There have been numerous cases of elder abuse reported in the media of late. And there are even more cases that are going unheard or even unspoken.

“Majority of elder abuse occurs not in aged care – I would argue as COTA – the majority of elder abuse happens in people’s homes in the community, not in aged care. But wherever it is, it’s unacceptable,” said COTA CEO Ian Yates.

When an older person moves into aged care, it’s a basic necessity that they are safe, with no fear of being neglected or abused at the hands of their carers and the aged care staff.

Speaking about this sensitive topic at the Quality in Aged Care conference is Sydney was Dr Julie MacKenzie, Senior Legal Officer for the Australian Law Reform Commission.

In Dr MacKenzie’s elder abuse report, released last year in June, there were 43 recommendations made to decrease the prevalence of abuse in the community and aged care.

“It was a 15 month enquiry, it required us to look at Australian laws and legal frameworks and how they can better protect older people from abuse, and safeguard their autonomy,” Dr MacKenzie said.

According to the World Health Organisations, elder abuse is defined 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.”

Dr MacKenzie looked at law reform with “a particular view”, explaining that Australia has “a fragmented legal landscape”.

“Responsibilities for laws relevant to elder abuse lie across Commonwealth and state and territories….we made a recommendation that there be a “national plan” to address elder abuse.”

This national plan will facilitate a long-term strategic and whole-of-government response to elder abuse.

In terms of abuse specifically occurring in aged care, there is limited research on the rate in which it occurs.

“One research study observed that those living in residential aged care are more vulnerable to abusive behaviour because they tend to be frailer and more dependent on others to provide care.”

“For us in our enquiry, there have been many submissions into abuse in aged care, so these included reports of physical and verbal abuse from paid care workers, as well as other residents and family members.”

There were also many issues about neglect – people getting pressure sores, residents not being fed, rationing of continence pads, just to name a few. But it raises the question “is failings in quality the same as abuse?”

Dr MacKenzie said that this was a challenge in their enquiry.

Staffing Issues

“One issue that was repeatedly brought up to us was staffing in aged care. In particular, concerns were raised about the number of staff in facilities – which was frequently insufficient to provide adequate care.”

“We received many suggestions that we should recommend a mandatory minimum number of staff or a minimum number of registered nurses in aged care.”

“We didn’t make that recommendation, but we did consider that further guidance regarding adequacy was warranted.”

“So where staffing numbers are insufficient or the mix of staffing was inappropriate, we saw the potential for systemic neglect of aged care resident.”

“So we recommended that there should be evidence-based benchmark and adequacy of staffing in residential aged care.”

Dr MacKenzie proposed that that should be developed through independent evaluation by a “properly qualified body”.

This is reportedly “front of mind” for the Aged Care Workforce Taskforce.

Another recommendation was a “serious incident response scheme”.

“In relation to the existing scheme, we heard a desire for a reformed approach, I think it’s fair to say that most stakeholders were critical of the existing scheme.”

“So we concluded that there was a need for a new approach, we felt there was a need to shift the focus from requiring that there ‘need a report’ to ‘need to investigate and respond’ to incidents.”

Part of the recommendation included expanding the definition of “serious incident” to include; financial abuse, as well seriously inappropriate/improper/inhumane/cruel treatment and unexplained serious injury and neglect.

There were some interesting things that were not recommended within the 43 recommendations.

“We did not recommend that providers be required to report an incident to the police, and this was partly due to the extended scope of the definition of a serious incident.“

There was also a recommendation that there be employment screening.

“We recommended that people working or volunteering should be subject to an employment screening process.”

“This screening process should assess criminal history, any adverse findings from the serious response scheme, as well as any finding from disciplinary or complaints that have taken by complaint handling bodies”.

Dr MacKenzie concluded that these reforms in aged care were “intended to provide safeguards against abuse” through various recommendations such as enhancing witness requirements, mandating requirement for record keeping and employee screening.

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