Neglect Is Still Abuse

Neglect is also a form of Elder Abuse.

How many elders have been seriously injured or have died as a result of staff or family carers neglecting to provide essential care and support to a vulnerable person?

Now, when I talk about neglect I am not referring to those times when someone simply neglects to call their grandmother on her birthday, or forgets to pick up something requested by a client. We all get busy and we all make mistakes. What I’m referring to is where neglect is a result of negligence.

I think that most people understand the meaning of the term negligence as a lack of action that leads to serious negative consequences.

How might this look in an aged care setting?

Rosie is unable to get out of bed easily and get to the toilet in time. She doesn’t want to wear continence aids as they feel uncomfortable. When she calls for assistance to get up to go to the toilet in the night, her buzzer is ignored and she ends up wetting the bed. Still no one comes to assist her and she spends the rest of the night lying in a wet bed.

Sam has difficulty getting out and about in the community and relies on his son to collect his essential medication each fortnight. Sam’s son doesn’t give collecting his dad’s medication a high priority and often Sam misses taking his medication for days at a time as he runs out regularly.

Julietta has dementia and can’t get around easily. She relies on her family to bring her drinks and remind her to eat. Julietta has been losing weight recently as her family carer has been leaving her to eat her meal alone. The carer socialises with other family members in another room as they find Julietta’s behaviour too distracting for her to eat with the rest of the family.

Phillip is unable to walk far; he uses a wheelchair to get around the community. Phillip’s family have been wheeling him outside each morning and placing the chair under a shady tree. However, as the sun moves so does the shade, and Phillip is left in the sun for hours at a time with no water. Last time this happened, he needed to be evacuated due to severe dehydration.

Tilly requires assistance with personal care including changing her continence aids. She visits the community care centre each morning from Monday to Friday for a shower and to change her continence pad. Her family have agreed to help Tilly change her continence pads on the weekend, however staff at the centre notice that every Monday morning Tilly comes in wearing the same clothes that she went home in on Friday and that her continence pad is soaked or has been removed.

Other instances we have heard of are:

• Withholding sufficient fluids to minimise the amount of times a person needs to be taken to the toilet or have their continence aids changed.
• Not bothering to give a person their medication each day.
• Not providing a pureed meal to someone who requires it.
• Not providing a person with essential items such as clothing or personal hygiene products, which results in the person becoming isolated from society due to feelings of shame.
• Leaving a vulnerable person, e.g. someone with dementia, in a public place without adequate support or supervision.
• Not providing access to dental services for the repair or replacement of broken dentures.
• Deliberately isolating a person from others of their culture or language.
• Not assisting a person to access services such as podiatry support to trim nails, leading to walking problems or difficulty handling items due to overgrown fingernails
• Not assisting an immobile person to turn regularly leading to pressure sores.

Is every instance of neglect elder abuse?

Where the person participates in self-neglect, this is not considered elder abuse. Everyone is different and has different standards of what is acceptable. If a person decides to purchase ‘end of shelf life’ products from the supermarket, or restrict their intake of food due to religious or lifestyle choices, that is their right of decision making. It might be prudent for the service provider to discuss these choices with the client and / or their carer though.

How can you prevent neglect?

Follow the person’s care plan.
If you read through and understand just what the person needs and when they need it, it is less likely that an essential care support will be overlooked or inadvertently missed.

Recognise that the individual client is a person, just like you and I.
Recognising the humanity of each and every one of your clients is important. If people are acknowledged for their uniqueness and their individual needs rather than just another shower to get through or another continence pad to change, you are more likely to have empathy and to respond appropriately and in a timely manner.

Be observant.
One of the roles of a support worker is to notice when things are not right and report appropriately. If you notice that a client is losing weight for no obvious reason, that they are experiencing more frequent acute health events, that they are coming in to the centre looking unkempt or with unchanged continence aids, or a client has complained of having a reasonable request repeatedly ignored by staff, this should be reported to management for further investigation as soon as possible.

Ensure everyone knows and understands their role.
In the case of community care where family carers are providing some of the supports or there is a shared care arrangement with another provider make sure that responsibilities are clearly documented in the support plan. Also check that family carers have the knowledge and skills required to provide the care they have agreed to; you may need to provide training or education if a gap is identified.

Educate older people on their rights.
Making sure that older people understand they have rights is an important part of ensuring people are equipped to deal with elder abuse. If people understand they don’t have to put up with being mistreated, if their self-esteem is maintained, and they know of and feel comfortable in seeking support, then they may be less likely to tolerate injustices and reach out for help.

Resources that can help

The Older Persons Advocacy Network (OPAN) is a national network comprised of nine state and territory organisations that deliver advocacy, information and education services to older people in metropolitan, regional, rural and remote Australia. OPAN is funded by the Australian Government to deliver the National Aged Care Advocacy Program and provides free services to support older people and their representatives in addressing issues related to Commonwealth-funded aged care services.

Click here to access information on the National Elder Abuse Prevention and Advocacy Framework. There are also resources for consumers and providers that you and your service, staff, clients and carers may also find helpful.

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