal government initiative aiming to reduce the risk of abuse and neglect in Commonwealth-funded residential aged care. It expands upon the protections offered by the Aged Care Act 1997 (ACQSC 2021; Ausmed 2021).

Under the SIRS, Commonwealth-funded residential aged care providers are required to identify, record, manage and resolve all serious incidents, which include:

  • Unreasonable use of force
  • Unlawful sexual contact or inappropriate sexual conduct
  • Neglect
  • Psychological or emotional abuse
  • Unexpected death
  • Stealing or financial coercion by a staff member
  • Inappropriate physical or chemical restraint
  • Unexplained absence from care.

(ACQSC 2021)

Furthermore, these incidents, along with any allegation, suspicion, or witness account of these incidents, must be reported to the Aged Care Quality and Safety Commission (ACQSC 2021).

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).

abuse mandatory reporting
Under the SIRS, Commonwealth-funded residential aged care providers are required to identify, record, manage and resolve serious incidents.

Recognising the Signs of Abusive Behaviour

Clients experiencing abusive behaviour may not seek help due to fear, guilt, shame, lack of capacity or lack of knowledge about the resources available to them (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
  • Sudden and unexpected changes in financial status.

(Better Health Channel 2018)

A more comprehensive list of indicators is available from Disability Services Queensland.

Responding to Abuse

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 2016).

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 2016)

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).

abuse recognise
Your organisation should have clear policies and procedures for responding to abuse.

Conclusion

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.

Useful Organisations

Additional Resources


References

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