Elder Abuse – why it’s important to talk about it, recognise it, and act

This week on the 15th of June, the very sobering topic of Elder Abuse is highlighted and formally recognised across the world with ‘World Elder Abuse Awareness Day’.

The value of seniors in our community should not be underestimated. Seniors continue to actively contribute to society through volunteering – using their knowledge, perspective and guidance based on many years of lived experience. They are an important part of our society.

But what happens when our elders aren’t valued or treated with care, respect and dignity?

The risk is Elder Abuse.

Elder abuse is defined as any act that ‘causes harm to an older person.’ Abuse can take many forms; for example, it may be physical, social, financial, psychological or sexual and can include mistreatment and neglect. Abuse is usually carried out by those close to the older person, such as a family member, carer or support worker.

When this happens in society, the result can be substandard care being provided by those who are paid to care and support vulnerable older people.

This is the situation currently being highlighted by the Royal Commission. Where staff members and organisations have not assumed an attitude of care, but rather one of ‘getting the job done’ or ‘keeping an eye on the profit’.

Sometimes, the abuse and subsequent injury has occurred because staff have not been adequately trained; they inadvertently caused harm or injury. Some people have also knowingly and consciously harmed individuals. Whether this behaviour is the result of frustration arising from their job, or a heartless approach towards caring for their fellow man, when a person deliberately harms another individual, especially those who are vulnerable and cannot defend themselves, this is totally unacceptable.

In our workplace, we need to be aware of the signs of elder abuse and respond appropriately and in a timely manner if we observe, or suspect, another staff member is abusing a client.

What might this look like in a care environment?

Elder abuse can be physical and includes actions such as slapping, pinching and hitting a client. Physically restraining a person such as locking them in a room or putting them in a chair that they cannot freely get out of is also a form of abuse.

Chemical restraint has come under a lot of scrutiny recently, with evidence highlighting an overuse of medications to sedate clients, particularly those with dementia, in an effort to reduce the number of staff required to supervise clients.

Psychological abuse is also a concern in the care environment. If a person feels unable to express themselves, if they feel they have to keep their identity suppressed, or they become isolated, this can have a significant negative impact on a person’s psychological wellbeing.

Some residents in care who identify as LGBTIQ+ have reported instances of being isolated by staff or management, or have been asked to suppress their identity whilst in care. Other examples can arise where clients from a non-English speaking background have become isolated due to language barriers. The person may be isolated from society, with no connection to culture or other people. No one understands them, no one takes the time to really find out what they need, no one ‘cares’ for them or supports them in a way that helps them maintain their dignity and sense of self.

The risk of financial abuse can sometimes be higher in community care than in residential care, where staff are often not as closely supervised. A risk can arise where close professional relationships are formed between care staff and clients, sometimes with the staff member being the one regular visitor that the client sees. In these situations, there have been reports of unscrupulous support workers taking advantage of the client’s vulnerability. This can be seen in purchasing a packet of cigarettes for themselves from the client’s funds when carrying out the client’s shopping, accepting gifts of money or valuables from the client, or stealing items, especially where the client is unlikely to be aware of the loss.

Prevention is better than cure as they say, so what can you do to prevent it in the first place?

Training is number one on my list. All staff should be aware of what is acceptable behaviour and what is not.

A code of conduct should be in place and staff should be taken through this when they start and regularly thereafter. Any instances where a staff member deviates from the code of conduct should be addressed in a timely manner.

Staff should receive training on what constitutes elder abuse and the signs to look for. This training should be delivered annually. Take the opportunity to use reports of abuse that have been highlighted in the news as a discussion point when conducting staff meetings.

Staff should also receive training on how to provide quality care. It is not enough to employ a staff member and send them in to shower a client without buddying them up first to ensure that they understand what the expected standards are and how to effectively (and appropriately) care for the individual.

Staff should receive training on dealing effectively with challenging behaviours and staffing levels should be sufficient to manage clients with challenging behaviours in a way that minimises the risk of injury or harm to themselves or others.

Your organisation should have a policy of open disclosure, so when something goes wrong there is an open discussion with the consumer and other support people, and an explanation of what happened, what action will be taken to manage the situation, and what will be changed to prevent it from happening again.

Sometimes staff may inadvertently cause injury or harm to a client and it's critical that they feel able to report the incident. Staff should be offered further training or support to improve their performance and minimise the risk of the incident reoccurring.

Your organisation should also have in place policies and procedures, overarching diversity plans and individual cultural support plans that support clients who identify with a specific cultural group. Staff should be aware of these and they should be working documents, not merely words on paper.

If you have staff who are operating unsupervised for much of their work day, such as in the case of community care workers, ensure that there are processes in place to minimise the risk of abuse. This might be policies and procedures around handling client funds that have checks and balances built in; clear information in client and staff handbooks that emphasise the limit on gifts that can be given or accepted.

Follow up on anything that doesn’t ‘feel right’ or a concern reported by a family member or neighbour. It might take a bit of digging – sometimes those who have been, or are, the victim of abuse don’t like to talk about it or aren’t necessarily aware there is something wrong.

And don’t forget the need for both police checks and the importance of conducting proper reference and background checks when employing new staff.

As the Royal Commission has highlighted, elder abuse is not something that is limited to some care staff or to an organisation or residential care setting.

Unfortunately, elder abuse is sometimes carried out by close family members or friends of an older person. We discussed what this might look like in a remote setting in a previous blog article that you might want to read: Recognising Elder Abuse – And What You Can Do About It.

Older people are special people that have contributed much to our society and they deserve to be treated with dignity and respect. What we really want to emphasise is that elder abuse has no place in our society, and that all of us have a responsibility to support clients in our care to live a life free from abuse or the fear of abuse.