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COTA Over 50s Elder Abuse

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					    IMPROVING THE PROTECTION AND
     SAFETY OF VULNERABLE OLDER
                PEOPLE




             SUBMISSION




    BY THE COTA OVER 50S ALLIANCE




March 2006


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1.      Introduction

The recent case about sexual assaults in nursing homes have brought the often hidden
issue of abuse of vulnerable people to Ministerial and public attention. The COTA \ Over
50s Alliance (Alliance) welcomes the media and Ministerial focus on this issue. It
believes it is time to review the current approaches to abuse of vulnerable older people
and put in place a national initiative to improve the protection and safety of older people.
Such an initiative needs to involve the Commonwealth and State Governments working
more collaboratively to ensure a more co-ordinated and integrated approach in Australia.

2.      What is Elder Abuse

There is no accepted definition of elder abuse in Australia. The definition of elder abuse
adopted by the Healthy Ageing Taskforce of the Community Services’ Ministers’
Conference is the most widely used definition in Australia and in our submission should
be adopted as the agreed national definition. It is very similar to the internationally
accepted definition adopted by the World Health Organisation. (WHO 2002).

        ‘Elder abuse is any act occurring within a relationship where there is an
        implication of trust, which results in harm to an older person. Abuse may be
        physical, sexual, financial, psychological, social and\or neglect. Abuse can take
        the following forms,

        Financial Abuse - illegal or improper use of mismanagement of a person’s
        money, property or resources.
        Psychological abuse – language or actions designed to intimidate another person
        and are usually characterised by a pattern of behaviour repeated over time
        intended to maintain a hold or fear over the older person.
        Physical Abuse – a non-accidental act which results in physical pain or injury. It
        includes coercion and physical restraint.
        Sexual abuse - non - consensual sexual contact, language or exploitative
        behaviour.
        Neglect - the failure of a care giver in a relationship of trust to provide necessities
        or blocking the provision of basic needs being provided. Neglect can be deliberate
        or unintended.
        Social abuse- restricting or stopping social contact and stopping or restricting
        activities.




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3.       Prevalence

Available Australian statistics do not provide satisfactory indicators of the prevalence of
abuse. The most reliable indicator of the prevalence of elder abuse is large population–
based studies from the USA, Canada, Britain and Europe. They have demonstrated
incidence rates for elder abuse of between 3% and 5% of the population 65+ in domestic
settings, (Lachs and Pillemer 2004).

Applying these rates to Australian Bureau of Statistics data for the projected Australian
population 65+ in 2004 , (ABS 2004), indicates that somewhere between 80,000 and
130,000 cases of elder abuse occur in Australia.

Table 1:         Projected Numbers of Elder Abuse Victims in Australia 2004


      State          Lower Range @ Incidence             Higher Range @
                             Rate of 3%               Incidence Rate of 5%
      NSW                      27,220                         45,366
       VIC                     19,910                         33,183
      QLD                      13,957                         23,261
       SA                       6,923                         11,538
       WA                       6,923                         11,539
       TAS                      2,064                          3,439
       NT                        264                            440
      ACT                        907                           1,512
     Australia                 78,167                         130,278

The following factors will drive the increasing numbers of Australians projected to
experience abuse:

              1. Demographic growth in the numbers of people aged 75 + over the next 30
                 years.

              2. Increasing longevity for men and women in Australia.

              3. Increasing length of time that older people receive assistance at home
                 from family and friends.




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4.        The experience of being abused and mistreated.

A critical understanding in developing effective responses to elder abuse are the factors
that shape the reasons why older people, their families and staff do or do not report elder
abuse. Elder abuse is a complex, diverse and still a predominantly hidden issue. Ageist
attitudes shape the way in which many people including many older people, perceive
particular behaviours as abusive or exploitative. Reports and stories from older people
reflect the complexity of this issue and the diversity of people’s experiences and
perceptions of abuse. Some people can’t believe that it is happening to them and don’t
want anyone else to know. Other people can perceive abusive behaviours by spouses,
friends and staff as something they can’t do anything about and consider they have few
options but to accept such abuse.

5. Current Responses to Elder Abuse

The Commonwealth and State Governments all have policy positions on elder abuse
which have been in place since the mid 1990’s. The ACT, Queensland, WA, and South
Australia have funded specialist information and education services. All States and
Territories have guardianship and other legislative provisions in place. A key issue is why
the reported incidence of abuse is substantially below the prevalence figures indicated
above Some States have developed professional and community education programs.
However, funding and penetration of these initiatives has been limited.

Historically, the respective roles of the Commonwealth and State Governments have been
very distinctly demarked. The Commonwealth Government has perceived its role as
being responsible for regulating standards of care and providing protections and
investigations of abuse in commonwealth funded residential care settings. The States see
their roles as being responsible for abuse of older people in community and non-
Commonwealth funded residential settings. As argued by the Federal Minister in 2000,
(Bishop 2000)the lack of a consistent national policy framework is a significant weakness
of the current approaches.

5.1       Mandatory Reporting

COTA Over 50s Alliance notes the Ministers’ comments that strong arguments for and
against the introduction of mandatory reporting were presented at recent meting of the
National Aged Care Advisory Committee. It is our understanding that the strengths,
weaknesses and costs of such an approach are under active consideration by the Minister
and the Department. The Alliance makes the following contributions to this
consideration.

      •   Every Australian report that has considered the issue of mandatory reporting over
          the past 15 year has recommended against the efficacy of its introduction.
      •   Available overseas experience indicates that there are strengths and weaknesses to
          such a mechanism. Its introduction in itself will not guarantee improved
          prevention and protections.



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If mandatory reporting is to be introduced, it must be considered as part of a broader suite
of initiatives. Such a suite needs to include the elements detailed in section 6 of this
submission. It must be accompanied by:
     • investigative teams with the powers to investigate,

      •   strengthened liaison between State police and Australian Federal Police,

      •   the ability to offer protections to people suspected of being abused, while a
          matter is being investigated and prosecuted.

Such initiatives need to be introduced prior to the introduction of mandatory reporting. If
mandatory reporting is to be introduced it needs to be accompanied by an increased
capacity to respond effectively to situations of abuse.

      •   If mandatory reporting were to be introduced in residential care settings, careful
          consideration needs to be given to the definition of the scope of behaviours and
          suspicions that must be reported. The lack of a consistent definition in the United
          States has created some major difficulties and these problems should be avoided
          in Australia. (Bonnie and Wallace 2003), (Mason and Cummins 1997).

6. Key Issues Moving Forward

6.1       Objectives

The COTA\Over 50s Alliance considers that a national elder abuse prevention,
protection and support initiative should be introduced. Such an initiative should have the
following objectives:
     • Build community understanding of the problem and delivering the message that
        abuse of older people is not acceptable.
     • Empower older people to deal more confidently with abuse by family, friends and
        staff.
     • Provide information about abuse and sources of advice and assistance.
     • Improve protections and ensure the provision of effective and timely service
        responses from service agencies when older people seek assistance.
     • Build support services for victims and their families.
          .
6.2     Principles

The Alliance considers that the following principles should underpin the reforms that take
place to improve protections for vulnerable older Australians.

          Older people have a right to live safely in their own homes, free of violence,
          abuse, neglect and exploitation.

          Older people with capacity are entitled to make their own decisions on
          matters affecting their lives.


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           Coercion and undue influence by people in positions of trust can limit some older
           people’s capacity to exercise their rights at law. In such circumstances, older
           people may require assistance and support to regain control.
           Older people are entitled to participate in the development and implementation of
           services, policies and programs affecting them.
           Older people are entitled to autonomy and dignity.
           The welfare, rights and interests of older people should be of paramount
           consideration in decisions affecting them.
           Older people should be provided with assistance which is culturally and
           linguistically appropriate.

6.3        Research

COTA recommends the funding of research and evaluation studies so that a clearer
picture can be built of the nature of elder abuse and effective assistance from the
perspective of those experiencing abuse. Such research is important in building a better
understanding of what is happening and informing future policy and program
development. Such research would provide a baseline of what is occurring now as a basis
for the evaluation of the elements of the proposed strategy including the effectiveness of
community education campaigns, the development of service practices in regard to
investigation, case planning and intervention strategies.

6.4        National and Commonwealth\State Initiative
Improving the protection and safety of vulnerable older Australians needs to be given the
priority and focus it deserves. A national initiative with the Commonwealth working
collaboratively with the States is required. Such initiatives have been successful in the
domestic violence field, through the Partnerships Against Violence campaign. The
following elements of such a national initiative should be considered.

      1.      Development of a national community education campaign to highlight the
              message that abuse of older Australians is not on.
      2.      Ensuring that each State has in place timely and effective responses to
              voluntary reports of suspected abuse.

      3.      Introduction of effective and compulsory staff screening mechanisms.
              Specifically, the use of police checks and other staff screening information
              should be phased in as a compulsory requirement over the next 2 years.

      4.      Encouragement and assistance for agencies to develop policies, information
              and protocols for dealing with investigation of suspected cases and adequate
              support and practical assistance to victims of such abuse. The initiative should
              fund the development of model or suggested policies and protocols in
              collaboration with consumer, professional and industry associations. Once



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           developed, such model policies and protocols should be widely distributed
           throughout the industry.

   5.      Funds to allow staff awareness training on elder abuse for service provider
           staff and training for specialist investigation, police and prosecution staff.

   6.      Commonwealth funding for further research for prevalence studies in
           community and residential settings, evaluation studies of effective
           interventions and consumer perceptions of what assist them in situations of
           abuse.

   7.      The development of inter-agency collaboration on a state and regional basis to
           encourage a more co-ordinated and inter-jurisdictional approach to abuse of
           older people.

   8.      The provision of additional funding and resources to implement the national
           initiative.

   9.      The piloting of victim support services which address the specific issues faced
           by victims of elder abuse.

   10.     A review of the complaints resolution scheme with a specific brief to examine
           the need for independent investigative powers.

   11.     Need for greater collaboration between the Australian federal police and State
           Police authorities in regard to evidentiary and prosecution processes.

   References

ABS (2004). Estimated Population by Age and Sex 30 June 2004. Series 3201. Canberra,
Australian Bureau of Statistics.

Bishop, A. (2000). The National Strategy for an Ageing Australia: Attitudes, Lifestyle
and Community Support. Canberra, Office on Aging, Department of Health and Aging.

Bonnie, R. J. and R. B. Wallace (2003). Elder mistreatment : abuse, neglect, and
exploitation in an aging America. Washington, D.C., National Academies Press: xiv, 552.

Lachs, M. S. and K. Pillemer (2004). "Elder abuse." Lancet 364(9441): 1263-1272.


Mason, J. and J. Cummins (1997). Mandatory reporting of abuse of older people. Sydney,
N.S.W., NSW Advisory Committee on Abuse of Older People.

WHO (2002). World Report on Violence and Health. Geneva, World Health
Organisation..



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