Judith Davey 19/7/21
Reporting Elder Abuse and Neglect.
Most studies of elder abuse and neglect conclude that the great majority of cases are never reported to the authorities. Why is this?
- Social and cultural attitudes that dissuade disclosure through fear of community disapproval, shame, and embarrassment.
- Lack of awareness of the problem at societal level and among professional groups.
- Social isolation among vulnerable older people, lacking access to and knowledge of services.
- Fear of retaliation or escalation of the abuse, wishing to protect the abuser/s (whom the older person may depend upon), being reluctant to damage relationships.
- Inability to report abuse, or not being believed, because of cognitive impairment.
- The financial cost of potential remedies, especially those involving the use of lawyers.
Given these barriers to disclosure, how can abuse come to the notice of services which may be able to help? Elder Abuse Response Services offer free assessment, intervention support, and advice where an older person’s safety may be in doubt. These services are throughout the country as part of Age Concerns and other community agencies.
Health services – reporting abuse
General practitioners and practice nurses are in frequent contact with older people and are well placed to identify signs of elder abuse and neglect, especially if they have long standing relationships with their older patients.
Currently there is no requirement on health professionals to report suspected elder abuse and neglect, although the Ministry of Health encourages voluntary reporting and has published information on identifying abuse. The InterRAI assessment tool, can assist. This has triggers to identify abuse, such as being afraid of a caregiver or family member. Residential aged care services must comply with the Health and Disability Sector Standards mandated in contracts held with the DHBs. These require safe care and practices but depend on how well each facility adheres to reporting requirements.
Mandatory notification of elder abuse is a requirement in some countries, by specified groups – doctors, nurses, and residential care staff. But there are challenges, given the complexity of the issue; handling information on different types of elder abuse and neglect, in different settings (especially private/family settings), and involving a wide range of individuals and government, NGO and commercial (e.g., financial) institutions.
Prevention – public awareness and education
Primary prevention initiatives focus on the general population.Many forms of elder abuse and neglect have their origins in ageist social attitudes and behaviour towards ageing and older people.
The United Nations International Plan of Action on Ageing (2002) strongly recommended that more emphasis be put on preventing elder abuse and neglect through a multi-sectoral, community-based approach. It called for changes in attitudes, policies and practices at all levels and in all sectors in order to ensure that people are able to age with security and dignity.
In 2006 the International Network for Prevention of Elder Abuse designated June 15 as World Elder Abuse Awareness Day, when an increasing number of events are held across the globe to raise awareness of elder abuse, and highlight ways to challenge it.
New Zealand Government Initiatives
The Positive Ageing Strategy, released in 2001, set out the Government’s commitment to the wellbeing of older people and aimed to shift attitudes on ageing. Its successor- Better Later Life: He Oranga Kaumatua, covering the period 2019 to 2034 also aims to “combat elder abuse and neglect by raising awareness and reducing its prevalence.”
In 2007 the Family Violence Intervention Guidelines: Elder Abuse and Neglect were released for health professionals. The Ministry of Health and DHBs work with community agencies to increase awareness and strengthen support available to older people at risk of abuse.
From 2017 the Office for Seniors produced the report Towards gaining a greater understanding of elder abuse and neglect in New Zealand. A 24-hour telephone service was set up to report concerns about elder abuse and neglect and to get help. Community-based agencies, including Age Concerns, are contracted to deal with referrals from this service phone line and any service or the public
Other government statements note the importance of elder abuse awareness.
- The Health of Older People Strategy, 2016, promotes the importance of fostering and modelling positive attitudes to ageing and older people.
- The New Zealand Carers’ Strategy, 2008, identifies actions needed to ensure informal carers are supported, valued and recognised. This aims to help in preventing abuse and neglect by care\
- rs. The strategy covers informal carers only, not paid residential or home care workers.
- The Community Action Fund for Family Violence Prevention Initiatives is part of the national campaign. The fund has supported events to raise awareness of elder abuse.
- The Media Advocacy Project offers media training to elder abuse and neglect services to help address the poor media coverage of elder abuse and neglect.
- The Taskforce for Action on Violence within Families, 2005, built on Te Rito – New Zealand Family Violence Prevention Strategy and identifies priorities for action with a focus on elder abuse and neglect.
- The Ministry of Justice has recently formed a joint venture involving 10 government agencies working together to eliminate family and sexual violence. This implicitly, but not very overtly, includes elder abuse.
Intervention – Legal initiatives
Legislation on domestic violence
Amendments to the Protection of Personal and Property Rights Act came into force in 2008 and 2012 to strengthening legislative safeguards and protections against misuse of enduring powers of attorney. The Office for Senior Citizens undertook a public awareness and education strategy to enable lawyers, doctors, attorneys, and those thinking about making an EPA to be aware of these protections.
The Crimes Act amendments from 2011 included the additional wording of “vulnerable adult” to several criminal offences. These are the ill-treatment or neglect of a vulnerable adult by a person and the failure to protect a vulnerable adult who is part of a household.
The Family Violence Act that came into force in 2019 deliberately changed from previous domestic violence wording to indicate that family violence can happen in any intimate or family setting and isn’t private. It also extends the family relationship to include people sharing a household and caregiver relationships, this law denoted physical, sexual, psychological abuse as part of family violence.
Protection orders are available for cases of elder abuse and neglect. The police and courts have prosecuted cases of physical and financial abuse. These are a civil process, but breach of the orders is a criminal offence. Most use of protection orders has involved partner violence rather than elder abuse (although the two are sometimes the same). Protection orders apply to family and household members, and people in close relationships, but not employment relationships, so paid carers are outside their scope.
Civil proceedings can address material or financial abuse and offer ways of claiming damages for financial or material injury. However, such options are expensive, involve time and stress, and outcomes are uncertain. Neighbourhood Law Centres may provide advice, and civil legal aid may be available in certain circumstances.
This is a voluntary process that gives victims a voice in the criminal justice system and enables them to receive reparation, apologies, and answers. It requires offenders to face their victims, redress the harm caused, and examine the causes of their offending. Before a referral for a restorative justice process can be made both the victim and the offender must agree to participate.
The Ministry of Justice contracts community-based providers to deliver restorative justice services to District Courts. Facilitators meet with the offender and the victim separately to decide whether it would be appropriate to hold a restorative justice conference. This will usually result in agreement on reparation or restitution from the offender to the victim and/or their families, as well as changes intended to alter the behaviour of the offender.
The use of restorative justice processes in elder abuse and neglect cases may not always be appropriate. A close and ongoing relationship between a victim and offender may further complicate the issue. Adequate protection and support for the victim should be paramount when decisions about the restorative justice process are made.
Alternative dispute resolution
This covers a range of alternatives to adversarial law processes.
In Mediation a neutral mediator assists disputing parties to solve the problem themselves through communication and co-operation. Because of power imbalance in elder abuse and neglect cases this may not be appropriate. But mediation may be the only option where the adverse behaviour is neither a criminal nor civil offence, nor a breach of any regulation or contract. Mediation lacks legal enforceability and accountability, but it may be a way of dealing with unintended neglect, or where the perpetrator had not understood how the abuse was affecting the older victim.
Any person – relatives, friends, concerned outsiders,or any organisation speaking on behalf of an abused older person may be involved in Advocate Intervention. This can be successful where the issues are straightforward, or have the potential of a clear solution, e.g. notifying rest home management about the inappropriate behavior of their staff.
These approaches use the advocacy intervention mode, where service providers aim not to intrude unnecessarily in the lives of the victims. They identify the ‘acceptable limits of intervention’ and the importance of the older person’s rights and autonomy. Support for intervention may be provided by community groups and individuals (including carers), churches and spiritual leaders, who have contact with older people. It could also be used for government agencies, by Māori, Pacific and other culturally specific organisations. It seems clear that awareness of elder abuse and neglect and its serious effects is growing, and population ageing makes it an issue for the future. What is needed now is careful and in-d