Someone should write A Seniors’ Guide to Health Care! It should be compulsory reading for everyone. Especially for those of us who are actually seniors. And for people who care about us. And for those who will one day be past the first flush of youth. No such document exists, as far as I can tell. I might have to write it myself.
Last week, around a hundred professionals whose work involves older people and their well-being attended a launch of a document, Elder Abuse Protocol: Guidelines for Action. The event was hosted by Advocare Inc., the lead agency of the Alliance for the Prevention of Elder Abuse:WA* (APEA:WA) at the Leadership Centre of the Australian Institute of Management. As the inaugural CEO of Advocare Inc. I was privileged to attend and delighted to see the work that these two organisations are doing.
The new Protocol provides general information about elder abuse, as well as information about appropriate responses to elder abuse for staff who work in organisations that deal with older people.
A seventy-year-old woman in a nursing home finds two masked men in her room early one morning. She yells for help but they knock to the ground and she suffers minor bruising. The intruders steal two handbags containing small change that belong to the staff on duty. The incident is reported on television news and on page 5 of the local newspaper. The intruders are later caught and convicted of break and entry, assault and theft.
A woman of similar age who lives in a nearby suburb does not escape so lightly. She has slight paralysis on her left side as the result of a cerebrovascular accident (stroke) a few years ago. She’s mentally alert and competent and lives alone with some support from aged care services. She completes a couple of cryptic cross-word puzzles a week; enjoys putting 1 000 piece jigsaw puzzles together; and sees friends regularly.
Unfortunately, many years ago, thinking she was preparing well for her old age, she donated enduring power of attorney to her only son so that he could manage her finances if she was ever incapable of looking after them herself. In the weeks while she was in hospital immediately following the stroke, when she had temporarily lost her decision-making capacity, he assumed power of attorney and took control of her finances.
Now he refuses to relinquish that power. He manages her bank accounts, pays all her household bills, gives her an allowance for food, and maintains tight control over her money. She is distressed by the predicament she finds herself in. The most recent episode was his response when she asked for $200 from her bank account to replace her shabby tracksuits and underclothes.
‘Don’t be so silly, Mum,’ he said.You don’t need new clothes. You don’t go anywhere. Why waste money on stuff you don’t need?’
The son may not see his behaviour as elder abuse. After all, he might argue, the old lady’s needs are being met. He is only looking after the inheritance he will, in his opinion, rightly acquire when she dies. He does not acknowledge that he no longer has a right to her power of attorney or access to her finances; and the money he ‘refuses’ to ‘give’ his mother is not his, but hers.
There have been no headlines in newspapers about the financial abuse of this old woman, nor are there likely to be in the near future. Financial abuse of elders takes many forms, and this story is simply one illustration.
There are other kinds of violence inflicted on older men and women by their families and ‘friends’ – people everyone expects they should be able to trust. Elder abuse includes physical, emotional and social abuse and neglect. We don’t hear a lot about it. No one likes to admit they are being mistreated and many older people are afraid to talk about it.
‘Elder abuse is not something newspapers like to cover,’ a journalist told me earlier this week. ‘Even if I wrote a really good article, it wouldn’t be printed.’
Short personal history
In the 1970s, domestic violence was not considered a crime. Men were allowed, under the law, to rape their wives. Police frequently sided with the perpetrator when called to a scene of domestic violence. The courts and the churches often turned a blind eye to the plight of victims of familial violence. They declined to condemn perpetrators in the same way they blindly failed to condemn perpetrators of child abuse.
The second wave Feminist Movement went some way to change community attitudes towards domestic violence.
In the 1970s a group of people, all of us passionate about social justice, set up Emmaus, the second women’s refuge in Western Australia in an old, four-bedroom house that we rented in Inglewood. We had little money, a great deal of goodwill – and no government assistance. Emmaus was soon full of women and children escaping violent husbands and fathers.
In the early 1980s, I was invited to represent Community Health Nurses on the Western Australian Advisory and Coordinating Committee on Child Abuse. At the time, I was working as the nurse in a high school and encountered children who were victims of abuse on an almost daily basis.
In the early 1990s, farsighted social workers, counsellors, teachers and others concerned with the welfare of women, children and families began to make connections, not seen before, between domestic violence and child abuse.
These days it is widely acknowledged that domestic violence in all its forms including child abuse is never OK.
But so far in our society there has been no major breakthrough in attitudes to elder abuse . Elder abuse receives little publicity and is barely recognised, perhaps because older people in our society receive less respect than they deserve.
According to APEAWA, elder abuse is underreported. But it is estimated that between two and five percent of older people will experience abuse, which means that between 6 000 and 15 000 older Western Australians could be affected.
The protocol launched last week states:
In addressing elder abuse, the rights of the older person must be supported. Older people have the right to make decision, take risks, or refuse supports and interventions, as long as they have the cognitive capacity to make informed decision and can understand the consequences of those actions.
If you think you may be, or could in future be, the victim or elder abuse, or if you suspect someone you know may be the victim, please ring Advocare Inc. on (08) 9479 7566 and talk to an advocate who will provide information about the steps you can take, and if necessary support you.
Congratulations to everyone involved in producing Elder Abuse Protocol: Guidelines for Action, such a successful launch, and to those who supported its publication, especially the Department of Local Government and Communities for funding.
*Agencies which comprise APEA:WA are Advocare Incorporated; the Department of Aboriginal Affairs: Department of Local Government and Communities; Department of Health WA; Disability Services Commission; Legal Aid (WA); Office of the Chief Psychiatrist; Office of the Public Advocate; Public Trustee; WA Police; Western Australian Local Government Association.
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Twice during the last week I’ve been reminded sharply about the importance of advocacy in the lives of older people.Advocacy is a simple concept: it means standing by another person who needs support to confront a more powerful person or institution. The more vulnerable a person, the more he or she may need an advocate to address neglect, bullying or abuse, whether intentional or not. Even the strongest among us may need the support of other people when we are ill and in hospital.
Anyone can advocate for another person, regardless of the relationship between them. At one level, a lawyer who represents a client in court is the client’s advocate; parents regularly advocate on behalf of their children to a variety of people; and a student who stands up to a bully on behalf of a weaker child is also an advocate.
A few months ago I posted about a friend of mine who was a patient in a private hospital. As a retired registered nurse with considerable experience in aged care, I could see clearly that my friend was not receiving the care she required and to which she was entitled. In addition, as a patient in the hospital, she suffered several serious mishaps . These could have been prevented with better assessment and attention. They have impacted severely on her recovery and her on-going quality of life.
Several issues relating to the care and treatment of my friend were apparent, and I believed they should be addressed by nurses, doctors and other staff who were responsible for her care. One that worried her most was that she was moved from ward to ward several times without explanation. On one occasion, she was left sitting in a chair following a general anaesthetic because the bed to which she was being moved in another ward was still occupied.
I began to think it was highly probable that poor care of older patients might be endemic in that hospital. One of the additional positive outcomes of advocacy is that hospitals and other institutions often amend their practice as a result of well-measured complaints. This leads to better care for everyone who is or will become a client or patient.
Because my friend is not only an older person, but was also very unwell at the time, I discussed her position with her, and then wrote on her behalf to the chief executive officer of the hospital.
My written complaints were not addressed with me by hospital management, but several staff members entered into discussions with my friend (although she was very ill) and one ward nurse had a brief conversation with me.
As she was still ill and a patient in the hospital, likely to remain so for some time and perhaps even to be readmitted in the future, she was not prepared to discuss the issues with staff on the floor, even she was unhappy with the care she was receiving. She was afraid that there would be repercussions if she complained.
‘Patients can be punished if they say anything the staff doesn’t like,’ she told me. ‘As old nurses, we both know that.’
As my formal complaints to the hospital had not been addressed to my satisfaction (or that of my friend) when she left the hospital, I took the matter further. A third party told me in a telephone conversation that ‘the hospital thought’ that all the complaints had been resolved. And in spite of my first letter clearly stating I was acting as my friend’s advocate, they thought I was ‘just a friend!’
Some of the important lessons that I learned in ten years as a professional advocate were that anyone act as an advocate on behalf of another person; advocacy goes into the fray as hard as it needs to; and does not give up until the end of the matter. Obviously that hospital has not learned the same lesson. The story continues…
Another old woman who is much loved by a number of people lives in residential aged care facility. Last week, following a visit by one of her friends, there was a discussion about apparently poor care the old woman had received recently. I suggested the friends could address the matter with the director of nursing, or they could contact an advocacy agency for support. The friends thought that the woman’s family should be told of their concerns and the decision to deal (or not) with the concerns should be left to them.
In my experience, staff members in most aged care facilities and hospitals recognise their duty of care; they want to provide the best attention and treatment for their residents and patients. Often, a timely word to a senior staff member from whoever witnesses problem behaviour results in prompt resolution of the issue. There is often a written complaints procedure that will help if the complain is not resolved immediately.
Bystanders who do nothing to assist a vulnerable victim of neglect or abuse become part of the problem.
In Western Australia, for more information about the rights of residents and assistance with making a complaint about a residential aged care facility or a Home and Community Care Service, contact Advocare Incorporated.
For assistance with a complaint about a hospital, contact the Health Consumers Council
There are similar organisations in other Australian states.