Topics in this section:
|Reporting an abusive situation||Cultural Response|
|Gathering the facts||Responding|
|Consent to Act||Provider Responsibilities|
Principles of Assistance in Situations of Elder Abuse
Compulsory Rreporting requirements of unlawful sexual conduct and unreasonable use of force involving a resident of a Commonwealth subsidised aged care facility commenced on July 2007 following amendments to the Aged Care Act (1997). These requirements aim to ensure that any allegation or suspicion of a reportable assault is reported and managed appropriately.
The South Australian Abuse Prevention Program of the ARAS uses the following principles to guide its interactions with older people. These principles have two foundations:
1. Upholding the rights of the older person.
2. Do no harm, which is about not making the older person's situation worse.
These foundations will be useful to you when working with older people who are experiencing abuse.
1. Upholding the rights of the older person
All adults possess the right to make their own choices. They can decide for themselves where they live, who they live with, how they spend their money and so on. As they age, so their daily living needs might increase (1), becoming more dependent. In these circumstances, it can be harder to make choices for themselves.
This is exactly what happens to older people who are being abused. They find it difficult to stand up for their rights, to make choices for themselves, particularly to the people who are abusing them.
Assisting the older person to identify which of their rights has been abused is often the first step to take. An important right is the right 'to live in dignity and security and to be free of exploitation and physical or mental abuse'. (2)
Sometimes those responding to an abusive situation may find it difficult to uphold the rights of the older person, particularly if the older person decides to do something that they don't agree with. For example, an older person might decide to still see the relative who visits them most often, even though they know this person only insults them whenever they do visit.
Tensions like these can be resolved by referring to the older person's right to make their own choices. This right is the most important in all circumstances where the older person has the capacity to make their own choices. So if it is the older person's wish to continue seeing the person who abuses them, it is their right to do so, and they should be supported. The home's stance in these circumstances is one of minimising the risk, or ameliorating the situation.
Other parts of this website, particularly the duty of care, client confidentiality and freedom of choice sections will help you work out the practical limits on your role in relation to helping the older person uphold their rights.
2. Do not escalate your action unnecessarily.
Situations of abuse need to be resolved, wherever possible, using the least restrictive strategies available. In situations that involve Compulsory Reporting having an agreement from the victim to involve the Police or the Department is not required under the Act. Where you may have other situations of abuse i.e. financial that need to be resolved, wherever possible use the least restrictive strategies possible. It can be harmful if action suddenly escalates to involve the police, lawyers etc. without the consent of the older person or without first finding out the consequences of any actions to resolve the abuse.
It is important not to escalate your action unnecessarily to actions that have consequences which the older person thinks are worse than the original abuse. Possible consequences may include, permanently severed relationships with family members or friends that they have known for decades and still love (despite the abuse).
It is important to recognise that there are some instances when it is appropriate to escalate your action (with the consent of the older person), eg. where a crime is being committed or the older person or others need immediate protection.
As always, consult with your supervisor if you are ever unsure of what steps to take.
3. Do no harm
Assist the older person with information, options and strategies which will cause no further harm and ensures that any course of action undertaken will be legal and moral. For example, in financial abuse, where a spouse is misusing a Power of Attorney, it would be immoral to take action that prevented an alleged abuser access to the aged care facility if the older person wanted to spend time with their spouse.
In practical terms, wherever possible you need to respond to the abuse issues whilst upholding all other principles, eg. maintain relationships.
4. Accept what the Older Person is saying
The experience of the ARAS is that the vast majority of older people know when they are being abused. It is very important when someone first starts talking about abuse, that you believe them, that you accept what they say at face value (including those people who have dementia). When hearing stories of abuse it is also important to remain non-judgemental about all aspects of the abuse. How you respond to the older person is crucial in giving them the confidence to take action to overcome the abuse.
There may be times when you doubt if an older person is experiencing abuse. Enabling the older person to tell their story, and in particular gathering the facts, will assist the older person to be clear about what to do about their situation.
5. Identify significant others in the older person's network of informal and formal relationships.
The experience of ARAS is that older people who are abused can find it more difficult to uphold their rights than other adults. Because of this, older people have stated to ARAS that having another person to represent them can be the most successful means of overcoming complex situations of abuse. This is particularly the case where an older person feels disadvantaged due to their age, frailty or ageism. ARAS has identified a number of existing and/or potential networks of people or agencies that can assist older people to overcome the abuse they experience and in some instances become strong allies for the older person to ensure no further abuse occurs. They can be:
The strategies section gives more detail on ARAS's experience of how these networks can be helpful.
6. Maintain relationships wherever possible
The reality of abuse is that the older person is going to be closely connected to the individual(s) who have been/are abusing them. Moreover, they may have been coping with abuse for decades before they moved into the hostel or nursing home. They may also still love the person who is abusing them, and feel a sense of responsibility towards them.
- ARAS's experience suggests that the older person is likely to prefer a strategy to overcome abuse that considers the impact on the alleged abuser
- The older person is likely to want to maintain their relationship with the alleged abuser wherever possible
- The older person may decide to limit their action, or even take no action, if they consider the actions harmful to others. Other strategies more acceptable to the older person will need to be developed
7. Increase the control that the older person has over the abuse
The aim of this work is to support the older person so that they can regain their control, or remain in control, over the abuse. The process should be one that enables the older person.
Ensure that the older person makes all final decisions about what steps to take from the range of options (and consequences) that you have found for them.
This may not happen overnight, but almost certainly will occur over a period of time, as the older person learns to trust those assisting, and feels comfortable in the surroundings of the facility. The abuse that the older person is experiencing may have started before they moved into the home. They are now living in a facility that is safe and secure. This environment is likely to be a more supportive one than that which they left.
8. Each instance of elder abuse is different
The experience of the ARAS is that older people want solutions that fit their particular circumstances. The dynamics of an abusive situation are complex. Different risk factors are likely to be present in varying degrees for different people.
Although there may be common elements to abuse, outcomes will be as varied as the individuals who are experiencing abuse. What one person defines as a good outcome, may not be what another defines as a good outcome.
Be aware of this, and account for it in any plan of action.
9. Conflict of interest
Anyone who acts for an older person should not have a conflict of interest in the situation. Your work to support an older person to make choices about the abuse they experience by family members or friends will be less effective if the older person does not believe that you are on their side. This could be the case, for example, if you try and mediate between the older person and their abuser. Mediation involves both parties giving something up, in order to achieve a compromise solution, whereas the work you should do in abuse is supporting the older person to achieve their wishes in relation to the abuse.
One of the reasons that ARAS is successful is that older people see the agency as clearly being on their side: ARAS is independent and has no purpose other than to assist them to uphold their rights. ARAS is able to act exclusively from the perspective of rights.
Care staff and supervisors will need to identify any conflicts they have which may influence their role to assist the older person eg. insufficient time to follow through with the level of support required, or support and expertise they may need to access to be effective.
10. Do not be co-opted into other's agendas
Elder abuse is an emotive issue. There may well be conflicting views expressed by different family members over the same abuse. Some of them may express their views in a forceful way. When others are stating what the older person wishes and that they are wanting you to assist to resolve the abusive situation, you can do this in particular circumstances:
- Where the older person gives you permission; or
- Where another person has permission from the older person or is their representative and is clearly acting in the best interests of the older person. That is, where you can show the proposed action is in the best interests of the older person
Note that this principle does not address circumstances where an older person lacks capacity to make choices, and action needs to be taken to protect their rights. Further information on this area is provided in the legal considerations section.
(1) This isn't necessarily the case. Remember that the majority of older people live in their own homes independently, without any service assistance.
(2) Age Concern New Zealand (1992) Promoting the Rights and Well-being of Older People and Those who Care for Them - A Resource Kit About Elder Abuse and Neglect. Wellington N Z (pp17 International Federation of Ageing - Declaration on the Rights and Responsibilities of Older Persons)