Identifying, Responding to & Preventing Elder Abuse

1. Identifying, Responding to & Preventing Elder Abuse Northern Rivers Abuse of Older Adults Prevention Project

2. Northern Rivers Abuse of Older Adults Prevention Project • Funded by the Attorney-General’s Department of the Commonwealth Government under the National Community Crime Prevention Programme (NCCPP) • Duration of project is 2 years (Jan 07- Jan 09) • Northern Rivers region- Grafton to Tweed, which has the highest ageing population in NSW

3. Project Aims • To develop a local framework to assist local agencies and services in clarifying roles and points of contact for referrals • Develop public awareness of the nature, prevalence and impact of abuse of older adults. • Develop a training and education package for aged care service providers

4. Key Activities of the Project: • Empirical research (quantitative and qualitative) • Develop interagency response process • Develop education/training manual • Focus on prevention and education • Public forums • Advertising campaign • Respond to emerging needs of N.R communities

5. Identifying Older Adult Abuse

6. Definition of Elder Abuse Elder abuse is any act occurring within a relationship where there is an implication of trust, which results in harm to an older person. Abuse can include physical, sexual, financial, psychological and social abuse and/or neglect. Australian Network for the Prevention of Elder Abuse, 1999

7. Types of Older Adult Abuse Neglect Physical Abuse Sexual Abuse Psychological Abuse Financial Abuse Spiritual Abuse Social Abuse

8. Images courtesy of Dr Susan Kurrle

9. Images courtesy of Dr Susan Kurrle

10. Images courtesy of Dr Susan Kurrle

11. Images courtesy of Dr Susan Kurrle

12. Prevalence • Ranges from 1% to between 3 and 5 % • Adult daughter or son most common perpetrator • Financial abuse and psychological abuse most common • Women were abused at two and half times the rate of men • Co morbidity of abuse

13. Signs of Abuse • Physical symptoms such as cigarette burns, abrasions, bruising • Being afraid of a particular person or persons • Depressions, introversion, anxious and worried for no apparent reason, avoiding physical, eye, or verbal contact • Sudden inability to pay for basic necessities such as food, clothing, shelter, bills • Inability to access bank statements or to locate cheque books, credit cards, or bank correspondence • Drastic changes to wills • The older person appears to be unkempt or uncared for

14. Example 1

15. Example 2 • Mrs Wright - 2 weeks in hospital. • Son and daughter offered to help manage finances • Mrs Wright signed an Enduring Power of Attorney form • Mrs Wright agreed to lend her children $2000 each and found bank balance had dropped by $20,000 • When discussed with children, they were derogatory and threatened to put her away and would never see grandchildren again .

16. Example 3 • `Anne’ mid 60’s • Notifier witnessed abuser “slamming” victim in the area of her recent mastectomy operation • GP questioned `Anne’ about suspicious bruises but she was too ashamed to admit the assault. • Perpetrator acquired access to `Anne’s’ accounts when she was ill and heavily medicated and has now taken in excess of $100 000 • Abuser works in medical industry and has tampered with medical files • `Anne’ is attempting to take out an AVO • Perpetrator has promised to stop abuse if Anne signs over her house and if she stops legal action.

17. Risk Factors for Abuse • Impaired capacity, and in particular dementia increases risk • Physical illness, frailty, and/or dependency. • Insufficient planning for old age (baby boomers) • Lack of knowledge about rights, and important legal documents such as enduring powers of attorney, and powers of attorney

18. Risk Factors for Abuse (cont) • Pre-existing family conflict • Cultural factors- Indigenous clients, clients from CALD backgrounds • Mental health or substance abuse/psychopathology of abuser • Inadequate social and support networks

19. Perpetrator Risk Factors • Carer stress • Lack of knowledge about how to care for older person • Financial difficulty, greed, `inheritance impatience’ • Alcohol and substance abuse • Pre-existing family conflict and/or abuse • Family dynamics • Mental illness

20. Older Adults Abuse in Northern NSWEmpirical Findings

21. Agency Response: 33% of agencies had encountered cases of abuse during the previous six months (N=52 agencies)

22. Limitations: 77% of agencies recorded limitations relevant to responding to older adult abuse. Resources (29%) were reported as the most relevant limitation followed by reporting (21%)

23. Number of Victims: 183 (7%) of older persons seen in the previous six months were known/suspected victims of abuse. 76 were male and 107 were female.

24. Recorded Cases by Agency: Most male victims were recorded by Police (91%). And most female victims were recorded by Police (49%) and by Domestic Violence Services (27%)

25. Victims of older adult abuse over 80 years of age. Most victims of abuse aged over eighty were recorded by ACAT agencies (63%) and public hospitals (25%). Thirty-two percent of victims over eighty were male and 62% per cent were female.

26. Victims of older adult abuse between 61-65 yrs of age More than 90% of victims of abuse aged between 61 and 65 were recorded by domestic violence services.

27. Disability: 7% elder abuse victims had a decision-making disability, and 11% had a physical disability.Of the 44 victims of abuse that were known to have a disability, 73% had carers.

28. Type of Abuse: Most abuse seen by agencies was psychological abuse (22%) and financial abuse (20%). Sexual abuse was recorded the least (2%).

29. Perpetrators: Sons (20%) and daughters (20%) of older persons were identified most often as the perpetrators of abuse, followed by other relatives (15%) and friends/neighbours (15%).

30. Main causes of abuseAlcohol/drugs (25%) were listed as the main cause of older adult abuse, followed closely by mental health (20%), and carer stress (20%).

31. Community Members: Have you heard of older adult abuse? Most respondents (62%) said yes, while 38% said no.

32. Are you personally aware of elder abuse happening within your community? Twenty seven per cent of respondents answered `yes’.

33. Who would you report a case of elder abuse to? 84%- said would reportif they suspected an older person was being abused, 67% indicated ‘The Police’ when asked to which agency they would report the suspected abuse of an older adult

34. Summary of Key Findings • Police play a pivotal role in responding to cases of elder abuse, along with ACAT and DV services • Resources are a main limitation of responding to elder abuse cases • Financial and psychological abuse prevention strategies • Further research needs to be conducted to identify those at risk of being abused and those at risk of perpetrating abuse • Carer stress reduction strategies need to be identified

35. Responding to Older Adult Abuse

36. Key Issues for Service Providers • Emergency and non-urgent responses • Mental capacity and consent • Privacy, Confidentiality, and Duty of Care • Confirming suspicion of abuse- Elder Abuse Suspicion Index • Cultural Issues • Understanding the abuse within a historical context • Deliberate abuse or misinformation?

37. Response to an abusive situation • REMAIN CALM: Do not panic. Consider if you can safely stop the abuse. • ALERT: Other staff by using call bell, phone or alarm system. • REASSURE: The older person. Offer comfort. • PROTECT: The scene. Do not alter or remove items from the area. • ADVISE: Yoursupervisor. • RECORD:Details of the event on appropriate document.

38. Preventing Older Adult Abuse

39. Global Elder Abuse Prevention Strategies • Structuring financial transactions to reduce the possibility of abuse .eg Canada- Older adults authorising monitoring of accounts for unusually large transactions • Implementation of specific financial abuse legislation • Engaging the financial and legal sector • Staff training and screening • Community education campaigns to promote awareness of powers of attorney and their advantages for older people • ANPEA - national prevalence study

40. Local Elder Abuse Prevention Strategies Financial Abuse Prevention Strategies Locally • Reducing social isolation • Engaging local financial and legal sector e.g. the establishment of a financial abuse prevention committee • Education and training for both service providers and community members in how to identify and respond to cases of older adult abuse • Collaboration- interagency approach in which various services and agencies within the community work together, incl. Govt. and NGO • Linking in with other elder abuse prevention units in Australia • Development of Intergenerational Contact Programs

41. Safeguarding Against Abuse • Manage your own financial matters for as long as possible • Plan for the future, and ensure that those around you are aware of your wishes • Seek independent advice from a trusted person outside the family • Avoid making important legal and financial decisions, or signing documents under pressure. Wait until you have all the information you need • Obtain legal advice before signing any important documents • Continue to remain active in the community, and keep connected to your network of family, friends and neighbours. • Avoid making important financial and legal decisions after major life events such as the loss of a loved one, or relocation.

42. Key Contacts • Police 000 • Your local Community Legal Centre for information and advice or LegalAid • Guardianship Tribunal • Domestic Violence Service • ACAT (Aged Care Assessment Teams) • Commonwealth Carelink • Sexual Assault Service

43. ACSA Elder Abuse: A Holistic Response background paper, Confronting Elder Abuse position paper; policies and procedures resource guide www.agedcare.org.au ACT Elder Abuse Information and Referral Service Boldy, D ( 2002, Curtain University) Queensland Elder Abuse Prevention Unit (EAPU) www.eapu.com.au Seniors Advocacy Information and Legal Service (SAILS) www.caxton.org.au/services South Australia ARAS: Abuse Prevention Program www.sa.agedrights.asn.au/prevent Western Australia Advocare: Elder Abuse Prevention Program www.advocare.org.au VIC new Community Education and Older Person’s Legal Service Acknowledgement: Images courtesy of Dr Susan Kurrle, Hornsby Hospital Resources

45. www.nrsdc.org.au Northern Rivers Abuse of Older Adults Prevention Project