CHCAC318A Work effectively with older people

Reading 2: Support the rights and interests of the older person

1© NSW DET 2009

2© NSW DET 2009

Contents

Introduction 4Encourage and support the older person and/or their advocate/s to be aware of their rights and responsibilities 4Conduct work that demonstrates a commitment to access and equity principles 9Adopt strategies to empower the older person and/or their advocate/s in regard to their service requirements 12Provide information to the older person and/or their advocate/s to facilitate choice in their decision making 16Recognise and report to an appropriate person when an older person’s rights are not being upheld 22Provide services regardless of diversity of race or cultural, spiritual, or sexual preferences 24Provide information to the older person and/or their advocate/s regarding mechanisms for lodging complaints 31Identify indicators of elder abuse and respond appropriately in line with organisation guidelines 37

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IntroductionVisualise yourself as an 80 year old client of Grevillea Aged Care Facility. You need some help with ADLs but otherwise you are healthy and alert. You don’t have any family nearby and you rely on the service to maintain your independence.

Do you expect to have the same basic rights that you have now?

For the last few months your care worker has repeatedly ignored your requests to maintain some privacy when you undress. What would you do, accept the situation or fight for your rights? Who can you go to for help? What might stop you asserting your rights?

In this Topic you will learn how to work with older people in an empowering way, supporting them to understand and exercise their rights.

As Australian citizens, we all have the same rights and corresponding responsibilities. Your work practices must uphold the client’s rights and interests; this is a central philosophy of quality aged care services. It is also a central aspect of life in Australia and is reflected in all our legal and ethical frameworks.

Your organisation will have policies and procedures and a complaints system to support client rights. Rights are so important that it is said that the true test of a free society is the extent to which it protects the rights of citizens who are vulnerable and marginalised. Sooner or later you will need this information to help your client or their advocate complain about a service or ensure that their rights and interests are upheld.

Encourage and support the older person and/or their advocate/s to be aware of their rights and responsibilities

Client rights and responsibilities

What are our rights?

The word ‘rights’ is often used but what does it mean and what are our rights?

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Here are some important points:

everyone has the same basic rights

rights and freedom are part of the Australian tradition

every person has the responsibility to uphold the rights of others

it is against the law for someone to deprive you of your rights, and it is against the law for you to deprive someone else of their rights

rights and responsibilities go hand in hand – if you want to have rights, you must also fulfil your responsibilities.

Inclusive rights approaches

There is a long history of disagreement about the rights we should have. Different groups dispute the balances between rights and responsibilities, and between the laws that protect rights at the expense of other people’s freedom. For example, should we have the right to freedom of speech if what we say offends other people?

The aged care sector supports an inclusive approach to upholding client rights. Read the opinions of the aged care workers below, they illustrate important points that you need to be aware of to uphold the rights of clients and work within an inclusive rights based approach.

Joan

Inclusive practice

You need to be absolutely sure that you don’t discriminate against clients just because they are different to you. You need to make spaces to hear many voices, consider different points of view and appreciate that there can be many versions of the ‘truth’ out there.

A rights based approach to aged care work recognises that people will have a variety of needs and interests arising from different circumstances around family life and experiences, gender, class, cultural and linguistic diversity, sexual preferences, age and ability. Some of us will value certain rights over others.

Snezana

Duty-of-care

It is our responsibility to ensure that a safe and respectful work environment is created.

Workers and clients have different kinds of power in their relationships. Workers often have greater social power. It is our responsibility to ensure that we do not abuse our power or cause harm to the people we work with.

Clients have legal rights and we need to protect

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these rights. We also need to have clear strategies for clients to complain if they think their rights have not been upheld.

Anh

Values and ethical issues

Promoting and protecting human rights is a core value of community services work. This means that our services must try to meet the basic human needs of all our clients.

Promoting social justice and ensuring that everyone has access to our services is important for all aged care workers.

Your beliefs and values will affect your work, your relationships and the effectiveness of your work. So you need to constantly check your thinking, test your assumptions and reflect on your ethics.

Penny

Participation

Clients have a right to participate in decisions which impact on their lives. Many clients don’t feel confident enough to stick up for themselves; it’s up to us to help them feel more empowered.

Client rights

To uphold the rights of clients and work within an inclusive rights based approach, you need to consider these important points.

Clients receiving a service have the same general rights as all Australian citizens. They have the right to:

information about their own health and health care

privacy

confidentiality

access to quality health services regardless of race, gender, age, sexual preference, religious belief or marital status

dignity and respect

freedom from exploitation, abuse or neglect

involvement in decision making about their care

individualised services.

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People who have disabilities or who are dependent on others for support also have the right to:

support and protection in a least restrictive environment—this means that care services should be flexible and clients should have the best possible opportunity to make their own choices and express their individuality

advocacy – the right to have someone to speak up for them

guardianship – the right for someone who cannot make decisions for themselves to get support in making decisions and resolving disputes.

Responsibilities

Rights cannot be viewed in isolation from responsibilities. While clients can expect to their rights protected, as a client of a community services organisation they also have responsibilities to uphold.

Depending on the organisation, responsibilities could include:

respecting the rights of staff, management, volunteers, community members and other clients, including the right to work in an environment which is free of harassment

respecting and abiding by the rules of the service (as long as they are reasonable and have been agreed to in the first place)

following through on tasks that have been agreed to.

The more we encourage older people to fulfil their responsibilities, the more we are fostering independence.

Legal rights

There are many laws that describe our rights and state how they will be protected. These are some important Federal Acts (Commonwealth):

Racial Discrimination Act 1975

Sex Discrimination Act 1984

Disability Discrimination Act 1992

Aged Care Act 1997

Age Discrimination Act 2004

Human Rights and Equal Opportunity Act 1986 which allows The Human Rights and Equal Opportunity Commission HREOC to investigate complaints under many of these Acts.

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There are also many state laws that support rights:

NSW Anti-Discrimination Act 1977

Crimes Act 1900

Occupational Health and Safety Act 2000

Workers Compensation Act 1987

Privacy and Personal Information Protection Act 1998

Freedom of Information Act 1989

NSW Disability Services Act 1993

Community Services (Complaints, Appeals and Monitoring) Act 1993

Law Enforcement (Powers and Responsibilities) Act 2002

Mental Health Act 2007

Many of these acts also establish standards, guidelines and/or rules for how services must be provided in the community sector.

Information on legal rights is available at:http://www.austlii.edu.au/au/legis/cth/consol_act/ for Federal (Commonwealth) legislationhttp://www.legislation.nsw.gov.au/ and http://www.lawlink.nsw.gov.au for NSW State legislation.

Human rights

We are all born with basic human rights. ‘We are all born free and equal to each other; regardless of who we are, where we live or what we believe. Human rights have been described as the ‘rock bottom of human existence’ (HREOC, 2004).

Human rights and freedoms have a very long history dating back to many ancient civilisations including China, India, Babylon, Greece and Rome.

The Australian Government has signed international agreements with many other countries around the world to protect our basic human rights.

The United Nations Universal Declaration of Human Rights 1948 is the most well known statement on the rights of individuals.

The Declaration contains three types of rights:

1. civil and political rights

2. economic, cultural and social rights – these rights require our government to support citizens to participate fully in society

3. solidarity rights – self-determination and wealth sharing between rich and poor countries.

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What about human rights in the bush?

Australia is such a vast country however the large majority of us live along the East Coast. Think about people living in rural and remote areas, they often struggle to access basic health care and support services. Many do not have family support and their nearest neighbours could be hundreds of kilometres away.

Clients can feel particularly vulnerable because they are so far away from medical services and transport costs are enormously expensive. Community services workers are also often isolated and cope with difficult situations under minimal supervision.

You can get more information about human rights at:http://www.hreoc.gov.au

Conduct work that demonstrates a commitment to access and equity principles

Access and equity

Why are access and equity principles important? Access and equity are key parts of a social justice strategy. Access is about making things easier to use. Equity is about being fair. Together they promote a fairer system for everyone and they help disadvantaged groups improve their chances of accessing (getting) services and participating in society.

Social justice principles are about making sure that everyone in society has a fair go and receives their share of whatever society has to offer. They are concerned with:

equal distribution of economic resources

equality of civil, legal and industrial rights

equality of opportunity for participation and decision making in all aspects of society

fair and equal access to resources such as health, welfare, justice, housing and education.

The four key strategies to promote social justice principles are:

access

equity

equality

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participation.

Access

Access is primarily concerned with ensuring that no matter what their circumstances, abilities or background, all people are able to find out about and use services in their community. Examples of strategies which promote access are:

buildings are wheelchair accessible

information is available in a variety of forms from pictorial to Braille to different languages

interpreters are available

information gets to people who need it in ways that they can understand.

Equity

Equity is about providing additional services to ensure that people from disadvantaged groups have equal access to all that the community has to offer. Examples of equity strategies are:

Disability Consultants at TAFE help students with a disability get extra support and reasonable adjustment

Aged care services modify equipment and provide special training so that a person with a disability can be employed

Aged care services employ people with particular languages to improve communication with clients from various cultural groups

Older people in rural areas get financial subsidies to help offset the high cost of travel to specialist medical services.

Equality

We are all equal before the law; we all have the same rights. However, for many reasons not everyone can access their rights equally. For example some people are not aware of their rights and don’t know how to find out about their rights, some people may not be able to afford to pay for legal representation. Ensuring access and equity promotes equality—uniformity or equal terms for all.

Legislation is in place to ensure that all people are treated equally, no matter who they are or what their background is. Aged care workers have a responsibility to make sure that these equal rights are upheld in practice.

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Participation

Participation means that clients are given the opportunity to, and are actively supported in having a say in decision-making about policies and services that affect them. Examples of participation strategies are:

clients identify their goals for service delivery

these goals are written down in care plans and actively pursued by aged care workers

services send out questionnaires to all clients for feedback

you ask your clients regularly for feedback on their services

clients are involved in management committees, resident councils etc to ensure client input into policies and procedures

advocacy services are called in when a client needs help to participate effectively in decision making eg when the client has dementia

peak bodies are established to lobby at a government level and represent the voices of older people eg COTA.

Quality of life

Access and equity principles ultimately lead to improvements in quality of life. Quality of life isn’t easy to define because what constitutes quality of life to one person may be different to someone else. Individual values, beliefs, interests and experiences affect what quality of life means. A simple definition may be: quality of life refers to the overall satisfaction that we get from our life.

What influences quality of life?

There are a number of areas which influence ‘quality of life’ including:

social and personal relationships

the extent of our community integration and participation

productivity and rewards from daily achievements, interests and activities

our level of independence and decision making power

a general feeling of satisfaction with life.

Aged care workers have a vital role to play in promoting quality of life because they are in a practical position to do so – they work directly with older people. Aged care workers need to be aware that older people have the right to a good quality of life and they need to develop the necessary skills to make sure that this right is upheld.

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Because quality of life is such an individual thing, you need to discuss with the older person what is important to them and you need to act on what they say not your own attitudes about what constitutes a ‘good life’.

Adopt strategies to empower the older person and/or their advocate/s in regard to their service requirements

Empowerment

Many clients in our industry feel devalued for many reasons – disability, age, low social status, chronic illness. Sometimes this sense of inadequacy is compounded by the actual experience of ‘client hood’. Becoming a ‘client’ in the community services sector can increase a person’s sense of powerlessness. The ‘client’ feels less capable, less in control and less of a person.

Consequently empowerment is an important principle in community services which aims to:

develop self efficacy – a sense of personal power where the person feels competent to, with support if necessary, manage their affairs, have an impact on their world, make decisions, make the best of their situation

give power to the individual person and take power away from organisations or workers

promote client centredness which encourages clients to actively participate in service delivery, express their concerns and make informed choices about the kinds of services they want to receive

ultimately support the person to feel more empowered in all their social relationship.

Sometimes an organisation can have elaborate policies about empowerment and protecting clients’ rights but unless clients have appropriate skills and are actively supported by the organisation to make decisions about their care these policies remain ‘on the shelf’.

When you are able to implement strategies that are truly ‘client centred’, relationships with clients will be founded on more equitable terms and the clients’ health outcomes will markedly improve.

Levels of empowerment

Empowerment can happen at three levels:

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Personal empowerment: This means having the freedom to live without being limited by unreasonable constraints, the attitudes of other people and the misguided actions of service providers and aged care workers. Overall personal empowerment is the right to make choices in one’s own daily life and have them respected and upheld.

Social empowerment: This means having freedom from social values and beliefs which promote vulnerability and disempowerment, the right to live in the community and participate in all that it offers regardless of your age, abilities or attributes.

Civic empowerment: This means the freedom to have influence over policy and legislation, the right to lobby for change and have one’s needs and rights recognised by governments and services. For example feminists have been fighting for the civic empowerment of women and ‘Grey Power’ is a growing movement fighting for the rights of older people.

Powerlessness

Another useful way to think about empowerment is to think about powerlessness. In our own lives we may find ourselves in situations over which we have no control. Our sense of powerlessness is either increased or decreased depending on whether we can make choices or decisions to fix the situation.

Empowerment works against powerlessness by encouraging ‘self-ownership’ of problems. It works against the negative stereotypes such as ‘she’s such a dear little thing’, he’s way beyond that now’, ‘you know she’s disabled’ or ‘he’s just an old alco’.

The dictionary defines ‘caring’ as ‘providing help or comfort’. There may be a temptation to think that the more you do for a person, the more you care for them. An alternative definition of caring is to ‘have regard or consideration for a person or situation’. This implies thinking carefully about the situation and respecting the person’s capacity to ‘do for themselves’. ‘Caring’ must not be an excuse for taking over people’s lives.

Client-centred approaches

The following principles support an empowered approach to service delivery where the client is the central decision maker about his or her care:

The client is the primary focus for the service. The service exists solely to meet the needs of consumers (clients).

Each client is an individual and has different needs determined by their age, health, gender, cultural background and life circumstances. Clients therefore are the most knowledgeable judges of what is in their best interests.

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Clients have the right to make choices about their lives, and agency policy and procedures must encourage this.

Staff should always present the client with a range of options, and take account of their preferences.

Clients should have options such as:

when and how to access a service

what services they want

a choice about which organisations may be involved

consultation about the appropriate worker for their needs

input on intended changes to their service.

Treat everyone as an individual, be particularly sensitive to the needs of people who may be different to you, and let the older person be the judge of what is in their best interests.

Safeguarding residents’ rights

Older residents in aged care residential facilities often have very high care needs. They may require additional support to feel empowered enough to participate in decision making about the services they require and to stand up for their rights.

These strategies are in place to empower residents and support them to get the services they need and want:

the Office of Aged Care Quality and Compliance

o the Aged Care Commissioner

o the Aged Care Complaints Investigation Scheme

resident agreements

a complaint resolution process

resident councils

support from advocacy services such as the aged care rights service (TARS)

the community visitors scheme.

Complaint resolution

Each residential aged care service is required to establish its own comprehensive complaints handling scheme.

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Resident agreements

The Aged Care Act 1997 requires all residential aged care services to offer all residents a resident agreement to ensure both the resident and management know what services are to be provided. A person does not need to sign a resident agreement if they do not want to.

Resident Councils

Each service should assist residents or their representatives form a committee to discuss issues they feel are important, and to take these issues to management to resolve.

The Office of Aged Care Quality and Compliance

The Aged Care Complaints Investigation Scheme investigates concerns about any aspect of care provided by a subsidised aged care service under the Aged Care Act 1997 and the Aged Care Principles.

Complaints can be made by:

residents of aged care homes

people receiving community aged care packages or flexible care

relatives, guardians or representatives of those receiving care

approved providers and staff who work in aged care services.

The scheme is helpful because:

it is free and accessible

residents will be assisted to make effective complaints if they are unhappy with services

complaints can be confidential or anonymous

mediation services are available

the Complaints Resolution Committee can determine a course of action which is binding on the service provider.

The Aged Care Complaints Investigation Scheme can be contacted on 1800 550 552. Or accessed from their website at:http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-quality-about.htm-copy2

Community Visitors Scheme

This Scheme helps to establish links between people living in an aged care home and their local community.

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The Scheme aims to improve the quality of life of residents who have limited family and social contact and who may be at risk of isolation from the general community for social or cultural reasons, or through disability.

A community visitor befriends a resident who has been identified as being at risk of isolation.

The aged care home is responsible for identifying residents who may benefit from being matched with a community visitor.

Aged care homes are expected to support community visitors by welcoming them to the home.

Further information on the Scheme contact: Toll-Free: 1800 550 552.

Provide information to the older person and/or their advocate/s to facilitate choice in their decision making

Decision making skills

Clients may lack the skills to make decisions. They may have a long history of receiving care that was prescribed for them – in the same way that a doctor prescribes medication assuming that they know best.

Over time some clients learn to be passive and lose confidence in their ability to manage their own issues. To successfully implement an ‘empowerment strategy’, an organisation needs to plan activities that support clients to achieve these skills. This could mean assertiveness skills training or confidence building groups or simply client self support groups.

It is also important not to pressure clients to feel they must make decisions. It can be easier to start decision making with a range of options than suddenly to ask clients to take full responsibility for making scary decisions.

Advice: Don’t set people up to fail. Don’t ask people to do things when you know they don’t have the skills to succeed. Start small by encouraging clients to set their own goals for the services they receive. This empowers them and gives them some responsibility for the service they receive.

Advocacy

It can be very hard to stand up for your rights and interests especially if you really need the service to get by. Many people have family members or friends who can be their advocates.

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Advocacy services:

focus on the needs, wishes and rights of the person, including the protection of confidentiality

provide independent information, representation, education, advice and support to individuals and groups

assist residents to get involved in deciding how services should operate

help people understand their rights

encourage policies and practices in aged care homes which enable people to feel empowered and exercise their rights.

Aged care homes must allow advocacy services access to their premises, this is enshrined in the Aged Care Act 1997.

External advocacy services

Sometimes a concern or a complaint cannot be managed at the service level, and the client, family member or carer needs to be referred to an outside agency. External advocacy services are also available in all States and Territories to help people who want someone else to talk to the service provider on their behalf.

The client may need a specialist advocacy advice. For instance a client may be involved in a complex domestic violence situation, where they require an advocate with sound knowledge of domestic violence legislation and the options available to that client. Clients with disabilities may require an independent advocate due to difficulties in communication and conflicting wishes by a number of family members. Remember, clients may not always be aware of their rights in the first place.

Examples of advocacy services include:

The Aged Care Rights Service

Citizen Advocacy NSW

Domestic Violence Advocacy Service

The Law Society of NSW—free legal advice about a wide range of legal advocacy issues. (Telephone 02 93737300.)

As an effective worker in the CSI you need to network regularly with advocacy services that focus on the target group you work with, so that you are aware of recent developments in the area you are working in (such as changes to legislation) and can refer a client if necessary.

When making a referral to an advocacy service, you need to keep in mind the following:

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Be clear about what service the agency you are referring to offers and who is eligible to receive the service. (Don’t give the client false expectations.)

Obtain written information on the service to give the client, including an outline of the services offered, contact details, the name of a worker, and instructions on how to make contact with the service, eg a telephone appointment or present at the desk. A map or information on transport to the service can be useful

Obtain the client’s informed consent to refer them to another service. This means being very clear about what is involved in the referral, such as what personal information you will need to share and what will be expected of the client. Providing written information about the service will help.

Ascertain how confident the client is in accessing a new service. Would they like you to phone and make an appointment for them? Does that mean the referral is more likely to happen?

Follow up any referrals made – a quick check as to its suitability not only shows your concern but also increases your knowledge of appropriate local services and how they deal with your referrals.

Make sure you are familiar with services in your area, and attend inter-agency meetings and training wherever possible.

Working with reluctant clients

Sometimes it can be very difficult to know how to support clients who express constant disagreement or reluctance to participant in services that they have agreed to; you may wonder whether you should be re-negotiating services, advocating or simply cajoling them to participate.

People are not always grateful for the services that are provided. Sometimes they may refuse to participate or to cooperate; they may at times be rude or abusive. Why does this happen?

People may respond negatively to services for many reasons, including:

lack of interest – the activity does not fit in with their known areas of interest

previous experience – a negative past experience will increase anxiety and reduce the desire to participate

lack of understanding – where a person does not understand what is happening or why it is happening

context – the service may be acceptable but the location may be uncomfortable. Would this person prefer to be alone, not in a public area, outside or inside?

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emotional state – stress, boredom, anxiety and depression can all influence a person’s ability to make positive choices

change – if the activity involves any kind of change to the person’s normal routine it may be experienced as stressful or even painful

power and control – each person needs to feel that they are exercising control over their own lives. Sometimes saying no is the only available means of taking control.

Facilitating clients’ participation

To help facilitate a client’s willing participation, consent may be gained by:

Empowering – giving people a range of clear choices, rather than a single option, creates a sense of personal control and power.

Informing – giving people appropriate information, expressed in terms that they are able to understand. This may sometimes involve repeated practical demonstration and observation as well as verbal information.

Allowing time – people need time to get used to new ideas, time to make their decisions. Any feeling of being rushed or being criticised will produce a negative response.

Organising – check with other workers about what they know, what they have successfully tried in the past.

Re-negotiating – it may be that the service no longer suits their needs. Go back to step one and involve the client in decisions about what services they want and how they would like them delivered.

Case study: Stan and Paul

Stan and Paul in bathroom

Stan arrived yesterday at Boronia Village for two weeks respite. He is feeling anxious and disoriented, and has also been unwell with some short-term memory loss. It is 6:30am on the first morning.

Paul: Time for a shower mate. Get your clothes off so I can wash you.

Stan: I don’t need a shower.

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Paul: Course you need a shower, everyone has to have a shower, it’s the rules.

Stan: But it’s too early, on the farm we have a bath at night.

Paul: Well you’re not on the farm now are you, into the shower with you, quick smart.

Has Paul obtained valid consent from Stan? How would you support Stan to make choices and participate in decision making?

Feedback

As a worker, you have a legal and ethical obligation to get consent and involve your client in decisions about the services they receive. All people respond better when their wishes are taken into account.

Consent is agreement from the client that it is okay for the worker to provide some kind of service. To get valid consent from the client, the following things are necessary:

consent must be given voluntarily

consent must be informed – the person must be aware of the risks involved

consent must specifically refer to the actions that will be performed

the person must have the legal capacity to give consent – a mentally competent person over the age of 18 years

where the person does not have the legal capacity to give consent, it may be given by a legal guardian.

Who is the client? The answer may seem simple – it is the person receiving the service. However, in some services family members are very involved with decision-making about service delivery, for example when the person has an intellectual disability, mental illness or an older person has dementia. Family members and/or other legal carers are important gatekeepers for some clients and this is supported by legislation, eg Guardianship Act. There may be a legal obligation for workers to get permission from legal carers whenever something is being proposed that is outside the agreed service program, for example, a trip to the zoo.

Legal carers are usually included in intake procedures where agreements are signed about various rights and responsibilities. They usually agree, for instance that should the client be sick and they are not contactable, the service manager has the right to seek medical advice. Services need to plan for things that might go wrong, and seek agreement for alternate plans.

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Valid consent and seeking agreement from client

Read what Margaret, the director of Grevillea Aged Care Facility, has to say about consent.

Step 1: Who should give consent?

‘First of all you need to decide whose consent you need to get. Usually it is the person receiving the service. It can also be a family member or carer if the client has a decision making disability, for example when an older person people has an intellectual disability, a mental illness or dementia.’

Step 2: Written consent

‘When clients first apply for a service they usually complete an intake or assessment process where they sign a written agreement about what services are to be provided and give basic details about who we can contact in an emergency and to whom we can disclose their information.’

Step 3: Consult

‘We must consult clients about how they want services to be delivered and about decisions that affect their everyday lives.

provide choices wherever possible

don’t order or threaten people, you need their voluntary cooperation to assist them with their activities of daily living

discuss any changes with clients, be open to their input.’

Guardianship

Sometimes older people need a legal advocate or guardian because they cannot make decisions on their own and there is no one else to help or various people disagree about what is in the person’s best interests. Guardianship protects the rights and interests of people who have a decision making disability.

The Guardianship Act 1987 (NSW) established the Guardianship Tribunal with the power to appoint guardians and financial managers for people over the age of 16 years who are unable to make decisions for themselves because of a disability.

For example, people with dementia, mental illness or severe physical or sensory disability may require a guardian. The Tribunal is an independent NSW State Government body that began operating in August 1989, and reports to the Minister for Community Services.

The Tribunal may appoint a member of the family or a close friend to be the guardian or, if there is conflict or no ‘person responsible’, they may appoint

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a Public Guardian, the person of last resort. Guardians have authority to make personal and lifestyle decisions for the client.

Principles of guardianship the welfare and interests of the person are most important

the freedom and actions of the person should be restricted as little as possible

the person should be encouraged to live a normal life where possible

the views of the person should be considered

family relationships should be preserved and the cultural and linguistic environments should be recognised

the person should be encouraged to be self-reliant

the person should be protected from abuse, neglect and exploitation

the community should be encouraged to promote these principles.

The Tribunal can be contacted on: Phone 1800 451 510. Fax (02) 9671 9800

The following links may be of use:

The Office of the Public Guardian: http://www.lawlink.nsw.gov.au/opg

Guardianship Tribunal: http://www.gt.nsw.gov.au/

Recognise and report to an appropriate person when an older person’s rights are not being upheld

Confidentiality

From this case study, you can see that confidentiality can be quite complex. John did not maintain confidentiality hen he spoke to May’s neighbour.

Confidentiality is the protection of personal information. Confidentiality applies to all information that a client or colleague tells you verbally or gives you in writing. It also applies to things that you learn through observation. All information in a person’s care record is confidential and may not be disclosed without permission from the client or their guardian.

The need to maintain confidentiality is both a matter of common law—your duty to protect confidentiality is part of your duty-of-care to clients, and legislation—regulations and standards have been established in law that require you to protect the client’s privacy and confidentiality.

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Penny

What is confidentiality?

Confidentiality refers to protecting access to a client’s personal information to authorised people only.

Why is confidentiality important?

‘Confidentiality helps build trust. It encourages the free flow of information between the client and the worker. This is essential for effective service delivery. At the same time it acknowledges that the client’s personal life and all their issues belong to them and cannot be disclosed without their permission.

Only the client has the right to decide who to share their personal information with.

Client’s permission

You can discuss aspects of a client’s care and disclose relevant personal information to colleagues but only if this information is needed to provide proper care. But, you should always you get their permission first. Get permission in writing. Do not get ‘blanket’ approval. Blanket approval is where the client gives general approval for anyone at the organisation to disclose any information about them. Get approval for specific information to be shared and specify who you will share it with and why you need to do so. Keep a record of who had access to the information and for what purpose. Most organisations get this permission at the client first visit.

Information security

Written personal information must be carefully protected. Files need to be stored safely and protected from unauthorised access.

Clients need to know how they can get access to their information. They may need to apply for this under the Freedom of Information Act but usually organisations have policies that allow clients direct access to information about themselves.

Can I release information without permission?

Confidential information may be released without the permission of the client or guardian in some special circumstances. These circumstances are:

you get a summons to go to court and speak about the client

you get a subpoena to send your files to court

if the police have a warrant to read your files

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another government department with statutory (legal) power asks you, such as Centrelink

you think the client or someone else is likely to suffer serious injury if you don’t tell, eg. the client is suicidal or says they are going to attack someone

you suspect child abuse or neglect

you have information about a serious unsolved crime.

Consent to treatment

Consent is agreement from the client that it is OK for the worker to provide some kind of service. To get valid consent from the client, the following things are necessary:

consent must be given voluntarily

consent must be informed – the person must be aware of the risks involved

consent must specifically refer to the actions that will be performed

the person must have the legal capacity to give consent – a mentally competent person over the age of 18 years

where the person does not have the legal capacity to give consent, it may be given by a legal guardian or person responsible (their carer).

Provide services regardless of diversity of race or cultural, spiritual, or sexual preferences

Non-discriminatory practices

In this section we will consider how to provide services that are fair and equitable and which do not discriminate. It is essential that community workers employ non-discriminatory practices for both legal and ethical reasons.

Our community is a very diverse one but we often assume that clients and colleagues are all from the dominant cultural group. Thinking about discrimination will help you develop an awareness of the ways you might unwittingly discriminate against some people and help you plan better ways of working with people from culturally and linguistically diverse (CALD) backgrounds.

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What does discrimination mean?

Discrimination means treating someone unfairly because they happen to belong to a particular group of people. Many of us have prejudices which are preconceived negative views of people who are different from ourselves.

Discrimination is often an unconscious thing, we may not be aware that we are discriminating or even aware that we have negative views. Sometimes we think our beliefs are simply ‘commonsense’.

Self-reflection: Get to know yourself, be honest about your feelings; you don’t have to be perfect. The ‘best’ aged care workers understand themselves, including their shortcomings.

Types of discrimination

The laws dealing with discrimination give everyone an equal opportunity for a ‘fair go’.

Sex discrimination

Sex discrimination is where you are treated unfairly or harassed either because you are a woman or because you are a man. Sexual harassment is a type of sex discrimination that occurs when you feel uncomfortable about what another person is saying or doing. Discrimination against a woman because she is pregnant can also be sex discrimination.

Race discrimination

Race discrimination is where you are treated unfairly or harassed because of your race, colour, ethnic background, ethno-religious background, descent or nationality.

Age discrimination

Age discrimination is where you are treated unfairly because people think you are too old, too young or middle aged. Forcing people to retire early is also against the law.

Marital status discrimination

This is where you are treated unfairly or harassed because you are single, or married, or living in a de facto relationship, divorced, or widowed.

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Homosexual or lesbian discrimination

This is where you are treated unfairly or harassed because you are gay, or someone thinks you are gay, lesbian, bisexual, transsexual, transgender or intersex (have both male and female attributes).

Disability discrimination

Disability discrimination is where you are treated unfairly or harassed because you have a disability, or someone thinks you have a disability. It is also against the law to treat you unfairly or harass you because you had a disability in the past, or because you will or may get one in the future. Disability includes physical, intellectual and psychiatric disabilities, learning problems and emotional disorders.

Carer responsibility discrimination

This is where you are treated unfairly because you have to provide care or support someone in your family who has special needs.

Vilification

Racial vilification

Racial vilification means any public act that could encourage racial hatred, serious racial contempt or severe ridicule.

Homosexual vilification

Homosexual vilification means any public act that could incite hatred, serious contempt or severe ridicule against lesbians and/or gay men.

HIV/AIDS vilification

HIV/AIDS vilification means any public act that could incite hatred or serious contempt or severe ridicule against people who are HIV positive or who have AIDS.

Situations where discrimination is against the law

Employment: This includes everything to do with work, applying for a job, what happens at work and leaving a job.

State education: This includes everything to do with state schools, colleges and universities.

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Goods and services: This includes buying goods and getting services from banks, lawyers, government departments, hospitals, doctors, pubs, shops, aged care services and local councils.

Accommodation: This includes everything to do with renting flats, houses, hotel rooms, caravans and commercial premises.

Registered clubs: This includes becoming a member of a club, entry into a club and services inside the club.

NB: Community services and discrimination – ‘Goods and Services’ definitely includes any services provided in the community services and health sector.

Valuing differences

When people are different we often see them as ‘Other’ or unlike us. If you think about it, we often use terms like ‘us’ and ‘them’ to differentiate people we unconsciously classify as ‘normal’ from people who are different. Sometimes we see people who are different as ‘problems’ and to fix the ‘problem’ we try to make them conform to ‘normal’.

It is more helpful to ask:

What is ‘normal’ exactly?

Who says it’s normal?

Is anyone totally normal?

What would it be like if everyone was the same?

How do differences contribute to our society?

How do I protect the client’s right to be different if they want to?

We can view difference as something that exists between all of us and that ‘difference’ adds value by creating diversity. This helps us to see each other as individuals, each adding to our social resources, generating more perspectives and making life more interesting.

Homogenising

Even when we try to respond appropriately to people from culturally diverse groups by considering their cultural needs, we tend to think of them as ‘all the same’. This is called homogenising.

For example we might get some training to learn how to communicate with people from an Asian background. Then we use these new skills each time we meet an Asian person without considering their individual preferences and needs.

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Non-discriminatory practices

Non-discriminatory practice is based on the belief that differences generate diversity and are to be encouraged. Here are some ideas to promote non-discriminatory work practices.

Sexuality

A person’s sexuality encompasses many aspects – sexual preferences for gratification of physical desires, feeling good about yourself, needs for intimacy and close relationships.

Don’t assume that older people aren’t interested in sex.

Don’t assume heterosexuality. Recognise same sex relationships and support access to gay literature and services.

Be aware of your own impact on a client’s sexuality, be clear about your boundaries and what is inappropriate touching or innuendo.

Discuss any concerns with your supervisor.

Be open to clients raising sexuality concerns, but do not feel you have a right to know.

Gender

We often unconsciously apply gender stereotypes in our work. Assume nothing about individual needs and preferences. Men do not always like sheds and woman do not always like craft.

Respect the wishes of clients regarding mixing with the other gender.

Consider this:

Think about how few older men there are – there aren’t many available as potential partners and there are reduced opportunities for older men to share common interests.

Community services have a largely female workforce therefore client preferences for who provides care may be difficult to implement.

Gender issues for people from other ethno-religious backgrounds need to be carefully assessed.

Make sure the work environment is fair, harassment free and supports both genders.

Race

If you feel that race discrimination is not an issue for you because you treat everyone the same, consider this:

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Many community services workers have an Anglo-Australian background. Treating everyone as you would like to be treated may lead to unfairness. People from CALD backgrounds may not want to be treated this way.

Treating everyone the same, does not account for individual differences.

Cross-cultural awareness is very important, but sometimes it encourages us to think that we should always treat someone from a particular culture in a particular way.

Never assume racial preferences, for example Aboriginal people like sport and the outdoors or Arabic people are all Muslims. There can be just as many differences between people who from the same race or cultural background as similarities.

Case study exampleThe Activity Day Centre at Grevillea Aged Care Facility is run by Anh. She has a number of issues to address when she plans the activities program.

Anh

I am having problems developing activities in the activity centre that meet everyone’s needs. Most of the clients are women from an English speaking background. I am concerned that our programs always reflect the needs of this majority group.

Javed

I went to the Day Therapy Centre once but it was not suitable for me. I was very hungry, I do not eat meat and there was no rice. The only thing to do was play bingo or play cards but I did not know the rules and I don’t like any form of gambling.

Also, it was hard for me to talk to the other people. There were not many men and it was hard for us to talk and understand each other.

May-Bell

I found the activity centre a bit of a let down and I was really looking forward to it

The people were friendly but I felt uncomfortable, we didn’t have much in common to talk about.

I like playing cards but they already had their own partners, and Bingo was hard for me to play because my vision isn’t good.

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Anh needs to think about how she can incorporate different activities that meet the needs of diverse people. She also needs to understand the cultural needs of all of her clients

Aboriginal and Torres Straits Islander peoples

This section focuses on developing an appreciation of some of the issues faced by Aboriginal and Torres Strait Islander (ATSI) peoples. We will use the term peoples because it is important to identify that Aboriginal communities in Australia are not one homogeneous group.

However, there are important commonalties such as a shared history of cultural traditions and beliefs as well as a shared history of loss and the lived experience of racism, all of which are particularly relevant in the context of health and care giving.

Survivors

Many Indigenous Australians currently experience significant and systematic disadvantage especially in terms of poverty, education and health. However, it is also important to view Aboriginal and Torres Strait Islanders as great survivors, not just victims.

Many stories are emerging of survival despite systematic government policies of dispossession and cultural suppression. Keep this perspective in mind as well – never assume Indigenous Peoples need your special protection because of their disadvantage. This attitude, whilst well intentioned, disempowers rather than promotes rights.

Case study

Read what May-Bell and Mark think are important issues to keep in mind when working with Aboriginal and Torres Strait Islander peoples to respect differences and support non-discriminatory approaches.

May-Bell

You have to understand just how important family is to Aboriginal people. Aboriginal communities are based on kinship and extended family. As a Koori, you have responsibilities to a whole range of people. You’ll hear Kooris ask each other ‘Where are you from or who are your family, not what do you do for a living.

Taking Aboriginal kids away from their people was just devastating for all of us. These kids were cut off from their family, their culture and the law. Families were left either not knowing what had become of them or hearing about really bad things that happened, like abuse and rape. So

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many kids were taken, there’s hardly a family that isn’t affected.

Mark

Aboriginal culture has an oral tradition. Elders have special knowledge and stories about the law, and are greatly respected. Sometimes there can be a sense of shared ownership of things, and we focus differently on time; the past and the present are more important than the future.

Aboriginal people often speak Aboriginal English. This is a valid language; it is not broken English or poor English. For some Aboriginal communities, English is their second language.

Aboriginal people use a lot of non-verbal language instead of words. You show respect by lowering your eyes. When young Aboriginal people do this they are not being disrespectful, or telling lies!

To work with Aboriginal communities find out about local community protocols. You need to build relationships with the community and the Elders.

One other thing though, not all Aboriginal people would agree with what I just said. Many Indigenous communities have developed their own cultural and social traditions.

Provide information to the older person and/or their advocate/s regarding mechanisms for lodging complaints

Complaints

Supporting clients to complain can be very difficult and at the same time very rewarding when you see the improvements that can be made. A colleague may be doing something that does not uphold the client’s rights or interests. You may feel that you are letting your team mate down. At other times you may find out that a carer is not treating someone as they should. You may feel sorry for the carer because they are extremely stressed but very worried for the client. There may even be times when you feel personally threatened by a situation and feel unsafe—reporting it could have major repercussions for you.

All of these situations could easily happen to you; it is essential that you learn how to manage them effectively not only to protect the client’s rights,

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but also to look after yourself and ensure that you fulfil your own job role successfully.

What should you do if a client wants to complain?

You should help them make a complaint. If the situation worries you, you should also report it to your immediate supervisor. If your supervisor is not available you could date and document your concerns and follow up as soon as possible.

If the situation is urgent and you think there are immediate risks of harm, then you should try to contact your supervisor immediately. If the supervisor is not available, try to contact his or her manager.

This is not a breach of confidentiality.

For example, perhaps one of your client’s shows signs of physical abuse such as bruising on their upper arms and they tell you they that these wounds were caused by their care worker who got angry with them for being incontinent. This situation must be reported immediately.

Whistle blowing

Whistle blowing is the term used to describe ‘dobbing in’ your workmates or someone in authority at your workplace. It can be very hard to complain or help someone else complain if the complaint is about your colleague or your boss. In both situations you might feel scared of the consequences—loss of your job or social isolation at work.

You can go ‘up the line’ to the next manager or talk to a union representative. If you feel that the matter is really serious and no action has been or will be taken, you can make a report to an external government advocate such as a community visitor or an Ombudsman. There are specific Ombudsmen for most government services.

Complaints systems

A complaints system is an indispensable tool to protect the client’s rights and interests. They are necessary by law plus they enable clients to assert their rights and they allow organisations to get feedback about how useful and appropriate their services are.

Workers must become familiar with their organisation’s complaints guidelines so they can competently follow the correct organisational procedures.

Prepare yourself for complex or emergency situations. Read your workplace organisation’s Policy and Procedures Manual for more information about

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what you should do in an emergency and find out how your organisation manages complaints.

The NSW Ombudsman

The NSW Ombudsman has responsibility for responding to complaints for many government departments and organisations. The Ombudsman also has an extensive list of agencies which are responsible for handling other complaints relevant to the community sector. NSW Ombudsman Phone: 02 9286 1000 Toll free: 1800 451 524

Internal complaints

The basic principles underlying any complaint process is that complaints should be dealt with fairly, promptly, and that no one should be aversely affected or punished in any way for making a complaint.

All clients, including children and people with disabilities, have the right to express their concerns and provide feedback on the quality of service they are receiving. Workers need to actively seek feedback from clients and allow them to respond in a variety of ways, ways that are appropriate for the particular circumstances and abilities of the client.

When clients do give feedback, either directly or through others, this feedback is not always well received by managers and workers. It is important that all services are aware of the need to support every client’s right to comment on the service and to facilitate the giving of feedback where necessary.

Hearing clients

Sometimes it is difficult to identify what a client wants to express. A client may be obviously unhappy or unsettled but may be unable to clearly express their concerns. This can often happen to older people, people with disabilities and to children. At times, with appropriate permission and/or respect for the client, it may be possible to discuss your concerns with a family member, carer or advocate who may be able to assist with identifying what may be wrong.

Hearing carers

Carers, family members or others can often voice concerns about a client’s care. When the service is open to feedback this concern will be voiced earlier when there is a better chance of fixing a problem. Strategies for giving carers a voice include family meetings, afternoon teas and information sessions, providing a comment box and having a newsletter.

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Remember to check with the client and get their permission before making a complaint on their behalf.

Educating clients and carers about how to give feedback and how to complain must be essential elements of your complaints system.

Standards for complaints

Aged care organisations should ensure that:

clients are provided with written policies and procedures for receiving, recording, managing and resolving complaints in a timely manner

clients receive training and support to understand their rights to make a complaint

confidentiality is maintained

information is written in plain English or a relevant community language

service users making complaints are invited to have a support person of their choice to assist and represent them during the process

there are regular reviews of the complaints system to determine its effectiveness, involving clients and their advocates.’

Advice– You must ensure that when someone makes a complaint, they never lose or have their service reduced. The client’s right to make a complaint should be protected at all times.

External complaints

The Community Services (Complaints, Appeals and Monitoring) Act 1993 (NSW) established the Community Services Commission which acts as an independent ‘watchdog’. Consumers and their advocates can contact the Commission to make a complaint about community services in NSW such as:

the Home Care Service of NSW

all non-government community services funded by the Minister for Community Services such as respite, day programs, recreation services and food services.

The Commission can:

respond to complaints

seek informal resolution

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conciliate wherever possible

investigate serious complaints

provide advice and referrals.

You can find out more from:http://www.carersnsw.asn.au/storage/pdfs/facts/fscama.pdf

What if I need to be an advocate for the older person?

Advocacy is when you speak up for someone else to change a situation or solve a problem. It is needed when someone’s rights are being overlooked or abused and that person does not feel capable of standing up for themselves without support.

There are many reasons why clients need someone else to speak up for them:

low status

poor health

fear of complaining

dependence

disability

lack of knowledge about how the system works.

Many clients in the community services sector have a sense of ‘disenfranchisement’ – a belief that they do not have rights, that they are not equal to others or feel powerless to change anything. They may have had previous negative experiences trying to get their rights upheld.

In all of these situations advocates can help negotiate ‘the system’ and achieve success for the client by knowing who to talk to, what to say and how to complain effectively.

Advocacy involves encouraging people to be involved in advocating for themselves, thus it is empowering not oppressive.

The advocate is the person who acts on behalf of another party. This can mean an informal arrangement where you, a friend or relative acts as the advocate. It can also be a more formal arrangement where the advocate is a professional person who intervenes on behalf of the client to protect their rights. The advocate’s role is to act as a spokesperson in upholding the client’s rights, to act as a negotiator, to participate in meetings, to monitor services to the client, and to act as an adviser, friend and provider of information.

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Making a referral

Sometimes the most appropriate thing for you to do is refer the older person to an external advocacy service. When you make a referral to an advocacy (or any other) service, you need to keep in mind the following:

1. Be clear about the services the agency offers and who is eligible to receive the service (don’t give the client false expectations).

2. Obtain written information on the service to give the client.

3. Obtain the client’s informed consent before you refer them to another service. This means being very clear about what is involved in the referral, such as what personal information you will need to share and what will be expected of the client.

4. Find out how confident the client is in accessing a new service. Would they like you to phone and make an appointment for them?

5. Follow up any referrals.

To make sure you are familiar with other services in your area, it’s best to visit or make personal contact with relevant services. Interagency meetings or joint training, are effective ways to keep your knowledge current.

Occasionally clients are not able to make decisions for themselves or there is conflict over decisions about the kinds of care services that the client needs. The best interests of the client then become unclear and guardianship is used as the decision maker of the last resort.

The strategies of advocacy and guardianship are vital methods used to protect client rights.

What if you need to make a written complaint?

A complaint can be written or oral. Sometimes the client will want you to do the talking and/or the writing. Your supervisor might ask you to write down your concerns after an oral report. Important things to remember about reporting:

use short descriptive sentences

do not make assumptions

state whether you have observed something yourself or whether something has been told to you

date observations

choose your words carefully, use neutral language and be objective

be timely, don’t delay reporting and worry about it for ages, get advice

use a black pen and write legibly

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don’t use whiteout if you make a mistake, rule a line through the mistake and write it again.

Identify indicators of elder abuse and respond appropriately in line with organisation guidelinesThe abuse of older people is a complex issue which until recently has not been talked about openly. It is known that older people are being consistently abused by carers, family, friends, aged care workers and to a lesser extent strangers.

Quantitative research is lacking, partly because this has been a taboo topic and it is difficult to get people to speak up about it, and partly because is has not been a priority for governments and services to address.

However this is changing. This section explores elder abuse, its causes, its signs and ideas for aged care workers to report suspected abuse and support older people who may be experiencing it.

What is elder abuse?

Elder abuse is a term that is used to describe the mistreatment of an older person which violates their rights and causes psychological, physical, financial or social harm. Abuse is often perpetrated by a person that the older person trusts.

Abuse occurs across a spectrum from unintentional acts to minor misdemeanours to major assaults. It can be a one off event, repeated over time or result from inaction. Different forms of abuse can co-occur.

This mistreatment may take several forms:

Psychological abuse

The older person is intimidated and/or threatened by another. In this form of abuse the older person can be silenced through the use of fear or with threats of punishment or abandonment. Abuse can involve withholding emotional support, isolation, shaming, ignoring the older person and verbal abuse.

Financial abuse

The material goods and/or the finances of the older person are exploited. For example, valued items such as jewellery are stolen, money may be withheld or the older person may be pressured to change their will.

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Physical abuse

The older person is physically hurt by the actions of another such as biting, slapping, shaking, punching, kicking, hair pulling, burning and rough treatment.

Sexual abuse

The older person is sexually harassed, made to engage in sexual acts without valid consent and/or raped.

Neglect is the failure of a care giver to provide the basic necessities for survival.

The NSW Interagency Protocol for Responding to Abuse of Older People also recognises domestic violence, systems abuse (where organisations chronically fail to provide adequate services) and the inappropriate use of restraints as forms of abuse.

What causes elder abuse?

Elder abuse is very complex and its causes are largely unclear however there are associated risk factors. While there are multiple situations of risk associated with care giving and ageing which are exacerbated by ongoing stresses of inadequate services, fatigue and emotional distress, this is only part of the story. Elder abuse is also related to blatant abuses of power and exploitation, unequal treatment before the law and denial of human rights.

Abusers are often people who are known to the victim, and quite often they are their relatives or their carers, including aged care workers.

Other related risk factors include:

Dementia – people with dementia are more likely to experience abuse and to abuse their carers.

There may be a history of domestic violence, drug misuse or long term emotional problems.

There are often high levels of dependency both in terms of financial needs and care support needs which contribute to carer stress.

What are the signs of elder abuse?

Many people who are victims of abuse won’t tell. They may feel ashamed, guilty, worried about what might happen to the abuser and to themselves if the abuser is their carer or anxious about retribution if the abuser is a care worker. You need to be alert to the observable signs of elder abuse.

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Behavioural signs

Some of these behaviours might indicate elder abuse:

the person may tell you what is happening or they may refuse to talk to you

they may be withdrawn or openly angry and aggressive

they may be fearful, agitated or worried and constantly seek company

they may cry a lot, seem depressed and have sleep disturbances

they may steal food, borrow or beg for money.

Physical signs

Some of these physical signs might indicate elder abuse:

there may be physical signs of trauma such as fractures, scratches or bruising

they may look sick and unhealthy

they might loss or gain excessive weight

they might seem unduly nervous.

What procedures should be followed?

What we have now is a dual system. Aged care organisations funded under the Aged Care Act such as residential aged care facilities, CACP and EACH packages must report allegations of physical and sexual abuse unless they have been perpetrated by someone with a decision making incapacity.

There is a hierarchy of reporting. Workers should report any suspicions to their immediate supervisor who will record and investigate the situation and ultimately report it to a senior manager who needs to report to the Office of Age Care Quality and Compliance.

On the other hand, community based HACC funded aged care services such as meal services, home care and neighbour aid need to respond to suspected abuse of older people according to the Interagency Protocol for Responding to Abuse of Older People developed by the Department of Ageing, Disabilities and Home Care (DADHC). This protocol emphasises a rights based approach. The older person should be treated with dignity and respect; they have a right to live in a safe environment, to access the protections that are available to other citizens and very importantly, to be self determining.

These are the ‘Golden Rules’ that you should follow:

don’t confront the alleged abuser

ensure the safety of the older person

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contact your supervisor straight away

if there is immediate danger contact the police or a sexual assault service if appropriate

if possible protect any evidence

even if you’re not sure that abuse is occurring, discuss your concerns with your supervisor who will advise you on the action you should take. This is not a breach of confidentiality.

Restraints

Restraints are used in residential facilities to restrict an older person’s movement in order to prevent harms or manage risks. The use of restraints is hugely contentious. Restraints can be physical – vests, chairs, locked doors, bed rails, or chemical or psychological. Historically restraints have also been used to make an aged care worker’s job easier and this is where allegations of abuse have arisen.

Each facility will have a formal restraint policy. A medical practitioner must approve the restraint and be regularly consulted about its continued use.

If you think restraining an older person may be required as a protection from injury, a thorough assessment of the situation needs to take place. This will include considerations such as:

identification of the problem

history of the problem and previous strategies

medication history

recent changes in the older person’s life

psychological and physical states

people involved; the older person, carers, other professionals, family, etc.

Decisions are made which aim to balance the person’s rights to freedom against the risk of injury.

Restraining an older person may have short term and long term effects which can include:

loss of dignity

loss of self esteem

disempowerment

diminished physical mobility

negative psychological states such as a withdrawal from reality

increased dependency on others

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increased confusion and disorientation

chemically restraints can cause a multitude of polydrug problems

incorrect doses of medication increase confusion and can lead to overdose and death.

It is also important to understand that restraining an older person can lead to injuries. A physical restraint may result in skin tears or bruising, even strangulation if the older person resists the restraint and is not monitored closely.

Case study

In 2004 an ABC television program reported on the repeated sexual abuse of a 90+ year old woman with dementia in a Victorian nursing home. She was so traumatised by the abuse that she ceased talking all together. The perpetrator was an aged care worker and she was allegedly not his only victim.

This incident incensed the general public and reignited ongoing debates about whether Australia should have a mandatory (compulsory) system of reporting the abuse or neglect of older people. The Commonwealth Government responded with a mandatory reporting system for federally funded aged care services as well as compulsory police checks for employees, volunteers and anyone else who would have unsupervised access to older residents.

Feedback

You could say ‘the jury is still out’. Many people in the aged care industry do not think that mandatory reporting is helpful, many think that it is.

The other thing that really concerns me is how we think about the abuse of older people. Somehow, because it occurs in the context of a caring relationship, we don’t think of it as a crime. Even worse is my fear that we covertly blame older people for being a burden and somehow contributing to their own abuse. If we thought of elder abuse as domestic violence we might consider different ways of responding such as seeking Apprehended Domestic Violence Orders (ADVOs) and pressing for criminal action.

The abuse of older people is a complex issue and we need to talk about it more often and more openly to encourage debate and seek better responses.

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