Recognising and Responding to Elder Abuse
Published: 22 August 2021
Published: 22 August 2021
Content warning: Please be aware that this Article contains graphics and information relating to abuse, which some people may find distressing.
Any person receiving care - regardless of age, gender or disability - should be able to access support without experiencing (or fearing) violence, abuse, neglect, exploitation or discrimination.
Abusive behaviour of any kind towards older adults (from staff, residents or others) is a violation of basic human rights and unacceptable in any setting (Better Health Channel 2016).
An older person’s right to access care without suffering abuse is set out in Aged Care Quality Standard 8: Organisational Governance.
The following article provides an outline of different forms of abusive behaviour so that you can recognise the signs and take action.
A 2020 report from the Royal Commission into Aged Care Quality and Safety estimates that almost 40% of aged care residents experience neglect, emotional abuse or physical abuse:
(The Royal Commission into Aged Care Quality and Safety 2020)
According to the report, the abuse being experienced by aged care residents includes:
Neglect |
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Emotional abuse |
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Physical abuse |
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(The Royal Commission into Aged Care Quality and Safety 2020)
Violence is defined as the use of physical force with the intention to hurt, damage or kill somebody else (Better Health Channel 2016). This might include:
(Hall, Karch & Crosby 2016)
Abuse is a violation of rights that involves the exploitation of power. There are several types of abuse that may be experienced by older adults:
Sexual abuse refers to any sexual activity that takes place without consent. It does not necessarily involve penetration or physical contact and may take the form of indecent exposure or other sexually inappropriate actions that are not consented to (RACGP 2014; NSW Ombudsman 2017).
Emotional abuse is behaviour that scares or terrorises someone, potentially causing them to lose confidence, self-esteem or self-determination. It includes:
(RACGP 2014; NSW Ombudsman 2017)
Social abuse is the intentional isolation of a person from their family, friends and other contacts (RACGP 2014; NSW Ombudsman 2017).
Systems abuse is mistreatment related to how the organisation’s service is run (e.g. clients being made to eat meals at a certain time to fit in with staff changeover) (RACGP 2014; NSW Ombudsman 2017).
Statistics regarding the prevalence of abuse against older Australians is limited, however, it is estimated that between 2-14% of the older adult population has suffered abuse (AIFS 2016).
Neglect is failure to fulfil a client’s basic physical or psychological needs (RACGP 2014). It includes:
(Better Health Channel 2016)
Exploitation, also known as financial abuse or economic abuse, is the intentional misuse of a client’s money or assets for personal gain (RACGP 2014). It includes:
(RACGP 2014; CDC 2016)
Discrimination is the mistreatment or bullying of a client based on their personal characteristics (or presumed characteristics). These characteristics can include (but are not limited to) gender, age, sexual orientation, disability, employment, race or religious belief (Victorian Equal Opportunity & Human Rights Commission n.d.).
Your organisation must have clear policies and procedures established to protect clients from abusive behaviour. It is also important to maintain a workplace culture that promotes positive values, experience and attitudes and is transparent about its processes (NDS 2017).
Disability Services Queensland (pp. 18-21) outlines key features of abuse prevention that should inform policies and procedures.
It is also essential for your organisation to have a code of practice stating expectations and values (DSQ 2008).
In addition to individual organisations’ policies and procedures, there is federal and state legislation designed to protect the rights of clients. These include, but are not limited to:
There are a number of Australian advocacy groups for aged care. The Older Persons Advocacy Network (OPAN), which is contracted by the Australian Government, provides free, independent and confidential advocacy services to aged care clients (ACQSC 2020).
Each Australian state and territory also has its own elder abuse service.
Read: What is the Serious Incident Response Scheme (SIRS)?
The Serious Incident Response Scheme (SIRS), which commenced in April 2021, is a federal government initiative aiming to reduce the risk of abuse and neglect in Commonwealth-funded residential aged care. It expands upon the protections offered by the Aged Care Act 1997 (ACQSC 2021; Ausmed 2021).
Under the SIRS, Commonwealth-funded residential aged care providers are required to identify, record, manage and resolve all serious incidents, which include:
(ACQSC 2021)
Furthermore, these incidents, along with any allegation, suspicion, or witness account of these incidents, must be reported to the Aged Care Quality and Safety Commission (ACQSC 2021).
Mandatory reporting exists for a number of offences and it is not only part of your duty of care as a healthcare professional to report these, but also your legal responsibility. In other cases, you must gain the client's (or their substitute decision maker's) consent before reporting abuse to a third party (NSW DoH 2020).
If a client chooses not to report abuse, you should respect their wishes but provide them with resources and helplines in case they change their mind (NSW DoH 2020).
You should also be mindful of the client’s decision-making capacity. Always adhere to the capacity assessment principles (NSW DoH 2020).
Clients experiencing abusive behaviour may not seek help due to fear, guilt, shame, lack of capacity or lack of knowledge about the resources available to them (Better Health Channel 2018).
Therefore, it is important to be able to recognise the signs of abuse in case it is not being disclosed by the client. Signs may include, but are not limited to:
(Better Health Channel 2018)
A more comprehensive list of indicators is available from Disability Services Queensland.
Your organisation should have clear policies and procedures for responding to abuse. All staff should be familiar with these frameworks, as well as their duty of care to clients (Seniors Rights Victoria 2016).
Healthcare workers may be the first people to notice or suspect abuse. If you suspect abuse:
(Seniors Rights Victoria 2016)
Mandatory reporting exists for a number of offences and it is not only part of your duty of care as a healthcare professional to report these, but also your legal responsibility. In other cases, you must gain the client's (or their substitute decision maker's) consent before reporting abuse to a third party (NSW DoH 2020).
If a client chooses not to report abuse, you should respect their wishes but provide them with resources and helplines in case they change their mind (NSW DoH 2020).
You should also be mindful of the client’s decision-making capacity. Always adhere to the capacity assessment principles (NSW DoH 2020).
All clients have the right to receive care without abuse or fear of abuse. Abuse is never acceptable in the workplace. Ensure you can recognise the signs of abuse and always take action if you suspect a client is being harmed.
Question 1 of 3
Jeff is a nurse at an aged care facility. His favourite client to visit is Mary, who he has a good rapport with. However, whenever Jeff sees Mary interacting with another nurse, he gets very upset and berates Mary for ‘betraying’ him. What kind of abuse is this?