Old age is a risk factor for a range of conditions, including elder abuse and neglect which manifest through conditions such as bedsores, impaired mobility, incontinence, falls, dehydration, malnutrition and confusion.
Australia's aged care infrastructure is struggling to meet it's moral obligations under unsupportive and lacklustre policies resulting in inadequate care, being given to our elderly citizens. That strain is also obvious in that many aged care advocates and media, have consistently reported on the shameful state of our aged care system. Many nursing homes are clearly unable to cope with providing the level of care that is required to look after our precious elderly citizens.
As the older population increases, so does the need for comprehensive geriatric evaluation and treatment of our elderly in hospitals and nursing homes. Carers charged with the responsibility of caring for the elderly need to be able to provide thorough evaluation and treatment of geriatric symptoms.
Narrow definition of elder abuse in aged care
ACC are concerned that the Aged Care Act 1997 does not have sufficient measures in place to deter elder abuse. The Aged Care Amendment (Security and Protection) Bill 2007 was introduced in response to the nursing home rapes scandal in 2006. This response was a host of draconian police checks and mandatory reporting requirements.
Prior to the introduction of the 'compulsory reporting' regime, concerns at the time pointed to the limits of the proposed Bill in addressing all potential forms of abuse, which included concerns around poor nutrition, hydration, hygiene, verbal and emotional abuse or financial fraud. The limitations in the scope of reporting requirements fail to address other forms of abuse, which include neglect, financial and residents-on-resident abuse.
No attempt was made to examine the underlying problems in the system although some tried. The limitations in the scope of reporting requirements failed to address the most common forms of elder abuse and were reduced to unlawful sexual contact or unreasonable use of force.
The legislation justifies this by requiring aged care providers to effectively manage peoples’ behaviours and to provide adequate staffing to control these and prevent recurrence.
"… There is no duty of care to protect residents from the actions of other residents with cognitive impairment who may put others at risk. The government talks about ‘behavioural management’. Too often the latter fails and we note the refusal of the Government to commit to safe staff/resident ratios. As well, there has been no commitment to fund dementia units to separate residents who put other frail residents at risk - although there have been several cases where serious injury to frail people due to resident assault (perhaps even resulting in death) have occurred…”
Source: Aged Care Crisis submission, Aged Care Amendment (Security and Protection) Bill 2007, Feb 2007
As a result, resident on resident assaults are not even recorded let alone reported. Nearly 70 per cent of aged care complaints impact directly on the health, wellbeing and human rights of patients in aged care. Health and personal care is the issue most raised.
Residents subjected to alleged events which occurred in a New South Wales nursing home, which included the horrors of having resident's genitalia photographed for some sick game (spot the body part); depriving a dying man of food; and taunting a dementia resident. Sadly, none of these events satisfied the official government requirements of the "compulsory reporting" regime that was introduced in 2007 to purportedly 'protect' residents in aged care. Although in this case, the provider optionally contacted the department, but there was no requirement to do so.
These issues were also raised in mutiple submissions made to the Productivity Commission’s Caring for Older Australians by ACC and the Queensland Law Society, but were ignored.
Safe staffing ratios and community presence in residential aged care homes would significantly reduce the incidence of resident-to-resident elder abuse, which is currently excluded from reporting requirements.
ACC are not alone in urging the Federal Government to extend reporting to include other common forms of abuse - including psychological abuse.
2013: The tragic case of 88 year-old Cynthia Thoresen recently made headlines in Queensland. Mrs Thoresen’s sad decline and the extent of her injuries have been comprehensively documented.
Despite shocking neglect, her carer, daughter Marguerite, could not be successfully prosecuted in the context of existing laws. As a result of the case, Queensland’s deputy state coroner called on the state attorney-general to consider relevant law reform. Such a review would include, it seems, the criminalisation of mistreatment of older people.
Learn more: The mistreatment of older people: is it time to legislate against abuse?
Whilst the MyAgedCare government website has adopted the definition of elder abuse according to the World Health Organisation, this conflicts with the narrow definition of government legislation’s definition of elder abuse in aged care:
Elder abuse concerns
No older person should be subjected to any form of abuse, often referred to as ‘Elder abuse’. Elder abuse can take various forms such as physical, psychological or emotional, sexual or financial abuse. It can also be the result of intentional or unintentional neglect.
Elder abuse can be defined as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (World Health Organization).
Source: MyAgedCare website: http://www.myagedcare.gov.au/financial-and-legal/elder-abuse-concerns
Types of elder abuse
Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.
- Physical Abuse - Slapping, hitting, beating, shoving, pushing, kicking, pinching, burning, biting, severe beatings, inappropriate restraint
- Emotional Abuse - Inflicting mental pain, anguish, .
- Sexual Abuse - Non-consensual sexual contact of any kind, sexual exhibition to rape or sodomy; Inappropriate touching; Photographing in suggestive poses; Forcing to view pornography; Forcing sexual contact; Coerced nudity
- Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.
- Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
- Neglect - Withholding appropriate attention; Intentionally failing to meet older person's physical, social, emotional needs; Failure to provide food, water, clothing, medications; Failure to assist with activities of daily living or help with personal hygiene
- Emotional and Psychological Abuse - Name-calling, "Silent treatment", Intimidate or threaten the individual; invoke fear or mental anguish; cause emotional pain or distress, or distress on an elder person through verbal or nonverbal acts
- Financial Abuse - Misuse of older family member's funds; Embezzlement; Fraud, forgery; Taking money under false pretences; Forced property transfers
Elder abuse can affect people of all ethnic backgrounds, social status and gender.
An extract found in one of eight commissioned papers prepared for: 2020 A Vision for Aged Care In Australia - The Myer Foundation:
Morbidity among Older People in Residential Care:
The vast majority of older people in residential care have either severe or, more often, profound disability. Even within the group of people with profound disability, those in residential care are likely to be the oldest and frailest, and are also more likely to be women.
It is an indictment of the currently-poorly-maintained data sources that there is no clear overall study to quantify the health conditions and needs of those people in residential care, with the possible exception of cognitive impairment."
Source: The Myer Foundation - 2020 A Vision for Aged Care in Australia
Why don't we know more about abuse or neglect of older people?
It's not a "sexy" subject, is it? If you don't care about it now, it could be too late when it happens to someone you love. That someone could be you.
The Australian newspaper's Aged Care writer, Kate Legge reported in June 2004:
"There are no reliable national statistics to confirm the size of the problem. There is no mandatory reporting. No policy framework for investigating complaint. Not even an agreed definition of what constitutes elder abuse"
"They are hidden away. They don't go to school or out to the shops. No one sees them. Vulnerability and dependency are the two main prerequisites of elder abuse..."
Fast forward to 2016, this untennable situation remains.
Some of the reasons attributable to abuse and neglect of the elderly are:
- until recently there has been little public or professional awareness of elder abuse and neglect
- victims are often isolated and hidden from outside scrutiny
- societal attitudes and negative stereotyping of older people may lead to a lack of recognition of the problem
- victims may feel ashamed that the abuse is happening
- older people may feel they are the only ones in such a situation
- older people may fear retaliation
- signs of abuse and neglect may be overlooked and attributed to age related changes
There are many locations where abuse can occur, such as in a domestic situation, nursing homes, assisted living facilities, and other long term care facilities. Abuse can even occur in adult day care centers and community centers. Abuse can happen to anyone.
Some medical conditions can be difficult to deal with - especially if you have not had any experience OR exposure to it before. As a starting point, we would suggest that you browse through this site, where you will find many links, resources, and articles.
What are the causes of nursing home neglect and abuse?
Nursing home neglect and abuse has often been attributed to under qualified and insufficient staff. When staff are not properly trained, or overworked because there are too few workers, the results can be deadly. Some instances of nursing home neglect and abuse are acts of frustration. Nursing home staff has been viewed as "under-valued". Most aged-care workers earn only $13 or $14 an hour, despite many having to care for 60 or 70 residents a night (note there are no guidelines for actual number of staffing levels). Fast-food giant McDonald's pays workers over 21 almost $14 an hour.
Elder abuse or neglect by staff in care facilities may occur because of:
- Worker burnout; workers may be overworked, working long shift hours
- Untrained staff
- Staff underpaid or not enough benefits
- Staff may be frustrated with aggressive or rebellious clients
- Staff in a hurry to leave after a long day
Neglect is a type of elder abuse defined as the refusal or failure to fulfill any part of a worker's obligations or duties to a nursing home resident. Neglect and elder abuse in nursing homes may also include the failure to provide necessary care. Neglect typically means the refusal or failure to provide a nursing home resident with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to a resident.
The following descriptions are not necessarily proof of abuse, neglect, or exploitation, but they may be cues that a problem exists.
Elder abuse and neglect
Signs and symptoms of elder abuse and neglect include but are not limited to:
- dehydration, malnutrition (without illness-related cause), untreated bedsores, and poor personal hygiene
- unattended or untreated health problems
- hazardous or unsafe living conditions/arrangements (for example, improper wiring, no heat, or no running water)
- unsanitary and unclean living conditions (for example, dirt, fleas, lice on person, soiled bedding, faecal/urine smell, inadequate clothing)
- a nursing home resident’s report of being mistreated
- an injury that has not been cared for properly
- an injury that is inconsistent with explanation for its cause pain from touching
- cuts, puncture wounds, burns, bruises, welts
- poor coloration, sunken eyes or cheeks
- inappropriate administration of medication
- frequent use of hospital or health care/doctor-shopping
- lack of necessities such as food, water, or utilities
- lack of personal effects, pleasant living environment, personal items
- forced isolation
- Fear; Anxiety; Agitation; Anger
- Isolation, Withdrawal; Depression
- Non-responsiveness; Resignation; Ambivalence
- Contradictory statements; Implausible stories
- Hesitation to talk openly; Confusion or disorientation
Signs by care giver:
- Prevents elder from speaking to or seeing visitors
- Anger, indifference, aggressive behavior toward elder
- History of substance abuse, mental illness, criminal behavior, or family violence
- Lack of affection towards elder
- Flirtation or coyness as possible indicator of inappropriate sexual relationships
- Conflicting accounts of incidents
- Withholds affection
- Talks of elder as a burden
Medical neglect is the failure to provide proper medical geriatric care to the elderly. There have been recent reports alleging that nursing homes or hospitals, have failed to provide appropriate medical treatment to the elderly.
Signs and symptoms of medical neglect include but are not limited to:
- non-treatment of medical problems
- presence of bed sores
- over sedation
- incorrect medication administered (at times proving lethal)
- non-treatment of pain
Self-neglect is characterised as the behavior of a nursing home resident that threatens his/her own health or safety. Self-neglect is elder abuse that generally manifests itself in a resident as a refusal or failure to accept adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions. The definition of self-neglect excludes a situation in which a mentally competent nursing home resident, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.
Signs and symptoms of self-neglect include but are not limited to:
- dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene
- hazardous or unsafe living conditions/arrangements (for example, improper wiring, no indoor
- plumbing, no heat, no running water)
- unsanitary or unclean living quarters (for example, animal/insect infestation, no functioning toilet, fecal/urine smell)
- inappropriate and/or inadequate clothing, lack of the necessary medical aids (for example, eyeglasses, hearing aids, dentures)
- grossly inadequate housing
Physical elder abuse is the use of physical force that may result in bodily injury, physical pain, or impairment. Physical elder abuse may include acts of violence like striking, with or without an object, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning.
The inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical elder abuse.
Signs and symptoms of physical elder abuse include but are not limited to:
- bruises, black eyes, welts, lacerations, and rope marks
- bone fractures, broken bones, and skull fractures
- open wounds, cuts, punctures, untreated injuries in various stages of healing
- sprains, dislocations, and internal injuries/bleeding
- broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained
- laboratory findings of medication overdose or under utilisation of prescribed drugs
- a nursing home resident’s report of being hit, slapped, kicked, or mistreated
- nursing home resident’s sudden change in behavior
- the nursing home worker’s refusal to allow visitors to see a nursing home resident alone
Emotional or psychological abuse
Emotional or psychological elder abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological elder abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating a nursing home resident like an infant; isolating a nursing home resident from his/her family, friends, or regular activities; giving a resident the "silent treatment;" and enforced social isolation are examples of emotional/psychological elder abuse.
Signs and symptoms of emotional/psychological elder abuse include but are not limited to:
- being emotionally upset or agitated
- being extremely withdrawn and non communicative or non responsive
- unusual behavior usually attributed to dementia (for example, sucking, biting, rocking)
- a nursing home resident’s report of being verbally or emotionally mistreated
Abandonment in the form of elder abuse is the desertion of a nursing home resident by a nursing home worker, who has assumed responsibility for providing care for the resident.
Signs and symptoms of abandonment include but are not limited to:
- the desertion of a nursing home resident
- the desertion of a nursing home resident at a public location
- a nursing home resident’s own report of being abandonement
Sexual elder abuse is defined as non-consensual sexual contact of any kind with a nursing home resident. Sexual contact with any person incapable of giving consent is also considered sexual elder abuse. It includes but is not limited to unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.
Signs and symptoms of sexual elder abuse include but are not limited to:
- bruises around the breasts or genital area
- unexplained venereal disease or genital infections
- unexplained vaginal or anal bleeding
- torn, stained, or bloody underclothing
- a nursing home resident’s report of being sexually assaulted or raped
Financial or material exploitation is the illegal or improper use of a nursing home resident’s funds, property, or assets. Examples of this elder abuse include, but are not limited to, cashing a nursing home resident’s checks without authorization/permission; forging a resident's signature; misusing or stealing a resident’s money or possessions; coercing or deceiving a resident into signing any document (contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.
Signs and symptoms of financial or material exploitation include but are not limited to:
- sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the nursing home resident
- the inclusion of additional names on a nursing home resident’s bank signature card
- unauthorised withdrawal of the nursing home resident’s funds using the resident's ATM card
- abrupt changes in a will or other financial documents; unusual activity in bank account
- unexplained disappearance of funds or valuable possessions
- substandard care being provided or bills unpaid despite the availability of adequate financial resources
- discovery of a nursing home resident’s signature being forged for financial transactions or for the titles of his/her possessions
- sudden appearance of previously uninvolved relatives claiming their rights to a nursing home resident’s affairs and possessions
- the provision of services that are not necessary
- a nursing home resident’s report of financial exploitation.
- Frequent expensive gifts from elder to caregiver
- Elder’s personal belongings, papers, credit cards missing
- Numerous unpaid bills
- A recent Will when elder seems incapable of writing a Will
- Caregiver’s name added to bank account
- Elder unaware of monthly income
- Frequent cheques made out to “cash”
- Irregularities on tax return
- Elder unaware of reason for appointment with banker or attorney
- Caregiver’s refusal to spend money on elder
- Signatures on cheques or legal documents that do not resemble elder’s signature
More information: Guide for reporting reportable assaults (Dept. of Health: Ageing and Aged Care)