Audio transcript (edited)

HIGGINS

Good afternoon everyone and welcome to today's webinar, "Elder Abuse: Recent Research and Effective Responses." My name is Daryl Higgins and I'm a Deputy Director here at the Australian Institute of Family Studies. Today we will hear about elder abuse, what we know from research, and how practice and policy can effectively respond, and we are very pleased to present this webinar in collaboration with the Greater Melbourne Family Law Pathways Network. Before I introduce our speakers I would like to acknowledge the traditional custodians of the land on which we meet. In Melbourne, the traditional custodians are the Wurundjeri people of the Kulin nation, I pay my respects to their elders, past and present, and to the elders from other communities who may be participating today.

I'd like to alert you to a couple of brief housekeeping details. Firstly, one of the core functions of the CFCA Information Exchange is to share knowledge, so I'd like to invite everyone to submit a question via the chat box at any time during the webinar today and we'll try and respond to your questions at the end of the presentation. But we'd also like you to continue the conversation that we begin here today afterwards. So to facilitate this we've set up a forum on our website where you can discuss the ideas and issues raised and submit additional questions for our presenters, and we'll send you a link to that forum at the conclusion of today's presentation. Please remember that this webinar is being recorded and the audio, transcript and presentation slides will be made available on our website and YouTube channel in due course.

But I do need to mention a couple of disclaimers, first of all, the views expressed during this presentation are those of the presenters and may not reflect the views of the Australian Institute of Family Studies or the Australian Government, and it's also important to remember that this presentation and its contents are not legal advice. While every effort has been made to ensure that the content is accurate and up to date, the law is complex and constantly changing. As a result, specific advice should be sought from a solicitor.

Now it's my great pleasure to introduce today's speakers. Firstly, one of my colleagues here from the Institute, Dr Rachel Carson. She's a research fellow and is in our area of family law and family violence here at the Institute, and after practicing as a family lawyer, Rachel completed a socio-legal PhD at the University of Melbourne where she worked as a researcher as well in the Law School, and she's been with us here at the Institute since 2012 and has worked on various mixed-methods research projects, including the scoping study on elder abuse that we're going to be hearing about today.

We'll also be joined by Melanie Joosten – sorry I've mispronounced that, Joosten. Melanie is a research officer at the National Ageing Research Institute. Her recent projects include an action plan to address elder abuse in Victoria, doing research into the outcomes of elder abuse interventions with Seniors Rights Victoria, and a Beyond Blue funded study regarded depression and anxiety in older lesbian, gay, bi-sexual, transgender and intersex people.

Gary Ferguson has worked in community education and training for the past 20 years and has extensive experience in delivering programs and since 2008 has been establishing the community education program for Seniors Rights Victoria. He's been responsible for the delivery of professional education sessions to professionals and workers in health, community, aged care and associated sectors.

And last but not least, Dr Anita Frayman, who's a nationally accredited mediator, qualified lawyer and an adjunct researcher at Monash University. She practices as an elder mediator, facilitator and aged care consultant, and is a member of the Australian Associate of Gerontology and the Aged Care Policy Committee of the Ethnic Affairs Community Council of Victoria, and the EECV Elder Abuse Project steering committee. So please join me in giving all of our presenters a very warm, virtual welcome and I'll hand over to our first speaker now, Dr Rachel Carson, thanks Rachel.

CARSON

Thank you Daryl. Today in this presentation I will briefly outline what might be said to constitute elder abuse, I will cover the state of the evidence about the prevalence of elder abuse, and population and wealth dynamics, before considering risk factors, and the issue of reporting and the complexities seeking redress. My discussion today is based on the AIFS research report, No.35, entitled "Elder Abuse: Understanding Issues, Frameworks and Responses," which is the report from a scoping study undertaken by Dr Rae Kaspiew and I from the Institute and Professor Helen Rhoades from the Melbourne Law School.

The aim of this scoping study, which was commissioned and funded by the Australian Government Attorney-General's Department, was to provide a broad analysis of the issues raised by elder abuse in the Australian context. So let's begin with what may be said to constitute elder abuse. While there is no single definition of elder abuse in Australia, a commonly applied definition is that applied by the Australian Network for the Prevention of Elder Abuse in 1999. This definition of elder abuse, which is presented here on this slide, covers any act occurring within a relationship where there is an implication of trust which results in harm to an older person. This abuse may be physical, sexual, financial, psychological, social or involve neglect.

At an international level, the World Health Organisation in their 2015 World Report on Ageing and Health reported that the estimated prevalence rates of elder abuse in high or middle income countries ranged from two to 14 per cent, with prevalence estimates for the varying forms of elder abuse being up to five per cent for physical abuse, up to one per cent for sexual abuse, between one and six percent for psychological abuse, between one and nine per cent financial abuse, which has been defined by the WHO as the illegal or improper exploitation or use of funds or resources of the older person, and up to 6 per cent for neglect.

We can see from these figures that psychological and financial abuse are estimated as the most common types of abuse reported, although an Australian Longitudinal Study of Women's Health suggests that neglect could be as high as 20 per cent among older aged women. It is also important to note that these prevalence estimates do not draw on data from elders in institutional care, or those with cognitive impairment, so this limitation must also be borne in mind. Looking more specifically at this state of play with Australian data, it's important to note that we have no systematic national prevalence data relating to elder abuse experienced by elder men and women in Australia, however we have two population-based studies that yield some insight into the extent to which older women experience violence. But, in addition to relating only to women, there were limitations in relation to the measures used and the extent to which these measures assess concepts relevant to elder abuse.

The first is a recent analysis published by Australia's National Research Organisation for Women's Safety of data from the 2012 Personal Safety Survey. While this survey was aimed at assessing violence against women rather than elder abuse directly, and it also focussed on sexual assault and partner violence involving physical assault, physical threat, sexual assault and sexual threat of a cohabiting or intimate partner. It did nevertheless provide some insight into elder abuse. Despite the limitations including the age range for older women in this survey being 55 years and older, the data indicates that 0.4 per cent of women in this age category reported experiencing cohabiting partner violence in the previous 12 months, and 0.2 per cent of the sample in this age group reported experiencing sexual assault.

The second population-based survey yielding some insight into approximations of prevalence of abuse of elder women is the 2014 Australian Longitudinal Study of Women's Health, which I alluded to earlier. This study was based on a random sample of women drawn from Medicare. When the oldest cohort of women surveyed in 2011, at the ages of 85 to 90 years, the findings from his cohort suggested that eight per cent had experienced vulnerability to abuse, with verbal abuse such as name-calling and put-downs being the most common form. Slightly lower levels of prevalence were reported at the younger ages at of age 70 to 81 years, and as I mentioned earlier there was a prevalence rate of about 20 per cent for neglect. As noted on the current slide, there have also been studies based on calls to Helpline, with three recently published studies from Victoria, Queensland and New South Wales respectively providing insights into situations where elder abuse is suspected or known to be occurring, and a concerned person has sought advice from a helpline.

The Victorian study which was undertaken by Melanie Joosten who is presenting shortly, and her colleagues at the National Ageing Research Institute and commissioned by Seniors Rights Victoria, who are represented by Gary Ferguson, here also today. This study was based on an analysis of data from records – calls to a Helpline that was operated by Seniors Rights Victoria between July 2012 and June 2014. Of the 755 calls, 455 raised elder abuse issues, the most common concerns were about financial abuse at 61 per cent, and psychological or emotional abuse at 59 per cent. Physical abuse was raised much less frequently at 16 per cent, neglect at one per cent, and sexual abuse at 0.4 per cent.

In this data elder abuse issues were most commonly recorded in relation to female victims and the most commonly reported perpetrators were males. And the majority of alleged perpetrators of the abuse reported to the Seniors Rights Victoria helpline were children of the victims. In Queensland an analysis of calls to the Elder Abuse Prevention Unit helpline for a five year period, also provided a profile of elder abuse concerns. The calls were mostly in relation to female victims at 68 per cent and the most common aged group of victims was 80 to 84 years at 23 per cent, followed by 75 to 79 years at 16 per cent and 85 to 89 years at 15 per cent.

In 2014 to 2015 the most commonly reported type of abuse to the EAPU helpline was financial abuse, accounting for 40 per cent of reports, compared to 35 per cent for psychological abuse. In New South Wales, two years of call data to the New South Wales Elder Abuse hotline were broadly similar to the Queensland and Victorian studies. Three other studies listed at the bottom of the slide, used data from a range of agencies to assess the extent and nature of elder abuse. The reports by Wainer and colleagues and Miskovski focused on financial abuse and this form of abuse also emerged as a primary concern in the Clare and colleagues report. So in summary while the AIFS scoping study highlighted that there was no systematic national prevalence data, valuable insights emerged from some recent research and in particular from analysis of calls to helplines that indicated that concerns relating to financial abuse and psychological abuse were most commonly raised. And that the most common concerns involved parents as victims - mothers more commonly reported than fathers - and children as alleged perpetrators with sons a little more commonly reported than daughters. So while we have a lack of solid evidence about the prevalence of elder abuse in Australia, what we can expect is that the incidence of elder abuse is likely to rise with increased life expectancy, with elders comprising a greater proportion of the population than ever before. Older Australians have increased significantly as a proportion of the total population, rating 15 per cent in June 2014. And the proportion of people aged 85 years and older has tripled between 1971 and 2014. Population predictions indicate that these trends are set to continue. The ABS has projected that persons aged 65 years and older, will account for 20 to 21 per cent of the population by 2040. The projections indicate that from less than two per cent in 2011, persons aged 85 years and older will represent about four per cent of the population by 2040.

When we consider the wealth dynamics, we see that the baby boomer wealth profiles are characterised by high levels of home ownership and the rewards of periods of economic prosperity that have occurred throughout their adult lives. In addition to home ownership, the introduction of the superannuation guarantee system in 1993, has seen substantial growths in levels of superannuation holdings. Together these factors have increased the amount of potentially inheritable assets. The 2015 Intergenerational Report predicted that superannuation assets, which stood at $1.84 trillion at the end of 2013-14, could rise to $9 trillion by 2040. These wealth dynamics are important to keep in mind in the context of an analysis of elder abuse and financial abuse in particular.

While the literature indicates different risk factors for the different forms of elder abuse, international empirical evidence identifies common risk factors, as arising where the older person is isolated or has cognitive impairment or other disability, or where there has been a prior history of traumatic life events, such as a history of interpersonal abuse, or domestic and family violence. Other risk factors include an elder person's depression, drug or alcohol misuse, or circumstances where the elder person is in a position of financial, emotional, or relational dependence with an abuser. The AIFS scoping study highlighted the complex dynamics and structures that are relevant to the disclosures or discovery of elder abuse and to the reporting of elder abuse. And the risk factors highlighted on the previous slide may also emerge as factors inhibiting the disclosure or discovery of elder abuse.

For example, an elder person with a cognitive impairment, or an elder person who is socially isolated, maybe unable to disclose their abuse, and their abuse may not be discovered by a third party. An elder person in a dependent relationship with their abuser, may be frightened to disclose, and if they reveal their mistreatment this may mean that they are left without any family support or that they move to residential care. Reporting obligations are also a subject of significant debate in Australia. Reporting pathways are acknowledged to be complex and confusing, both for members of the community and professionals. Duties in relation to reporting depend on the professional context in which the elder abuse is discovered, and apart from limited obligations in relation to specific offences for Commonwealth funded care facilities, there are no statutory mandatory obligations on professionals to report elder abuse. And some analyses have shown that even professionals providing care and other services to elders are unaware of the available reporting mechanisms.

So going forward now, there has been widespread recognition among experts in the field that both the existing knowledge base concerning elder abuse and approaches to preventing and identifying and addressing such abuse, however defined, have significant limitations. Community concerns have also increasingly become evident, reflected in the New South Wales Parliamentary Inquiry into Elder Abuse. And in February this year the Attorney-General of Australia asked the Australian Law Reform Commission to look into the existing Commonwealth laws and frameworks that aim to protect older persons from misuse or abuse by formal and informal carers, supporters and representatives and others. After a process of submissions and further consultation rounds, the final report of this inquiry is expected in May 2017. This important work, together with the National Australian Prevalence Study are the sort of important sources of information that may inform and guide future policy responses to elder abuse. I'd like to thank you for your attention and your interest in this research and I'd like to now hand over to Gary Ferguson from Seniors Rights Victoria, who will briefly outline the role of Seniors Rights Victoria.

FERGUSON

Thank you Rachel. Seniors Rights Victoria is a state based, free legal and advocacy service, which provides information, support, advice and education to help prevent elder abuse and safeguard the rights, dignity and independence of older people. It's funded by the Victorian Government through the Department of Health and Human Services and Victorian Legal Aid and is a service within COTA Victoria. It offers a unique response to incidences of elder abuse and is driven by providing legal advice and advocacy support, simultaneously to the client. I'd now like to hand over to Melanie who's going to present on her report.

JOOSTEN

Thank you. Today I'll be presenting on a project that was completed by the National Ageing Research Institute on behalf of Seniors Rights Victoria. This project gives an understanding of the clients that Seniors Rights Victoria work with. Their experiences of elder abuse and the results of interventions to address this abuse. So as Gary mentioned Seniors Rights Victoria have a telephone help line, specialised legal services, advocacy and education. Anyone can access the help line if they have concerns for an elder person, but the service will only take on cases from an older person who can give instruction and not for concerned family members.

Taking action to end abuse isn't easy and support services like Seniors Rights Victoria play an important role in helping the older person address and stop the abuse. In terms of outcomes of these interventions, most available research literature comes from the perspective of staff involved in the intervention. Seniors Rights Victoria wanted to know more about their client's experiences of the intervention, such as how did the intervention affect the relationship with the perpetrator, what were the intended and unintended outcomes of the intervention and what could be done differently. So to give you an overview of the project, 24 interviews were conducted with 28 participants, four of whom were couples whose ages ranged from 62 to 89.

Most of the participants were women and ten came from a non-English speaking background. All perpetrators were family members. Mostly adult children, 16 sons and eight daughters, who were often living with the older person at the time of the abuse. Only a small proportion of participants reported intimate partner violence in this project. Psychological and financial abuse were the most common types of abuse reported, followed by physical abuse and social abuse. The majority of the older people interviewed were independent and not reliant on the perpetrator for care. In these ways the participants in the project were representative of the clients that Seniors Rights Victoria often encounter.

Because of the nature of the service, they don't often deal with intimate partner violence and as they rely on older people knowing about the service and being able and willing to make contact, Seniors Rights Victoria does not often come across cases of sexual abuse or neglect. As was mentioned, almost all of the cases in this project, involved intergenerational abuse. That is, abuse perpetrated by an adult son or daughter, as this was the most common situation that Seniors Rights Victoria encounter. This is important to note as the family dynamic often affects what the older person wants to achieve from any intervention. And it can also affect their inclination and ability to take action to end the abuse. In particular, the unique parent-child relationship is likely to have an impact on the decisions made by the older person.

This list shows some of the factors that were apparent in the interviews and which might influence the parent-child relationship. It includes stress, fear, ambivalence, parental love and responsibility, concern for external factors affecting the perpetrator, family violence and family conflict, inheritance issues, communication difficulties, power and control and trauma. In particular, many parents exhibited feelings of ambivalence. They wanted the abuse to stop, but they didn't want to cause trouble for the perpetrator, who was often the adult child. While unbearable fear and stress was often a motivation to take action, one of the most commonly expressed desires was that the older person wanted to get help for their child to address external factors that were seen as causing the abuse. For example, they wanted support for their child's mental health problems, housing trouble, financial stress or anger management.

It was also apparent from the interviews that many of the elder abuse situations extended from long term family violence or family conflict. There were a range of interventions that Seniors Rights Victoria either initiated or provided support, advice and referrals in order to help the older person. These included intervention orders, caveats, debt recovery procedures, detailing the options available and the process for each option, letters to perpetrators, for example, giving notice to vacate the older person's premises. Advice regarding wills and powers of attorney, emotional and other advocacy support, including going to court with the client and arranging referrals to other support services.

This project was primarily focused on how the older person felt about the intervention and whether it delivered the result they desired. I'll now go through and discuss the different intervention outcomes that were identified by the participants and researchers. These include positive and negative consequences of taking action and some were intended outcomes, while others were unintended. While all of the participants would have liked the abusive behaviour to stop, this desire was often complicated by their relationship with the perpetrator. Feelings of responsibility and concern for the perpetrator might mean that the older person was not quite ready to take steps to end the abuse, if that was also likely to end their relationship with their son or daughter. Therefore whether the abuse ceased or was partially resolved, is only one outcome of the intervention and there were others that were equally important.

Feeling supported. All but one of the participants reported feeling supported by Seniors Rights Victoria. It is arguable that even if the intervention achieves nothing else, that an older person feels they are not alone in facing their situation, can be considered a positive outcome. Feeling supported may also be an important step for many people in coming to terms with their situation, having it validated and getting ready to take action in the future. As one participant said that was enough for all of them to know that I have got somebody standing behind me. Feeling empowered and enabled to act. For some participants feeling empowered was what enabled them to act. Whether this was asking the perpetrator to move out of home, or making the difficult decision of calling a CAT team to support the perpetrator. As one mentioned, "Being able to talk to someone gave me the power to make decisions."

Independence and peace. One of the valued outcomes of taking action was the feeling of peace of mind and increased independence. This was both due to stopping the abuse, but also to feelings of positivity from having taken a stance and improved their situation. Another positive outcome that was noted, was increased knowledge of rights, options and consequences. Once Seniors Rights Victoria staff understand a client's situation, they're able to offer advice and let the client know what options are available to them. Knowing that there are possibilities for action can be an important factor for some people, even if they elect not to act immediately. It was also very important for the older person to have access to advice specific to their unique situation, rather than general legal advice, as well as a proper understanding of the consequences of taking action and how their relationship and situation might be affected. As one participant said, "Seniors Rights Victoria, gave us very, very good advice and told us how it should all happen and all the consequences of each thing that we were going to do."

Knowledge that Seniors Rights Victoria could help in the future. Knowing that they could go back to Seniors Rights Victoria at any point to follow up outstanding issues, or if problems re-emerged was a comfort to participants and a valuable, direct outcome of the intervention. A common intervention outcome was that the perpetrator was required to leave home. One of the main ways the abuse was stopped was if the perpetrator left the person's home - the older person's home. An older person may not wish for this to happen or may not have considered the ongoing consequences of such a major change for themselves or the perpetrator, so it is important for support services to be realistic and clear, in the fact that this might be the only way to stop the abuse in some cases.

An improved relationship with the perpetrator. In some cases one of the outcomes of the intervention was an improved relationship. This included the older person feeling that after going through the interventions they had better conflict resolution skills, or knew how to resolve disputes. Sometimes an intervention to address elder abuse can have unintended or negative consequences for the older person.

Loss of relationship. An often reported negative consequence of taking action was losing contact with the perpetrator and this may be a temporary or permanent loss. Some expressed feelings of regret over this loss and of the conflictual relationship and abuse. However none of the participants in this project regretted taking the action to stop the abuse, even if it caused the relationship to end. As one participant said, "The only thing I would have liked is to be able to talk to him on the phone or see him occasionally. I know he's out there and I know he's got nothing, but I couldn't live with him anymore, I couldn't, no way."

Family conflict. The abusive scenario was sometimes the result of long term family conflict and sometimes the older person's move to stop the abuse, increased the conflict within a family. For example, when family members took sides in a disagreement or how it was handled. For example, there was a man who required his abusive son to move out and he found this decision created conflict within his marriage. And as another participant said, "My daughter won't speak with the other members of the family, they're all offside at the moment." Another negative outcome, was the older person having to change accommodation. For some of the participants the only way to stop the abuse was to move out of home themselves. While solving the problem, this could have lasting financial and other consequences for the older person.

A commonly reported outcome was concern for consequences on the perpetrator and others. As one of the participant's said, "We worry about him, he is our son." Some of the participants felt the pressure their child was under was causing the abusive behaviour. Things such as mental illness, marital breakdown and financial difficulties were cited as reasons for the perpetrators behaviour. Therefore, even when the abuse stopped for example, because the perpetrator was forced to leave, the older person often worried about the perpetrator and what would happen to them. Some also expressed concern for the consequence on others. For example, an older couple asked their abusive son to move out, but since he moved in with his girlfriend they worry about her welfare.

While fear was a relatively common feeling amongst the participants while the abuse was happening, for some the fear continued or exacerbated after the intervention. And there were ongoing fears and worry about repercussions. As one participant said, "I can't go back and live in the house, because if my son goes off his head or something, he will come there and he will murder me in the house." Ongoing financial concerns. Financial abuse left some participants with outstanding debts, financial hardships or other concerns. This often went unresolved if a perpetrator was in no position to repay or reimburse the older person. A few participants expressed disappointment that the intervention could not fully resolve the problem, such as recover money, or that the perpetrator could not be punished. There was also concern and worry about potential legal costs and frustration about the lack of options available, such as alternative accommodation for the older person or the perpetrator.

In some situations, when the case was closed, the intervention had not achieved any change for the older person. This might be because various interventions that were initiated were unsuccessful, as the perpetrator would not co-operate, or the older person decided not to pursue legal redress, or where a court case was won but the older person was unable to recover money. What could be done better? While many of the interviewees did not think that anything more could have been done or could have been done differently, some participants wished they were able to obtain help for the perpetrator. For them this was the missing piece of the intervention. Many participants felt there was a need for appropriate and affordable services to help perpetrators’ experience mental health issues, substance abuse problems and gambling addictions.

As one participant said for the police to talk to him and say, "Why are you so angry, do you need medication, do you need help. I suppose I'm being a Mum and wanting the best, but that's me." Failures by the mental health system and health and other professionals including the courts to adequately deal with the mental health problems faced by their adult children were highlighted by many of the participants. Participants also highlighted the need for services to assist with family conflict, preferably with the authority to compel perpetrators to participate in programs, undergo assessment, or step in when there's conflict. In some situations, the only option was for the older person to call police when faced with an abusive child. Which many were reluctant to do, for fear of getting their child into trouble.

Some participants also expressed a desire for better information from lawyers that might have stopped them from getting into trouble in the first place and better protection from banks to stop misuse of powers of attorney or access to money by family members, as well as better information about obtaining intervention orders, which might have sped up the process. So, in conclusion, this project tells us that when elder abuse is perpetrated by a family member, as it often is, this family member, and this family member is a child of the older person, then the intervention needs to take the parent-child relationship into context. Many older people are as equally concerned about the behaviour their child is exhibiting toward them, as they are about the reasons behind the child's behaviour. Interventions would address the circumstances of the perpetrator, maybe more likely to be successful in the long term and more acceptable to the older person, than ones that only remove the perpetrator.

This project has also demonstrated that, whilst stopping the abuse is important, a successful short term or initial intervention may be supporting the older person and enabling them to feel heard and understood, while supplying them with information about their options. They may not choose to take action until a later point, but they should not be seen as a failure. This project has given us a better understanding of what the results of an intervention are like for an older person and the consequences the intervention has on the ongoing experience. So thank you for your attention and now I'll hand over to you, Gary Ferguson.

FERGUSON

Okay thanks Melanie. I've already explained what Seniors Rights Victoria does in Victoria and it's important to say that there is a similar agency in each state and territory in Australia. What I'm going to talk about today, is a little bit about ageism, a little bit about rights based approach, which Rachel touched on earlier. And then key elements of an effective response to elder abuse. When biases lead to discrimination and devaluing of a person or population they become problematic: ageism is one of these biases. It discriminates and stereotypes based on age. It stigmatises people of the same age as sharing all the same negative qualities. For example, “when people get older they lose their marbles”. For older men and women, ageism leaves them disregarded and discredited as a group. It has a potential to create a society that doesn't uphold the rights of older people and is less inclined to protect vulnerable seniors.

Elder abuse is an extreme form of ageism. In Australia, all governments at state and territory level have adopted a rights based approach to responding to elder abuse. Australian governments have adopted this implementation, or have made a decision to implement this model, rather than one of mandatory reporting, as is evidenced in child abuse. In some international jurisdictions, especially in the United States, mandatory reporting has been adopted for elder abuse. In Australia, the empowerment approach is underpinned by values and policies that reflect and support self-determination, informed choice and the ability of adults to make their own decisions. Sometimes this might be at odds with the values of the worker. This approach also reflects a commitment to support the safety, security and dignity of older adults in our community. I'm now going to look at elements of an effective response.

The first point of contact is important, in building trust, together with an atmosphere that conveys openness, caring and a non-judgmental attitude. It's important to allow sufficient time, for the older person to talk about their issues. A positive encounter for the person, includes being asked what plan of action they would like to take and being offered resources, support and information to do this. To begin with I'd like to look at the client needs. And this really reinforces what Melanie has found in her study that she's just reported on. Ultimately, the client will want to stop the abuse, but it may not seem as straightforward as it appears. And certainly in Melanie's report, what's been suggested, is that there are many ways in which this can be achieved. It could include things like emotional supportive counselling, preservation of relationships between the older person and the alleged perpetrator, safety and shelter of the older person. The safety and needs of the victim are very important.

This might mean that remedies or redress occurs indirectly. Abused persons want to know their legal rights and remedies and this might empower an abused person to feel more confident about taking action. Financial resources are necessary in some cases and could mean things like deferment of bill payment to assist the older person. And finally, as mentioned by Melanie, home support services and housing alternatives, might be required. For example, an adult child living with their older parents might require alternative accommodation to move out and therefore stopping the abuse, or an older person who's living with family members, who are also abusive, may also require alternative accommodation. One of the things that we know at Seniors Rights Victoria is that responses are multi-faceted. Remedies to incidences of elder abuse aren't always straightforward and might include collaboration with other services to resolve the issue.

For example, one of our earlier clients, an older woman in her 70s, was living on her own and was dependent on her long term neighbour to take her shopping. He insisted that she pay him $50 a week for this to cover petrol costs for a round trip that was less than two kilometres. As she was isolated, she thought that if she didn't pay the money she wouldn't be able to go shopping. When she came to Seniors Rights Victoria, she insisted that staff not approach the neighbour as she didn't want him to know she was taking action. A response to this situation included an assessment by an aged care assessment service and the inclusion of transport in a subsequent aged care package. Family dynamics are also an important part of any response. And in instances of elder abuse, they might be complex and might have a long history. While a response should be focused on the older person being abused, it's important to recognise that the older parent might want to care for their adult child, even at the risk of abuse or mistreatment occurring or it continuing. Sometimes this parent obligation to care for their child, might include requests that support be provided to the alleged perpetrator though programs for addictions such as alcohol, gambling, or substance use. Or accommodation if the adult child is living with his or her parent.

There are several aspects to consider in your communication with an older person who is being subjected to abuse or mistreatment. Language. Elder abuse is not a term that is easily understood in many populations, can translate with different meaning and as we'll see in a moment, might include a broader population in Aboriginal communities than those who are over 45 years of age. In a Canadian prevalence study recently, in the pilot version, a question was asked of those who completed the study, whether they had experienced elder abuse and the majority answered no. Subsequent questions on specific incidences of elder abuse, such as whether a family member had taken money from you, were answered with a yes. So it's clear from that pilot study that while a lot of people who responded didn't understand the term elder abuse, they were experiencing some form of abuse or mistreatment.

In our experience at Seniors Rights Victoria, if the person's first language is not English, then the use of interpreters is critical in gaining an understanding of what the issues are from the older person.

Be flexible where you meet with the older person. Sometimes it might be in their home, sometimes it might be at a café, sometimes it might be at a place and a time where they can legitimise their absence from home, so that it doesn't alert the alleged abuser. Seniors Rights Victoria conducts most of the consultations by telephone, but has a commitment to undertaking face to face meetings with the older client, to ensure that there is a building of trust between our staff and the older client and to gain a greater understanding of what the abuse issues are for the older client. Consultations, wherever possible, should be with the older person alone and not with the family member or relative present even if they insist. This allows the older person to be free to talk about what they want and direct the conversation.

Other factors to consider are noise, especially if the older person has hearing impairment, the size of font in reading materials and documents, especially if there is vision impairment and an assurance that confidentiality of the older person will be respected. One of the most important things that we see at Seniors Rights Victoria is the consideration of cultural issues. Culturally and linguistically diverse populations, may in fact have a lack of understanding what constitutes elder abuse. For example, in a number of communities we've worked with, the word abuse does not translate to the broader spectrum of abuse and mistreatment that we understand in the English language. People from culturally and linguistically diverse populations might have an increase in vulnerability, because they don't have a familiarity with legal and support processes, because of their language and because of cultural issues. Their social isolation might result in reliance on family members to translate documents, manage finances and assets, which could increase their vulnerability.

In Aboriginal populations, cultural context is very different to white fellow culture. For example, family is defined much more broadly. In addition elders play a key role in communities and are defined by their place in the community, rather than on age and they are respected because of this. So for example, some elders might be relatively young. This then raises questions regarding the term elder, especially when referring to elder abuse. In work at Gunditjmara the use of the term abuse of older persons, rather than elder abuse, was accepted. In addition, while we might refer to various forms of abuse with particular vocabulary, it's clear that a more vernacular description is more appropriate in Aboriginal communities. For example, bludging off, scabbing and ripping off, are words which were identified by the Gunditjmara project as being more appropriate for a printed resource. They even referred to abuse of older persons as a real dogs act. Cultural and family context are an important aspect of Aboriginal populations.

The breakdown of traditional Aboriginal culture, including respect for elders, through colonisation and disposition, has to be taken into consideration. And the role of the Aboriginal people due to family context, is becoming increasingly important. Mick Gooda talks about previously elders being cared for and cherished and now more commonly having the role of guardian of grandchildren while looking after their families and having a leadership role in their community.

Gay, lesbian, bisexual, transgender, intersex and queer populations may be less likely to disclose elder abuse, for fear of further discrimination related to their sexuality. In a visit that I made to the United States of America to the SAGE activity centre in New York, it became clear from the work that they had done, that because older people in the GLBTI community had faced discrimination over a period of time, they were less likely to disclose elder abuse because of potential further discrimination. There's also indications that the support networks might be smaller and that the meaning of family in these populations, might include non-biological members, because a number of people in this older age bracket are estranged from their families. In addition, social isolation might be greater because of the fear of hostility towards their sexuality or gender.

In concluding I'd like to acknowledge the case work team at Seniors Rights Victoria, who had considerable input into this particular presentation and to acknowledge that they have the experience in this as was reflected in the report that Melanie just reported on. Now I would like to hand over to Anita, who's going to talk about mediation.

FRAYMAN

Thank you Gary. Good afternoon everyone. In this presentation you are going to hear about mediation and elder mediation and its role in responding to elder abuse, especially where the abuse involves family members. Elder mediation is under researched. I believe that this gap in the research on elder abuse needs to be addressed as it may provide the evidence to support elder mediation as a practical response to some of the many forms of elder abuse. Before we begin, I would like to tell you about how I became involved in elder mediation. My interest in cultural diversity and ageing, particularly the differences in older people's social and support networks, was the basis of my doctoral research. When interviewing older people and their adult children, I noticed that members of the same family would view the same situation but from different perspectives. Often older people and their adult children were not communicating about important emotions that mattered to them.

So I asked, why aren't they communicating? The answer was simply that these conversations were conversations that people find too difficult. Some of these emotional conversations eventually brew into conflict and in the case of older people that conflict may result in loneliness, emotional and psychological distress. Older people may end up living somewhere where they don't want to live, or feeling pressured into giving their children when they really need it for themselves. It could result in, what is now being identified as elder abuse.

Facilitated family discussions and mediation are ways of enabling family members to explore one another's needs and interests and to see things from one another's point of view. In my presentation I'm going to explain what is elder mediation. I will look at why it is now that we are talking about intergenerational conflict in elder abuse. I will place older people within the context of their family relationships and I will talk about the connection between social capital and the wellbeing of older people.

This is directly linked to the social and support networks of older people. We will see how mediation can help with the operation of the family and social support networks which have resulted in, or are not managing to prevent, elder abuse. Firstly, elder mediation is based on the underlying principles of self-determination, respect and dignity for all people regardless of age. Its aims are twofold. A) to avoid or resolve family conflict in situations where there's elder abuse. Often the aim is not to resolve the conflict all together, but to mediate family members through a process of transformation, to help them move towards a better understanding of one another's perspectives. And B) elder mediation provides a forum where older people and their family members can plan for the care and support of the older person.

Secondly, elder, mediation is a process. The process begins with individual private sessions with each of the family members involve. There are usually numerous parties to the mediation, each with their own needs and interests. The length of the joint mediation session depends on the situation and the stamina of the participants and the complexity of the issues. And there may be numerous sessions. Facilitated family discussions may have to be conducted periodically as people's needs change and as the ability for particular carers to meet those needs also change.

Thirdly, A key feature of elder mediation, is that it is conducted by an independent, trained mediator. Elder mediators do not give advice, they do not counsel, they do not represent the interest of any particular party to the mediation, rather they assist the parties in communicating, sharing and understanding concerns, examining all the options and coming to some kind of mutual understanding plan of action or agreement.

To do this, the elder mediator needs to be a specialist in issues concerning the experience of old age. This distinguishes elder mediators from other types of mediators.

And finally the circumstances of elder mediation, which I will be discussing today, refer to mediation between older people and their family members who are involved in their care and support. I will not be covering mediation with aged care facilities. Intergenerational family conflict and elder abuse are not new, so why are we talking about them now? Rachel, in her presentation discussed the data behind what I'm about to talk about in relation to these following trends. Firstly, there are new demographic trends, where older people are living longer. And while they are living longer, so are their adult children. If an older person is in his or her 80s their adult children are likely to be in their 60s. That is 60 years of relationship consisting of fluctuating, dynamic, emotional, financial and physical support.

There may be two generations of older people in the one family. From a historical perspective, this is a new trend which has created new complexities in family relationships, with new types of conflicting, physical, emotional and financial needs.

Secondly, in relation to the new financial trends, Australia is experiencing generational changes in the proportion of the population who are owning their own homes, who are carrying debt and other factors that impact on the intergenerational transfer of wealth. Once again, I refer to Rachel's data on this.

Thirdly, there are new health trends, older people living longer, often with chronic diseases or cognitive impairment and therefore they may require complex and increasing carer support over a long period of time.

And finally combating ageism is the new social frontier. A combination of all of the above that I've just discussed, as well as other factors, have led to the recognition of the rights of older people being the new social cause, following the rights of women, people living with disability, people of diverse sexual orientation and identity. Fighting ageism is the cause being championed by the baby boomers themselves who are now reaching the stage of old age.

Let us turn to older people and family relationships. Older people and their close family are in a unique relationship, which has the potential to offer care and support both directly and indirectly, by linking the older person to other sources of care and support. I express this care and support relationship in terms of social capital. Social capital is based on relationships and networks which are at the core of society and essential to people's wellbeing. Social capital is constituted by the networks, together with the shared norms, values and understandings, which facilitate co-operation within or among groups such as families.

Better social capital among older people, is linked to their better general health. I've illustrated this through - in the following slide. There are different types of social capital, bonding, bridging, or linking social capital. This slide represents bonding social capital. It is characterised by shared interests and can be seen among people with shared cultural backgrounds, people who are members of the same social organisational group and it could be also shared by people of the same family. While it can be very supportive and bonding for those who are on the inside of the circle, the flip side is that for those who are on the outer, it can be alienating and it can be hard to link into other people in other groups within the bonding circles.

The next type is bridging social capital. In many ways this is better than bonding. People can be part of many different networks. The more networks they belong to the more connections they are then able to make with other networks. As people age their social capital changes.

In the period immediately post retirement, in many cases social capital increases as people become involved in clubs and hobbies and in activities they were never involved in before. But then in later life, as the older person becomes less mobile and more frail and the people in their network fall away, social capital usually decreases. An older person's social capital pattern may look more like this (refer to presentation slide). The inner circle becomes smaller and it becomes more difficult for them to connect with people outside of their inner circle. The older person's wellbeing depends on the strength of the inner circle and this is where family comes in. If we have a closer look at it, we can see that the inner circles consists of the informal care given by spouse or partner and close family and perhaps also friends and neighbours. In this slide I have drawn what I called the circles of care.

The circles fluctuate. The inner circles offer informal care as I've just said and the outer circles offer a more formal type of care, the circles are dynamic and change as the older person's needs change and are dependent upon the availability and the skills of an individual caregiver. There may be a need to obtain formal care from aged care service providers, doctors, et cetera, or to participate in community programs. The older person needs to be able to move from one circle to another, making the connections between the circles, is often dependant on the family members and their willingness to assist the older person in making these connections.

I have a couple of case studies, but I might just abbreviate them because of time restraints. In the first case study I was approached by an adult daughter regarding her 85 and 89 year old parents.

The daughter and the brother were concerned about the parents and wanted them to move into aged care. We got together for the mediation and I had been told beforehand that there was no conflict in the family, but after interviewing the parents separately, I realised that there was tension, a lot of tension between the mother and the father. The mother was concerned about the father's increasing frailty and the way this was curtailing her life. At 85, she wanted to participate fully in what was available to her and she couldn't express this to her children. So when we all got together, we realised, going around in the circle, talking about the different options that were available, the children realised actually that it wasn't aged care that the parents needed, I mean, institutional aged care that the parents needed, but rather it was that the father needed to have somebody come in and look after him a couple of days a week just for a couple of hours, to give the mother the freedom to do what she needed to do, in order for her to get the most out of the opportunities that were available to her.

And this was one of the benefits of mediation in that all facilitated family discussions, it allows families to explore what's available to them as a group and to understand what the other people in the family who are interested, what their interests are and what their needs are at a particular time.

In this slide, in cases for elder abuse, we can see the ways family discussions can actually fill the gaps. People can call in accountants, lawyers, financial advisors, aged care service providers, doctors, allied health, psychologists and police but what is often needed is a co-ordinated response, and a multidisciplinary response at the very centre of that response is often the family and what the individual family members' needs are.

I want to leave you with two messages. One is that elder mediation can assist families in distinguishing between what is important for the older person and what is important to the older person. And then finally which is the crux of my talk is that there is a need for research in this area as being a valid and worthwhile response to elder abuse. Thank you.

HIGGINS

Well thank you to all of our speakers today. That's been a fantastic overview of the research and also the perspectives of service providers working in mediation and working in advocacy around, the rights and the options available to those experiencing elder abuse or wanting to provide services or supports.

WEBINAR CONCLUDED

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Slide outline

1. Elder abuse: Recent research and effective responses

• Rachel Carson, Melanie Joosten, Anita Frayman and Gary Ferguson
• CFCA Webinar 24 October 2016
• Australian Institute of Family Studies, Family Law Pathways,
• The views expressed in this presentation are those of the presenter and may not necessarily reflect those of the Australian Institute of Family Studies or the Australian Government.

2. Elder abuse: Prevalence and dynamics

• Dr Rachel Carson, Research Fellow – Australian Institute of Family Studies (Co-authors: Dr Rae Kaspiew and Professor Helen Rhoades) CFCA Webinar 24 October 2016

3. Overview

• Elder abuse – what is it?
• State of the evidence
• Population and wealth dynamics
• Risk factors
• Reporting and complexities in seeking redress

4. What is elder abuse?

• There is no agreed definition in Australia.
• One commonly employed definition is: "any act occurring within a relationship where there is an implication of trust, which results in harm to an older person. Abuse may be physical, sexual, financial, psychological social and/or neglect". (Australian Network for the Prevention of Elder Abuse, 1999)

5. Prevalence – International estimates

• High to middle income countries:
  • Physical abuse (0-5%)
  • Sexual abuse (0-1%)
  • Psychological abuse (1-6%)
  • Financial abuse (1-9%)
  • Neglect (0-6%)
• (World report on Aging and Health, World Health Organisation, 2015)

6. Prevalence – Australian studies

• 2 population-based studies providing some insight:
  • 2015 ANROWS analysis of Personal Safety Survey data
  • 2014 Australian Longitudinal Study of Women's Health
• Studies based on calls to helplines re elder abuse:
  • Victoria (Joosten, Dow and Blakey, 2015)
  • Queensland (Spike, 2015)
  • NSW (NSW Elder Abuse Helpline and Resource Unit, 2015
• See also Clare, Blundel & Clare, 2011; Miskovski, 2014 and Wainer, Darzins and Owada, 2010.

7. Summary – Australian context

• No systematic, national prevalence data.
• Some insight from recent analyses of calls to helplines suggesting:
  • Financial abuse concerns most commonly raised and
  • Most concerns involved children as perpetrators and parents as victims (sons a little more often than daughters and mothers more than fathers).

8. Population profile

• An unprecedented proportion of Australia's population will be aged in the coming decades 65 and over:
  • 15% in 2014; cf. 7% in 1941
• By 2040:
  • 20% will be 65+
  • 4% will be 85+ (cf less than 2% in 2011)

9. Wealth dynamics

• In light of the prevalence estimate of financial abuse, intergenerational wealth dynamics are causing concern:
• High rate of home-ownership for Australians aged 65 + years.
• Over the longer term, superannuation holdings will also be considerable 2013-14: $1.84 trillion in superannuation assets.
• Projected increase to $9 trillion by 2040.
• (2015 Intergenerational Report: Australia in 2055)

10. Risk factors

• The literature indicates different risk factors for different types of elder abuse.
• International studies evidence these risk factors:
  • Traumatic life events, including a previous history of abuse as a child or adult;
  • Social isolation and
  • Cognitive impairment or other disability.

11. Reporting and complexities in seeking redress

• Complex, intersecting legal, policy and practice frameworks.
• Issues for elders seeking redress:
  • Parents find it very hard to reveal they have been mistreated by their children.
  • Revealing the mistreatment may mean they are left without family support.
  • It may also mean an unchosen change in living circumstances (into residential care for example).
  • If abuse is financial, assets may be unrecoverable.
  • How do these frameworks work for people with cognitive impairment?

12. Going forward

• ALRC Inquiry into protecting the rights of older Australians from abuse – Final report expected May 2017.
• Development of prevalence assessment strategies.
• Future policy responses to elder abuse.

13. The Older Person's Experience: Outcomes of Interventions into Elder Abuse

• Briony Dow, Freda Vrantsidis, Mandy Walmsley, Jenny Blakey & Melanie Joosten
• Seniors Rights Victoria, National Ageing Research Institute Ltd

14. Seniors Rights Victoria

• Provides information, advice, education and support to help prevent elder abuse and safeguard the rights, dignity and independence of older Victorians through:
  • Telephone information and referral (helpline)
  • Specialised legal services
  • Advocacy, including short-term individual support
  • Education

15. Outcomes of Interventions into Elder Abuse

• Aim: To better understand the older person's experience of the abuse, the intervention and the outcome
  • Relationship with the perpetrator
  • Intended and unintended outcomes of the intervention
  • What could be done differently?
• Funded by: Lord Mayor's Charitable Foundation and the Victorian Government

16. Overview

• 24 semi-structured interviews were conducted with 28 past clients
• 10 interviews involved older people from non-English speaking backgrounds
• All alleged perpetrators were family members
• Psychological and financial abuse were most common matters reported

17. Intergenerational abuse

• Stress
• Fear
• Ambivalence
• Parental love and responsibility
• Concern for external factors affecting the perpetrator
• Family violence and family conflict
• Inheritance issues
• Communication difficulties
• Power and control
• Trauma

18. Interventions

• Intervention orders, caveats, debt recovery procedures
• Detailing the options available and the process for each option
• Letters to perpetrators, e.g. giving notice to vacate the older person's premises
• Advice regarding wills and powers-of-attorney
• Emotional and other advocacy support, including going to court with the client
• Range of referrals to other support services

19. Intervention outcomes

• Abuse ceased or partially resolved
• Feeling supported "That was enough, for all of them to know that I have got somebody standing behind me."
• Feeling empowered and enabled to act "Being able to talk to someone gave me the power to make decisions."
• Independence and peace

20. Intervention outcomes

• Increased knowledge of rights, options and consequences "[SRV] gave us very, very good advice and told us how it should all happen and all the consequences of each thing that we were going to do."
• Knowledge that SRV could help in the future
• Perpetrator required to leave home
• Improved relationship with the perpetrator

21. Intervention outcomes

• Loss of relationship "The only thing I would have liked is to be able to talk to him on the phone or see him occasionally … I know he's out there and I know he's got nothing … but I couldn't live with him anymore, I couldn't no way."
• Family conflict "[My daughter] won't speak with the other members of the family. They're all off side at the moment."
• Older person having to change accommodation

22. Intervention outcomes

• Concern for consequences on perpetrator and others "We worry about [him]…he is our son."
• Ongoing fears and worry about repercussions "I can't go back and live in the house because ... [if my son] goes off his head or something he will come there and he will murder me in the house."
• Ongoing financial concerns
• Disappointment
• No change

23. What could be done better?

• Help for the perpetrator "For the police to talk to him and say, ‘Why are you so angry? Do you need medication? Do you need help?' I suppose I'm being … a mum and wanting the best, but that's me."
• Better information
• Faster processes

24. Conclusion

• Unique effect of parent-child relationship on interventions
• Support and assistance for perpetrators

25. Seniors Rights Victoria

26. Ageism

• Discrimination and stereotyping
• Older people disregarded and discredited
• Ignoring the rights of older people
• 1300 368 821 www.seniorsrights.org.au

27. Rights Based Approach

• Self Determination
• Informed Choice
• Own Decision Making
• (With Respect to Age 2009 – Victorian Government)

28. Elements of an Effective Response

29. Client Needs

30. Responses are Multifaceted

31. Communication

32. Cultural Issues

33. Acknowledgement

34. Contacts

• Australian Capital Territory: ACT Disability, Aged and Carer Advocacy Service (ADACAS), www.adacas.org.au, Tel. 02 6242 5060 Older Persons Abuse Prevention Referral and Information Line (APRIL). Tel 02 6205 3535
• New South Wales: The NSW Helpline and Resource Unit, www.elderabusehelpline.com.au, Tel. 1800 628 221
• Queensland: Elder Abuse Prevention Unit, www.eapu.com.au, Tel. 07 3867 2528
• South Australia: Aged Rights Advocacy Service, www.sa.agedrights.asn.au, Tel. 08 8232 5377
• Tasmania: Advocacy Tasmania, www.advocacytasmania.org.au/elderabusehelpline.htm, Tel. 1800 441 169
• Victoria: Seniors Rights Victoria www.seniorsrights.org.au Tel. 1300 368 821
• Western Australia: Advocare, www.advocare.org.au, Tel. 08 9479 7566
• Northern Territory: Darwin Community Legal Service, www.dcls.org.au, Elder Abuse Information Line, Tel.1800 037 072

35. Elder Mediation: A Response to Elder Abuse

• Dr Anita Frayman, Elder Solutions

36. Overview

• What is elder mediation?
• Intergenerational conflict & elder abuse - Not new, so why talk about them now?
• Older people and family relationships
• Social capital and well-being
• Social and support networks of older people
• How can mediation help?

37. What is Elder Mediation?

1. Principles: Self-determination, respect and dignity
2. Aims: a) Avoid or resolve disputes and elder abuse b) Plan for the care and support of the older person
3. Process: Facilitated family discussion(s) and/or mediation
4. Conducted by: a) Independent experienced mediator b) Specialist in issues of concern to older people
5. Between: Older person, family members and others

38. Intergenerational conflict & elder abuse Why now?

1. New demographic trends
2. New financial trends
3. New health trends
4. New social frontier

39. Older People & Family Relationships - Care and Support

• Relationships and networks are at the core of society and are essential to wellbeing (ABS 2006)
• Social capital = "…the networks, together with shared norms, values and understandings which facilitate cooperation within or among groups" (OECD, ABS)
• Better social capital among older people is linked to their better general health (Robert Putnam)

40. Bonding Social Capital

• Examples:
  • Shared cultural backgrounds
  • Family members
  • Social organisations

41. Bridging Social Capital

• Diagram: showing how the examples of Social Capital relate to each other in various combinations

42. Older Person's Circle

• Formal Care
  • Medical
  • Care at home
  • Community programs
• Informal Care
  • Friends, neighbours etc
• Informal Care
  • Spouse, Partner, Family, Older person

43. Circles of Care

• Dynamic
  • Depending on needs of older person and availability and skills of caregiver
• Informal –at home
  • Spouse or partner
  • Family & Close friends
• Formal – at home
  • Care providers - nurses, doctors, care workers
• Community Programs
• Residential Aged Care
  • Main target of government funding

44. Case Studies

• Case study 1
  • Social Isolation
• Case study 2
  • Financial abuse

45. How can mediation help?

• Elder Abuse: Family discussions fill the gaps
  • Accountants
  • Lawyers
  • Financial advisors
  • Aged care service providers
  • Doctors & Medical personnel
  • Allied health care
  • Psychologists
  • Police

46. Summary

• Described elder mediation
• Explained why intergenerational conflict & elder abuse are important now
• Discussed the importance of family relationships
• Examined social & support networks of older people
• Explored how mediation can help resolve elder abuse

47. Elder Abuse and Mediation

1. Distinguish between:
   • a) What is important for the older person
   • What is important to the older person
   • Understood through facilitated discussions and mediation with the older person and family members
2. Need for more research in elder mediation

48. Questions?

• Join the conversation & access key resources
• Continue the conversation started here today and access a range of key resources on the CFCA website: www.aifs.gov.au/cfca/news-discussion