Elder abuse is defined as any action or deliberate inaction by a person in a position of power that causes distress or harm to Australians over the age of sixty. It is a form of family or domestic violence, and it can take many forms.

While evidence about prevalence is lacking in Australia, international indicators show that between 2% and 14% of older Australians will experience elder abuse in any given year with neglect possibly higher.

Alarmingly, people living in Australian aged care facilities are at even greater risk with about 39.2 per cent experiencing neglect, emotional and physical abuse according to estimates by the Office of the Royal Commission into Aged Care Quality and Safety.

So, what is elder abuse and how can we identify, report and prevent this type of violence to protect older Australians?

Types of elder abuse

According to the Domestic Violence Resource Centre, elder abuse includes physical, financial, psychological, sexual abuse and neglect of an older person.

Physical
Physical abuse includes inappropriate handling, taking or controlling a disability aid, sedating or providing care in a cruel or rough manner.

Financial
Financial abuse includes using power of attorney to withhold or misuse money, not allowing a person to keep or carry their own money and withholding knowledge of bank balances or household bills paid.

Psychological
Examples of psychological or emotional abuse include denying a person the right to make decisions due to their cognitive state, withholding access to small pleasures and talking about how hard it is to provide care in front of the older person.

Sexual
Sexual assault, force or coercion to partake in sexual activity or withholding care in exchange for sexual favours are forms of this type of abuse.

Neglect
Neglecting hygiene, withholding medication, personal or medical care, refusing or delaying assistance in case of an accident and receiving carer’s pension without providing care are all types of elder neglect.

Elder abuse in aged care

Abuse that occurs in aged care facilities and nursing homes can be attributed to resident-to-resident abuse and also abuse and neglect at the hands of staff and carers.

River Night, CEO of Australian Communities and disability sector professional, says he has witnessed and investigated elder abuse in many forms throughout his 25-year career.

“Elder abuse and neglect are common, and the sector is not raising the bar fast enough despite decades of learning and experience.”

Mr Knight says there are several reasons for abuse and neglect, including:

• Staff number and skills shortages resulting in large scale recruitment of staff without experience, adequate supervision or regulation.

• Staff-resident ratios are inadequate and encourage fast tracking and depersonalisation.

• It is a hidden sector culturally – we hide our ageing population and their care which impacts on transparency and accountability.

Protecting elders in aged care

We can prevent abuse through statutory regulations and legislation compliance, but there needs to be a willingness and commitment to do so, explains Mr Knight.

“We need a statutory agency that visits all aged care facilities monthly.

“[The agency] should have total power to access all records and impose directives with the capacity to escalate matters to financial and regulatory consequences for breaches with quick response times.

“Service and practice models need to become principle based rather than focused on ticking boxes and doing the minimum for compliance.

“Legislation compliance should be an expected basic standard not a point of difference. From a scale of one to 10 - 1 should be following the law, 10 should be excellent service delivery.”

Quality of life care

The aged care system must protect older Australians from abuse, but it should also enrich their lives, and this should be the goal, says Mr Knight.

“The service needs to become just that, a service. Aged care residents need to be treated as customers with status and respect, not as patients lucky to get anything at all.

“Food, environment and culture need to be assessed and the bar raised to a level you would like yourself.

“It is not rocket science! Medication, showers and meals are a minor part of an average person’s day, but they are the primary focus of aged care facilities.

“Quality of life, culture, stimulation, community, identity, relationships, physical activity and enjoyment are what life is made of.”

Grescha Brewer, a former aged care registered nurse and manager, agrees saying the aged care system is in need of reinvention.

“The current aged care system is broken – it has become big business, building larger and larger homes to accommodate residents in a deeply impersonal manner.

“Carers are given too high a workload and far too much responsibility for their education level.

“Families rarely visit their loved ones in an aged care and carers are often also required to be the emotional support for the residents.

“This leads to compassion fatigue and increased stress. It’s a frightening cycle, and it has to change.”

Increasing legislation and paperwork is not the solution, advises Ms Brewer, instead humanity must be put back into aged care.

It’s this insight that led her to open an independent aged care home.

“We decided to reimagine aged care and opened Honey Bee Homes.

“It’s a small home for seniors with 24-7 live-in care and supported living for a select number of seniors from a team with decades of care experience.”

What can aged care professionals do?

Mr Knight says aged care professionals can make a difference by reporting abuse and lifting standards of quality care.

“There is plenty of work in the sector, so stop tolerating abuse and neglect…Raise the bar, expect more and tolerate less.”

“Ensure written documentation and evidence is created for all interactions, report abuse and neglect and include names so those involved cannot escape responsibility.

“Never be afraid to escalate matters in writing to the regulatory body, the Federal Minister responsible and every media outlet you can find.

“If we don’t allow people to act in the shadows and behind a screen of fear, avoidance and bureaucracy – we will see change!”