Submission - Inquiry into elder abuse

Inquiry into elder abuse
The Australian Law Reform Commission

Background
As the population ages, and the frailties of age and the vulnerabilities of older people increase, the potential reach of elder abuse may grow. The Toronto Declaration on the Global Prevention of Elder Abuse (2002) stated that ‘[p]reventing elder abuse in an ageing world is everybody’s business’.

However, there is limited evidence available about the prevalence and incidence of elder abuse in Australia. Internationally, the World Health Organization (WHO) has estimated that the prevalence rate of elder abuse in high- or middle-income countries ranges from 2% to 14%.

The Australian Law Reform Commission (ALRC) is currently considering existing Commonwealth laws and frameworks that seek to safeguard and protect older persons from misuse or abuse by formal and informal carers, supporters, representatives and others.

About the Old Colonists’ Association of Victoria
The Old Colonists’ Association of Victoria is a leading not-for-profit retirement village provider offering a continuum of care from independent living, assisted living and aged care in Victoria. Our four villages in Berwick, Euroa, North Fitzroy and St Helena are home to 500 older Victorians in need.

The OCAV was established by Victorian founding fathers including George Selth Coppin, a Member of Parliament and philanthropist. The association’s first village was located in Rushall Park, North Fitzroy after the Government of Victoria gifted an acreage of land.

Our vision
To be the benchmark provider of affordable, independent community living for elderly Victorians.

Our mission
To advocate and provide affordable, safe and dignified independent homes for older Victorians within a village environment, and to offer appropriate and practicable extended care when it is required.

Our values
Safe, Responsible, Dignified, Affordable, Open, Improving

Executive Summary
The OCAV is pleased to make a submission to this important inquiry about existing Commonwealth laws and frameworks to safeguard older people from elder abuse.

As a leading retirement village and aged care provider in Victoria, we work to safeguard the rights of older people, whether they live independently, or in supported or aged care living. Many of our residents live within OCAV villages for ten years and longer, maintaining relationships with friends and families.

Our interest in this inquiry comes primarily from an aged care perspective. As a responsible provider, we abide by all legislation affecting older people in aged care, including the Accountability Principles, 1998, the Aged Care Act 1997, the Privacy Act 1988, and others.

While we understand that laws and legal frameworks are important in providing safeguards for older people, we strongly believe that they should not interfere with the rights or preferences of individual older people.

Nevertheless, we are aware that elder abuse is largely a gendered issue: 79 per cent of our residents are elderly women who are vulnerable, particularly financially, and thus the potential for elder abuse is ever present.

Further we acknowledge that there can be a lack of awareness amongst the staff of both family violence services, and of community and aged care services specifically for older people, of the existence of elder abuse. This means that signs that abuse is occurring may not be picked up, or that staff may not be sure what to do when abuse is suspected. To remedy this, we regularly present lectures and professional development workshops on elder abuse and other issues that may affect our residents.

Our policies and procedures mirror these concerns. Abuse of residents living in OCAV villages will not be tolerated. Abuse includes assault, financial or psychological abuse or neglect. Reportable assaults and suspicions of reportable assaults are to be reported to local police and the Department of Social Services.

Recommendations
1. Critically we support others in their call for a national prevalence study into the extent of elder abuser and an examination of programs to combat elder abuse in Australia.

2. Care assessment processes should include a series of questions directed at determining whether an older person is suffering or at risk of suffering elder abuse.

3. All health professionals should receive education to identify the signs of elder abuse and also be trained in the reporting process for elder abuse.

Question 1 To what extent should the following elements, or any others, be taken into account in describing or defining elder abuse:
• harm or distress;

• intention;

• payment for services?

OCAV defines elder abuse as any act which causes harm to an older person and is carried out by someone they know and trust, such as family, friends, and potentially workers in aged care facilities. We believe that like other forms of family violence, elder abuse may be psychological, financial, physical, social or sexual, and can also involve neglect.

For some older people this abuse can be exacerbated by the challenges of ageing, including their increased need for support and care.

Other examples of elder abuse include verbal abuse and threats to cause harm; physical abuse such as kicking, shoving and rough handling; taking up residence in the older person’s home for reasons other than the benefit or care of the older person (not applicable to our residents); threatening or coercing an older person into handing over an asset; preventing contact with family or friends; physical restraint; and taking over the decision-making and finances of a competent older person without authority

Specifically reportable assault should also be included in any definition of elder abuse. This includes:

· Unreasonable use of force on a care recipient, ranging from deliberate and violent physical attacks on a care recipients to the use of unwarranted physical force

· Unlawful sexual contact, meaning any sexual contact with a resident where her has been no consent

Question 2 What are the key elements of best practice legal responses to elder abuse?
We defer to the submission from Seniors Rights Victoria which provides legal and advocacy support to Victorian victims of elder abuse, and to research which show that multidisciplinary intervention can be successful at stopping or reducing the abuse and protecting the older person

(Alon & Berg-Warman, 2014; Rizzo, Burnes, & Chalfy, 2015; Wilber, Navarro, & Gassoumis, 2014.)

However, we note that as there is a lack of community awareness about elder abuse there may also be a lack of awareness of Seniors Rights Victoria and its service, so there are potentially many older people experiencing elder abuse who are not receiving assistance.

Question 4 The ALRC is interested in identifying evidence about elder abuse in Australia. What further research is needed and where are the gaps in the evidence?
We defer to the National Ageing Research Institute which recently held a roundtable to explore the lack of evidence-based research into elder abuse. We note that this lack of recognition and under-reporting may mean that the extent of elder abuse is difficult to estimate. NARI research indicates it is experienced by approximately 2–6 per cent of older people in Australia.

While OCAV residents tend to stay with us once they have moved into one of our villages, we believe that further research is needed about possible conflict arising within intergenerational family homes, including older parents moving in with adult children. Increased public awareness and understanding of the possible conflict in these circumstances may help families and older people make better plans for their future.

We also believe that further research is needed into the motivations of perpetrators of elder abuse.

A lack of understanding of carers and family members about frailty, chronic or age- related conditions such as dementia, and the needs of people as they age may increase the occurrence of unintentional elder abuse, which also needs to be addressed.

Critically we support others in their call for a national prevalence study into the extent of elder abuser and an examination of programs to combat elder abuse in Australia.

A growing number of research studies around the world are starting to reveal the magnitude of the crisis, yet according to the World Health Organisation in August 2011: “... the scope and nature of the problem is only beginning to be delineated. Many risk factors remain contested, and the evidence for what works to prevent elder mistreatment is limited”.

We believe that this will especially valuable for helping aged care facilities continue to enhance their elder abuse programs, policies and protocols.

Aged care
Question 11 What evidence exists of elder abuse committed in aged care, including in residential, home and flexible care settings?
There are numerous stories, both local and international) reported in the media that provide evidence that elder abuse exists. As highlighted above, forms of abuse range from financial and physical to sexual abuse. Some studies suggest 3% of Australians aged over 65 suffer some form of abuse. This is only going to increase as the population ages. It is also likely that most elder abuse cases go unreported. Here are two recent reports of incidents that may be considered as elder abuse.

http://www.theage.com.au/victoria/nurse-investigated-for-becoming-beneficiary-of-dying-mans-939000-will-20160524-gp33g8.html

http://www.9news.com.au/national/2015/02/06/17/03/family-seeking-answers-after-nurse-added-to-91-year-olds-will

Question 12 What further role should aged care assessment programs play in identifying and responding to people at risk of elder abuse?
The assessment process should include a series of questions directed at determining whether an older person is suffering or at risk of suffering elder abuse. There are a number of indicators of elder abuse and questions can be framed around these. If the assessor has any concerns as a result of the assessment process they could be referred to the person’s doctor in the first instance.

Question 13 What changes should be made to aged care laws and legal frameworks to improve safeguards against elder abuse arising from decisions made on behalf of a care recipient?
We believe there could be a requirement that people must have an Enduring and Medical Power of Attorney and that their cognitive ability is assessed annually by their GP. A further recommendation is that consideration be given to financial decisions above a certain figure, for example $100k, require sign off by all power of attorneys not just one.

Question 14 What concerns arise in relation to the risk of elder abuse with consumer directed aged care models? How should safeguards against elder abuse be improved?
We do not have as many concerns with consumer directed care specifically but are do have about home care. People receiving services in the home are the most at risk as there is a lack of supervision and oversight of care delivery by the provider. It is most often delivered on a one on one basis (care recipient/care worker). There needs to be an improved audit process.

Question 15 What changes to the requirements concerning quality of care in aged care should be made to improve safeguards against elder abuse?
Part of resident care planning should include an annual elder abuse assessment with a process similar to that outlined in our response to question 12.

Question 17 What changes to the requirements for reporting assaults in aged care settings should be made to improve responses to elder abuse?
Currently reportable assaults are limited to unreasonable use of force and unlawful sexual contact. This should be expanded to include financial abuse as this is one of the most common.

Question 18 What changes to aged care complaints mechanisms should be made to improve responses to elder abuse?
We recommend that non-reportable instances of elder abuse should be investigated in a more timely manner.

Question 19 What changes to the aged care sanctions regime should be made to improve responses to elder abuse?
A proven instance of elder abuse should warrant an audit by the agency. We are not convinced that upping sanctions will have any impact as the general instances of elder abuse are at the individual level. If it was identified that there had been instances that were not appropriately dealt with, then the severity of the sanction should be significantly increased.

Question 20 What changes to the role of aged care advocacy services and the community visitors scheme should be made to improve the identification of and responses to elder abuse?
Increased resourcing and greater community knowledge of the availability of these services. This underscores the importance of a public education campaign about elder abuse and what services there are available for older people who are experiencing elder abuse.

Appointed decision-makers
Question 29 What evidence is there of elder abuse committed by people acting as appointed decision-makers under instruments such as powers of attorney? How might this type of abuse be prevented and redressed?
The OCAV does not have any specific evidence and believes that most would go unreported. To address the issue, we maintain that there should always be a minimum of two powers of attorney, they can only act severally on transactions up to a certain value, above that both or all must sign.

Question 30 Should powers of attorney and other decision-making instruments be required to be registered to improve safeguards against elder abuse? If so, who should host and manage the register?
We do not believe that this will reduce elder abuse other than simply being registered may deter some abusers.

Question 31 Should the statutory duties of attorneys and other appointed decision-makers be expanded to give them a greater role in protecting older people from abuse by others?
Yes, as long as it does not expand opportunities for attorneys to abuse older people.

Question 32 What evidence is there of elder abuse by guardians and administrators? How might this type of abuse be prevented and redressed?
Health services
Question 35 How can the role that health professionals play in identifying and responding to elder abuse be improved?
All health professionals should receive education to identify the signs of elder abuse and also be trained in the reporting process for elder abuse. This recommendation was made forcibly in the Victorian Royal Commission into Family Violence findings.

Question 36 How should professional codes be improved to clarify the role of health professionals in identifying and responding to elder abuse?
As part of a research program, codes of ethics should be reviewed and where required, expanded to specially include and cover elder abuse. This should also include a commitment to ongoing education.

Question 37 Are health-justice partnerships a useful model for identifying and responding to elder abuse? What other health service models should be developed to identify and respond to elder abuse?
The current model works well in a residential aged care environment however not so in the home care and public domain where there may need to be greater interaction with GPs and other health professionals who work closely with elderly clients.

August 4 2016