Responding to elder abuse: Rights, safety and participation
28 August 2019, 01:00PM to 02:00PM
Adam Dean, Megan Frost
This webinar was held on Wednesday 28 August 2019.
Elder abuse has gained increasing attention in Australia over recent years, with several public inquiries highlighting the need to develop comprehensive and coordinated responses to address it. The abuse of older adults is often hidden, can take many forms and can occur in a range of contexts. In light of these complexities, it can be challenging for policy makers and practitioners to effectively respond to address elder abuse.
This webinar presented an overview of elder abuse in Australia, with a focus on what it is, emerging evidence on its prevalence, its effects and risk factors, and the implications for policy and practice. The presenters discussed some of the main challenges involved in responding to the complexities of elder abuse, including the need to work in coordinated and flexible ways to address the particular circumstances of older people and their families. This approach was illustrated with a case example of an elder mediation and support service piloted by Relationships Australia NSW that aims to balance the rights, safety and participation of older adults in response to elder abuse.
This webinar is of interest to policy makers and practitioners working in family and community welfare sectors, including family relationship services, family violence, primary and allied health, aged care, disability, legal services and related areas of practice.
Audio transcript (edited)
MS CARSON: Good afternoon everyone and welcome to today's webinar, Responding to elder abuse: Rights, safety and participation. I'm Rachel Carson, a senior research fellow with the family law and family violence team here at the institute. I would like to start by acknowledging the traditional custodians of the land on which we meet in. In Melbourne the traditional custodians are the Wurundjeri people of the Kulin nation. I pay my respects to their elders past, present and emerging and to the elders from other communities who may be participating today. Today's webinar will present an overview of elder abuse in Australia with a focus on what it is, emerging evidence on its prevalence, its effects and risk factors and the implications for policy and practice.
We encourage you to send your questions through during the webinar for our presenters Adam and Megan to answer during the Q&A session at the end of today's presentations. Those we can't get to will be answered in the forum. Please let us know if you don't want your question published in the online forum following the presentation. CFCA webinars are recorded. The slides are available in the handout section of the GoToWebinar. And the audio, slides, transcript and recording of the webinar will be available on our website in the coming week.
Now to our presenters. Adam Dean is the senior research officer in the CFCA. He works across a range of knowledge translation activities, including with sector professionals to share research and practice expertise across the child family and community welfare sector. Indeed, it is Adam that coordinates many of the CFCA webinars. Adam is the author of a recent paper on elder abuse that he will be discussing today.
Megan Frost is a seasoned social worker, lawyer and mediator with over 25 years of experience working in the community services sector. Megan currently works in direct service delivery and in program design, coordination and with management – and management with Relationships Australia New South Wales. Megan is coordinating the implementation of a new elder mediation and support service, funded by the New South Wales Government's Domestic and Family Violence Innovation Fund. I will now hand over to Adam, please give him a warm virtual welcome.
MR DEAN: Well thank you very much Rachel for your introduction and hello to everyone listening today. So I'll just move on to my first slide. So as Rachel said my part of today's presentation is based on a CFCA paper that I authored entitled, 'Elder abuse: Key issues and emerging evidence'. And this is available via the CFCA website for anyone interested. The paper explores three main areas and these are the key issues involved in how elder abuse is defined, emerging evidence on its prevalence, impact and risk factors. And it also looks at implications for policy and practice. So I'll be looking at these three broad areas today, beginning with a brief overview of the population of older people in Australia.
So in Australia older people are generally defined as adults aged 60 to 65 years and older for non-indigenous Australians. And due to a difference in average life expectancies and cultural understandings, 45 to 50 years and older for Aboriginal and Torres Strait Islander peoples. In 2016, people aged 65 and older represented about 15 per cent of the overall population in Australia. And that's a rate that's increased from about 5 per cent in 1926 and is expected to increase to 22 per cent of the population by 2056.
This trend is known as Australia's aging population and as I discuss in the paper we should be careful about how we talk about the challenges associated with an aging population in order to avoid older people – or characterising older people as a burden to society or devaluing their role and status in the community. So older people in Australia are of course a diverse population. They represent diverse cultural backgrounds, lifestyles and abilities. In relation to an older person's risk of abuse, there's a few key points worth mentioning here in relation to this diversity.
Firstly, older people are much more likely to have a disability or a severe or profound core activity limitation compared to younger people. In 2015, around half of all older people had a disability. Secondly, like disability, the risk of dementia also increases with age. The vast majority of people living with dementia are 60 years or older. Thirdly, most older people live in private households, with only a small proportion living in care accommodation. For people living in households, about a quarter lived alone in 2015, with women more likely than men to live alone. And lastly, the need for assistance increases with age, with many older people needing assistance with a range of daily activities as they get older. So it should be noted, however, that these factors are not intrinsic to aging itself. And while these factors can represent vulnerability for older people, it's the combination of other factors such as poor quality relationships or low social support that can exacerbate the risk of abuse for older people.
So moving to the question of what elder abuse is, it should be noted at the outset that there isn't any universal consensus about how it should be defined. However, some definitions are more widely used than others. So a widely accepted definition is one that's been adopted by the World Health Organization and it defines elder abuse as, and I quote, 'A single or repeated act or lack of appropriate action occurring within any relationship, where there is an expectation of trust which causes harm or distress to an older person.'
In this definition there is a focus on the kinds of relationships that exist between potential perpetrators of abuse and older people. And that's one where there is an expectation of trust. So this will include those relationships built on trust with non-professionals, such as family, friends and informal carers as well as relationships with professionals who occupy positions of trust. Included in this definition are relationships with other older people, who may also be potential perpetrators of abuse, such as spouses or partners, friends and, more debatably, peers.
Beyond this general definition, there are other aspects that I don't have time to cover today unfortunately, but these include whether potential victims of abuse should be defined purely in terms of age, for example, all adults aged 65 years or older or whether it would be better to focus on particular at risk populations and how we define potential victims of abuse. There is also the question of how elder abuse relates to family violence. And these are some topics that are covered in more detail in the paper.
So there are different types of elder abuse. It covers a range of potential harms to an older person. So typically, five types of abuse are recognised. There's physical abuse, psychological or emotional abuse, sexual abuse, financial abuse and neglect. There is some debate about these categories and whether others should be included. For example, other types of abuse may include social abuse, chemical and medical abuse, self-neglect or abandonment. However these are generally included in the five main types of abuse and neglect outlined here. These forms of abuse can of course occur together. For example emotional abuse and financial abuse may co-occur in a pattern of polyvictimization. And it's also worth highlighting that various forms of abuse and neglect can be perpetrated and experienced in varying degrees of severity and frequency.
So moving now to the question of prevalence. The first thing to note is that we don't have national prevalence data on elder abuse in Australia as yet. Most of what we know is based on international population studies. A recent meta analysis of prevalent studies from around the world, including from lower income countries, estimated that 15.7 per cent of older adults, 60 years and older living in community settings, have experienced some form of abuse in the past 12 months. Prevalence rates for particular sub-types of abuse were lower than that pooled average and ranged between about 1 per cent and almost 12 per cent, depending on type, with psychological abuse found to the be most prevalent. International data also indicates that higher rates of abuse are likely to occur in institutional care settings and for people with disability.
So we have some idea about its prevalence elsewhere in the world but what about Australia? So as I've just mentioned there is currently no national prevalence data for elder abuse in Australia, but based on international data in countries similar to Australia, it has been estimated that between 2 and 14 per cent of older people in Australia may experience some form of elder abuse every year. We also have data collected from elder abuse helplines in Australia that give us some insights into the incidents of abuse, but not its prevalence per se. So this data tends to indicate that firstly, financial and psychological abuse are the most frequently reported types. And that sons or daughters are the most frequently reported perpetrators of abuse.
Elder abuse of course has negative impacts on older people. Broadly, negative impacts can be conceptualised as having the common effect of reducing an older person's quality of life. More specifically, it's known to have a range of particular negative impacts for older people, depending on the nature and circumstances of the abuse or neglect perpetrated. And this includes, but not limited to, psychological distress and emotional difficulties, destructive relationships and restrictions on autonomy, compromised health, physical injury and in the extreme cases, premature death. And it's also about a loss of assets and finances among others.
There hasn't been a lot of research on the particular impacts of elder abuse and we should remember that this includes not only the impacts it can have on older people, but also on the family members. We do know, however, that its impact can often go undetected and is sometimes difficult to quantify. In one of the few studies looking at its impacts, it was found that victims of elder abuse experienced higher rates of depression, post-traumatic stress disorder, anxiety and poor health compared to non-victims, with these effects enduring over long periods of time.
So turning now to look at the emerging evidence on risk factors associated with elder abuse. Again, what is known about risk factors is largely based on international studies. And these factors relate to older people, the perpetrator's relationship types and characteristics and also broader community and societal context. So these shouldn't be seen in isolation to each other, rather the risk of abuse often involves a combination of all these factors associated with victims of perpetrators in the context that they live in. So I've got a diagram on the screen there. And as it shows, this an ecological model. And it's a common framework used to understand how these factors can relate to each other.
So that is, there are factors relating to both, an older person and a potential perpetrator that can increase the risk of abuse. And these are moderated by relationship characteristics. So it's represented by the first circle around the older person and perpetrator. And lastly these factors may be influenced by broader environmental factors at the community social and cultural levels that can increase or moderate this risk. So looking firstly at factors that are known to increase the risk of abuse for older people, the main factors to have emerged consistently across a range of studies are cognitive impairment and disability, poor mental health, social isolation of older people as well as the history of abuse, family violence or conflict.
There are also other factors and these are identified in prevalent studies and these have included frailty, alcohol use, trauma, lower income or poverty, problem behaviours, personality traits, as well as incontinence. Unfortunately, I don't have time to get into much detail about each of these, so I'd encourage you to read the paper if you're interested. So there's also risk factors associated with perpetrators, less is known about these. The main factors found in the research include caregiver stress, financial or emotional dependency on an older adult, poor mental health, the use of alcohol and other drugs as well as attitudes of entitlement.
There are also factors associated with relationship types and characteristics that can moderate this risk. The available evidence indicates the different types of relationships are associated with different types of abuse. In some population studies, family relationships are found to be the most common relationship type in overall cases of abuse. Other studies have found that adult children are more likely to neglect older people's care needs. On the other hand available evidence suggests that intimate partners are more likely to be physically or psychologically abusive than other perpetrators.
In addition to relationship types are also relationship characteristics that have been found to increase the risk of abuse. In general, emerging evidence indicates that elder abuse is more likely to occur where there's a history of family conflict in relationships, in poor quality relationships, as well as in situations of dependence or inter-dependence. That is where someone, and it's usually a family member, has an emotional or a financial dependence on the older person and vice versa. Overall there is evidence to suggest that the quality of relationships and access to social supports are the most consequential factors influencing the risk of elder abuse.
Finally there are also factors that operate at the level of community and societal context that may be associated with the abuse of older people. At the community level, these factors include social isolation and exclusion. So researchers have suggested that an older person's alienation from community can increase their vulnerability to abuse. And this can occur in various ways, including through the loss of friends or families, or in the absence of formal support networks that can keep older people connected to their local community. Factors relating to institutional care settings include opportunities for peer to peer abuse, in particular the co-habitation of older adults who maybe have increased risk of potentially perpetrating abuse, but also an increased vulnerability of victimisation.
Also where present, the lack of institutional resources, unregulated use of restrictive practices used in ways disproportionate to need, caregiver stress and the lack of appropriate carer skills, may increase the risk of abuse in institutional care settings. Lastly, societal factors that increase this risk may include ageism, inadequate health and social support services, economic pressures and finally, inter-generational conflict.
So moving now to the last part of my presentation, I'll give a short summary of approaches to the prevention and intervention of elder abuse in Australia. So one way to think about prevention and intervention strategies is from a public health perspective. This approach focuses on three levels of intervention. Firstly, there's primary or universal interventions which target whole communities or populations to prevent elder abuse. There are also secondary interventions that target particular at risk populations to prevent or intervene early before problems get worse. And there's also tertiary interventions, respond to victims or perpetrators of elder abuse. Before looking at these in more detail, I think it's worth framing this discussion with some guiding principles that I think are helpful to consider when we think about how we should respond.
So in 2017, the Australian Law Reform Commission published its final report on the enquiry into protecting the rights of older Australians from abuse. As part of its enquiry, the Commission made a series of recommendations that aim to balance two guiding principles. The first is the principle of dignity and autonomy and the second is the principle of protection and safeguarding. As the report recognised, these principles are sometimes intention. So on one hand there is the principle to recognise the dignity and autonomy of older people, which includes recognition of an older person's right to make decisions about their own life and their capacity and agency to do so.
On the other hand there is the principle of protection and safeguarding which aims to respond for an older person's rights to safety and well-being in those cases where they are at risk of abuse and may not have the capacity to ensure that their rights are respected. So balancing these principles can be a challenge for practitioners and policy makers working with older people. And it's worth keeping these principles in mind when thinking about prevention and intervention strategies.
So primary interventions. Primary interventions are mainly focused on preventing elder abuse. Prevention strategies tend to operate at a national or a state and territory level and these can include legislation that's relevant to the prevention or remediation of forms of elder abuse. This includes both Commonwealth and state and territory based legislation. There's also policy and practice frameworks. These exist more at a state and territory level and seek to guide practice in the areas of health, social welfare and related areas of practice.
Education and awareness strategies. These can be directed to older people, to the broader community or particular professional sectors. And finally there are sector-wide workforce development strategies that aim to increase the capability and support for particular professional sectors to help prevent abuse. So a major development in this area of national policy has been the national plan to respond to the abuse of older Australians, which was released earlier this year. And you can find a copy of the plan available on the Attorney-General's Department website. And we'll also have a link to that plan on our website following this webinar.
So secondary interventions. These involve two main kinds of strategies. The first is screening and risk assessment strategies. These are typically used in healthcare settings, although they may be used elsewhere. They aim to screen older people for known risk factors, make an assessment of the nature of risk and determine an appropriate course of action in response to that risk. The other main kind of secondary intervention is social support and capacity building strategies. And these include caregiver and family support services, financial management and related services, legal assistance and elder abuse helplines.
The evidence is still emerging across all these strategies. However, what seems to be clear in the research is that social support is a key protective factor that helps reduce an older person's risk of abuse. I'll move on to the next slide. Tertiary interventions aim to address the incidents and impact of elder abuse after it has occurred and typically targets either older adults who have been victims of abuse or the perpetrators. There are two main challenges in this emerging area. First is the complexity of elder abuse that occurs in its multiple forms and combinations, as well as there's a lack of strong evidence that would inform effective programs and practices. Tertiary interventions may target different groups, including older people, carers and perpetrators of abuse as well as families.
So just looking at tertiary interventions targeting older people. The main types of interventions that appear in the research and policy literature focus on multi-disciplinary and coordinated approaches. These strategies aim to bring together different kinds of professionals, such as social workers, legal professionals and health and mental health practitioners to provide a holistic and tailored response to particular forms of abuse. There's also case management and advocacy strategies. These may be similar to multi-disciplinary approaches, but rather than being managed by a team, they're facilitated usually by a case manager to assess an older person's support needs.
There are also elder abuse helplines which are another type of intervention that can advocate for an older person by providing advice and assistance referred to other support services. And finally emergency shelters which can cater to the unique needs of older adults. So tertiary intervention is targeting carers – I'm just running out of time, so I'll keep it quick. Less is known about interventions targeting carers, but the main kinds of interventions include psychoeducative support groups, anger management and counselling. Broadly, the evidence to support these interventions is still emerging. But the positive results associated with these programs and practices relate more to improve knowledge and awareness or reduce anxiety or depression among carers, but not necessarily a reduction in the incidents of abuse itself.
So finally, interventions that target families, again to be – they appear to be a relatively new and emerging area. These can include family mediation, family care conferences and family focused psychological or counselling approaches. So like interventions targeting carers or perpetrators, there's not a strong evidence base to demonstrate the effectiveness of these interventions in reducing the incidents or impacts of elder abuse as yet. But there's always research and evaluation going on in this space, so watch this space.
However, as mentioned earlier, available evidence does indicate that healthy relationships with family members is a key protective factor. And so there's a good argument that family focused interventions are an important side of intervention and should be developed further. So just to conclude, elder abuse is a complex phenomenon involving a range of abusive behaviours and experiences. Practitioners, policy makers and researchers are encouraged to consider the various prevention and intervention strategies that we know, in particular to think about working with others to develop coordinated approaches to address and respond appropriately to the abuse of older people. Thank you for listening and I'll hand over to Megan.
MS CARSON: Well thank you very much Adam for that very comprehensive presentation. We are now going to hear from Megan Frost. Megan has a video to show us so bear with us while we get this going. If you cannot see the video, we will provide a link to it in our resources section of the 'Join the conversation' page.
MS FROST: - - - and I'm the coordinator of the Let's Talk Elder Mediation and Support Services. This is a project designed to mitigate the risk and respond early to elder abuse. In my presentation today, I'm hoping to describe the Let's Talk project to you, give you a sense of the work that we've done so far and raise some of the challenges we face in working in this space.
You've seen a video. So the Let's Talk Elder Mediation and Support Service is funded by the New South Wales Government's Domestic and Family Violence Innovation Fund. We're funded for three years and this is ending in June 2021. We actively seek feedback from clients and stakeholders and we'll continually revise, adapt, change and develop a service throughout this period and share our learnings. As with all the projects funded on the innovation fund, Let's Talk will be externally evaluated and we do hope to be contributing to the evidence base for work in this space.
Relationships Australia New South Wales is a not-for-profit organisation and our goal is to promote relationships that are safe, healthy and strong. Backed by 70 years of experience, we offer judgment, pre-support to people of all cultural backgrounds, family structures, gender and sexual orientation. Let's Talk is anchored in and builds on Relationships Australia New South Wales counselling and mediation services. And as mentioned before, the aims of Let's Talk is to mitigate the risk of and to respond earlier to elder abuse.
So why Let's Talk? The name Let's Talk came for this project emerged during conversations with the New South Wales elder abuse helpline and resource unit as we were developing our proposal for funding. As just one example of the many changing and evolving aspects of the work, the helpline, as of 1 July this year, is now the New South Wales aging and disability abuse helpline. The helpline became and still is a key partner in the Let's Talk project. We wanted to know if the helpline thought there was a need for mediation, counselling services in New South Wales specialised in working with older people, their families, carers, friends and support people.
Meeting with the helpline we learned about the people who called the helpline. 46 per cent of the callers were a concerned family member, 18 per cent the older person themselves and 14 per cent a concerned bystander. All categories of elder abuse were reflected in the calls. Sexual, physical, psychological, financial and neglect, with the most frequent type of abuse being financial at 39 per cent and psychological at 58 per cent. And as mentioned by Adam, these often co-exist.
When speaking with callers, the helpline noticed a predominant theme, is that people want to preserve family relationships. They want to be safe, they don't want to lose relationships. One of the questions the helpline frequently asks callers is, 'Have you thought about talking with the other people concerned? Have you thought about talking with your adult child, whom you love and are fearful of losing? Have you thought about talking with your parent who you don't want to frighten about their money? Have you thought about talking with your sibling, who you haven't spoken to for three years, to see if they actually do have a power of attorney? Have you thought about talking to your sister-in-law who your aunt lives with now and you can't see your aunt anymore?' 'It's too hard, I don't know where to start. They wouldn't want to talk to me. I don't want to make things worse.'
Yes there is a need to help people come together to have important and sometimes difficult conversations. There is a need to help families manage conflict and make decisions. The Let's Talk service can help bring families together to start the conversation about age-related issues, such as inter-generational relationship challenges, risk safety and well-being, planning for the future, powers of attorney and guardianship, end of life planning and decision making. Let's Talk ensures the voice of older people are heard, the rights of older people are known and upheld, the wishes of older people are respected and relationships are supported and strengthened. It's also important to know and help connect people to what other services might be able to assist in.
A brief out view of Let's Talk in what clients can expect, is just that no pathway is exactly the same. We understand that people have different needs and wishes, so we ensure that we spend time to understand why the person has contacted our service. We tailor the service and how it is delivered to the needs of each client group. That said, there are some key service connection points. So someone can come to the Let's Talk service either by calling or contacting the service them self. They might be an older person. They might be a family member. We've also worked hard at developing relationship with other services and referrals may actually come from another service provider.
We call the first appointment that a client has with our service the initial consultation and this is conducted with a family advisor who's got training and skills in counselling and also in elder mediation. In this phone call we are seeking to understand the concerns, what we might be able to offer, refer to other support, give information about going forward, talk about who else might be involved in moving forward and who else might need some information. If people choose to go forward from that, we then arrange a face-to-face appointment, so we can do appointments over the phone as well. And this will either be what we call a pre-mediation interview, or it might be that the decided pathway forward for this particular group, is that counselling might be the best pathway forward.
As I said, it can be by phone, but most often in one of our Relationship Australia offices. We are flexible and have arranged to use other people's offices, meet in community rooms to be closer to clients. More information about moving forward and what support people might need, perhaps counselling before coming together in mediation and what – also information people might need about making decisions, legal, medical, financial and other supports. We look at who needs to participate and how. We invite other people in for the same pre-mediation or counselling appointment.
Other mediation is a forum for decision making where family members are encouraged to express their concerns. Decisions are confidential and take place in a private and safe setting. The court principle guiding elder mediation is that the voice of the older person is heard, their rights upheld and their wishes represented. For mediation to be effective it is preferable for all interested parties to attend or be represented, though at times this is a challenge. Agreements reached are based on goodwill and not legally binding. Services are voluntary and confidential and limits to confidentially are discussed at the outset and include reporting if they are concerned about safety or otherwise we're compelled by law.
There's some links here too. The Let's Talk Elder Mediation Support Service, and this is a New South Wales Service, though Relationships Australia New South Wales is part of a national network of Relationships Australia services and they have senior relationships services as well. In fact four of our states are trial sites for the Federal Attorney-General's Elder Mediation and Case Management. Let's Talk was launched on 12 June this year and we're able to offer it in the city metropolitan area in Mandarin and Cantonese as well as we have two mediators who speak both Mandarin and Cantonese.
We're committed to providing work in regional parts of New South Wales as well. From Relationships Australia New South Wales, we have two mediators and counsellors trained in elder mediation based from our office in Bathurst and one of our other key partners is Relationships Australia Canberra and region, so Let's Talk is also offered in the Riverina from Wagga and in the far south coast from Moruya. The design of Let's Talk was informed by a national trial that Relationships Australia ran in 2016. Key learnings from that trial included the need to build strong collaborative partnerships with key stakeholders and service providers.
As well as the challenge and priority to work creatively, thoughtfully and safely, when inviting older people, family members and support networks to come together to talk. And the paper of that trial written by Paula Mance is a link on your slides. Let's Talk is also building on the international body of work that has been undertaken in elder mediation. Elder mediation is relatively new in Australia, particularly when compared with other countries such as Canada.
And I've chosen an article here for you, written by Judith McCann-Beranger as it describes various models of mediation and different ways that elder mediation can be used in working with older people and their families, different contexts. Judy was one of the key note speakers at the National Mediation Conference in Canberra this year. And she's also one of the trainers of advanced elder mediation that I attended with Relationships Australia colleagues this year and greatly appreciate learning from her.
Let's Talk is delivered by qualified mediators and counsellors who have also had specialised elder mediation training. We are committed to growing in our knowledge and skill. We already have one elder mediator who is applying for international accreditation as an elder mediator. This bar is really high and at last, look, only three Australians have this accreditation. And we expect others to be in a position to apply later this year.
Our initial elder mediation training was delivered by Dale Bagshaw and Dale is one of those three people, and is one of the leaders of elder mediation and working in elder abuse in Australia. She was also involved in the revision of the International Elder Mediation Code of Ethics which is reading for you. One of the key elements in elder mediation training and elder abuse training is recognising ageism and understanding ageism.
Ageism can impact how we see and value older people. It can also impact whether we see or listen to older people. And I note that Adam mentioned ageism in his presentation. I'd like to draw your attention, in case you haven't heard of it yet, to the Every Age Counts campaign. A campaign to tackle ageism faced by older Australians. For me a disturbing illustration of ageism appears in research undertaken with social workers. I became aware of this research in the Helplines training for professionals on elder abuse.
In a study of social workers in 2013, two groups of social workers were shown an identical account of domestic violence against a woman. The only difference in the case study that they were shown is, one woman was aged 77 years old and then the other, 37 years old. Results found that the abuse was considered significantly less serious when the victim was older. The only difference was the age of the female victim.
Ageism and the prejudice against our future selves it's been called, can limit people recognising elder abuse. And it can also influence the way the practitioners conceptualise a case and plan their work. For example, who we speak to and who we invite to be in part of a process. As part of the Let's Talk project, all Relationships Australia in New South Wales will be trained in elder abuse recognition and responding.
We will ensure that older people are visible. That when exploring the impact of domestic and family violence, as well as attending to the impact of children, we explore whether or not there may be an older person who might also be affected. Older people will be visible. Let's Talk has a commitment to hear directly from the older person. However there's a challenge. Are there times when we would not speak directly with the older person? If we have made that choice with careful planning and consideration, how do we ensure that the voice and the wishes of the older person are represented and are present?
I'll give you a case example, a family member approached the Let's Talk service on the suggestion from a worker at Dementia Australia. The caller was an adult child who was concerned about the care of their parent who had been diagnosed with one of the dementias. The concern was serious that the parent was at risk of not being adequately cared for as the caller was the main carer and could no longer provide the care needed.
The caller thought the parent needed to be moved into a home. For this family, the caller, their siblings and the older persons spouse, all agreed that they were the ones who needed to talk together. The worker from Dementia Australia met with a mediator before the mediation and agreed to attend the beginning of the mediation to speak with the family to let them know what the care needs might look like in the future. And what support might be needed and also where assistance can be found.
There were multiple challenges, the adult children hadn't seen eye to eye for a while. One felt like they carried the burden of care, the other felt excluded. And there were pressures for everyone in other aspects of their lives, whether it be personal relationships, care of other people or work. Let's Talk helped these people make decisions that enabled the older person to stay at home. There was a better understanding of each persons' needs and fears. A better understanding of service options. There were action plans to follow up support service.
The initial caller was able to let people know that they were feeling over-burdened. This enabled others to offer more help. And the adult siblings have entered counselling to improve their relationships. Let's Talk also is committed to ensuring that the rights of older people are known and are upheld. When I'm thinking about rights, we can think about things in lots of ways and one of the areas I don't want to skip, but can't spend much time on is just thinking about human rights.
For those of you who may have been at the National Elder Abuse's conference there was a speaker in Brisbane earlier this year, Bethany Brown who is a researcher of older people's rights at the United States Human Rights Watch was a key note speaker. And her key note address was entitled, 'Human rights don't evaporate when we get old. Our rights to dignity, self-determination, liberty, security, equality, non-discrimination don't evaporate when we get older.'
And again, although I'm in New South Wales I do notice that South Australia does have a charter of rights and freedoms of older people. In terms of one of the areas that we've noticed with a lot of our calls is – and so far we've conducted over initial consultations. Issues of concern that have prompted the call have included financial abuse and concern about the management of finances and assets as well as family relationship conflict. We've noted there's a lot of uncertainty amongst callers about, what in New South Wales we have a power of attorney and also we have guardianship. What they entail are many – report the misuse of these powers leading to reports of financial abuse.
It's really important when working in this space, as professionals that we understand legal documents in our context, that we understand what documents give powers of decision making, what those decisions can be and also how people might be able to change those instruments. So the limits, the nature of the decisions, when it can be changed. People need some information about this, we've had for example someone who thought, because their parent had gone into an aged care facility, that the aged care facility was then the guardian of that person and got to make all the decisions.
So getting information to people about their legal status, the status of decision making, is really important. If you don't understand legal documents or if you're not sure, ask for help. I know each day has legal services that produce a lot of information and advocacy services as well. For example, in New South Wales, the New South Wales Legal Aid website is fantastic, it's got lots of facts sheets and resources. And one of the sheets, that I think is one of – the helpline has mentioned is most downloaded is adult children living at home.
How to get them to leave. The New South Wales Trustee and Guardian also has lots of resources on their website and include things to help people consider planning ahead. What documents might they need, to ensure that the decisions that they want to be made for them, should they not be able to make the decisions themselves, are made. And also, in terms of advanced care directed service worker. So just thinking around there's a lot of information and resources out there. Giving people legal information doesn't mean they're starting legal action, it doesn't mean they're fighting a legal battle, it means that people understand the context in which decisions are made. And people need that information when they're making decisions and thinking and planning for the future.
Let's talk safety. Relationships Australia is committed to positively and appropriately addressing issues of safety, including family and domestic violence, elder abuse and the abuse and neglect of children and young people. So we, our Let's Talk follows our client safety procedures which include, and I'll touch on them, screening, ongoing assessment of risk and suitability of the service, safety, planning and referral. As mentioned before referral might be for legal support or legal information.
It might be that we've heard something that has us being concerned about the safety or well-being of someone that might be a situation of possible elder abuse. And there's a New South Wales aging and disability abuse helpline. And as of the 1st of July in New South Wales, we have an Aging and Disability Commissioner and that Commissioner has investigative powers with respect to elder abuse. So this is new for us, again part of the changing landscape. We may also go to the police if there are emergencies or crimes and we do have in New South Wales that's just starting, is that the New South Wales police are establishing specialised elder abuse liaison officers.
So in New South Wales we already have domestic and violence liaison officers, and multi-cultural liaison officers who have been able to work with and speak with around cases and we are now also having elder abuse liaison officers. I'd like to refer you to the New South Wales elder abuse toolkit. It's linked in and it is, as I said, a source of much information. It has a five step approach to identify in responding to the abuse of older people. It includes tools for screening and assessment, heaps of information and practical support. For example, a policy checklist if you're wanting to write an agency policy in relation to the abuse of older people.
We have as a challenge, in working with safety, the fact that we're dealing with older people and adults who are able to make decisions and family members may not like some of the decisions that people make, they might not think they're the best decisions, but people are entitled to make bad decisions. So some of the dilemmas are, when is something someone's choice, their autonomy, their decision to do what they want with their money, their decision not to tell their adult children what their plans are with their will, their decision to choose who their executors might be, or who they might give powers of attorney to. And when is it something that's actually impacting their safety and safety and that the contexts of support and other services actually needs to be there to safeguard people.
We don't have all the answers to this, but we do grapple with this challenges and I think while working in this space, these are challenges to grapple with. We cannot do this work in isolation. We are developing referral pathways and building working relationships with many services. These include the aging and disability abuse helpline, seniors rights service, Dementia Australia, New South Wales police, general practitioners, and apologies for that apostrophe if anyone's noticed it. We've actually found talking to GPs with consent from clients has really helped us bridge the gaps that some people have with their understanding of My Aged Care, how to get assessment, how to actually start entering into the My Aged Care system to get the support and the services.
A lot of people don't know and sometimes they've had assessment but hadn't realised that they had their assessments. So again and with permission with people, we've been able to help them get the information they need to then access services for themselves. We also have designated community engagement work in Bathurst, Wagga, Moruya and metropolitan Sydney. And this is to help to raise the awareness but also to build working relationships with other services.
When thinking about this work, we've been thinking around each family and in each family planning is unique and the time it's taken to listen, to plan, to think, to follow up, particularly on referrals and making sure that people have landed with the services able to support them. We've noticed and are concerned about a lot of people and particularly the older people being referred to a service that may not quite be the right one for them and they tend to bounce around a little bit. So we're trying to do a lot of work in making sure before they arrive that we actually have picked the right service for them.
And if it hasn't been, that we're able to work out what might be of benefit for them. Being aware of ageism, keeping this in front of mind, our own experiences, our own thoughts are impacted by living in an ageist world and working with clear statements that help challenge ageist assumptions that inform and maybe even define the issue of the caller. For example the adults, children sense of entitlement to parents' financial resources. We might reframe the conversation to say, for example, 'Your Mum and Dad may or may not choose to let you know their plans for their money or how they spend it'. And just again acknowledging that for workers and for us all in this space that it's often very close to home.
These issues and challenges are close in our families, in our friends, with our neighbours and it is important that as always we ensure that we don't impose our own values, our own thoughts, or our own choices that we've made on others as well as ensuring that we take care of staff, working in this space, with good support and good supervision.
I'd like to leave you with some statements that our clients have made. 'I really feel hopeful that things might improve. I'm so glad I contacted you.' 'I thought there was nothing I could do, you feel so helpless, it's great to know that there are options and people who can help.' 'I feel I'm moving forward and have a plan, I feel more confident to contact my son and try to work things out now that I have some support.' 'Thank you for keeping us safe and on-track.' Thank you Rachel, over to you.
MS CARSON: Thanks very much Megan for that very informative and insightful presentation. And now we're going to turn to questions from the audience. We've had a question that asks whether you could talk a little more Megan about the potential risks in responding to elder abuse with mediation and whether it puts responsibility on the older person who's the victim.
MS FROST: Yes. So as with all our mediation services, whether it be family dispute resolution or elder mediation, before we even decide on going down that pathway, we make sure that it is safe to do so. So if there is a situation where people aren't safe, or they aren't that confident that they're safe, we would not be bringing people together to have those conversations. We might contact a person and then refer them for support and work with that family, but we – and again, depending on what kind of situation it is, it's hard to say exactly which pathway we take forward but we definitely don't proceed unless we are confident that people are safe either with their living and with planning. And if we are aware of concerns we actually do, with the consent of the person usually, make connections with the elder abuse helpline.
MS CARSON: Excellent. We've had some questions about the alleged perpetrators and working with alleged perpetrators, so I might group these questions together if that's okay Megan and address them to you.
MS FROST: Sure.
MS CARSON: The first question asks, 'I'm wondering if you know if there's much evidence on how to work with, in parentheses, "male perpetrators of elder abuse". Would it be similar or the same as the model for working with perpetrators of general family violence?' The questioner goes on to say, 'I'm curious as I know the model for working with perpetrators is underlined by gender, however I'm guessing for elder abuse it would be more informed by an understanding of ageism.' And then another questioner asks about Relationships Australia's work with the alleged perpetrators and the framework that you use in working with those perpetrators.'
MS FROST: Okay. I'd like to just make some general statements and if I don't fully answer your question, and with some more reflection, I'll make sure that the written responses fully address the questions. Some points to start with, is in elder abuse, yes, there are some classic presentations of intimate partner violence and domestic and family violence that we're used to working in a lot of our services. We also see in terms of working with the families, and where there are allegations of elder abuse, that potentially people are not so intentional of their abuse.
For example, I'll give you an example of financial abuse. Absolutely you might be a rat bag out there to fleece your older parent but sometimes what happens is you don't actually realise the limits of what you should be doing. People's sense of entitlement, they don't realise that it's actually wrong to pocket the change. We did it as teenagers but actually as we're getting older, if we're shopping for people – and the use of the technology for banking for example.
So some of the areas of abuse and some of the perpetrators, once you actually let them know and reinstate rights and choices, people can sometimes realise going forward that things need to change, particularly if things have been raised by siblings. So the challenge is to get the person who might've been accused by their family members together to the table to listen. In terms of the – I can't remember the second part of your question, I'm really sorry.
MS CARSON: So that was in relation to - - -
MS FROST: It was around the – it was the gendered work. So in terms of who the perpetrators are as well, it's daughters as well as sons. So some of the gendered work is a bit different in elder abuse. There still seems to be more women victims to male victims. I don't have a full understanding of that. But it is different, it is different to our classic work with domestic and family violence but then at different times, it's the same as well. So the principles around safeguarding, safety planning and screening and assessment, and ongoing assessment of, 'Is this the right service and what else might people need?' underpins the work.
MS CARSON: Okay, well thank you very much Megan. I'm afraid we don't have any time for further questions but thank you for attending today and please follow the link on your screen to our website to continue the conversation. And as you leave the webinar, a short survey will open up in a new window and we would greatly appreciate your feedback. Please note that any unanswered questions may be published along with your first name on the CFCA website for a response from presenters after the webinar. Please let us know if you don't want your question or your first name to be published on our website. Thank you Megan, thank you Adam and thank you everyone for joining us today. Good afternoon.
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1. Responding to elder abuse: Rights, safety and participation
Adam Dean and Megan Frost
28 August 2019
2. House keeping
- Send through your questions via the chat box at any time during the webinar.
- Let us know if you don’t want your question published on the online forum following the presentation.
- All our webinars are recorded.
- The slides are available in the handout section of Gotowebinar.
- The audio and transcript will be posted on our website and YouTube channel in the coming week.
- CFCA paper, Elder abuse: Key issues and emerging evidence
- Key issues involved in how elder abuse is defined
- Prevalence, impact and associated risk factors
- Implications for policy and practice
4. Older people in Australia
- ‘Older people’ are generally defined as:
- 60 to 65 years and older (non-Indigenous Australians)
- 45 to 50 years and older (Aboriginal and Torres Strait Islander peoples).
5. Diversity, ability and living arrangements
- Diverse population, representing different cultural backgrounds, lifestyles and abilities
- Older people are more likely to have a disability
- Risk of dementia increases with age
- Most live in private households
- Need for care/assistance with daily living increases with age
- Disability, dementia and need for assistance may increase risk of elder abuse, but other factors exacerbate it
6. What is elder abuse? General definition
- Contemporary definitions are more inclusive, but no universal consensus.
- A widely accepted definition defines elder abuse as:
‘a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person’. (WHO, 2008, p. 1)
- Older people may also be potential perpetrators of abuse (e.g. spouses/partners, friends or peers in institutional care settings).
7. What is elder abuse? Different types
- Five types of abuse are generally recognised:
- physical abuse
- psychological or emotional abuse
- sexual abuse
- financial abuse
- Types of abuse may co-occur and vary in severity and frequency.
8. Prevalence of elder abuse: International findings
- International prevalence data indicates:
- 15.7% of adults aged 60 years and older living in community settings experience elder abuse every year.
- Sexual abuse (0.9%)
- Physical abuse (2.6%)
- Neglect (4.2%)
- Financial abuse (6.8%)
- Psychological abuse (11.6%)
- Higher rates of abuse occur in institutional care settings and for people with disabilities.
- 15.7% of adults aged 60 years and older living in community settings experience elder abuse every year.
9. Prevalence of elder abuse: Australian estimates
- No national prevalence data for elder abuse in Australia.
- Based on international data, it has been estimated that 2–14% of older people in Australia may experience elder abuse every year (Kaspiew, Carson, & Rhoades, 2016).
- Incidence data from elder abuse helplines tends to indicate that:
- financial and psychological abuse are most frequently reported
- sons or daughters are most frequently reported perpetrators.
10. Impacts of elder abuse
- Common effect of reducing an older person’s quality of life
- Specific impacts may include:
- psychological distress, emotional difficulties
- disrupted relationships, restrictions on autonomy
- compromised health, physical injury
- loss of assets and finances.
- Long-term effects may include higher rates of depression, PTSD, anxiety and poor health compared to non-victims.
11. Risk factors for elder abuse
- A range of factors are associated with increased risk of elder abuse.
- These include factors relating to:
- older people
- relationship characteristics
- broader community and societal context (environment).
12. Risk factors: Older people
- Cognitive impairment and disability
- Poor mental health
- Social isolation
- History of abuse, family violence or conflict
- Other factors
13. Risk factors: Perpetrators
- Caregiver stress
- Financial or emotional dependency on an older adult
- Poor mental health
- Alcohol and other drugs
- Attitudes of entitlement
14. Risk factors: Relationships
- Relationship types
- Family relationships
- Adult children
- Relationship characteristics
- History of family conflict
- Poor quality relationships
- Dependence and interdependence
15. Risk factors: Community and societal contexts
- Community-level factors
- Social isolation and exclusion
- Institutional care setting factors
- Opportunities for peer-to-peer abuse
- Lack of resources, unregulated restrictive practices, carer stress, lack of appropriate carer skills (all risks for abuse where present)
- Societal factors
- Inadequate health and social support services
- Economic pressures
- Intergenerational conflict
16. Prevention and intervention
- Public health approach to prevention and intervention:
- Primary (or universal) interventions target whole communities or populations to prevent elder abuse
- Secondary interventions target particular at-risk populations
- Tertiary interventions respond to victims and/or perpetrators of elder abuse
17. Prevention and intervention: Guiding principles
- In its final inquiry report, the Australian Law Reform Commission made recommendations that aimed to balance two guiding principles:
- dignity and autonomy
- protection and safeguarding.
- Policy and practice responses are challenged to balance these principles.
18. Primary interventions
- Prevention strategies operating at national or state/territory levels may include:
- legislation relevant to preventing or remediating forms of elder abuse
- policy and practice frameworks
- education and awareness strategies
- sector-wide workforce development and support for relevant professionals.
- The National Plan to Respond to the Abuse of Older Australians (Elder Abuse) 2019–2023 is part of a national strategy to address elder abuse.
19. Secondary interventions
- Screening and risk assessment strategies aim to screen/assess risk and determine appropriate action.
- Social support and capacity building strategies:
- Caregiver/family support services
- Financial management
- Legal assistance
- Social support is a key protective factor
20. Tertiary interventions
- Tertiary interventions face two main challenges:
- complexity of elder abuse occurring in multiple forms
- lack of strong evidence base.
- Tertiary interventions can target:
- older people/victims
21. Tertiary interventions: Targeting older people/victims
- Multidisciplinary and coordinated intervention approaches:
- Social workers
- Legal professionals
- Health and mental health professionals
- Case management and advocacy
- Elder abuse helplines
- Emergency shelters
22. Tertiary interventions: Targeting carers/perpetrators
- Less common than interventions targeting older people/victims.
- Interventions include:
- psycho-educative support groups
- anger management
23. Tertiary interventions: Targeting families
- New and emerging area of practice
- Interventions include:
- family mediation
- family care conferences
- family-focused psychological/counselling approaches.
- Healthy relationships with family members is a key protective factor.
- Elder abuse is a complex phenomenon involving a range of abusive behaviours/experiences.
- Practitioners, policy makers and researchers are encouraged to consider various prevention and intervention strategies – in particular, to think about working with others to develop coordinated approaches.
- Family Law Act 1975 (Cth)
- Australian Law Reform Commission (ALRC). (2017). Elder abuse - a national legal response: Final report. Sydney: ALRC.
- Council of Attorneys-General. (2019). National Plan to Respond to the Abuse of Older Australians (Elder Abuse) 2019–2023. Canberra: Attorney-General's Department. Retrieved from www.ag.gov.au/elderabuse
- Kaspiew, R., Carson, R., & Rhoades, H. (2016). Elder abuse: Understanding issues, frameworks and responses. Melbourne: Australian Institute of Family Studies. Retrieved from aifs.gov.au/publications/elder-abuse
- World Health Organization (WHO). (2008). A global response to elder abuse and neglect: Building primary health care capacity to deal with the problem worldwide. Geneva: WHO.
26. Responding to elder abuse: Rights, safety and participation
28 August 2019
27. Let’s Talk Video
28. Let’s Talk – Elder Mediation and Support Service
- Funded by NSW Government Domestic and Family Violence Innovation Fund (for 3 years)
- Builds on Relationships Australia NSW’s counselling and mediation services
- Aims to mitigate the risk of, and respond early to Elder Abuse
29. Let’s Talk Elder Mediation and Support Service – who is it for?
- Let’s Talk works with older people, their families and support networks struggling with ageing and age-related issues, including:
- intergenerational relationships challenges
- safety and wellbeing
- planning for the future
- housing and living arrangements.
- Let’s Talk assists older people, their families and support networks to:
- have important, sometimes difficult, conversations
- manage conflict
- make decisions that protect the interests and rights of the older person and their family
- know what other services are available.
30. Let’s Talk Elder Mediation and Support Service – what clients can expect
- Referral to Let’s Talk made by older person, family member, other service
- Initial Consultation by phone with a Family Advisor
- First appointment (pre-mediation or counselling) usually face-to-face
- Mediation and / or counselling
RANSW - Let's Talk Elder Mediation and Support Service
Relationships Australia - Senior Relationship Services
31. Let’s Talk – the background and beginnings
- Relationships Australia National Trial - Elder Relationships Services Pilot
- International work in Elder Mediation
- NSW Elder Abuse Helpline and Resource Unit, now the NSW Ageing and Disability Abuse Helpline
- Staff training
- Elder Mediation - Associate Professor Dale Bagshaw, PhD, Adjunct, School of Psychology, Social Work and Social Policy, University of South Australia.
- EMIN Code of Ethics for Elder Mediators 9th edn
- Elder Abuse
32. Let’s Talk – ensuring the voices of older people are heard
- Commitment to hear directly from the older person
- Are there times when we would not speak directly with the older person?
- How to ensure that the voice and wishes of the older person are represented?
33. Let’s Talk – ensuring the rights of older people are known and upheld
- Human Rights
- Understand legal documents (ask for help if you don’t)
- Who are decision makers?
- When and what decisions can be made?
- How to change?
- Have resources available to help people know about legal rights and options
- NSW Legal Aid Fact Sheets and Resources
- An example NSW Legal Aid - Adult children living at home, how to get them to leave
- The NSW Trustee and Guardian
34. Let’s Talk – safety
- Relationships Australia NSW is committed to positively and appropriately addressing issues of safety, including family and domestic violence, elder abuse and the abuse and neglect of children and young people.
- Let’s Talk follows RANSW client safety procedures which include:
- ongoing assessment of risk and suitability of service
- safety planning
- Challenge: people are entitled to make bad decisions
- NSW Elder Abuse Toolkit
35. Let’s Talk – working with other services
- Working with other services
- NSW Ageing and Disability Abuse Helpline
- Seniors Rights Service
- Dementia Australia
- Carers NSW
- NSW Police
- Financial advice
- Many others!
36. Let’s Talk – practitioner reflection
- Planning for each family
- Close to home
37. Let’s Talk – clients say…
- “I really feel hopeful that things might improve. I’m so glad I contacted you.”
- “I thought there was nothing I could do. You feel so helpless. It’s great to know that there are options and people who can help.”
- “I feel I am moving forward and have a plan. I feel more confident to contact (my son) and try to work things out, now I have some support.”
- “Thank you for keeping us safe and on track.”
- Assisting Families with Ageing Related Issues - Paula Mance, Relationships Australia
- Exploring the Role of Elder Mediation in the Prevention of Elder Abuse Final Report. Department of Justice Canada- Judith McCann-Beranger (2012)
- NSW Ageing and Disability Commission
- NSW Elder Abuse Toolkit
- NSW Legal Aid Fact Sheets and Resources
- RANSW - Let's Talk Elder Mediation and Support Service
- EveryAge Counts
- Elder Mediation International Network (EMIN) <https://elder-mediation-international.net/>
- Elder Mediation Australasian Network (EMAN)
39. Continue the conversation…
Please submit questions or comments on the online forum following today’s webinar.
- Elder abuse: Key issues and emerging evidence
This CFCA paper provides an overview of elder abuse in Australia. It discusses key issues involved in how elder abuse is defined and examines its prevalence, impact and associated risk factors, with a focus on implications of recent research for policy and practice.
Adam is a Senior Research Officer in the CFCA information exchange, based at the Australian Institute of Family Studies. He works across a range of knowledge translation activities within CFCA, including working in close collaboration with sector professionals to share research and practice expertise across the child, family and community welfare sector. Adam is the author of a recent paper on elder abuse that explores its key issues and emerging evidence on its prevalence, impacts and risk factors.
Megan is a social worker, lawyer and mediator by training based at Relationships Australia NSW, with over 25 years of experience working in the community services sector. Since joining Relationships Australia NSW in 2000, she has worked in direct service delivery and in program design, coordination and management, including the position of founding manager of the Northern Beaches Family Relationship Centre. Currently, Megan is coordinating the implementation of a new elder mediation and support service, funded by the NSW Government’s Domestic and Family Violence Innovation Fund.
Focusing on recent research, this paper discusses elder abuse in Australia and its prevalence, impact and associated…Read more
Assisting families with ageing-related relationship issues
This discussion article explores Relationship Australia's service response to the ageing of Australia's population.Read more