tag:theconversation.com,2011:/ca/topics/elder-abuse-5798/articlesElder abuse – The Conversation2023-12-19T16:53:48Ztag:theconversation.com,2011:article/2190532023-12-19T16:53:48Z2023-12-19T16:53:48ZFraud is a problem so big we need to start teaching children how to spot it in schools<figure><img src="https://images.theconversation.com/files/565490/original/file-20231213-27-gu78dv.jpg?ixlib=rb-1.1.0&rect=0%2C67%2C4992%2C3255&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fraud can happen to anyone. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dishonest-evil-salesman-business-suit-car-1059618683">Twinsterphoto/Shutterstock</a></span></figcaption></figure><p>Have you or someone you know been a victim of fraud? If so, that’s not unusual.</p>
<p>The UK’s Office for National Statistics (ONS) reported a <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/natureoffraudandcomputermisuseinenglandandwales/yearendingmarch2022">rise of 25%</a> in the number of fraud offences in 2021 compared to 2020 in the UK. Representing over 40% of all crimes against individuals, fraud is <a href="https://ukparliament.shorthandstories.com/breaking-fraud-chain-committee-report/index.html">the most common</a> crime in the UK. </p>
<p>If these statistics are not alarming enough, there is some evidence <a href="https://www.forbes.com/sites/jeffkauflin/2023/09/18/how-ai-is-supercharging-financial-fraudand-making-it-harder-to-spot/">that AI is</a> making it <a href="https://www.mcafee.com/blogs/privacy-identity-protection/artificial-imposters-cybercriminals-turn-to-ai-voice-cloning-for-a-new-breed-of-scam/">harder to</a> detect scams.</p>
<p>People often <a href="https://commsrisk.com/some-victims-of-fraud-are-just-stupid/">blame fraud victims</a> for being foolish or trusting enough to fall for a scam. But it’s time to accept that it can happen to anyone. It’s a problem so large we need to revise our concept of fraud as something that only happens to gullible or vulnerable people. The human brain can’t keep up with all of the new technology-enabled types of fraud.</p>
<p>So we need a new approach that holds financial institutions and businesses responsible for identifying or facilitating fraud and that harnesses AI to spot suspicious transactions. It’s not reasonable to expect consumers to know when they’re being scammed if banks and social media platforms can’t.</p>
<h2>Who falls prey to fraud</h2>
<p>If you were asked who is the most likely to become a victim of fraud, what would be your answer? If you are like most people, you probably thought about <a href="https://financialpost.com/executive/executive-summary/most-likely-financial-scam-victims">older adults</a>. Investment bankers, IT experts or young adults might not have come to mind. </p>
<p>This misconception about who is vulnerable or susceptible to fraud is one of the core problems surrounding the topic of fraud. For example, <a href="https://www.experian.co.uk/assets/insight-reports/brochures/The-Insight-Report-Victims-of-fraud-survey-March-2010.pdf">a 2010 survey</a> by credit reporting company Experian examining identity fraud in the UK found that two age groups, 25-34 and 35-44, represented 54% of the victims, while those over 65 represented only 4% of the victims of that type of fraud. </p>
<p>With cryptocurrency, victims tend to be young, well-educated, professional, and <a href="https://academic.oup.com/rof/article/26/4/855/6478303%20">traders who have risky portfolios</a>. </p>
<p>It is enough to read the list of main investors (and victims) in the fraud-ridden <a href="https://markets.businessinsider.com/news/currencies/ftx-bankruptcy-top-investors-list-tom-brady-kevin-oleary-sbf-2023-1">cryptocurrency exchange FTX</a> and fraudulent medical technology company <a href="https://www.integrityline.com/expertise/blog/elizabeth-holmes-theranos/">Theranos</a> cases to realise that even the savviest investors and celebrities can become victims. Their supporters included media moguls, politicians and hedge fund managers. </p>
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<img alt="Frustrated and upset man outside office building looking at his smartphone and holding a bank card" src="https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565493/original/file-20231213-21-98fg16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Educated adults make up a large percentage of fraud victims.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-upset-african-american-man-outside-2212767551">voronaman/Shutterstock</a></span>
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<p>A 2023 report by <a href="https://www.ukfinance.org.uk/news-and-insight/press-release/gen-z-more-likely-be-tricked-criminals-and-fall-impersonation-scams">UK Finance</a> indicates that 18- to 24-year-olds are being increasingly targeted by fraudsters, and are far more likely to fall prey to an impersonation scam, compared to those aged 65 and over. Also, the rate of 13- to 17-year-olds falling prey to <a href="https://www.lloydsbankinggroup.com/assets/pdfs/who-we-are/our-purpose/fraud/lloyds-bank-game-fraud-report.pdf">scams via gaming</a> has seen a sharp rise. </p>
<h2>Developing educational and therapeutic programmes</h2>
<p>Many schools around the world have introduced <a href="https://educationhub.blog.gov.uk/2023/02/01/how-we-promote-and-teach-online-safety-in-schools/">online safety programmes</a>.</p>
<p>The programmes currently on offer, however, tend to be rather thin on how to protect yourself from fraud. Children’s charity <a href="https://www.nspcc.org.uk/keeping-children-safe/online-safety/?gclsrc=aw.ds&gad_source=1&gclid=CjwKCAiAg9urBhB_EiwAgw88mXcr3TpCRmIGbNM_A0C7uuvBV0uO6TrC4FpNSvyjP71aOIMRR4MM2hoCgPMQAvD_BwE&gclsrc=aw.ds">the NSPCC</a>, for example, has programmes for protecting children from online abuse, staying safe while using social media, and from legal but harmful content – but not for online scams. </p>
<p>Fraud prevention should be taught in schools and universities as part of the curriculum. </p>
<p>For older adults, charities <a href="https://www.aarp.org/money/scams-fraud/about-fraud-watch-network/">the AARP</a> and <a href="https://www.ageuk.org.uk/information-advice/money-legal/scams-fraud/">AgeUK</a> offer guidance and resources, but it is unclear how effective or widely used they are. </p>
<p>Fraud prevention programmes, training, and information have rarely been scrutinised and we lack data on their effectiveness. We need to develop programmes for each age group and evaluate their effectiveness. </p>
<h2>Improve deterrence</h2>
<p>One of the most important theories in criminology is <a href="https://www.house.mn.gov/hrd/pubs/deterrence.pdf">deterrence theory</a>, which says crime reduction relates to the severity of the punishment, and, more importantly, the likelihood of being caught. </p>
<p><a href="https://www.gov.scot/publications/works-reduce-crime-summary-evidence/pages/5/">Research suggests</a> that increasing the likelihood of being caught is far more effective than increasing punishment. However, fraudsters have little to worry about. By the <a href="https://www.gov.uk/government/publications/fraud-strategy/fraud-strategy-stopping-scams-and-protecting-the-public">UK government’s admittance</a>, fraud accounts for over 40% of all crimes yet it receives less than 1% of police resources. </p>
<h2>Businesses must better protect consumers</h2>
<p>During the COVID pandemic, media outlets reported that Google blocked <a href="https://www.bbc.co.uk/news/technology-52319093">18 million coronavirus scam</a> emails every day. Despite these efforts, according <a href="https://www.ftc.gov/news-events/data-visualizations/data-spotlight/2023/10/social-media-golden-goose-scammers">to a report</a> by the Federal Trade Commission (FTC), a US agency that enforces consumer rights, tech companies and especially social network sites are a breeding ground for scammers.</p>
<p>Indeed, the FTC reported that a quarter of the people who lost money to fraud said the process started on social networking platforms. </p>
<p>The nature of social media sites provides scammers with the ability to hide behind fake personas and pretend to be a legitimate business. They also allow scammers to reach millions of people with a press of a button —- <a href="https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/">particularly younger adults</a> who tend to be more heavy and prolific users of social networking sites. </p>
<p>The FTC <a href="https://www.ftc.gov/news-events/news/press-releases/2023/03/ftc-issues-orders-social-media-video-streaming-platforms-regarding-efforts-address-surge-advertising">has issued orders</a> to a range of social media – including Meta, TikTok and YouTube – seeking information on how these companies screen for malicious and nefarious ads and scams. </p>
<h2>Introduce new policies</h2>
<p>California legislators are <a href="https://pluralpolicy.com/app/legislative-tracking/bill/details/state-ca-20232024-sb278/1277035">considering a bill</a> offering older adults greater protection against fraud by holding banks responsible when tellers facilitate fraudulent transactions.</p>
<p>In the UK, former home secretary Suella Braverman presented a
<a href="https://www.gov.uk/government/publications/fraud-strategy/fraud-strategy-stopping-scams-and-protecting-the-public">a fraud strategy</a> the parliament in May 2023, which proposes a range of measures such as banning all phone calls related to financial products. </p>
<p>We see these two bills as a move in the right direction but more work is needed, and urgently. Policymakers must allocate funding to research and law enforcement agencies, introduce laws that provide greater protection to people, and collaborate with international law enforcement bodies, such as Interpol. </p>
<p>Fraud affects society on all levels: individuals, organisations and governments. We are all in it together, whether we like it or not.</p><img src="https://counter.theconversation.com/content/219053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Recent studies have shown fraud is an even bigger problem than people realise.Yaniv Hanoch, Professor in Decision Science, University of SouthamptonStacey Wood, Professor of Psychology, Scripps CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168272023-11-10T02:06:24Z2023-11-10T02:06:24ZAbout 1 in 6 older Australians experiences elder abuse. Here are the reasons they don’t get help<p>Each year, many older Australians experience abuse, neglect or financial exploitation, usually at the hands of their adult children or other close relatives. </p>
<p>A recent <a href="https://aifs.gov.au/research/research-reports/national-elder-abuse-prevalence-study-final-report">national prevalence study</a> revealed one in six older Australians living at home experiences elder abuse. This may encompass various forms of abuse, such as emotional, financial, social, physical and sexual abuse, or neglect.</p>
<p>Despite elder abuse being such a common problem, older people often don’t get the help they need. With the right responses, we can make it easier for those working with older people, and the wider community, to support them. </p>
<p>Our <a href="https://www.wa.gov.au/system/files/2023-11/everyones_business_research_into_responses_to_the_abuse_of_older_in_wa_report.pdf">new research</a> reveals the key reasons older people experiencing harm do not receive the support they so desperately need. </p>
<p>Our study included a survey of nearly 700 service providers throughout Western Australia. Respondents worked in diverse fields including healthcare, law, aged care, financial services and law enforcement. We found four key obstacles to people getting help with elder abuse. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-elder-abuse-and-why-do-we-need-a-national-inquiry-into-it-55374">Explainer: what is elder abuse and why do we need a national inquiry into it?</a>
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<p><strong>1. Older people are too scared to report abuse.</strong></p>
<p>Older people are often afraid to report abuse because they fear repercussions both for themselves and for the perpetrator, usually an adult child or other close relative. </p>
<p>These concerns can mean an older person endures abuse for a long time. They may only seek help when the situation escalates to an extreme level or when someone else notices the ongoing mistreatment.</p>
<p>Equally important, they may fear other negative outcomes of reporting abuse. They may fear having to leave their home and enter residential care. They may fear increased isolation and loneliness, or that the abuse will get worse. </p>
<p>All these fears combined create a formidable barrier to older people promptly reporting abuse and getting the help they need.</p>
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<p><strong>2. Older people don’t know where to turn for help</strong> </p>
<p>Elder abuse cases are often complex, involving long family histories and complicated relationships. Older people trying to improve their situation may need support from multiple service providers. The challenge of accessing the right services and acting on their advice can be daunting. </p>
<p>Addressing complicated matters may require intensive support and advocacy for an extended time. In the words of one experienced advocate, </p>
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<p>People don’t need to know the next ten steps. They need to know one step, maybe two, and then see where they are at.</p>
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<p>Helping older people feel empowered to seek help requires simple, accessible channels of assistance, promoted through multiple formats and outreach efforts.</p>
<p><strong>3. Government-funded responses to family violence are more focused on intimate partner violence and child protection, leaving elder abuse out of the picture</strong> </p>
<p>Most programs targeting family violence prioritise intimate partner violence and child protection, inadvertently sidelining elder abuse. Services such as shelters and perpetrator programs are not always compatible with the distinct characteristics of elder abuse. </p>
<p>Additionally, the gendered nature of family violence responses fails to address the diverse demographics of elder abuse, which includes older men. As a result, older people, regardless of gender, may struggle to access supports suited to their needs. </p>
<p>A refuge manager explained: </p>
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<p>When a bed becomes available we have this awful job of deciding who’s more high-risk and who gets the bed. If an older person needs the bed, as opposed to a single mum with a newborn, unfortunately we would go with the mum. That really presents a barrier where there isn’t refuge accommodation specifically for older people.</p>
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<p>There is a pressing need for a shift in focus to better recognise elder abuse as a significant issue and tailor responses to meet the specific needs of older people. This includes creating safe and accessible refuge options and providing specialised support services to address the multifaceted nature of elder abuse.</p>
<p><strong>4. There’s low public awareness about what elder abuse looks like or how to respond</strong></p>
<p>Awareness of elder abuse remains surprisingly low, hindering effective responses. Changing this requires clear public information campaigns and community-wide conversations about abuse. This includes greater awareness of the challenge for well-meaning adult children who might limit the choices of their older relatives, thinking they know best. This can result in unintended social isolation or even neglect.</p>
<p>A society that speaks openly about elder abuse, without stigma, is better equipped to support victims and intervene. By building public knowledge and promoting a culture where such issues can be freely discussed, we lay the groundwork for reducing its incidence.</p>
<p>We are living longer lives than ever before, meaning we can expect to spend more years in older age than previous generations. This is good news, but also means we need to do more work to support people to age well. Positive steps we can all take include tackling ageism when we see it and normalising conversations about abuse so older people can feel confident to seek help when it’s needed.</p><img src="https://counter.theconversation.com/content/216827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catriona Stevens has received funding as an initiative of the WA Strategy to Respond to the Abuse of Older People (Elder Abuse) 2019-2029.</span></em></p><p class="fine-print"><em><span>Professor Loretta Baldassar has received funding as an initiative of the WA Strategy to Respond to the Abuse of Older People (Elder Abuse) 2019-2029.</span></em></p><p class="fine-print"><em><span>Eileen O'Brien does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Elder abuse is common and can be devastating. New research has uncovered four key reasons older people do not seek the help they need with the abuse.Eileen O'Brien, Professor of Law, Discipline of Law, Justice and Society, University of South AustraliaCatriona Stevens, Forrest Prospect Fellow in Sociology and Anthropology, Edith Cowan UniversityLoretta Baldassar, Vice Chancellor Professorial Research Fellow, School of Arts and Humanities, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1815692022-06-14T12:29:56Z2022-06-14T12:29:56ZElder abuse comes in many forms – appropriate Adult Protective Services referrals can help reduce mistreatment<figure><img src="https://images.theconversation.com/files/467845/original/file-20220608-16-u7z954.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Elder abuse can take many forms, including financial, emotional, physical and sexual abuse, along with neglect.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/helping-the-needy-royalty-free-image/499062115">Barcin/iStock via Getty Images Plus</a></span></figcaption></figure><p>Before the pandemic, around <a href="https://doi.org/10.2105/AJPH.2009.163089">1 in 10</a> older adults in the U.S. experienced elder mistreatment. In 2020, this number doubled to <a href="https://doi.org/10.1016/j.jagp.2021.01.007">1 in 5</a> – a nearly 84% increase.</p>
<p>Mistreatment comes in many forms, including various types of abuse, neglect, exploitation and fraud. <a href="https://doi.org/10.3389/fpubh.2021.659640">Adult Protective Services</a> agencies exist in every U.S. state and territory to investigate adult mistreatment reports and work with clients to address their needs. APS staff members gather information from clients, alleged abusers and third parties such as family members, friends or neighbors to determine whether there is enough evidence to support a mistreatment claim. They also use this information to match clients to social, health care, legal or other services as desired. </p>
<p>Since APS agencies do not receive dedicated federal funding, and regulations vary by state and local jurisdiction, standardized assessment of APS involvement in mistreatment cases has been challenging. As an <a href="https://scholar.google.com/citations?user=lHP5_JAAAAAJ&hl=en">elder justice researcher</a>, I wanted to examine what differences APS agencies make in their clients’ lives and, more specifically, what services can help ameliorate mistreatment.</p>
<p>In our recently published study, my colleagues and I identified the <a href="https://doi.org/10.1093/geront/gnac040">four most common types of elder mistreatment</a> and found that while APS can help ameliorate abusive situations for older adults, different types of elder mistreatment require different services to address them.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/OQN7Lz-_1Ww?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Elder abuse can happen to anyone.</span></figcaption>
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<h2>Matching service to mistreatment</h2>
<p>We collaborated with San Francisco and Napa APS agencies in California to identify which services decreased the severity of elder mistreatment. In California, county APS agencies focus on <a href="https://www.cdss.ca.gov/inforesources/adult-protective-services">nine types of mistreatment</a>: emotional abuse (called “mental suffering” by the California APS), physical abuse, financial abuse, neglect, sexual abuse, isolation, abandonment, abduction and self-neglect.</p>
<p>We trained San Francisco and Napa APS staff members to evaluate and measure how effective provided services are at reducing mistreatment. Staffers documented what types of services were given for each type of mistreatment and recorded how severe mistreatment was before and after services were provided.</p>
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<a href="https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse talking to older adult in home" src="https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467846/original/file-20220608-23-gzym6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Adult Protective Services can provide or refer clients to specific services according to their needs.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-man-having-a-health-exam-royalty-free-image/1282163901">Marko Geber/DigitalVision via Getty Images</a></span>
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<p>We found that APS interventions were able to decrease abuse severity for four of the most common types of elder mistreatment: 43% for emotional abuse, 62% for physical abuse, 31% for financial abuse and 72% for neglect.</p>
<p>Not surprisingly, we found that services targeting the specific problem worked best. Victims and survivors of physical and emotional abuse benefited most from care and case management services. Emotional abuse victims benefited from additional legal services. Financial abuse victims had better outcomes with financial planning services. Finally, victims of neglect benefited most from care and case management as well as language translation and services provided to their alleged abusers, such as counseling and behavioral health treatments.</p>
<h2>Shedding light on APS service outcomes</h2>
<p>There are still many unknowns about Adult Protective Services report outcomes.</p>
<p>Notably, APS agencies cannot force their clients to accept services they do not want unless a health professional determines that they don’t have decision-making capacity. And once an APS case is closed, agencies will not know what happens to these older adults unless they or someone else sends another report. </p>
<p>My colleagues and I are currently conducting another study following up with APS clients after case closure. In addition to tracking mistreatment severity across time, we will also track other longer-term factors that affect one’s ability to live independently and safely, such as physical and mental health. Those who decline services will be a natural comparison group.</p>
<p>In addition to their elderly clients, many APS agencies also work with dependent adults, often younger people with physical, mental or intellectual disabilities. Not much is known about mistreatment in this vulnerable group. While our study did not have a large enough sample size to focus on this population, we would like to do so in the future as we collect more data.</p>
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<a href="https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of younger person holding hand of older person" src="https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467840/original/file-20220608-302-bau4g5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Everyone can play a part in ending elder abuse.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/44514681@N06/33397293554">Avansa regio Gent vzw/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Finally, <a href="https://namrs.acl.gov/Learning-Resources/Adult-Maltreatment-Reports/2020-Adult-Maltreatment-Report.aspx">self-neglect</a>, in which an older or dependent adult puts their own health or safety at risk, makes up the majority of mistreatment cases APS receives. My colleagues and I are also working to identify subtypes of self-neglect and which services would best address them. </p>
<p>Adult Protective Services agencies are the only governmental entities dedicated to addressing older and dependent adult mistreatment. However, even with APS staffers ready to connect older and dependent adults with service providers, clients need to be willing to accept help. APS is not a silver bullet that makes elder mistreatment magically disappear. </p>
<p>It takes a village – starting with recognizing when elder mistreatment is happening, and taking action to stop it.</p><img src="https://counter.theconversation.com/content/181569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marian Liu receives funding from the Administration for Community Living, U.S. Department of Health and Human Services. </span></em></p>World Elder Abuse Awareness Day highlights the increasing population of older adults around the world and the accompanying rise in elder mistreatment.Marian Liu, Assistant Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1776312022-03-14T18:57:20Z2022-03-14T18:57:20ZHow to choose a legal decision-maker as you get older – 3 things to consider<figure><img src="https://images.theconversation.com/files/450600/original/file-20220308-126059-lpbkzh.jpg?ixlib=rb-1.1.0&rect=13%2C0%2C8661%2C5787&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-shot-senior-woman-signing-documents-451268143">Shutterstock</a></span></figcaption></figure><p>“It’s my life and I’ll do what I want,” <a href="https://www.youtube.com/watch?v=HNzmrEgz_GI">sang</a> Eric Burdon of The Animals to the baby boomer generation. Unfortunately, that’s not always the case. As we get older, sometimes we are no longer capable of making our own decisions. Diseases that affect the brain such as dementia, stroke and head injury can impair cognition and thinking.</p>
<p>Some people may choose to appoint a <a href="https://www.legislation.vic.gov.au/in-force/acts/medical-treatment-planning-and-decisions-act-2016/008">medical treatment decision-maker</a> or an <a href="https://www.legislation.vic.gov.au/in-force/acts/powers-attorney-act-2014/007">enduring power of attorney</a> to make certain decisions on their behalf. Alternatively, a legal tribunal or court may appoint <a href="https://www.legislation.vic.gov.au/in-force/acts/guardianship-and-administration-act-2019/005">a guardian or trustee</a> to help guide decisions about health care, finances, accommodation and lifestyle.</p>
<p>Who is the right person to take on this important role? Is it the family member or partner who knows you best? Or someone with time and energy? Perhaps someone who understands the services you need – like a nurse, accountant or real estate agent?</p>
<p>The role of a decision-making representative has <a href="https://www.alrc.gov.au/publication/equality-capacity-and-disability-in-commonwealth-laws-alrc-report-124/3-national-decision-making-principles-2/will-preferences-and-rights-2/#:%7E:text=The%20'best%20interests'%20principle%20is,an%20equal%20basis%20with%20others">changed significantly</a> in recent years, shifting from a paternalistic approach to a more person-centred focus. Our <a href="https://pubmed.ncbi.nlm.nih.gov/35157838/">research</a> looks at the differences between these approaches and how subconscious bias can influence decision-making. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/safe-at-home-we-need-a-new-strategy-to-protect-older-adults-from-violent-crime-163260">Safe at home? We need a new strategy to protect older adults from violent crime</a>
</strong>
</em>
</p>
<hr>
<h2>Taking care</h2>
<p>These days, guardianship has <a href="https://www.legislation.vic.gov.au/in-force/acts/guardianship-and-administration-act-2019/005">moved</a> from deciding what’s deemed to be in the individual’s “best interests” to what best reflects their “will and preferences”. </p>
<p>While <a href="https://www.legislation.vic.gov.au/repealed-revoked/acts/guardianship-and-administration-act-1986/089">previously</a>, decisions were made for the person by their guardian or representative, new laws require representatives to enact the person’s “will and preferences”. That is, to make decisions with them.</p>
<p>This is an important difference. The newer model gives the represented person more autonomy over personal, financial and other decisions. It recognises that even though a person may struggle with aspects of decision-making, they should not be excluded from decisions about how they live their life. This fundamental shift was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313688/">earlier adopted</a> by the United Nations in the <a href="https://www.ohchr.org/en/hrbodies/crpd/pages/conventionrightspersonswithdisabilities.aspx">Convention on the Rights of Persons with Disability</a>, to which Australia is a signatory.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/theres-no-need-to-lock-older-people-into-nursing-homes-for-their-own-safety-73954">There's no need to lock older people into nursing homes 'for their own safety'</a>
</strong>
</em>
</p>
<hr>
<h2>Challenging in real world situations</h2>
<p>The will and preferences <a href="https://supporteddecisionmaking.com.au/wp-content/uploads/sites/4/2021/08/Realising-will-preferences-and-rights-reconciling-differences-on-best-practice-support-for-decision-making.pdf">framework</a> may sound simple, but it can be <a href="https://www.tandfonline.com/doi/full/10.1080/09687599.2021.1941781">challenging in practice</a>, when concepts of empowerment are tricky to define and the will of someone with cognitive difficulties is hard to discern. </p>
<p>Representatives <a href="https://supporteddecisionmaking.com.au/wp-content/uploads/sites/4/2021/08/Realising-will-preferences-and-rights-reconciling-differences-on-best-practice-support-for-decision-making.pdf">bring their own biases, perceptions and lived experience</a> to the role of supporting another person to make decisions. This subjectivity is a natural and an inherent part of decision-making. The representative faces the challenge of setting aside their own opinion and, instead, stepping into the shoes of the represented person to give effect to what they want. </p>
<p>A mismatch between the age, gender, ethnicity, religion or socioeconomic status of the representative and the represented person can exacerbate this challenge.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="younger woman holds hand of older woman" src="https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450601/original/file-20220308-128341-1c54ff4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s important a representative can put themselves in the shoes of the person they’re representing.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/cheerful-old-woman-wheelchair-her-600w-467172827.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>An older able-bodied female, who is deeply religious and from a middle-to-high income background might find it difficult to represent a young man with a disability who is an atheist and from a working-class background. Now, imagine a scenario where the young man expresses a desire to go bungee-jumping or parachuting, despite previously showing a fear of heights. What’s his representative to do?</p>
<p>Older people and women generally <a href="https://www.tandfonline.com/doi/abs/10.1080/1366987032000105315?journalCode=rjrr20">have a lower appetite for risk</a>, as do those who have a faith and with a high socioeconomic status. </p>
<p>A heightened perception of danger or a feeling the activity as frivolous, may lead to the representative reframing the situation with their subconscious bias. They may fail to respect the younger person’s will and preferences. </p>
<p>Understanding what might shape a representative’s approach to decision-making is essential. Especially when decisions involve <a href="https://theconversation.com/do-you-want-to-be-resuscitated-this-is-what-you-should-think-about-before-deciding-105506">health</a> or <a href="https://theconversation.com/theres-no-need-to-lock-older-people-into-nursing-homes-for-their-own-safety-73954">living arrangements</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1359731322927812611"}"></div></p>
<h2>3 things to look for when selecting a legal decision-making representative</h2>
<p><strong>1. Deep understanding</strong></p>
<p>An intimate understanding of your situation is crucial. An ideal representative is someone who actively listens and has a holistic view of your circumstances. This may come from discussions with you and your loved ones. The representative must be careful your views are not outweighed by those of family or friends who are often more vocal. They should have a deep sense of who you are as an individual.</p>
<p><strong>2. Self-awareness</strong></p>
<p>The person you choose should be able to describe their personal views and values and understand how their perspective may influence their decisions. This is vital to mitigate the effects of pre-existing bias. They should be able to reflect on their own lived experiences, to understand how their history shapes their approach to decision-making. They should be able to assess whether what you would do is the same as what they think you should do, and why.</p>
<p><strong>3. Effective documentation</strong></p>
<p>A record of conversations between the representative and represented person often helps to illuminate a person’s will and preferences. Writing or recording compels us to commit to an idea and explain what we mean. It helps to clarify what is intended far better than a one-time conversation that may be remembered differently by participants.</p>
<p>Further research is needed to better match representatives with represented persons. Improved tools are needed to identify the role of bias in decision-making and evaluate whether the represented person’s wills and preferences are being respected.</p><img src="https://counter.theconversation.com/content/177631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim received funding from Commonwealth Social Service (2015–17) and State Health Department (ongoing) for research, education and consultancies into residential aged care services and health care services. He also is an independent advocate for age care reform.</span></em></p><p class="fine-print"><em><span>Amelia Grossi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Someone who is self-aware may be a better choice then your nearest and dearest, when it comes to enacting your will and preferences as you age.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityAmelia Grossi, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737502022-01-21T13:42:57Z2022-01-21T13:42:57ZConflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect<figure><img src="https://images.theconversation.com/files/440793/original/file-20220113-23-w6ed7m.jpg?ixlib=rb-1.1.0&rect=42%2C18%2C3977%2C2621&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Conflicts between residents with dementia occur often in long-term care settings.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/assistant-in-the-community-center-giving-advice-to-royalty-free-image/653495116?adppopup=true">CasarsaGuru/E+ via Getty Images</a></span></figcaption></figure><p>Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” <a href="https://www.saultstar.com/2013/02/21/remembering-frank-piccolo--oconnor">wrote a former student</a>. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.” </p>
<p>But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later. </p>
<p>The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, <a href="https://s3.documentcloud.org/documents/21048374/inspection-report.pdf">the agency determined</a>. “There were no interventions implemented, no strategies developed,” the report stated. </p>
<figure class="align-right ">
<img alt="Frank Piccolo and his wife, Theresa, standing near each othe, on vacation, with a hillside village and the sea behind them." src="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001.</span>
<span class="attribution"><span class="source">Theresa Piccolo</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>As a gerontologist and <a href="http://dementiabehaviorconsulting.com">dementia behavior specialist</a>, I’ve <a href="https://www.healthpropress.com/product/understanding-and-preventing-harmful-interactions-between-residents-with-dementia/">written a book</a> on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “<a href="https://terranova.org/film-catalog/fighting-for-dignity-a-film-on-injurious-and-fatal-resident-to-resident-incidents-in-long-term-care-home">Fighting for Dignity</a>.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes. </p>
<h2>Reporting and stigmatizing</h2>
<p><a href="https://doi.org/10.1111/j.1532-5415.2008.01808.x">Resident-to-resident incidents</a> are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.” </p>
<p>These incidents <a href="https://doi.org/10.7326/M15-1209">are prevalent</a> in U.S. nursing homes. But they are <a href="https://www.statnews.com/2021/11/29/resident-to-resident-incidents-hidden-source-nursing-home-harm/">largely overlooked</a> by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents <a href="https://doi.org/10.1080/08946566.2017.1333939">remain untracked</a>, <a href="https://doi.org/10.1016/j.jamda.2015.10.003">understudied</a> and largely unaddressed.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man with severe injuries, including cut marks and bruises, across his face and forehead." src="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Frank Piccolo sustained severe injuries to his face and head after a woman with dementia entered his bedroom and hit him repeatedly with an activity board.</span>
<span class="attribution"><span class="source">Theresa Piccolo</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>These interactions don’t just result <a href="https://doi.org/10.1001/jama.291.5.591">in injuries</a>
<a href="https://doi.org/10.1177/0733464819863926">and deaths</a> among residents. They also leave behind devastated families who then must <a href="https://www.washingtonpost.com/business/2021/08/20/nursing-home-immunity-covid-lawsuits">fight for answers</a> and accountability from nursing homes.</p>
<p>Making matters worse, <a href="https://www.gao.gov/products/gao-19-433">government reports</a>, <a href="https://doi.org/10.1017/S0714980815000094">research studies</a> and <a href="https://doi.org/10.1177/1471301220981232">media coverage</a> commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to <a href="https://www.startribune.com/when-senior-home-residents-are-abusers-minnesota-rarely-investigates/450625693/">label the incidents as “abuse</a>,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on <a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">the phenomenon</a> in Canada, the Toronto Star called it “abuse.” </p>
<h2>Getting to the root of the real problem</h2>
<p>Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require. </p>
<p>Two of every three residents <a href="https://doi.org/10.1016/j.jamda.2021.02.009">involved in these incidents</a> have dementia. One study found that the rate of these episodes was nearly <a href="https://doi.org/10.1001/jama.291.5.591">three times higher</a> in dementia care homes than in other long-term care homes. A recent study also found <a href="https://doi.org/10.7326/m15-1209">an association</a> between residency in a dementia care home and higher rates of injurious or fatal interactions between residents. </p>
<p>But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that <a href="https://doi.org/10.1080/08946566.2018.1474515">“push-fall” episodes</a> constitute nearly half of fatal incidents. </p>
<p>Another U.S. study found that as residents’ cognitive functioning declined, they faced <a href="https://doi.org/10.1001/jama.291.5.591">a greater likelihood</a> of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents. </p>
<p>The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents <a href="https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf">is not abuse</a>. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on <a href="https://doi.org/10.1177/0733464819863926">fatal incidents</a> in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.” </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/gk5iEo-s_6M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An undercover yearlong investigation into nursing homes in Ontario, Canada, revealed shocking instances of abuse and neglect by staff members.</span></figcaption>
</figure>
<h2>How incidents often occur</h2>
<p>In one study, researchers examined <a href="https://doi.org/10.1177/1054773813477128">situational triggers</a> among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body. </p>
<p>That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. <a href="https://doi.org/10.1177/1471301213502588">My own work</a> and a different <a href="https://doi.org/10.1177%2F0733464820955089">Canadian study</a> came to similar conclusions.</p>
<p>Other research shows that when residents are bored or lack <a href="https://doi.org/10.1177%2F153331750502000210">meaningful activity</a>, they become involved in <a href="https://doi.org/10.1177%2F1471301213502588">harmful interactions</a>. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. <a href="https://doi.org/10.1080/08946566.2018.1474515">Conflicts between roommates</a> are also common and harmful. </p>
<figure class="align-center ">
<img alt="With a smiling staff member looking on, two nursing home residents enjoy conversation while having coffee." src="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caretaker-with-senior-people-in-nursing-home-royalty-free-image/489582967?adppopup=true">Morsa Images/DigitalVision via Getty Images</a></span>
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<p>A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that <a href="https://doi.org/10.7326/M15-1209">higher caseloads</a> among nurses’ aides were associated with higher incident rates. </p>
<p>And with <a href="https://doi.org/10.4137/hsi.s38994">poor staffing levels</a> in up to half of U.S. nursing homes, <a href="https://doi.org/10.1080/08946566.2018.1474515">staff members do not witness</a> many incidents. In fact, one study found that staff members missed the majority of unwanted <a href="https://doi.org/10.1080/13607863.2016.1211620">bedroom entries</a> by residents with severe dementia. </p>
<h2>Residents with dementia are not to blame</h2>
<p>In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents. </p>
<p>Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations. </p>
<p>Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control.</p>
<p>Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “<a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">duty to protect</a>” Piccolo. “They did not keep my husband safe as they are required to do,” she said.</p><img src="https://counter.theconversation.com/content/173750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am a founding member and board member of Elder Voice Family Advocates in Minnesota. </span></em></p>Research shows that violence between patients is prevalent, often overlooked and largely unaddressed.Eilon Caspi, Assistant Research Professor of Health, Intervention, and Policy, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1697342021-10-18T06:12:03Z2021-10-18T06:12:03ZAged care staff urgently need training to report and prevent sexual assault<figure><img src="https://images.theconversation.com/files/426822/original/file-20211018-27-1nzhgi2.jpg?ixlib=rb-1.1.0&rect=33%2C44%2C7315%2C4858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/azerbaijan-baku-october-15-2017-600w-768686728.jpg">Shutterstock</a></span></figcaption></figure><p>An estimated <a href="https://www.abc.net.au/news/2020-10-22/aged-care-royal-comm-told-of-50-sex-assaults-a-week/12801806">50 sexual assaults</a> occur nationally every week in Australian residential aged care facilities. Despite this shocking figure, none of the Aged Care Royal Commission’s <a href="https://agedcare.royalcommission.gov.au/publications/final-report">148 recommendations</a> released earlier this year specifically address the prevention of sexual violence. </p>
<p>Our recent <a href="https://pubmed.ncbi.nlm.nih.gov/34399034/">study</a>, published in the International Journal of Older Persons Nursing, found two-thirds of aged care staff had not received any training in prevention of sexual violence in the previous 12 months. Staff confirmed aged care approved providers often do not have dedicated or specific procedures to prevent or manage incidents.</p>
<p>Failing to combat sexual violence in aged care homes demonstrates an apathy towards older survivors and reinforces the existing difficulties faced by older people to achieve a basic human right: to live free from sexual violence.</p>
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Read more:
<a href="https://theconversation.com/4-key-takeaways-from-the-aged-care-royal-commissions-final-report-156109">4 key takeaways from the aged care royal commission's final report</a>
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<h2>Reacting, not preventing</h2>
<p>Australia’s approach to preventing sexual violence in aged care focuses on mandatory reporting obligations set down by the <a href="https://www.agedcarequality.gov.au/sirs">Aged Care Quality and Safety Commission</a>. The rules require staff to define “victim impact” and “incident seriousness”. This approach lacks a scientific basis and deprives the older person of their autonomy – a right included prominently in the Royal Commission recommendations. It also shifts responsibility of complex social, legal and health issues unfairly onto care staff.</p>
<p>In response to the concerns from the aged care sector about how to apply the new rule, this month the regulator released the <a href="https://www.agedcarequality.gov.au/sirs/decision-support-tool/unlawful-sexual-contact">unlawful sexual contact decision support tool</a>. This tool seeks to define incidents as “Priority 1” or “Priority 2” according to how staff, not the survivor, have the perceived seriousness.</p>
<p>Criminal acts of sexual violence, including those perpetrated by staff members, may fall under the tool’s less urgent category – if the resident doesn’t require medical or psychological treatment as judged by the person using the tool. This means reporting to the regulator only needs to occur within a 30-day period. The longer reporting period could put others in danger and cause distress to residents and co-workers.</p>
<p>The regulator <a href="https://www.abc.net.au/radio/programs/worldtoday/anger-over-new-online-sexual-assault-reporting-tool-in-aged-care/13572522">has argued</a> there’s an expectation aged care providers will report any “serious” incident immediately to police and to the regulator. In a statement, the Aged Care Quality and Safety Commission told the ABC this was covered by the question: “Are there reasonable grounds to report the incident to the police?”</p>
<p>However, an earlier <a href="https://www.health.gov.au/resources/publications/prevalence-study-for-a-serious-incident-response-scheme-sirs">report commissioned from KPMG</a> into the prevalence of abuse between aged care residents found aged staff reported no (58.1%) or minor (35%) physical or psychological impact afterwards for those raped or otherwise sexually assaulted survivors. </p>
<p>This report also revealed only 3 of the 1,259 incidents deemed Priority 1 or “very serious” were reported to the police. Although this was before the advent of the decision tool, it highlights the dangers of placing responsibility on individual staff members with inadequate training. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/only-3-8-of-australian-aged-care-homes-would-meet-new-mandatory-minimum-staffing-standards-new-research-165877">Only 3.8% of Australian aged care homes would meet new mandatory minimum staffing standards: new research</a>
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<h2>Expecting aged care staff to do forensic work</h2>
<p>A fundamental flaw in this tool is that it assumes certain capabilities of aged care staff. </p>
<p>What constitutes reasonable grounds to report to police is a complicated forensic concept. In the aged care setting, incidents of sexual violence may involve both a survivor and a perpetrator with <a href="https://pubmed.ncbi.nlm.nih.gov/30469073/">cognitive impairment</a>. This adds to the already difficult task of “proving” an act of sexual violence has occurred. When the crime involves staff assaulting a resident, <a href="https://humanrights.gov.au/our-work/part-2-sexual-harassment-perspective-bystanders">bystander stress</a> and the daunting task of reporting a co-worker add further complexity. </p>
<p>Asking aged care staff to take on decisions that require policing expertise is dangerous.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman cries in hands" src="https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426821/original/file-20211018-57123-1nshi9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Asking care staff to determine victim impact is a problem.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1456162018889-1d2b969f7084?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2073&q=80">Unsplash/Danie Franco</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<strong>
Read more:
<a href="https://theconversation.com/its-hard-to-think-about-but-frail-older-women-in-nursing-homes-get-sexually-abused-too-107013">It's hard to think about, but frail older women in nursing homes get sexually abused too</a>
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<h2>Tailored training could help</h2>
<p>At the Health, Law and Ageing Research Unit we have developed an <a href="https://www.monash.edu/__data/assets/pdf_file/0008/2535758/PREVENTING_UNWANTED_SEXUAL_BEHAVIOUR_IN_RESIDENTIAL_AGED_CARE_SERVICES.pdf">e-training intervention</a> to improve sexual violence incident detection, management and prevention. It aims to promote collaboration with expert dementia and sexual violence support services.</p>
<p>The e-training intervention covers key definitions and characteristics, detection, management and ways to support resident victim-survivors, as well as tools to teach staff how to manage residents and prevent incidents.</p>
<p>Participants in our <a href="https://pubmed.ncbi.nlm.nih.gov/34399034/">study</a> who did the training reported better awareness, enhanced reflection on their current practice and improvement in sexual violence workplace management. The majority said they found the training relevant, practical and useful.</p>
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<h2>Only part of the solution</h2>
<p>This training provides a first step to identify the learning needs of this population. It provides a model curriculum to guide development of training initiatives nationally and internationally.</p>
<p>Advocate’s for reform have repeatedly detailed <a href="https://www.lawreform.vic.gov.au/wp-content/uploads/2021/07/Sub_3_Ibrahim_et_al_Health_Law_and_Ageing_Research_Unit_final.pdf">what else should be addressed</a>. This includes engaging government, insurers, boards of management and executives to resource and develop an organisational culture that eliminates sexual violence. </p>
<p>Preventing sexual violence should be of critical concern to Australia. We must move past reactive measures and unsubstantiated approaches such as asking staff to assess the impact of sexual violence. Instead we should be developing solutions to protect residents from incidents ever occurring.</p><img src="https://counter.theconversation.com/content/169734/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim received funding from Commonwealth Social Service (2015-17) and State Health Department (ongoing) for research, education and consultancies into residential aged care services and health care services. He also is an independent advocate for age care reform details available at <a href="https://www.profjoe.com.au/">https://www.profjoe.com.au/</a></span></em></p><p class="fine-print"><em><span>Amelia Grossi is a research assistant for The Victorian Institute of Forensic Medicine, Health, Law & Ageing Research Unit, Monash University. </span></em></p><p class="fine-print"><em><span>Daisy Smith is a research officer for The Department of Forensic Medicine, Health Law & Ageing Research Unit, Monash University.</span></em></p><p class="fine-print"><em><span>Meghan Wright is a research assistant for The Victorian Institute of Forensic Medicine, Health, Law & Ageing Research Unit, Monash University.</span></em></p>There are around 50 sexual assaults in Australian aged care homes every week. But staff are expected to assess the severity and impact of incidents without training.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityAmelia Grossi, Monash UniversityDaisy Smith, Research Assistant, Monash UniversityMeghan Wright, Research assistant, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1690592021-09-30T17:17:20Z2021-09-30T17:17:20ZBritney Spears gets free of father’s conservatorship – but many others remain shackled by the easily abused legal arrangement<figure><img src="https://images.theconversation.com/files/424052/original/file-20210930-22-1efo28n.jpg?ixlib=rb-1.1.0&rect=0%2C1365%2C3916%2C2523&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Britney Spears' supporters erupted in cheers after her father was removed as conservator.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PeopleBritneySpears/12fca10aaeda4b9ca43b5a7a3b5ec2b6/photo?Query=Britney%20AND%20spears&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=1508&currentItemNo=0">AP Photo/Chris Pizzello</a></span></figcaption></figure><p>Britney Spears finally got her wish: <a href="https://www.wvtm13.com/article/britney-spears-hearing/37787551">A judge suspended her dad as conservator</a>, about two and a half months after she told the court that <a href="https://www.nbcnewyork.com/entertainment/entertainment-news/britney-spears-says-father-jamie-is-ruining-her-life-and-wants-him-charged-with-conservatorship-abuse/3155432">he was ruining her life</a>.</p>
<p>During the Sept. 29, 2021, hearing, Spears’ lawyer, Mathew Rosengart, described Jamie Spears as a “cruel, toxic and abusive man” and cited a recent report in The New York Times that <a href="https://www.nytimes.com/article/controlling-britney-spears.html">he established an intense surveillance apparatus</a> to monitor and control his daughter. Earlier, Britney Spears claimed her father <a href="https://www.nytimes.com/2021/06/24/health/britney-spears-forced-IUD.html">even prevented her from having a baby</a>.</p>
<p>Whether or not the conservatorship is ended entirely won’t be decided until November. To <a href="https://www.cbsnews.com/news/britney-spears-conservatorship-father-how-to-end/">terminate a conservatorship</a>, California law simply requires the filing of a petition demonstrating <a href="https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=1861.&lawCode=PROB">that it is no longer required</a>. </p>
<p>Spears’ case is unusual: Conservatorships <a href="https://www.npr.org/2021/06/24/1009726455/britney-spears-conservatorship-how-thats-supposed-to-work">are typically not imposed</a> on someone who doesn’t have severe cognitive impairments. Since her conservatorship was put in place in 2008, <a href="https://www.newyorker.com/news/american-chronicles/britney-spears-conservatorship-nightmare">Spears has toured the world</a>, released four albums and earned US$131 million, all while deemed legally unfit to manage her finances or her own body. </p>
<p>But it does illustrate how easily <a href="https://theconversation.com/the-disturbing-history-of-how-conservatorships-were-used-to-exploit-swindle-native-americans-165140">conservatorships can be abused</a> – which is one reason some members of Congress <a href="https://www.nytimes.com/2021/07/15/us/politics/britney-spears.html">are considering ways to enact reforms to the state-run system</a>.</p>
<h2>What is a conservatorship?</h2>
<p>I teach about conservatorships in my course on aging and law and <a href="https://www.law.virginia.edu/faculty/profile/nrc8g/2915359">have written extensively</a> about the parent-child relationship. </p>
<p><a href="https://www.nolo.com/legal-encyclopedia/conservatorships-adult-guardianships-30063.html">Conservatorships are legal arrangements</a> that give a third party control over someone else. They can be imposed only by a court, and only a court can terminate them. The person put in charge of the person’s affairs is called the conservator, or the guardian in some states. </p>
<p><a href="https://scholar.smu.edu/cgi/viewcontent.cgi?article=1090&context=law_faculty">Conservatorships have been around for centuries</a> and are critical legal mechanisms to help people – often <a href="https://www.nature.com/articles/nrneurol.2014.181">older persons with dementia or other neurocognitive disorders</a> – who are <a href="https://law.justia.com/codes/california/2019/code-prob/division-4/part-3/chapter-1/article-1/section-1801/">considered unable to care</a> for themselves or their finances. </p>
<p>Conservators are subject to court oversight and are typically required to submit annual reports to the court. And California law – which <a href="https://www.aarp.org/money/estate-planning/info-2007/2007_21_guardians.html">is similar to the rules in most states</a> – <a href="https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=1850.&nodeTreePath=5.3.2&lawCode=PROB">requires the court to monitor</a> each conservatorship to protect against abuse and ensure that the conservator is acting in the best interests of the subject. </p>
<h2>Conservators often have broad powers</h2>
<p>Jamie Spears was <a href="https://www.cbsnews.com/news/britney-spears-conservatorship-updates/">appointed as conservator by a California court in 2008</a>. Since then, he’s reportedly received <a href="https://www.marketwatch.com/story/how-much-has-13-years-under-conservatorship-cost-britney-spears-11624654464">at least $5 million in fees</a>.</p>
<p>At different points in time, Jamie Spears has served as both the “conservator of the person,” which refers to someone able to make medical and other personal decisions on another’s behalf, as well as the “conservator of the estate,” which involves financial decisions. Most recently, before he was removed on Sept. 29, Spears <a href="https://www.npr.org/2021/07/14/1015674045/britney-spears-conservatorship-is-back-in-court-whos-who-and-what-they-want">served only in the second role</a>, while Jodi Montgomery, a licensed personal fiduciary and care professional, is Britney Spears’ conservator of the person. </p>
<p>The California judge <a href="https://www.nbcnews.com/pop-culture/pop-culture-news/freebritney-heads-court-judge-considers-terminating-britney-spears-conservatorship-n1279893">approved accountant John Zabel</a> as Jamie Spears’ successor as conservator of the estate, at least until the Nov. 12 hearing that will decide whether the conservatorship is terminated.</p>
<p>While the standard in many states is to impose the <a href="https://www.americanbar.org/content/dam/aba/administrative/law_aging/06-23-2018-lra-chart-final.pdf">fewest restrictions</a> so the person retains the most rights possible, the powers of a conservator can be broad. And the person subject to one may lose the right to marry, make a will, vote or consent to medical treatment. </p>
<p>And imposing a conservatorship is not supposed to be easy. California <a href="https://codes.findlaw.com/ca/probate-code/prob-sect-1823.html">requires “clear and convincing evidence”</a> that one is necessary. The law also states that the individual has the right to be represented. The one imposed on Spears, however, <a href="https://www.newyorker.com/news/american-chronicles/britney-spears-conservatorship-nightmare">was done quickly</a>.</p>
<h2>Conservatorship abuse and ‘anemic’ oversight</h2>
<p>Broad powers and what my colleague, Nina Kohn, has characterized as <a href="https://www.aging.senate.gov/imo/media/doc/SCA_Kohn_04_18_18.pdf">“anemic” oversight</a> make conservatorships subject to multiple forms of abuse, ranging from the imposition of unnecessary restrictions on the individual to financial mismanagement. Nothing can be done if no one finds out about the abuse. </p>
<p>A 2010 U.S. government report <a href="https://www.gao.gov/products/gao-10-1046">identified hundreds of allegations of physical abuse, neglect and financial impropriety</a> by conservators. Most of them related to financial exploitation, and that, in turn, often meant that the victim’s family was affected, losing not just expected inheritances but also contact with the person subject to the conservatorship.</p>
<p>A 2017 New Yorker article on abusive guardians <a href="https://www.newyorker.com/magazine/2017/10/09/how-the-elderly-lose-their-rights">highlighted the case of April Parks</a>, who was sentenced to <a href="https://apnews.com/article/248799d4fd254fdfa6df2e6c2db4dfcb">up to 40 years</a> in prison for financial conduct related to numerous conservatorships she handled. She was also ordered to pay more than half a million dollars to her victims.</p>
<p>But beyond these anecdotes, no one even knows the magnitude of the problem. That’s because conservatorships are subject to state law, and each state handles the imposition of them as well as data collection differently. A 2018 Senate report found that <a href="https://www.aging.senate.gov/hearings/ensuring-trust-strengthening-state-efforts-to-overhaul-the-guardianship-process-and-protect-older-americans%20report%20here:%20%20https://www.aging.senate.gov/imo/media/doc/Guardianship_Report_2018_gloss_compress.pdf">most states are unable to</a> report accurate data on conservatorships.</p>
<p>The National Center for State Courts estimated in 2016 that <a href="https://int.nyt.com/data/documenttools/warren-spears-letter/54dfe78a81eb7135/full.pdf">1.3 million adults</a> in the U.S. are subject to some kind of conservatorship – representing about $50 billion in assets – but a previous report <a href="https://ncsc.contentdm.oclc.org/digital/collection/ctadmin/id/1846">suggested the number of cases could be more than double that</a>. </p>
<p>There’s virtually no data on how often conservators misuse their power or when a conservatorship has been improperly imposed.</p>
<p>[<em>Over 110,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<h2>‘Free Britney’ may lead to reforms</h2>
<p>However, this may begin to change, thanks to growing publicity of the issue.</p>
<p>The 2020 Netflix movie “<a href="https://www.netflix.com/title/81350429">I Care a Lot</a>” told the story of a fictionalized abusive guardian played by Rosamund Pike, who won best actress at the Golden Globe for the role. And a 2020 episode of the investigative series “Dirty Money” profiled what it alleged was guardian abuse by several lawyers, including one who <a href="https://www.milforddailynews.com/story/news/courts/2020/09/27/defamation-lawsuit-against-netflix-linked-to-dirty-money-episode-guardians-inc-which-has-massachuset/42697355">subsequently filed a lawsuit claiming defamation</a>. </p>
<p>In February 2021, The New York Times aired “<a href="https://www.nytimes.com/article/framing-britney-spears.html">Framing Britney Spears</a>,” which documented her “yearslong struggle under” the conservatorship. Times reporters also <a href="https://www.nytimes.com/2021/06/22/arts/music/britney-spears-conservatorship.html">exposed confidential court records</a> that showed Britney Spears has been unhappy with her father since at least 2014. A court investigator in 2016, for example, wrote that the conservatorship “had become an oppressive and controlling tool against her.”</p>
<p>Now, members of Congress as ideologically opposed as Texas Sen. Ted Cruz and Massachusetts Sen. Elizabeth Warren <a href="https://www.nytimes.com/2021/07/15/us/politics/britney-spears.html">have joined the “Free Britney” cause</a> and are pushing for conservatorship reforms and more data on the legal arrangements. </p>
<p>While <a href="https://www.americanbar.org/groups/law_aging/resources/wings-court-stakeholder-partnerships0/guardianship-reform-wings-background/">states have made some improvements</a>, such as urging <a href="https://www.americanbar.org/content/dam/aba/administrative/law_aging/2017_SDM_%20Resolution_Final.pdf">more autonomy for conservatees</a> and less restrictive alternatives to conservatorships, <a href="https://www.aging.senate.gov/imo/media/doc/SCA_Kohn_04_18_18.pdf">reform advocates such as Kohn</a>, a Syracuse University law professor, say more is needed to protect the rights of individuals and prevent abuse, including stronger oversight. </p>
<p><em>This is an updated version of an <a href="https://theconversation.com/why-conservatorships-like-the-one-controlling-britney-spears-can-lead-to-abuse-164617">article originally published</a> on July 19, 2021.</em></p><img src="https://counter.theconversation.com/content/169059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Cahn does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Spears’ battle to end her conservatorship may lead to reforms.Naomi Cahn, Professor of Law, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1632602021-07-14T20:12:54Z2021-07-14T20:12:54ZSafe at home? We need a new strategy to protect older adults from violent crime<figure><img src="https://images.theconversation.com/files/411153/original/file-20210714-17-ja99g9.jpg?ixlib=rb-1.1.0&rect=51%2C8%2C5760%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/night-image-cute-modest-little-renovated-1833072724">Shutterstock</a></span></figcaption></figure><p>Compared to younger homicide victims, older homicide victims are more likely to be women who die in their own home at the hands of a stranger.</p>
<p>These are among the findings of our <a href="https://journals.sagepub.com/doi/10.1177/15248380211030250">review study</a>, published this week, examining the prevalence and nature of homicide of older people (aged 65 and over) in the community.</p>
<h2>What we did and what we found</h2>
<p>We pooled results from 17 studies on homicide in older people to gather information on the profile of the victim, perpetrator, motive, means and location.</p>
<p>Across the research we looked at, the homicide rate for adults 65 and older was 2.02 per 100,000 people. This was half the rate for younger adults (3.98 per 100,000). </p>
<p>Compared with younger adult homicide victims, we found older homicide victims were significantly more likely to be female. Some 46% of victims over 65 were women, compared with 26% of victims under 65.</p>
<p>The perpetrator was a stranger in almost one-quarter (24%) of older adult homicides, which is 1.8 times the rate seen for younger adult victims. </p>
<p>In another quarter (25%) of older adult homicides the perpetrator was a member of the victim’s family, which is similar to what we see in younger adult homicides. But in older adult homicides, intra-familial victim-offender relationships (for example, a child killing a parent) are more common, and the perpetrator is <a href="https://journals.sagepub.com/doi/10.1177/1088767910362328">less likely to be</a> an intimate partner. </p>
<p>The majority of the other relationship types were either acquaintances, or unknown.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/violent-crime-against-older-people-is-at-record-levels-heres-why-98266">Violent crime against older people is at record levels — here's why</a>
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<p>The motives most frequently reported for older adult homicides were related to an argument between the perpetrator and the victim, and/or crime-related, for example during a robbery. </p>
<p>Compared with younger adult homicide, older adults were almost three times more likely to have died during a crime against them, while an argument was 67% less likely.</p>
<p>In terms of the means, the odds of firearms being used was 62% lower for older victims. Firearms were involved in less than one-quarter of older adult homicides, compared to almost half of younger adult homicides.</p>
<p>While we didn’t analyse other means used, we know <a href="https://pubmed.ncbi.nlm.nih.gov/9544544/">physical assault without a weapon</a> is common in this context. Older people may be <a href="https://journals.sagepub.com/doi/10.1177/1088767903262396">more susceptible to assault</a> than younger people because of physical fragility and poorer biological capacity to recover.</p>
<p>As for the location, older adults were most often killed in their home (71%). This is almost a four-fold greater level than for younger adults. This disparity could potentially be explained by the fact <a href="https://journals.sagepub.com/doi/10.1177/1088767998002002003">older adults</a> likely spend more time at home compared with younger victims.</p>
<figure class="align-center ">
<img alt="An elderly woman at home." src="https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411154/original/file-20210714-23-1gptp4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Almost half of older homicide victims are women, compared to only one-quarter of younger homicide victims.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>COVID could make things worse</h2>
<p>While global homicide rates <a href="https://www.unodc.org/documents/data-and-analysis/gsh/Booklet2.pdf">are declining</a>, the rates for older adults either <a href="https://www.sciencedirect.com/science/article/abs/pii/S1752928X10000892">remain stable</a> or have <a href="https://injepijournal.biomedcentral.com/articles/10.1186/s40621-021-00299-w">slightly increased</a>, depending on the data you look at.</p>
<p>An ageing population could lead to an increase in the homicide rate <a href="https://academic.oup.com/bjsw/article/49/5/1234/5211414?login=true">because of factors</a> like caregiver stress, increasing prevalence of mental illness in the community, and inter-generational familial stressors, such as financial issues.</p>
<p>Contemporary pressures on older adults that may increase vulnerability to violent incidents include lack of appropriate housing, and inadequate mental health, disability and aged-care support.</p>
<p>Our study didn’t address whether the victims lived alone and/or were isolated from others, which would increase their vulnerability at home.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/homicide-is-declining-around-the-world-but-why-125365">Homicide is declining around the world – but why?</a>
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</em>
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<p>Importantly, COVID lockdowns have compounded these issues, and reduced service availability — especially for already marginalised groups including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234937/">older adults</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195322/">women</a>.</p>
<p>Indeed, the pandemic has seen an increase <a href="https://www.sciencedirect.com/science/article/pii/S106474812100018X">in elder abuse</a> and other forms of <a href="https://www.proquest.com/openview/11255fd2e5ba902a8cb651a20eeb035f/1?pq-origsite=gscholar&cbl=2043523">domestic violence</a>.</p>
<p>All of this adds to the complexity of keeping our most vulnerable safe. We need a different and targeted response to prevent homicides in older people. </p>
<h2>Older adult homicide is different from elder abuse</h2>
<p>Elder abuse can incorporate a range of physical, psychological, sexual and financial abuse and neglect of older people. </p>
<p>Some people may assume older adult homicide is simply an extension of physical or other types of elder abuse. But this is not the case; the characteristics we see in homicide cases in older people differ from elder abuse.</p>
<p>For example, an opportunistic robbery that becomes a fatal assault is very different to a familial caregiver restricting an older adult’s access to their finances.</p>
<p>Elder abuse as defined by the <a href="https://pubmed.ncbi.nlm.nih.gov/12384003/">World Health Organization</a> rarely leads to homicide, and homicides are not necessarily the result of <a href="https://journals.sagepub.com/doi/10.1177/1088767912438713">ongoing or recent elder abuse</a>.</p>
<figure class="align-center ">
<img alt="Yellow police tape in the forefront of a crime scene." src="https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411158/original/file-20210714-25-isu1h7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We need evidence-based strategies to protect older people against violent crime.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>Promising elder abuse <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291158/">interventions include</a> caregiver programs, coordinated responses from multidisciplinary teams, <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010321.pub2/information">emergency shelters and screening tools</a>.</p>
<p>But the existing strategies we use to reduce elder abuse may not be adequate to prevent older adult homicides.</p>
<p>To ascertain what sort of interventions would be most suitable, and to inform changes in policy and practice, we need better research describing victims, offenders, incident characteristics and <a href="https://doi.org/10.1016/j.avb.2019.08.008">risk factors</a> of older adult homicides.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-elder-abuse-and-why-do-we-need-a-national-inquiry-into-it-55374">Explainer: what is elder abuse and why do we need a national inquiry into it?</a>
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<p>Health-care professionals should be aware of the contexts in which an older adult may be more vulnerable to assault or violent death. </p>
<p>Older adults, their friends and family could look to ensure the safety of the home, reach out to improve social networks and ask for help when needed.</p>
<p>Our research shows older and younger adult homicides are not identical phenomena. As such, we need a different and tailored approach to preventing these violent deaths in older people, who are among the most vulnerable in our society.</p><img src="https://counter.theconversation.com/content/163260/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Briohny Kennedy receives a PhD stipend from Research Training Program funding administered by the Australian Government Department of Education, Skills and Employment. </span></em></p><p class="fine-print"><em><span>Joseph Ibrahim has received funding from Commonwealth and State Health Departments for research, education and consultancies into residential aged care services and health care services. He also is an independent advocate for age care reform details available at <a href="https://www.profjoe.com.au/">https://www.profjoe.com.au/</a></span></em></p>Older adults’ experience of violent death is different to that of younger adults, our new research finds.Briohny Kennedy, PhD Candidate, Monash UniversityJoseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1477362020-10-20T19:05:21Z2020-10-20T19:05:21ZDespite more than 30 major inquiries, governments still haven’t fixed aged care. Why are they getting away with it?<figure><img src="https://images.theconversation.com/files/363601/original/file-20201015-23-1w2a37e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our series on aged care. You can read the other articles in the series <a href="https://theconversation.com/au/topics/aged-care-series-2020-94869">here</a>.</em></p>
<hr>
<p>Australia’s aged care sector has been the subject of <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2019-12/background-paper-8.pdf">more than 30 major</a> inquiries and reviews since 1997. </p>
<p>It is fair to say the findings have been <a href="https://agedcare.royalcommission.gov.au/news-and-media/background-paper-8-history-aged-care-reviews">highly critical</a> of the way aged care is run in this country. Many of these concerns have been brought to light again — along with new issues raised — in the ongoing <a href="https://agedcare.royalcommission.gov.au/">Royal Commission</a> into Aged Care Quality and Safety.</p>
<p>Yet, as the <a href="https://agedcare.royalcommission.gov.au/news-and-media/background-paper-8-history-aged-care-reviews">royal commission has noted</a>, successive Australian governments have shown a “lack of willingness to commit to change”. </p>
<blockquote>
<p>Responses often come years after the review and recount what has been done in an almost tangential way.</p>
</blockquote>
<p>Even the establishment of the royal commission was not based on previous inquiries or recommendations, but in response to <a href="https://www.abc.net.au/4corners/who-cares/1025829">media exposés</a> of the appalling conditions in some aged care facilities. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aged-care-failures-show-how-little-we-value-older-people-and-those-who-care-for-them-103356">Aged care failures show how little we value older people – and those who care for them</a>
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<p>From these dysfunctional circumstances, three questions arise. </p>
<p>First, what are the ongoing issues with aged care in Australia? </p>
<p>Second, why have successive governments been comfortable making do with piecemeal solutions rather than truly “<a href="https://www.canberratimes.com.au/story/6462382/governments-have-failed-to-fix-aged-care/?cs=14231">fixing</a>” aged care, once and for all? </p>
<p>Finally, and most perplexingly, why have Australian voters let them get away with it? </p>
<h2>What’s the problem?</h2>
<p>It is important to emphasise that aged care is predominantly a federal government responsibility. The 1997 <a href="https://www.health.gov.au/health-topics/aged-care/about-aged-care/aged-care-laws-in-australia">Aged Care Act</a> is the main law covering government-funded aged care. This includes rules for funding, regulation, approval of providers, quality of care and the rights of those in care. </p>
<figure class="align-center ">
<img alt="Elderly woman looking out a window." src="https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363634/original/file-20201015-13-1t5e8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Royal Commission released a damning interim report into aged care in October 2019.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<p>Since 2019, the federal <a href="https://www.legislation.gov.au/Details/C2018A00149">Aged Care Quality and Safety Commission Act</a> regulates complaints, sanctions and enforcement, but has been criticised for <a href="https://www.smh.com.au/national/toothless-staff-at-aged-care-regulator-claim-they-lack-resources-and-power-20200819-p55nay.html">lacking teeth</a>. </p>
<p>The 1997 act diluted many preexisting regulatory protections, such as strict financial accreditation and staffing requirements, and opened the sector up to privatisation. At the time, <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/1996-99/aged/report/index">concerns were raised</a> the new regime could compromise standards of care in aged care facilities and disadvantage older people on lower incomes. </p>
<p>The concerns were raised again and amplified in subsequent years. For example, in 2011, a <a href="https://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-volume1.pdf">Productivity Commission report</a> noted Australia’s aged care system needed a “fundamental redesign”. </p>
<p>Here is a brief summary of the recurring issues raised in multiple reports: </p>
<ul>
<li><p>the huge difficulty people have <a href="https://agedcare.royalcommission.gov.au/news-and-media/royal-commission-aged-care-quality-and-safety-interim-report-released">navigating</a> the aged care system, including finding accurate information about facilities</p></li>
<li><p>failure to meet the needs of <a href="https://www.pc.gov.au/inquiries/completed/human-services/reforms/report">vulnerable</a> older people</p></li>
<li><p>poor quality care, especially for those with <a href="https://www.aph.gov.au/parliamentary_business/committees/senate/community_affairs/completed_inquiries/2004-07/aged_care04/report/index">dementia</a> and other disabilities</p></li>
<li><p>the use of chemical or physical <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/Human_Rights/QualityCareAmendment">restraints</a> </p></li>
<li><p>inappropriate <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2019-12/research-paper-1.pdf">staff ratios</a> and poor <a href="https://www.health.gov.au/sites/default/files/a-matter-of-care-australia-s-aged-care-workforce-strategy-at-a-glance-the-14-strategic-actions-of-australia-s-aged-care-workforce-strategy_0.pdf">training</a></p></li>
<li><p>the rising <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2020-06/consultation_paper_2_-_financing_aged_care_0.pdf">cost of care</a>, especially in light of an ageing population</p></li>
<li><p>adherence to <a href="https://apo.org.au/node/8564">accreditation</a> standards </p></li>
<li><p>ineffective <a href="https://www.anao.gov.au/work/performance-audit/managing-aged-care-complaints">complaints</a> mechanisms.</p></li>
</ul>
<h2>Why haven’t these problems been fixed?</h2>
<p>One of the major hurdles to real reform is the <a href="https://grattan.edu.au/report/rethinking-aged-care/">relationship</a> between the aged care industry and the federal government. </p>
<p>The government funds the sector and provides a relatively “<a href="https://www.monash.edu/__data/assets/pdf_file/0007/1408651/The-role-of-government-and-regulators-in-aged-care_Heather-Wellington.pdf">light-touch</a>” oversight, while the providers attend to the day-to-day running of the facilities.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/federal-government-did-not-prepare-aged-care-sector-adequately-for-covid-royal-commission-147307">Federal government did not prepare aged care sector adequately for COVID: royal commission</a>
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<p>However, there is concern this alignment has meant successive governments are not as involved as they should be and proposals for change are diluted by the influence of <a href="https://medium.com/lobbywatch/lobby-groups-and-the-australian-aged-care-sector-ced7d9babf18">industry lobbyists</a>.</p>
<p>Another reason for governments’ reluctance to intervene is many of the providers are “<a href="https://www.abc.net.au/news/2019-09-12/bupas-aged-care-homes-failing-standards-across-australia/11501050?nw=0">too big to fail</a>”. A facility’s licence and government funding can be withdrawn if standards are not met. Yet this <a href="https://www.abc.net.au/news/2019-10-10/gold-coast-earle-haven-nursing-home-will-not-reopen/11589148">rarely happens</a>.</p>
<p>Why? Because if a licence is revoked, residents need somewhere to go. The issues here can be seen in the closure of the <a href="https://www.theguardian.com/australia-news/2019/sep/11/gold-coast-aged-care-home-that-abruptly-shut-down-also-subject-of-abuse-claims">Earle Haven</a> nursing home in July 2019. Here, 68 elderly people were left homeless and had to be moved to hospitals and other aged care facilities. </p>
<p>As a further example, Bupa, one of Australia’s largest providers, <a href="https://www.abc.net.au/news/2019-09-12/bupas-aged-care-homes-failing-standards-across-australia/11501050?nw=0#:%7E:text=13%20Bupa%20homes%20have%20been,have%20had%20their%20accreditation%20revoked.">continues to operate</a>, despite sanctions or failing fundamental assessments.</p>
<h2>Why isn’t aged care a vote winner?</h2>
<p>After so many inquiries and so many <a href="https://www.abc.net.au/news/2020-07-30/how-to-help-elderly-family-dementia-aged-care-coronavirus/12504880">horror headlines</a>, the problems in aged care are well and truly common knowledge. But do Australians care enough about aged care for it to influence their vote — and so, influence the way governments respond?</p>
<p>If we cast our minds back to the 2019 federal election campaign, the hot button issue concerning older people was the potential demise of <a href="https://www.abc.net.au/news/2019-05-07/federal-election-2019-bill-shorten-q&a/11085052?nw=0">franking credits</a> and negative gearing.</p>
<figure class="align-center ">
<img alt="Australians voting at a polling booth." src="https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/363639/original/file-20201015-21-1aler2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aged care issues did not feature prominently in the 2019 federal election.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>In-home and residential aged care barely rated a mention in the campaigns of the major parties. </p>
<p>Even now, despite the <a href="https://www.theguardian.com/australia-news/2020/aug/24/royal-commission-blasts-morrison-government-for-inaction-on-aged-care">publicity surrounding</a> the royal commission, if an election was held today, would this issue actually influence voting intentions? Sadly, it seems unlikely. </p>
<p>During the July 2020 Eden-Monaro byelection, a <a href="https://www.agedcareinsite.com.au/2020/08/aged-care-is-in-crisis-and-we-dont-really-care-opinion/">survey of nearly 700 voters</a> showed while 84% believed the aged care system was “in crisis”, this influenced the vote of less than 4% of respondents. It also ranked last in a list of seven issues of importance. </p>
<p>When heartfelt concern does not translate to winning votes, there is little incentive for the federal government to provide meaningful solutions to well-documented problems. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-budget-must-address-aged-care-here-are-3-key-priorities-146678">The budget must address aged care — here are 3 key priorities</a>
</strong>
</em>
</p>
<hr>
<p>We only need to look to the record spending in the 2020 Budget, which provided only <a href="https://www.abc.net.au/news/2020-10-08/aged-care-budget-funding-for-home-care-packages-falls-short/12736428">23,000 extra</a> home care packages and <a href="https://grattan.edu.au/news/budget-2020-didnt-do-enough-to-fix-aged-care/">deferred consideration</a> of funding for residential aged care until the royal commission’s final report next year. </p>
<h2>It comes back to voters</h2>
<p>Why does concern for the plight of people in aged care fail to generate public action?</p>
<p>We suggest it is because many Australians consciously or unconsciously have <a href="https://fbe.unimelb.edu.au/__data/assets/pdf_file/0007/2729140/Research-Snapshot.pdf">ageist attitudes</a> — that older people are inherently not important. On this front, look no further than arguments made by <a href="https://www.theguardian.com/media/2020/aug/07/andrew-bolts-views-diagnosed-as-disgraceful-after-coronavirus-controversies">prominent commentators</a> about the fate of older people during COVID-19.</p>
<p>Yes, most fair-thinking Australians care about our older citizens, yet until either we or our family members are directly impacted, we do not prioritise it.</p>
<p>If we don’t care enough or care about other things more, nothing will change. And, while this remains the case, the government will have no reason to do more than just tinker with an unsatisfactory status quo.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-we-have-the-guts-to-give-older-people-a-fair-go-this-is-how-we-fix-aged-care-in-australia-147461">If we have the guts to give older people a fair go, this is how we fix aged care in Australia</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/147736/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Webb receives funding from Australian Housing and Urban Research Institute (AHURI), SA Health, and the Department of Social Services. She is is affiliated with the Australian Research Network on Law and Ageing (ARNLA) and the International Research Collaborative: Ageing, Law and Policy. </span></em></p><p class="fine-print"><em><span>Christie M. Gardiner is affiliated with the Australian Research Network on Law and Ageing (ARNLA), is an Organizer of the Law & Society Association's International Research Collaborative on Ageing, Law and Policy and holds memberships with the International Federation on Ageing, the Australian Association of Gerontology and CEPAR.</span></em></p><p class="fine-print"><em><span>Teresa Somes is affiliated with The Australian Research Network on Law and Ageing (ARNLA)</span></em></p>Thanks to review upon review, we have plenty of evidence about the problems in aged care. But federal governments have shown ‘a lack of willingness to commit to change’.Eileen O'Brien, Professor of Law and Ageing, UniSA: Justice and Society, University of South AustraliaChristie M. Gardiner, Associate Lecturer of Law, University of NewcastleTeresa Somes, Associate Lecturer, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1374302020-05-11T01:11:12Z2020-05-11T01:11:12ZCoronavirus lockdown measures may be putting older adults at greater risk of abuse<figure><img src="https://images.theconversation.com/files/333395/original/file-20200507-49558-kfpe9e.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5439%2C3634&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protective measures, such as lockdown, might put older adults at great risk of elder abuse.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/chiswick-suburb-summer-evening-london-1093071323">Alexey Fedorenko/ Shutterstock</a></span></figcaption></figure><p>Widespread media reports have highlighted the <a href="https://www.theguardian.com/society/2020/apr/12/domestic-violence-surges-seven-hundred-per-cent-uk-coronavirus">concerning rise in domestic violence</a> because of lockdown. Much of these reports have focused on the impact on women and children. However, many older adult victims of domestic violence are also at significant risk during the pandemic.</p>
<p>Older adults are more at risk from coronavirus due to age-related vulnerability often resulting from <a href="http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/statements/statement-older-people-are-at-highest-risk-from-covid-19,-but-all-must-act-to-prevent-community-spread">pre-existing health conditions</a>. But safety measures put in place to protect them from the virus may also be placing them at greater risk of experiencing elder abuse. Factors including isolation, depression and unemployment are all increasing because of the global pandemic – and these have been <a href="https://www.sciencedirect.com/science/article/pii/S1359178918303471?casa_token=VwHfitHoJz4AAAAA:JOTTK4aHHC2e5JqGu8LKgMshQcoReh2WoX-DCSy9LptD9abG_EMkqgA1DrbBOMT21EkPHASVkSg">identified as risk factors</a> in cases of elder abuse.</p>
<p>Adding to this problem is increased strain on health and social care services for older adults – partly because of heightened demand and staff shortages as a result of furlough. Older adults may therefore face the difficult choice of staying in an abusive situation (with less professional support) or fleeing the situation (with limited options of places they can go) but increasing their risk of contracting COVID-19. </p>
<p>Research into elder abuse has identified a number of factors that increase the <a href="https://www.sciencedirect.com/science/article/pii/S1359178918303471?casa_token=VwHfitHoJz4AAAAA:JOTTK4aHHC2e5JqGu8LKgMshQcoReh2WoX-DCSy9LptD9abG_EMkqgA1DrbBOMT21EkPHASVkSg">risk of abuse</a>. </p>
<p>Perpetrators of elder abuse are more likely to:</p>
<p><strong>Be dependent on the older adult victim:</strong> This dependence is often caused by unemployment or having low income. It may also be due to mental health or substance abuse problems. The global pandemic and subsequent lockdown has increased rates of unemployment and decreased income for many.</p>
<p><strong>Suffer from mental health problems, particularly depression:</strong> Lockdown and social isolation has increased stress, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756979/">reduced social contact</a> and <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2648.2010.05383.x">time outdoors</a>, which are all associated with depression.</p>
<p><strong>Feel highly stressed and lack the ability to cope:</strong> A pandemic is a highly stressful event and the lockdown has limited some of our usual coping mechanisms, such as socialising and playing sports.</p>
<p><strong>Report feeling more socially isolated and less supported:</strong> Reducing social contact is the objective of the lockdown and could lead to reduced social support.</p>
<p><strong>Report feeling resentful of and unhappy with their caregiving roles:</strong> The need to shield older adults from the virus may lead to increased caring responsibilities, such as getting food and medicine for older relatives.</p>
<h2>Protecting the elderly</h2>
<p>Victims of elder abuse are also more likely to be dependent on others for support and functional needs such as cooking and personal care. During social distancing, older adults may become more dependent on others. They may also be socially isolated or lack social support, which are also <a href="https://reader.elsevier.com/reader/sd/pii/S1359178918303471?token=35B2BFC6334332A7BDD4967F417EFA50601194225836D32704579346ED5F9D114925557F59897424ACB76AC8803E898">risk factors</a> for abuse.</p>
<p>Limited contact with friends and family to protect from the virus can also mean that the victim has fewer people to talk to about the abuse they may be experiencing. This also means there may be fewer people around to notice signs of abuse.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333396/original/file-20200507-49546-h8yv1b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Isolation might mean loved ones miss potential signs of abuse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-handicapped-lady-wearing-face-mask-1677576226">FamVeld/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Victims of elder abuse are also more likely to report <a href="https://reader.elsevier.com/reader/sd/pii/S1359178918303471?token=35B2BFC6334332A7BDD4967F417EFA50601194225836D32704579346ED5F9D114925557F59897424ACB76AC8803E898">mental health problems</a> – particularly depression, high stress and an inability to cope evidenced by behaviours such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13454">self-neglect</a>. All of these could be worsened during lockdown.</p>
<p>Elder abuse tends to be more common in communities where victims and perpetrators lack mental health treatment or social care resources in the community. Lockdown has increased demand for these services – but many of the organisations that provide the services have <a href="https://www.civilsociety.co.uk/news/age-uk-to-furlough-70-of-its-staff.html">decreased funding and staff</a>. Many older adults may not be able to access services that have moved online as a result of the pandemic – and many may be unable to pay for necessary care and treatment.</p>
<p>Sadly, many measures taken to protect older adults from coronavirus may inadvertently create conditions that increase instances of elder abuse. It is important to rethink how services are provided in order to stop this from happening.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-lockdown-is-a-dangerous-time-for-victims-of-domestic-abuse-heres-what-you-need-to-know-134072">Coronavirus lockdown is a dangerous time for victims of domestic abuse – here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<p>One barrier to reporting elder abuse is <a href="https://www.ncbi.nlm.nih.gov/pubmed/31291837">lack of knowledge about services</a>. It will be important to raise awareness about <a href="https://www.ageuk.org.uk/">available services</a> among older adults – especially about <a href="https://wearehourglass.org/">services available</a> in their community and how they can safely and privately access these services.</p>
<p>For these service and for criminal justice institutions, targeting older adults most at risk could be done by using tools such as the <a href="https://storeyje1.wixsite.com/drjenniferestorey/the-earli">Elder Abuse Risk Level Index (EARLI)</a>. The EARLI is a risk-assessment tool that guides users in identifying the risk of elder abuse in a given case and putting strategies in place to keep the older adult safe.</p>
<p>Only about <a href="https://www.who.int/news-room/fact-sheets/detail/elder-abuse">one in 24 cases</a> of elder abuse is reported. And where victims are isolated with their abusers, they may be even less likely or able to ask for help during the lockdown period. It’s critically important to check in on known victims of elder abuse and on older adults who are particularly vulnerable. </p>
<p>We should also be increasing general awareness about the signs of elder abuse and how to respectfully talk to older adults about abuse. This will allow friends and family to identify signs of abuse, seek help and advice from services and talk to loved ones. Anyone can report suspected elder abuse or reach out for guidance from elder abuse services. </p>
<p>More awareness and action can protect older adults during this pandemic, and in the future.</p>
<p><em>If you are experiencing abuse, or are concerned about someone who is, contact: <a href="https://www.ageuk.org.uk/information-advice/health-wellbeing/relationships-family/protection-from-abuse/">Age UK Advice Line</a> 0800 678 1174 or <a href="https://wearehourglass.org/">Hourglass</a> 0808 808 8141.</em></p><img src="https://counter.theconversation.com/content/137430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Storey is an author of the Elder Abuse Risk Level Index (EARLI).</span></em></p><p class="fine-print"><em><span>Michaela Rogers does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Safety measures put in place to protect older people from contracting COVID-19 may also be placing them at greater risk of experiencing abuse.Jennifer E Storey, Lecturer in Forensic Psychology, University of KentMichaela Rogers, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1225262019-12-09T13:43:50Z2019-12-09T13:43:50ZWhy the holidays are a prime time for elder abuse, and what you can do to thwart it<figure><img src="https://images.theconversation.com/files/304145/original/file-20191127-112526-1x8tuvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scams of elders are common during the holidays, when companies prey on people's loneliness and longing to help their families.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-senior-man-credit-card-using-1185760159">Andrey_Popov/Shutterstock.com</a></span></figcaption></figure><p>The holiday season brings up memories and emotions for people of all ages, but elders are often overlooked. This time of year also can provide an opportunity to become more alert to signs of elder abuse, aware of how to help and available to begin sincere conversations with older adults about their perceptions of abuse and the remedies they recommend. </p>
<p>The World Health Organization estimates that <a href="https://doi.org/10.1016/S2214-109X(17)30006-2.">one in six older adults</a> worldwide is a victim of elder abuse. As the global population grows grayer, this issue is only expected to increase. There are now more adults age 65 or older than there are children under five, and the number of adults age 85 or older is projected to triple from today, exceeding <a href="https://www.un.org/en/sections/issues-depth/ageing/">425 million by 2050</a>, according to the United Nations.</p>
<p>As director of the <a href="https://gero.usc.edu/secure-old-age/">Secure Old Age Lab</a> at the University of Southern California Leonard Davis School of Gerontology, I have spent the past several decades devoted to researching issues and interventions around elder abuse. It is important to recognize that there are actions family members and friends can take to prevent abuse while respecting the dignity and autonomy of their older relatives.</p>
<h2>Financial abuse of older adults</h2>
<p><a href="https://www.aarp.org/money/scams-fraud/info-2019/holiday.html">Financial fraud</a> is rife this time of year. That’s because the holidays can be a peak season for scammers who capitalize on the generosity of their victims. </p>
<p>Financial elder abuse is a growing problem that, while likely underreported, can cost older Americans approximately <a href="https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/">US$3 billion to $37 billion each year</a>, according to National Council on Aging estimates.</p>
<p>Here are some examples:</p>
<ul>
<li>An older adult is contacted by someone claiming to represent a charity and is convinced to wire a donation right away.</li>
<li>A grandparent gets a call from an alleged grandchild facing an emergency – they could be in jail in a foreign country, or in an accident out of state – and in urgent need of money to save them from a horrific fate.</li>
<li>An unsuspecting senior is congratulated for winning a sweepstakes and told to pay a processing fee with a gift card that is then quickly depleted of its value.</li>
</ul>
<h2>Beyond stranger danger</h2>
<p>While it is important to be on the lookout for the variety of scams targeting older adults, it is also important to know that most elder abuse is <a href="https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/">committed by family members</a>. And, <a href="https://www.justice.gov/file/1098056/download">abuse by family members</a> often goes beyond the financial to the emotional and even the physical.</p>
<p>The consequences cost lives: One study found that older adults who have been abused have a more than <a href="https://jamanetwork.com/journals/jama/fullarticle/187817">200% higher risk of death</a> when compared to those who have not been mistreated. Additional research associates elder abuse with <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15773">serious social and physical injuries</a>, including increased risk for depression, emergency room visits, hospitalizations and nursing home placements. </p>
<h2>Why it’s hard to stop</h2>
<p>One of the most challenging aspects in addressing elder abuse is in determining what is and is not a <a href="https://www.ncbi.nlm.nih.gov/pubmed/30901075">good outcome</a>. Of course, putting an end to all forms of abuse is desired but at what cost? If the solution to being abused by a family member at home involves the older adult being placed in a facility against his or her will, many people might, correctly in some cases, not consider that a successful resolution. </p>
<p>In addition to stigma, shame and fear of retribution, these concerns may prevent victims from seeking help. Medical providers, who are mandated to report abuse to Adult Protective Services, have also expressed concerns that filing reports can sometimes lead to more harm being done if patients lose trust or resist treatment as a result.</p>
<p>Several state and national studies, largely funded by the <a href="https://www.nia.nih.gov">National Institute of Aging</a> and the <a href="https://nij.ojp.gov">National Institute of Justice</a>, are currently underway to help inform the development of improved programs and effective treatment options. My USC colleague <a href="https://gero.usc.edu/faculty/diana-homeier-m-d/">Diana Homeier</a> and I designed a pilot program that, according to preliminary reports, may show promise. In this program, a team member is assigned to visit victims at home. He or she then represents the victim’s perspective to our team of medical and legal professionals, who discuss cases and determine the best course of action. </p>
<p>At the individual level, there are small steps we can all take to prevent and address elder abuse. </p>
<ul>
<li>Provide social support: It is important to ensure that older adults don’t become isolated. Be sure to check in on them or ask others to do so if you are not close by.<br></li>
<li>Give caregivers a break: Caregiver stress may contribute to forms of abuse. It can be alleviated by making sure they get the support and respite they need. </li>
<li>Pay attention to details: Notice the appearance of bruises on the body and the disappearance of money from bank accounts.</li>
<li>Start conversations: Older parents should be clear with their children and caretakers about what they want as they age. Elder abuse should be openly discussed as the stigma around it only helps hide it. </li>
<li>Know where to go: Call 911 in an emergency, or Adult Protective Services in your county. Also <a href="https://ncea.acl.gov">The National Center on Elder Abuse</a> has resources available online.</li>
</ul>
<p>Perhaps the most meaningful gift you can give an older adult, and your future self, is attention to their health and safety and wishes not just during the holidays but all the days of the year.</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/122526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Wilber receives funding from the National Institute of Justice, the Administration for Community Living, the National Institute of Aging, the Archstone Foundation, AARP, the County of Los Angeles.</span></em></p>People often associate the holidays with children, leaving older adults out of mind, but there’s reason to pay attention to them at this time of year. They are a prime target for financial scammers.Kathleen Wilber, Professor of Gerontology, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1202082019-07-24T19:28:20Z2019-07-24T19:28:20ZWebcams in nursing home rooms may deter elder abuse – but are they ethical?<p>Mary Ann Papp’s daughter Lisa was worried about her 75-year-old mother. </p>
<p>A foot infection seemed to be going untreated, leading Lisa to fear that her mother’s nursing home wasn’t providing proper care. </p>
<p>So Lisa did what any concerned child might: She bought a US$199 webcam from Target and put it in her mother’s room.</p>
<p>But she found that nursing home staff kept pointing the camera away from Mary Ann’s bed or unplugging it. Eventually, Lisa bolted it to a piece of furniture and brought a formal complaint against the facility. </p>
<p>In May 2017, the Minnesota Department of Health <a href="http://www.startribune.com/minnesota-maltreatment-finding-is-a-victory-for-granny-cams/423931753/">decided in the Papp family’s favor</a>: The nursing home had to allow a camera in Mary Ann’s room. </p>
<h2>A web of privacy issues</h2>
<p>Papp’s fight to monitor her mother’s care reflects a reasonable fear. More than <a href="https://www.kff.org/other/state-indicator/number-of-nursing-facility-residents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">1.3 million</a> Americans live in nursing homes, and elder abuse can be a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29333999">killer</a>. </p>
<p>Every year, <a href="https://www.cnn.com/2017/03/17/health/nursing-home-sex-abuse/index.html">news reports</a> surface about nursing home staff <a href="https://abcnews.go.com/WNT/video/hidden-camera-captures-michigan-nursing-home-employee-allegedly-53661394">physically</a> or <a href="https://www.cnn.com/interactive/2017/02/health/nursing-home-aide-rape-charges/">sexually assaulting</a> patients. Physical and <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2013.1261">cognitive vulnerabilities</a> may make it <a href="https://www.nejm.org/doi/10.1056/NEJMra1404688">difficult for residents to report abuse</a> or to have their reports taken seriously.</p>
<p>Web-enabled digital cameras offer one solution. Evidence suggests that ever more people are putting <a href="https://www.mcknights.com/news/momentum-grows-for-in-room-cameras-at-nursing-homes/">cameras</a> in a relative’s room to detect and deter abuse, though exact numbers are unknown as the practice is often done covertly. Seven states have passed <a href="https://theelderlawjournal.com/2019/02/18/levy-kilgour-and-berridge/">laws</a> enabling families to monitor the care of aging relatives this way. </p>
<p>But nursing home surveillance has significant <a href="https://theelderlawjournal.com/2019/02/18/levy-kilgour-and-berridge/">legal</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/23294515.2019.1568320">ethical</a> implications, according to two multidisciplinary studies we published in 2019.</p>
<p>Chief among them is privacy. The most intimate care activities are conducted in view of the camera: washing, using a bedpan, changing underwear. Sensitive conversations with visitors, from clergy to romantic partners, may also be recorded. </p>
<p>“Is this really what the resident would want to have recorded about themselves?” asked one respondent to our <a href="https://www.tandfonline.com/doi/full/10.1080/23294515.2019.1568320">survey on webcams in nursing homes</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285397/original/file-20190723-110166-qk8vh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Small, cheap and reliable webcams allow people to keep an eye on elderly relatives.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU2MzkyNzU3NCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTM2NTE4ODQzOCIsImsiOiJwaG90by8xMzY1MTg4NDM4L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJPQTdXOEk2ejVaNUJZVmNZZXRHbUx4R0h1S2MiXQ%2Fshutterstock_1365188438.jpg&pi=33421636&m=1365188438&src=UqFi3fBbDazJjXJv9x011A-1-11">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Recorded without permission</h2>
<p>Consent is another tricky issue.</p>
<p>While state laws regulating camera use require consent from the patient, roughly half of U.S. nursing home residents <a href="https://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf">have dementia</a>, according to the Centers for Disease Control and Prevention. These residents are unlikely to be consulted about camera installation, because they lack, or are perceived to lack, capacity for consent. </p>
<p>In these cases, children often act as parents’ legal proxy to give consent on their behalf.</p>
<p>Even when parents are capable of consenting, we found, children may simply want to avoid <a href="https://www.ncbi.nlm.nih.gov/pubmed/31102442">conflict with a parent</a> and judge it easier to install an always-on camera without discussion. </p>
<p>Since nursing home rooms are <a href="https://www.ncbi.nlm.nih.gov/pubmed/24352532">usually shared</a>, the consent and privacy of roommates presents an ethical problem, too. Inevitably, roommates’ conversations will be recorded, and they will be filmed when passing through a camera’s field of vision. </p>
<p>All of the <a href="https://theelderlawjournal.com/2019/02/18/levy-kilgour-and-berridge/">states that allow in-room cameras require that roommates or their legal representative be informed</a> of surveillance and allowed to require that the camera be pointed away from their bed. </p>
<p>But that’s no guarantee of privacy. Dementia or lack of familiarity with technology may mean roommates cannot adjust cameras to protect their privacy. And because nursing homes and assisted living facilities in the U.S. are dangerously <a href="https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html?module=inline">understaffed</a>, their caretakers may be unavailable to offer tech assistance when needed.</p>
<h2>Negative impacts on care</h2>
<p>Webcams are a consumer response to the United States’ inadequate long-term care system.</p>
<p>Long-term care in the United States is <a href="https://academic.oup.com/innovateage/article/2/suppl_1/224/5169878">poorly funded</a>, primarily by Medicaid. <a href="https://www.medicare.gov/coverage/nursing-home-care">Medicare</a> covers acute but not <a href="https://www.nytimes.com/2019/05/13/business/washington-long-term-care.html">ongoing services and supports</a>. Most Americans <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05233">can’t afford</a> the care they will <a href="https://www.nytimes.com/2019/05/10/health/assisted-living-costs-elderly.html">need</a> as they age.</p>
<p>As a result, the nursing home staff trusted to do this demanding and fraught work receive <a href="https://phinational.org/wp-content/uploads/legacy/phi-nursing-assistants-key-facts.pdf">low pay</a> – on average, making <a href="https://www.bls.gov/oes/2017/may/oes311014.htm">$27,470 a year</a>. Turnover is particularly high among caregivers who provide <a href="https://phinational.org/wp-content/uploads/legacy/phi-nursing-assistants-key-facts.pdf">the most hands-on</a>, intimate care in American nursing homes. </p>
<p>For these staff, the same in-room cameras that ease families’ fears often produce anxiety.</p>
<p>Respondents to our <a href="https://www.tandfonline.com/doi/full/10.1080/23294515.2019.1568320">survey of 273 staff at American nursing homes and assisted living facilities</a> said that surveillance could create a culture of mistrust. Ubiquitous webcams make eldercare workers feel that they aren’t seen as capable of professional, moral behavior. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285399/original/file-20190723-110149-iqd7dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kevin Perez, 19, assists resident Belle Bishop, age 93, with her cellphone at the Hebrew Home at Riverdale, New York, May 25, 2017.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Nursing-Home-High/dcb72299607041edae707e93a39c5872/176/0">AP Photo/Richard Drew</a></span>
</figcaption>
</figure>
<p>“It feels like … having a supervisor or someone breathing over your shoulder at all times,” one nursing home worker said, adding that cameras “take away employees’ confidence.”</p>
<p>That, in turn, has a chilling effect on the relationship between patients and their caregivers.</p>
<p>“There are no advantages that outweigh the concerns and the kind of culture you create by doing this,” one respondent asserted.</p>
<p>Additionally, while media coverage of elder abuse typically focuses on abuse by nursing home staff, <a href="https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/">studies</a> show that in almost 60% of elder abuse and neglect incidents, the perpetrator is a family member. </p>
<h2>Investment needed</h2>
<p>The demoralizing effects of in-room cameras, coupled with the ethical and privacy concerns that they raise, indicate that webcams are not the solution to preventing abuse in elder care facilities.</p>
<p>Our work points instead to the need for <a href="https://www.nytimes.com/2017/06/13/opinion/youre-probably-going-to-need-medicaid.html">more U.S. government investment</a>. </p>
<p>With better pay and working conditions, nursing homes could attract more direct-care staff who would stay in their jobs longer and be more invested in their workplace. Nursing assistants could get to know residents, and keep a better eye on them. Enhanced training on recognizing and reporting abuse would also promote accountability.</p>
<p>Such improvements will only become <a href="https://phinational.org/news/new-research-7-8-million-direct-care-jobs-will-need-to-be-filled-by-2026/">more critical</a> as the U.S. population ages, further straining the <a href="https://phinational.org/wp-content/uploads/2017/11/workforce-shortages-phi60issues01.pdf">care workforce</a>.</p>
<p>National efforts like the “<a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2009.0966">culture change</a>” movement – an attempt underway since the 1980s to make nursing homes more home-like with more privacy and individual care – are already empowering staff and residents and bettering the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.12987">quality</a> of <a href="https://www.ncbi.nlm.nih.gov/pubmed/30234764">care</a>.</p>
<p>According to one <a href="https://www.ncbi.nlm.nih.gov/pubmed/23514674">2014 study</a>, in states where Medicaid rewarded culture change practices through “pay-for-performance” reimbursement policies, nursing homes were far more likely to employ these practices. </p>
<p>More public investment could expand these promising efforts, giving families real peace of mind about their older parents’ safety and ensuring Americans get quality care in old age. </p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/120208/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors of this story received an Academic Research Grant from the Borchard Foundation Center on Law and Aging. A portion of Clara Berridge's time was supported by a T32 Department of Health and Human Services, National Research Service Award.</span></em></p><p class="fine-print"><em><span>Karen Levy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ever more Americans are using digital cameras to keep an eye on elderly relatives who live in nursing homes. This surveillance may violate patients’ privacy and demoralize their caretakers.Clara Berridge, Assistant Professor, School of Social Work, University of WashingtonKaren Levy, Assistant Professor, Department of Information Science, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1185692019-06-14T12:41:35Z2019-06-14T12:41:35ZElder abuse increasing, without increased awareness<figure><img src="https://images.theconversation.com/files/278739/original/file-20190610-52771-174ky8h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Elder abuse is far more common than many believe, making an already challenging time of life harder for those who are victims of it.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/care-worker-mistreating-elderly-man-238722568?src=kUXOOljZCgIpxNx-nHIBeQ-1-4">SpeedKingz/Shutterstock.com</a></span></figcaption></figure><p>About <a href="https://www.who.int/news-room/fact-sheets/detail/elder-abuse">16% of older adults</a> are victims of some form of mistreatment and the number of reported cases of elder abuse is <a href="https://www.usnews.com/news/health-news/articles/2019-04-04/elder-abuse-on-the-rise-in-america">steadily increasing</a>. Because of poor record-keeping, however, those of us who study elder abuse don’t know if the trend reflects an actual increase, an increase because of growing numbers of older adults, or only an increase in reporting due to greater awareness. </p>
<p>Elder abuse involves intentional or unintentional acts that result in physical, emotional or financial harm to an individual who is 65 years or older. In the Western world, one could make the case elder abuse was brought to public awareness in <a href="http://www.shakespeare-online.com/plays/kinglear/examq/mtwo.html">1608 with the publication</a> of Shakespeare’s “King Lear.” The play is plotted around the mistreatment of an elderly nobleman by his two daughters. However, it was not until the 20th century that the first political conversation about elder abuse appeared in <a href="https://babel.hathitrust.org/cgi/pt?id=mdp.39015031741195;view=1up;seq=1">the U.S. national record</a>. </p>
<p>Stories about elder abuse, including one in April 2018, involving a 70-year-old woman who was <a href="https://www.apnews.com/ef2166ebe0c543edac852f2931729bf1">kept in a dog kennel</a> and tortured by a family member, are not uncommon. Two sisters were arrested in March 2019 for <a href="https://www.huffpost.com/entry/sisters-charged-with-murdering-dad-after-the-man-theyre-both-dating-told-police_n_5c80323de4b06ff26ba555c1">murdering their 85-year-old father</a>. In April 2019 fraud and embezzlement charges were leveled against the manager of <a href="https://www.huffpost.com/entry/stan-lee-manager-elder-abuse_n_5ce9b499e4b00356fc227ebb">Stan Lee</a>, age 95, the late comic book legend. And most recently, a sheriff in rural Georgia was arrested May 29, 2019 for allegedly <a href="https://www.news4jax.com/news/bacon-county-sheriff-charged-with-grabbing-75-year-old-by-throat">grabbing a 75-year-old man</a> by his throat.</p>
<p>As gerontologists who have worked in the field and studied elder abuse for many years, we recognize the challenges behind meaningful conversations about elder abuse. The topic not only raises concerns about older adults we love, but also raises uncomfortable feelings about people we might trust and maybe even our own possible fate. We also are concerned because of the growing aging population. If older people are targets for people’s anger or rage and there are few programs in place to help them, what might this mean? </p>
<h2>Elder abuse is complex</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/279393/original/file-20190613-32335-krodnb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Elder abuse takes many forms, including emotional, financial and physical abuse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adult-woman-has-headache-she-sitting-1160020060?src=kUXOOljZCgIpxNx-nHIBeQ-1-68&studio=1">AimPix/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Elder abuse has many forms. The <a href="https://www.justice.gov/file/1098056/download">Department of Justice</a> estimates that the most prevalent form is financial exploitation, which affects about 5.2% of older adults, then neglect (5.1%), followed by psychological abuse (4.6%), physical abuse (1.6%) and sexual abuse (0.6%). As with the woman kept in a dog kennel, many victims experience multiple forms of abuse. </p>
<p>While the Centers for Disease Control called for standardized nationwide <a href="https://www.cdc.gov/violenceprevention/pdf/EA_Book_Revised_2016.pdf">elder abuse surveillance</a> in 2016, and <a href="https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/">standard definitions exist</a>, elder abuse is still treated as a state problem with each state having its own definitions and reporting systems. Adult Protective Services, federally funded by the Administration on Aging but state-administered to investigate allegation of elder mistreatment, instituted the National Adult Maltreatment Reporting System (NAMRS). However, data are available only since 2016 and participation by states is voluntary and only <a href="https://acl.gov/programs/elder-justice/national-adult-maltreatment-reporting-system-namrs">reported cases are included</a>.</p>
<p>Making it more complex is that elder abuse occurs in many different settings: private homes, nursing homes, assisted living facilities and public places. It also involves different types of perpetrators. A <a href="https://www.nij.gov/topics/crime/elder-abuse/Pages/extent.aspx">study funded by the National Institute of Justice</a> showed that most perpetrators knew their victims and included spouses, family members, acquaintances and health care professionals. Yet even strangers can be perpetrators.<br>
As a result, identifying a single cause or a simple prevention strategy is very difficult because of the interaction among the form of abuse, the setting and the relationship of the perpetrator to the victim.</p>
<h2>Research on elder abuse is scant</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/279395/original/file-20190613-32351-192pf7l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Financial abuse of older people can ruin their lives.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-teaching-confused-senior-older-267286940?src=jgbFGKdjgiTZ5We82STOTQ-1-20&studio=1">pathdoc/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Elder abuse has not been a national research priority. There has never been a nationwide prevalence study of elder abuse. Research is limited to reported cases, and only about <a href="https://www.who.int/news-room/fact-sheets/detail/elder-abuse">one in 24 cases of abuse</a> is reported. Many go unreported because older adults may not know how to get help or may be incapable of asking for help. Some older adults are unwilling or hesitant to report because they believe abuse is a family matter, or that the objectionable behavior isn’t really abuse. They may be ashamed and embarrassed. They may fear reporting will make the situation worse. They may even love the abuser and don’t want them to get into trouble.</p>
<p>Elder abuse has serious consequences. Studies suggest more than <a href="https://www.ncbi.nlm.nih.gov/pubmed/15804552">US$5.3 billion</a> is spent annually on medical care related to injuries incurred by older adults as a result of violent crime. Costs related to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965589/">premature deaths, illnesses and suffering</a> and costs related to other than “violent” crime, such as psychological abuse and neglect and the emotional toll on individuals who are already vulnerable, are incalculable. Every year <a href="http://documents.truelinkfinancial.com/FINAL_infographic_for_print_sm.pdf">older adults lose $36.5 billion</a> to exploitation, stranger fraud or violations of trust from family, friends and paid caregivers.</p>
<p>Social <a href="https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/">isolation breeds</a> elder abuse. Because the victims are usually socially isolated, no one is present to observe the perpetrator’s behavior. Even if there is someone to tell, the older adult may not be believed. Social isolation breeds loneliness, and loneliness is the “hook” of most financial scams experienced by older adults. Loneliness coupled with a real need for support services can drive older adults to form quick and unvetted relationships.</p>
<h2>Things to be aware of on June 15</h2>
<p>To fully understand the various causes of elder abuse and possible remedies for the various forms of abuse, the various settings and the various perpetrators need to be studied separately. Supporting victims to increase reporting is also essential. </p>
<p>People need to take personal responsibility and report what they see or suspect. We should also be aware of the importance of continued federal and local support for programs like those supported by the <a href="https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx">Area Agencies on Aging</a>, which are typically designated by states to meet needs older people in local and regional areas, and <a href="https://www.mealsonwheelsamerica.org">Meals on Wheels</a>. These groups not only provide support services but also decrease social isolation. </p>
<p>Finally, we need to provide personal contact for the older adults in our orbits. For older adults, personal contact with caring others not only prevents elder abuse, it can saves lives.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=thanksforreading">Thanks for reading! We can send you The Conversation’s stories every day in an informative email. Sign up today.</a></em> ]</p><img src="https://counter.theconversation.com/content/118569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linda R. Phillips has in the past received funding from NIJ/NIA on this topic and from the Research Retirement foundation. Her current position is partially funded by the Health Resources Administration (HRSA) through the Geriatric Workforce Enhancement Program.(GWEP).
</span></em></p><p class="fine-print"><em><span>Lisa Marie O'Neill has served on the Arizona Governor's Council on Aging, and her research has been funded by the Health Resources and Services Administration.. </span></em></p>World Elder Abuse Awareness Day is June 15; were you aware? Not many people are, yet abuse is growing. Two experts explain the trend and offer possible solutions.Linda R. Phillips, Professor (Emeritus) of Gerontological Nursing, University of ArizonaLisa Marie O'Neill, Associate Director of Research and Education, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1033352019-02-21T19:05:20Z2019-02-21T19:05:20ZWhen granny flats go wrong – perils for parents highlight need for law reform<figure><img src="https://images.theconversation.com/files/259629/original/file-20190219-121757-52twqm.jpg?ixlib=rb-1.1.0&rect=1527%2C0%2C3393%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Granny flats are often the result of informal arrangements between parents and children who assume it will all work out well.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/australian-residential-backyard-granny-flat-540473419?src=8nmKLvUcptrsHRPPcvnHIA-1-0">Markus J/Shutterstock</a></span></figcaption></figure><p>A “granny flat agreement” is an informal arrangement between a parent and their adult child or children. The parent (often elderly) contributes funds to create granny flat accommodation either by modifying a home or by buying a suitable property in the name of the children. In return they agree to provide the parent with a lifetime right to live in the granny flat, or at least until the parent needs residential care. </p>
<p>Many of these arrangements work out well. The older person then enjoys the love and support of having their family close by as they age. </p>
<p>When an arrangement of this kind goes wrong, however, it can seriously threaten the wealth, autonomy and dignity of the elderly parent. If the relationship between the parent and child, or child’s spouse, breaks down and the parent is asked to leave the property, he or she may be left with nothing. </p>
<hr>
<p><em><strong>Read more:</strong> <a href="https://theconversation.com/flatting-in-retirement-how-to-provide-suitable-and-affordable-housing-for-ageing-people-101598">Flatting in retirement: how to provide suitable and affordable housing for ageing people</a></em></p>
<p><em><strong>Read more:</strong> <a href="https://theconversation.com/co-housing-works-well-for-older-people-once-they-get-past-the-image-problem-79907">Co-housing works well for older people, once they get past the image problem</a></em></p>
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<h2>How does the law treat granny flats?</h2>
<p>The parent’s only chance of recovering her contribution is to go to court. These court cases depend on applying a complex set of rules.</p>
<p>The parent must prove the contribution was not a gift but that they supplied funds as part of an arrangement that the parties would live together. Agreements creating interests in land need to be <a href="https://www.legislation.nsw.gov.au/#/view/act/1919/6/part4/div1/sec54a">in writing</a>, and usually there is no written agreement. </p>
<p>The court can apply <a href="https://www.translegal.com/legal-english-dictionary/equitable-principle">equitable principles</a>. A parent who contributed to improving the property ought to have the contributions back, or a proportionate share of the property returned if the arrangement ends prematurely, because it is unjust for children to retain the benefit of the contribution without providing the granny flat. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259631/original/file-20190219-121735-4pcoyq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A parent who made a contribution to renovations or extensions ought to get that back if living arrangements break down.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/building-site-uk-brick-house-extension-1248532891?src=8nmKLvUcptrsHRPPcvnHIA-1-11">Paul Maguire/Shutterstock</a></span>
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<p>Where the court finds that the parent relied on a promise by the child that the parent would have an interest in the house, or at least a right to live with the child for life, the child can be required to repay the contribution.</p>
<p>This often means the child must sell their house if they cannot refinance to obtain the money to pay the parent. If the parent is entitled to a share of the property, the house has to be sold to realise the parent’s share. </p>
<p>The problem for parents is that court cases cost money, unless Legal Aid is available, but only parents who are truly destitute qualify for assistance. The parent has to produce evidence of the arrangement or the promise. They often have to recount conversations from many years ago to prove there was an arrangement. The children have to spend money on their own lawyers.</p>
<p>Parents and children very rarely put these agreements in writing and almost never consult a lawyer. Sometimes, to help the child get finance, a parent may have told the lender the contribution was a gift. </p>
<p>All this makes court cases complex, difficult and expensive. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-financial-services-royal-commission-highlights-the-vulnerability-of-many-older-australians-93359">The Financial Services Royal Commission highlights the vulnerability of many older Australians</a>
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<p>In New South Wales, the <a href="https://www.legislation.nsw.gov.au/%7E/view/act/1984/147">Property (Relationships) Act 1984</a> may apply to granny flat disputes, but the parent still has to show how they contributed to the child’s property. Other states and territories – including <a href="http://classic.austlii.edu.au/au/legis/vic/consol_act/ra2008173/">Victoria</a>, <a href="https://www.legislation.sa.gov.au/LZ/C/A/DOMESTIC%20PARTNERS%20PROPERTY%20ACT%201996/CURRENT/1996.51.AUTH.PDF">South Australia</a>, <a href="http://www7.austlii.edu.au/cgi-bin/viewdb/au/legis/tas/consol_act/ra2003173/">Tasmania</a> and <a href="http://www7.austlii.edu.au/cgi-bin/viewdb/au/legis/act/consol_act/dra1994253/">ACT</a> – have similar laws for couples, which might apply to family arrangements. However, the NSW legislation is broader, which makes things worse for parents outside NSW.</p>
<p>When a dispute arises, the parties usually want to resolve the matter as quickly and as cheaply as possible. But court cases can take a year or more to get to hearing. Affidavits must be prepared and financial documents reviewed. During this time the parent may be living in emergency housing, often at public expense. </p>
<p>The picture gets worse if the child’s marriage breaks down. The parent’s claim then gets taken into family property proceedings between the child and their spouse in the Family Court or Federal Circuit Court. This can take even longer than going to the Supreme Court. </p>
<h2>A better way to resolve disputes</h2>
<p>Parties to these disputes need fast access to a system of practical rules for separating the parties’ property interests, and one that offers early mediation. These rules would cover factors such as increases in the value of the property, how long the parties lived together, what benefits they received, and other discretionary considerations. Such rules might provide the basis for a set of statutory guidelines for a tribunal to apply. </p>
<p>Civil and administrative tribunals <a href="http://www.ncat.nsw.gov.au/Pages/going_to_the_tribunal/going_to_the_tribunal.aspx">emphasise informality and conciliation</a>, so giving these tribunals jurisdiction to resolve granny flat disputes according to statutory guidelines would arguably be more efficient than going to the Supreme Court or Family Court. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=546&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=546&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=546&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=686&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=686&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259640/original/file-20190219-121735-1mofllw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=686&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Parents and children who trust each other may be reluctant to get legal advice on a granny flat arrangement, but they really should.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-woman-her-daughter-3651263?src=cCxaBBwnbC8Kyt-a3vwNWA-1-61">Alexander Raths/Shutterstock</a></span>
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<p>Parties really should seek legal advice on granny flat arrangements before they commit to the deal. But parents often trust their children and are optimistic that they can live together as a family. If a lawyer provides advice to an elderly parent individually and with an awareness of their client’s possible incapacity or vulnerability to undue influence, that gives all parties a chance to decide what they want to happen if the relationship breaks down. </p>
<p>Centrelink <a href="https://www.smh.com.au/money/how-to-give-property-to-your-kids-and-keep-the-age-pension-20151118-gl1ypg.html">recognises granny flat arrangements</a>, so parents’ contributions are not automatically <a href="https://www.humanservices.gov.au/individuals/enablers/gifting">treated as a gift</a>. Gifting attracts an asset test under which the parent might be deemed still to have the funds contributed, which could reduce their pension. </p>
<p>The children can also be worse off if the Tax Office considers that the child accepting the contribution made a capital gain because the parents’ contribution increased the value of the home. </p>
<p>Although the Australian Law Reform Commission has <a href="https://www.alrc.gov.au/publications/elder-abuse-report">looked at some aspects of this issue</a>, action is need to reduce the complexity of existing equitable and statutory rules. Elderly parents should not have to take their children to court in expensive legal proceedings to retrieve the contribution that was meant to ensure they had a secure home in their later years. </p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/we-need-more-flexible-housing-for-21st-century-lives-102636">We need more flexible housing for 21st-century lives</a>
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<img src="https://counter.theconversation.com/content/103335/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Lane does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents and children rarely put agreements about granny flats in writing and almost never consult a lawyer. But when these arrangements go wrong, the consequences can be disastrous and costly for all.Patricia Lane, Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1066072019-01-17T19:14:11Z2019-01-17T19:14:11ZAged care royal commission benefits Generation X: it’s too late for the silent generation<figure><img src="https://images.theconversation.com/files/254039/original/file-20190116-152983-r3k00j.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C994%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Healthy people now in their 50s and 60s will be the first generations to benefit from reform. For people already in care, changes will come too late.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-happy-blond-haired-mature-woman-1105621715?src=hzVE5gB5cx4Z3cX2MB5OmQ-2-48 ">from www.shutterstock.com</a></span></figcaption></figure><p>A surprising group of people stand to benefit from the <a href="https://agedcare.royalcommission.gov.au/Pages/default.aspx">aged care royal commission</a>, whose <a href="https://agedcare.royalcommission.gov.au/hearings/Pages/default.aspx">hearings</a> start today. These are residents of nursing homes in the far future — people in their 50s and 60s, and their children. How is that possible?</p>
<p>All current nursing home residents the royal commission was established to help will have died before there is any substantive change. </p>
<p>The latest <a href="https://www.gen-agedcaredata.gov.au/Resources/Access-data/2018/September/Aged-care-data-snapshot%E2%80%942018">statistics show</a> there are 207,142 older people living in 2,695 facilities owned by 902 different providers. These providers receive more than A$11.2 billion a year from the commonwealth government. A total of 57,769 residents, or more than 27%, <a href="https://www.gen-agedcaredata.gov.au/Topics/People-leaving-aged-care">die every year</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/many-older-people-in-care-die-prematurely-and-not-from-natural-causes-77942">Many older people in care die prematurely, and not from natural causes</a>
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<p>Residents on average live in nursing homes for <a href="https://gen-agedcaredata.gov.au/Topics/People-leaving-aged-care">two years and six months</a>. This is shorter than the average of <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Browse_by_Topic/law/royalcommissions#1977">three to five years</a> it takes for most royal commissions to form, investigate, conclude and deliver their recommendations. </p>
<h2>How did we get here?</h2>
<p>It’s been a long road to this royal commission, paved with repeated shocking and disturbing episodes of neglect, abuse and poor care for our vulnerable elderly parents, grandparents and neighbours in residential care.</p>
<p>However, <a href="https://service.sa.gov.au/cdn/icac/ICAC_Report_Oakden.pdf?platform=hootsuite">Oakden</a> was the final straw. The South Australian aged care mental health facility <a href="https://www.abc.net.au/news/2017-09-22/oakden-closed-as-last-two-residents-moved-out/8974156">closed</a> in 2017 <a href="http://www.courts.sa.gov.au/CoronersFindings/Lists/Coroners%20Findings/Attachments/774/ROLLBUSCH%20Graham.pdf">following revelations</a> of abuse and neglect <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/4ae57e8040d7d0d58d52af3ee9bece4b/Oakden+Report+Final+Email+Version.pdf?MOD=AJPERES&CACHEID=4ae57e8040d7d0d58d52af3ee9bece4b">dating back a decade</a>.</p>
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Read more:
<a href="https://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112">Too many Australians living in nursing homes take their own lives</a>
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<p>This royal commission has its genesis in the 1997 <a href="https://www.legislation.gov.au/Details/C2017C00241">Aged Care Act</a>. Perhaps its greatest failing was a lack of an explicit single national common standard and understanding of the purpose of residential aged care facilities. That is what should be achieved for the person who becomes a resident.</p>
<p>We all understand the purpose of child care, schools, hospitals and prisons. We judge these by how they improve the lives and well-being of people they serve. However, the absence of a common positive social understanding of the purpose of nursing homes contributes to the community’s inability to judge how well they perform. The Act describes nursing homes’ tasks, activities and services but this is not enough.</p>
<h2>Evidence was there, but not acted on</h2>
<p>Another important and under-recognised factor is that the decade the Aged Care Act was written coincided with new thinking around <a href="https://www.ncbi.nlm.nih.gov/books/NBK225182">patient safety</a>, <a href="https://community.cochrane.org/handbook-sri/chapter-1-introduction/11-cochrane/112-brief-history-cochrane">evidence-based practice</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113460/">clinical governance</a>.</p>
<p>However, over the next two decades, successive governments, regulators and providers did not manage to actively or sufficiently apply this new knowledge to practice. That includes evidence from premature deaths <a href="http://vifmcommuniques.org/residential-aged-care-communique/">investigated by coroners</a> across Australia.</p>
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Read more:
<a href="https://theconversation.com/what-is-quality-in-aged-care-heres-what-studies-and-our-readers-say-104852">What is 'quality' in aged care? Here's what studies (and our readers) say</a>
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<p>For instance, <a href="http://webarchive.nla.gov.au/gov/20040604221357/http://judgments.fedcourt.gov.au:80/2000/J000434.yes.htm">Riverside</a> nursing home’s licence was revoked after 57 residents had kerosene added to baths <a href="https://www.theage.com.au/national/kerosene-bath-nurses-banned-20020329-gdu35d.html">in January 2000</a> to control an outbreak of scabies. A fundamental contributing factor was the failure to apply up-to-date evidence. We’d known about a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000320.pub2/full">better treatment for scabies</a> since 1931.</p>
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Read more:
<a href="https://theconversation.com/theres-no-need-to-lock-older-people-into-nursing-homes-for-their-own-safety-73954">There's no need to lock older people into nursing homes 'for their own safety'</a>
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<p>In <a href="http://www.coroners.justice.nsw.gov.au/Documents/finding,%20recommendation%20and%20reasons%20-%20quakers%20hill%20fire.pdf">Quakers Hill</a>, a recently employed registered nurse admitted to deliberately lighting a fire that killed 14 people. Contributing factors included the failure of clinical governance systems to recognise and assist impaired health professionals; and a lack of scrutiny of the employee’s qualifications and credentials.</p>
<p>And in Victoria, staff <a href="https://www.coronerscourt.vic.gov.au/sites/default/files/2018-12/caterinamontalto_201711.pdf">failed to disclose</a> to the family, GP and coroner the true circumstances of a resident who was found dead, lying head-first in an outdoor water feature. A contributing factor was not promoting <a href="https://safetyhub.co.nz/wp-content/uploads/2013/09/Safety-Paradoxes.pdf">the right culture</a> for <a href="https://www.safetyandquality.gov.au/wp-content/uploads/2013/03/Australian-Open-Disclosure-Framework-Feb-2014.pdf">incidents to be reported and disclosed openly</a>.</p>
<h2>What will the royal commission uncover?</h2>
<p>The royal commission will revisit the known. It will also uncover more criminal acts and other deliberate acts of <a href="https://www.alrc.gov.au/publications/elder-abuse-report">elder abuse</a>. It will examine <a href="https://www.monash.edu/__data/assets/pdf_file/0009/1507914/Hazard-Edition-84.pdf">care that causes unintended harm</a> and <a href="https://www.mja.com.au/journal/2017/206/10/premature-deaths-nursing-home-residents-epidemiological-analysis">premature death from injury</a>. </p>
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Read more:
<a href="https://theconversation.com/elder-abuse-report-ignores-impact-on-peoples-health-75926">Elder abuse report ignores impact on people's health</a>
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<p>The scale of the investigation is enormous and far greater than most people realise. We don’t know the breadth and depth of harm across the nation as this has not previously been examined in a rigorous, systematic way that we do with health care. </p>
<p>The royal commission appears to have limited its investigation to the nature of care over the past five years, which covers the current 207,142 living residents and the those who died in the past five years (around 290,000 residents).</p>
<p>The health department’s submission to the <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportrep/024167/toc_pdf/ReportontheInquiryintotheQualityofCareinResidentialAgedCareFacilitiesinAustralia.pdf;fileType=application/pdf">House of Representatives inquiry into residential aged care</a> (<a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/AgedCareFacilities/Submissions">submission 72, p8</a>), advised receiving reports of assault or alleged assault of 1.2% of residents a year. Over five years, the total number of residents affected would be more than 12,400 incidents (1.2% of 207,000 residents each year for five years). </p>
<p>Along with these serious incidents of potential abuse remains the question of substandard clinical care. A conservative estimate would be based on the premise that aged care performs as well as health care, which <a href="https://www.gmc-uk.org/-/media/documents/preventable-patient-harm-across-health-care-services_pdf-73538295.pdf">harms a minimum of 6% of patients</a> from each interaction. This equates to more than 62,100 incidents of harm (6% of 207,000 residents each year for five years).</p>
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Read more:
<a href="https://theconversation.com/violence-between-residents-in-nursing-homes-can-lead-to-death-and-demands-our-attention-87087">Violence between residents in nursing homes can lead to death and demands our attention</a>
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<p>The scale of neglect and abuse is potentially so large the royal commission will be consumed with addressing the potential criminal and human rights abuses. This is also consistent with why royal commissions are usually called — to investigate corruption, impropriety, illegal activity or gross administrative incompetence.</p>
<p>The challenge facing the royal commission is to better understand and rectify substandard clinical care by identifying how the aged care sector, government, regulators and health professionals failed to recognise, report and address this harm. By comparison, we’ve know how to do this in the health care sector since 2000.</p>
<p>We also need the royal commission to lead to reforms that shift the sector from being ranked <a href="http://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Australia">17th of 96 countries internationally</a> to one that is exceptional, on par with the <a href="https://interactives.commonwealthfund.org/2017/july/mirror-mirror/#chapter5">performance of our health care system</a>.</p>
<h2>Who is this royal commission for?</h2>
<p>This royal commission matters most to those who are still young, healthy and living at home. It is this group who will receive the benefits of any positive reforms or suffer the consequences of any shortcomings. </p>
<p>Given the broad terms of reference for the royal commission, it is difficult to imagine how it will deliver its findings in 12 months. A more realistic estimate is the inquiry will take up to three years followed by a fourth year for the incumbent government to consider the recommendations, a fifth year for reform to be debated in parliament and legislated, then five years for any substantive policy and practice reforms to be put in place. </p>
<p>This takes us to 2030, by which time at least four cohorts of residents will have entered a nursing home and died.</p><img src="https://counter.theconversation.com/content/106607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim has received funding from Commonwealth and State Health Departments for research, education and consultancies. He was an expert witness for the Coroner's Court in South Australia for the Inquest into a resident's death at Oakden and provided evidence to the multiple inquiries into aged care including but not limited to those lead by Carnell-Paterson, Senate and, House of Representatives. </span></em></p>By the time the aged care royal commission’s recommendations lead to improvements in our nursing homes, four cohorts of residents will have died. Here’s why.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1070132018-11-21T19:02:27Z2018-11-21T19:02:27ZIt’s hard to think about, but frail older women in nursing homes get sexually abused too<figure><img src="https://images.theconversation.com/files/246401/original/file-20181120-161627-1j21y5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eliminating sexual abuse in nursing homes is a major challenge.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>We don’t often think of older women being victims of sexual assault, but such assaults <a href="http://apo.org.au/node/40334">occur in many settings</a> and circumstances, including in nursing homes. Our research, published this week in the journal <a href="https://www.sciencedirect.com/science/article/pii/S1344622318302608#">Legal Medicine</a>, analysed 28 forensic medical examinations of female nursing home residents who had allegedly been victims of sexual assault in Victoria over a 15-year period. </p>
<p>The cases were examined by Clinical Forensic Medicine – a division of the Victorian Institute of Forensic Medicine – between January 1, 2000 and December 31, 2015.</p>
<p>The majority of the alleged victims had some form of cognitive or physical impairment. All 14 perpetrators who were reported were male, half of whom were staff and half other residents. The majority of case reports didn’t indicate whether the alleged victim had received treatment for the assault. </p>
<p>The most frequent alleged sexual contact was vaginal contact or penetration. Injuries weren’t reported for every case. Where present, they consisted of bruising, skin tears, redness and swelling. </p>
<p>The physical examination was often limited because of the cognitive status (in 38%) of the individuals, physical issues (in 31%), lack of cooperation (23%), and poor examination conditions (23%). Data on alleged victims’ behaviour was commonly missing. </p>
<p>These information gaps highlight the difficulty of examination which is essential to a detailed investigation. A better understanding of the context and setting of the assault, which is usually available when younger women are victims, is essential to inform prevention efforts.</p>
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Read more:
<a href="https://theconversation.com/sexual-assaults-in-psych-wards-show-urgent-need-for-reform-14265">Sexual assaults in psych wards show urgent need for reform</a>
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<p>Eliminating sexual assault in nursing homes is a major challenge which starts with acknowledging it exists and recognising the scale of this abuse.</p>
<h2>Much higher than we think</h2>
<p>Sexual assault is <a href="https://www.ncbi.nlm.nih.gov/pubmed/24652890">considered</a> the most hidden, as well as least acknowledged and reported, form of elder abuse. This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804623/">makes it difficult</a> to accurately estimate its prevalence.</p>
<p>Prior to 2007, it was estimated there were around 20,000 unreported cases of elder abuse, neglect and exploitation in Victoria. Between 2009-10 and 2014-2015 the <a href="https://www.ohchr.org/documents/issues/olderpersons/submissions/elderabusepreventionassociation.pdf">published number</a> of sexual assaults among older people rose from around 280 to 430 reports nationally (information about each jurisdiction was not available).</p>
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<a href="https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246590/original/file-20181121-161621-1sszb60.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Reliance on carers makes nursing home residents especially vulnerable to sex abuse.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>In 2015–2016 The Australian Department of Health <a href="https://www.alrc.gov.au/sites/default/files/pdfs/publications/elder_abuse_131_final_report_31_may_2017.pdf">was notified</a> of 396 reports of alleged or suspected unlawful sexual contact of residents in nursing homes in Australia.</p>
<p>Based on these statistics, we expected Victoria would have 80-120 sexual assaults of residents reported in nursing homes per year (equating to approximately 1,200 assaults during the study period). The 28 cases reported to the forensic investigation team over a 15 year period suggests under-recognition and under-reporting. </p>
<p>Nursing home residents are <a href="http://centeronelderabuse.org/docs/ConfrontingEMinLTC_GibbsMosqueda.pdf">particularly vulnerable</a> to sexual assault due to their dependency on caregivers, health problems, and the co-housing of residents, sometimes with <a href="https://www.researchgate.net/publication/50935751_State_Policies_for_the_Residency_of_Offenders_in_Long-Term_Care_Facilities_Balancing_Right_to_Care_With_Safety">potentially dangerous</a> older individuals with sexual assault backgrounds. </p>
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Read more:
<a href="https://theconversation.com/violence-between-residents-in-nursing-homes-can-lead-to-death-and-demands-our-attention-87087">Violence between residents in nursing homes can lead to death and demands our attention</a>
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<p>Negative stereotypes such as that older people aren’t sexual beings, their greater <a href="https://www.ncjrs.gov/pdffiles1/nij/grants/216550.pdf">dependency on others</a>, potential <a href="https://www.ncbi.nlm.nih.gov/pubmed/16430352">divided loyalty</a> to <a href="https://www.medscape.com/viewarticle/546942">staff members or residents</a> are unique barriers to reporting, detecting, and preventing sexual assault in nursing homes. Despite severe health consequences, efforts to prevent and address elder abuse <a href="https://www.ncbi.nlm.nih.gov/pubmed/22589024">remain inadequate</a>.</p>
<p>In the majority of cases we examined, signs of general or genital injury were not found. Further, post-assault victim responses, such as agitation, distress and confusion may mirror symptoms of cognitive impairment. This can create difficulties for nursing home staff in distinguishing between the usual behaviour or a response to trauma, such as sexual assault.</p>
<p>Also, nursing home victims of sexual assault tend to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/10868369">ignored by staff</a> who often don’t believe the accusations. Although we could not determine who or what prompted reporting, what is known is that sexual assaults are <a href="https://www.ncbi.nlm.nih.gov/pubmed/15611215">unlikely to have a witness</a>, though witnesses appear to be crucial to ensure successful prosecution.</p>
<p>Sexual assault, in any setting or age group, is one of the most difficult crimes to prosecute due to the required elements of intent and lack of consent. But this is made all the more complicated when it comes to nursing home residents.</p>
<h2>Awareness is crucial</h2>
<p>Staff must be aware of the existence of sexual assault in nursing homes. It is their duty as care providers to report alleged or suspected sexual assault in a timely manner. More education, training and research is needed to address the knowledge gaps around incidence, levels of reporting, nature of investigations, responses required to better assist the victim, and the interventions needed to prevent sexual assault.</p>
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Read more:
<a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">How our residential aged-care system doesn't care about older people's emotional needs</a>
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<p>Without a clear understanding of the alleged victim and incident characteristics, we will struggle to combat sexual assaults in nursing homes. There is an urgent need to better use the existing data held by the the Department of Health to understand the full extent of sexual assault in nursing homes. The Royal Commission is an opportunity to consider the development of tailored policies, staff training and legislation.</p><img src="https://counter.theconversation.com/content/107013/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim has received funding from Commonwealth and State Health Departments for research, education and consultancies into residential aged care services and health care. This research project was funded internal by the Health Law and Ageing Research Unit, Department of Forensic Medicine.</span></em></p><p class="fine-print"><em><span>Daisy Smith works for The Department of Forensic Medicine, Health Law & Aging Research Unit, Monash University. </span></em></p><p class="fine-print"><em><span>Lyndal Bugeja has received funding from the Federal Department of Social Services, and is currently in receipt of funding from Victorian Institute of Forensic Medicine providing research contributions to an unrelated project with the Clinical Forensic Medicine Unit, as well as Department of Forensic Medicine, School of Nursing and Midwifery, Monash University.</span></em></p>Eliminating sexual assault in nursing homes is a major challenge which starts with acknowledging it exists and recognising the scale of this abuse.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityDaisy Smith, Research Assistant, Monash UniversityLyndal Bugeja, Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1043082018-11-12T22:10:35Z2018-11-12T22:10:35ZDementia’s hidden darkness: Violence and domestic abuse<figure><img src="https://images.theconversation.com/files/244400/original/file-20181107-74754-4c1byl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dementia patients are often the perpetrators and often the victims of abuse. Research also shows that a medical history of head injury can more than double the risk of developing Alzheimer's disease in some populations, even after many years.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Every week in my neurology clinic, I see patients and their families who are dealing with the realities of dementia. Of the many people I encounter, these three stories highlight a growing health issue that I feel is neglected — the complex relationship between dementia and domestic violence. </p>
<p>The first is a story of confusion:</p>
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<p>“Dad is a nice guy, always has been. But now, because of the Alzheimer’s, he’s confused most of the time — and Mom isn’t coping. She doesn’t know what to do and she is frustrated. It started with her twisting his arm to get him to do things, but now she even hits him sometimes.”</p>
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<p>The second is a story of public safety: </p>
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<p>“The dementia has changed him — he’s not the same man I fell in love with and married so many years ago. He gets suspicious and angry a lot. He screams at me, he yells at our son, he shouts at the postman. He has even punched the caregiver who comes to help him bathe. I suppose we can cope, but I’m worried. We have two shotguns and a rifle in our basement — what do you think I should do with them?”</p>
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<p>The third is a scene of abuse: </p>
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<p>“I got divorced a long time ago because he used to hit me … a lot. He would get drunk every Saturday night and beat me up. He even knocked me out cold, probably five or six times. I haven’t seen him in more than 30 years, but I still feel that he is hurting me. Do you think all of these beatings caused my dementia? Did that bastard cause my dementia?”</p>
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<p>These stories are united by a common theme: the complex relationship between dementia and domestic violence. Today, both are commonplace. <a href="https://www.alz.org/media/HomeOffice/Facts%20and%20Figures/facts-and-figures.pdf">One in 10 people over 65 years of age in the United States have dementia</a>, typically Alzheimer’s disease (AD), and about one in four women and one in seven men in the U.S. <a href="https://www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf">experience severe physical abuse by an intimate partner</a> at some point during their life. </p>
<p>Alarmingly, evidence now suggests that there may be a complex but definitive link between dementia and domestic abuse. Notably, <a href="https://doi.org/10.1159/000093894">one case-control study</a> that I carried out with colleagues shows that spousal abuse could be associated with the development of Alzheimer’s. </p>
<h2>Caregiver abuse</h2>
<p>Abuse of older people is not a new problem. Elder abuse is a growing concern on a societal level, with <a href="https://www.cbc.ca/news/canada/elder-abuse-a-growing-dilemma-in-an-aging-population-1.1050233">more seniors reporting incidents of abuse and violence</a>. The abuser may be a partner, a relative, a friend or a paid caregiver. </p>
<p>Most abuse tends to take place in the privacy and supposed safety of the home — and so it’s typically a hidden problem. Yet, anywhere between <a href="https://doi.org/10.1093/ageing/afm194">five to 20 per cent of seniors globally may be physically abused, while up to 55 per cent may be abused in other ways</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Needing help with simple everyday tasks can be a huge blow to the sense of self and pride of someone dealing with dementia.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Patients with dementia are especially vulnerable to this disturbing trend. Unsurprisingly, caring for patients with dementia requires time and patience and, as with any advanced medical care, practice. </p>
<p>Dealing with dementia’s intellectual impairments can be especially challenging for unprepared caregivers and family members, and this frustration can sometimes lead to abuse.</p>
<h2>Violent mood swings</h2>
<p>Conversely, sometimes the person with dementia is the initiator of the violence rather than the recipient. The onset of dementia is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345875/">known to coincide with the development of aggressive and angry tendencies</a>. One study found that <a href="https://www.ncbi.nlm.nih.gov/pubmed/18258723">almost 20 per cent</a> of new dementia patients have behaved aggressively towards caregivers, including loved ones they’ve known for years. </p>
<p>It’s not hard to understand why. In the early phases of the disease, patients are acutely aware of the changes happening to their memories and thoughts and regularly feel overwhelmed. As the disease progresses, they may need help dressing, bathing or performing simple everyday activities, which they have done for themselves, without help, for all of their lives. </p>
<p>This can be devastating to a person’s pride or sense of self; sometimes these emotions can manifest as unusually aggressive or hostile behaviour. Dementia can also trigger violent mood swings and outbursts. At times, these can be extreme; a patient may seem perfectly fine one moment, then be screaming and overtly physical the next. </p>
<p>As yet, it’s a mystery as to why these outbursts occur. But it is possible that changes in the brain’s neurochemistry may destabilize moods and cause more violent emotions.</p>
<h2>‘Punch drunk’</h2>
<p>Finally, there is the possibility that abuse that occurred decades ago could be contributing to the onset of dementia today. There has been much debate as to whether head trauma can lead to dementia or Alzheimer’s disease later in life. </p>
<p>Typically, associations have been vague, and it seemed unlikely that trauma from years ago, with no other apparent effects, could somehow lead to dementia. But we now appreciate that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221805/">head trauma can be a major risk factor for dementia and Alzheimer’s</a>. In fact, as far back as 1928, the term <a href="https://jamanetwork.com/journals/jama/article-abstract/260461">“punch drunk”</a> was introduced to describe a disorder of progressive dementia that was first seen in boxers. </p>
<p>This was later called “dementia pugilistica” and is known today as <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/chronic-traumatic-encephalopathy-(cte)">chronic traumatic encephalopathy (CTE)</a>. Recent research suggests that concussions and other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835563/">traumatic brain injuries may increase the early brain pathologies that lead to the development of Alzheimer’s later on</a>. </p>
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<span class="caption">‘Punch drunk’ was a term used to describe the behaviour of boxers who had suffered repeated severe blows to the head.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Also, a medical history of <a href="http://dx.doi.org/10.1136/jnnp.74.7.857">head injury can more than double the risk</a> of developing Alzheimer’s disease in some populations, even after many years.</p>
<p>With the <a href="http://apps.who.int/iris/bitstream/handle/10665/112325/WHO_RHR_14.11_eng.pdf?sequence=1">World Health Organization estimating that up to 30 per cent of women worldwide have experienced violence from an intimate partner</a>, the global burden of domestic abuse on Alzheimer’s may be a critical factor.</p>
<h2>A call to action</h2>
<p>Despite its obvious significance, this dementia and domestic violence overlap remains under-recognized and incompletely understood. It’s not a new problem, but because it tends to be conveniently ignored, it has yet to garner proper scientific scrutiny.</p>
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<a href="https://theconversation.com/traumatic-brain-injury-the-unseen-impact-of-domestic-violence-92730">Traumatic brain injury: The unseen impact of domestic violence</a>
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<p>The growing prevalence of both dementia and domestic violence is worrisome. We need to appreciate the clear relationship between Alzheimer’s and domestic violence. </p>
<p>As science grapples with these uncomfortable questions over the years to come, stopping the spread of domestic violence seems like an obvious, and feasible first step.</p>
<p>Dementia is more than just three stories or some ambiguous science; it is a call to action.</p><img src="https://counter.theconversation.com/content/104308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Donald Weaver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From aggressive patients with Alzheimer’s to frustrated caregivers, dementia is increasingly entwined with violence in private homes and residential facilities.Donald Weaver, Professor of Chemistry and Director of Krembil Research Institute, University Health Network, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/986392018-06-20T08:37:51Z2018-06-20T08:37:51ZPolitics Podcast: Attorney-General Christian Porter on a crowded agenda<p>Attorney-General Christian Porter says the response to the <a href="https://www.nationalapologyconsultation.gov.au/">consultations for the national apology</a> to victims of child sexual abuse has been very strong with a total of 167 attendees at consultation sessions so far. “There are further consultations coming up in Ballarat, Melbourne, Bendigo, Newcastle and Sydney … it is a very important process and is going very well,” he said.</p>
<p>Porter also says there’s “some level of common sense” to suggestions that former Prime Minister Julia Gillard, who set up the royal commission, should have a role in the apology. “I do think those things are best dealt with by exchange of letter or meetings directly between the Leader of the Opposition and the Prime Minister.”</p>
<p>In this interview Porter also speaks about foreign interference laws, elder abuse, the amalgamation of the Family and Federal Circuit courts, and why he rejects calls for change to section 44 of the constitution.</p><img src="https://counter.theconversation.com/content/98639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Christian Porter says the response to the consultations for a national apology to victims of child sexual abuse has been very strong with a total of 167 attendees at consultation sessions so far.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/933592018-03-15T06:49:46Z2018-03-15T06:49:46ZThe Financial Services Royal Commission highlights the vulnerability of many older Australians<p>One worrying takeaway from the first week of the Financial Services Royal Commission is how many elderly people are being adversely affected by irresponsible lending. </p>
<p>Such lending is often the result of an agreement with a family member, for example an adult child, to help that person financially by entering into a joint loan. These loans are secured against the older person’s home, which is a huge risk if the loan defaults and the older person cannot service the debt. </p>
<p>To ensure that older people contemplating joint loans are aware of the downside of transactions, there needs to be greater access to legal and financial advice prior to the transaction and better training for bank employees and loan officers about responsible lending obligations and the potential “unsuitabilty” of such loans. </p>
<p>Consideration should also be given to larger penalties for banks that provide unsuitable loans to older people.</p>
<p>Other examples we have seen this week include an elderly woman who has been <a href="https://www.themorningbulletin.com.au/news/financial-services-royal-commission-begins-public-/3359815/">paying off the same A$1,000 since the 1990s</a>, and a 72-year-old nurse who was <a href="http://www.abc.net.au/news/2018-03-12/banks-lending-practices-questioned/9534010">permitted to borrow</a> more than A$3 million to buy 11 investment properties. </p>
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Read more:
<a href="https://theconversation.com/what-the-royal-commission-can-do-if-the-banks-dont-play-ball-on-evidence-93283">What the Royal Commission can do if the banks don't play ball on evidence</a>
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<p>On the face of it, there are laws that should safeguard elderly consumers from “getting in over their head”. </p>
<p>When a consumer applies for credit, the <a href="http://www.austlii.edu.au/cgi-bin/viewdb/au/legis/cth/consol_act/nccpa2009377/">National Consumer Credit Protection Act</a> obliges a credit provider to make reasonable inquiries about the consumer’s financial situation and their requirements and objectives. </p>
<p>In so doing, the credit provider must take reasonable steps to verify the consumer’s financial situation. This means that payments <a href="http://download.asic.gov.au/media/2243019/rg209-published-5-november-2014.pdf">must be able to be made without substantial hardship to the consumer</a>. </p>
<p>However, the Consumer Action Law Centre <a href="https://policy.consumeraction.org.au/wp-content/uploads/sites/13/2018/01/180122-Consumer-Action-Sub-to-Royal-Commission-Part-1-FINAL.pdf">says</a> that “it is common that these steps are not adequately followed by lenders”.</p>
<p>Even if these steps are followed, the legislation does not define “substantial hardship”. There is a presumption that if a consumer must sell their principal residence to pay back a loan, this demonstrates substantial hardship. </p>
<h2>Emotional lending</h2>
<p>Of particular concern is when an older person is persuaded to enter into a joint loan with a third party, such as their son or daughter. These loans are invariably secured by the older person’s property, with the younger person agreeing to pay off the debt. </p>
<p>If the adult child does not pay off the debt, the older person – who is often asset-rich but income-poor – may be unable to service the loan. The older person’s property will be repossessed by the lender, forcing them to relocate, enter the rental market, or even become homeless. </p>
<p>The loans may arise simply because the older person wants to help their adult child through a difficult financial period. It is understandable that a parent would want to help if a business is failing or a child is at risk of losing their house. </p>
<p>But such loans often arise within an atmosphere of crisis (real or exaggerated), in which the adult child pressures the older person into entering into the loan. </p>
<p>In extreme cases, older people <a href="https://www.perthnow.com.au/news/wa/adult-children-abusing-their-parents-to-get-into-the-perth-property-market-ng-43eaad1147bbc11bb20dc821e754eeaf">have been told</a> that they will be unable to see their grandchildren if they do not enter into loans. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-elder-abuse-and-why-do-we-need-a-national-inquiry-into-it-55374">Explainer: what is elder abuse and why do we need a national inquiry into it?</a>
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<p>It is not always that the older person is vulnerable per se, but that they are “situationally vulnerable” because of concern for the well-being of a child, or the desire to maintain relationships. </p>
<p>The reality is that it is often difficult for the older person to refuse. </p>
<p>Karen Cox of the Financial Rights Legal Centre <a href="https://www.themorningbulletin.com.au/news/financial-services-royal-commission-begins-public-/3359815/">noted</a> at the Royal Commission that these loans are:</p>
<blockquote>
<p>outright exploitative … elderly persons [are] left in dire circumstances as a result of a loan for which they’ve seen absolutely no benefit.</p>
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<p>Similar comments apply to other financial transactions made for the benefit of a third party such as entering into a “<a href="https://www.moneysmart.gov.au/superannuation-and-retirement/income-sources-in-retirement/home-equity-release/reverse-mortgages">reverse mortgage</a>”. This is where the older person takes out a loan against the equity built up in a home (or other asset), with the money given to a child to buy a house or prop up their business.</p>
<h2>What could be done?</h2>
<p>Advocates are rightly concerned about the financial consequences for older people who enter into such loans. However, the property does belong to the older person and they are entitled to make whatever decisions they want, including risky ones. </p>
<p>Elderly people should be fully informed of their obligations and the potential consequences, should a transaction goes wrong. Banks could lead the way with this.</p>
<p>One initiative would be for the banks to contribute to legal and financial advice for older people, or subsidise the provision of such advice at community legal centres.</p>
<p>Loan assessors and brokers must also be made aware of the risks of such transactions. </p>
<p>The Australian Bankers Association <a href="https://theconversation.com/how-can-we-prevent-financial-abuse-of-the-elderly-84991">is introducing</a> enhanced measures to address elder financial abuse and the risks associated with such loans should be emphasised.</p>
<p>Finally, the government should consider tougher penalties against credit providers who disregard responsible lending obligations. Presently, if a bank is found to have lent irresponsibly they will simply compensate the consumer for the loss. Meaningful penalties that deter reckless lending should be considered.</p><img src="https://counter.theconversation.com/content/93359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Webb receives funding from: Queensland Government (Department of Communities), Review of the prevalence and characteristics of elder abuse in Queensland - With Dr Barbara Blundell, Dr Joe Clare, Dr Mike Clare and Dr Emily Moir; 2017 - 2018 AHURI Older Australians and the housing aspirations gap - With Dr Amity James and Professor Steven Rowley; 2017 Bankwest Curtin Economics Centre Grant Strategies to enhance tenure security for WA's older renters - With Dr Amity James and Associate Professor Helen Hodgson; Eileen is a Foundation member of the Australian Research Network on Law and Ageing (ARNLA) and a member of the Western Australian Ministerial Committee on Consumer Law; and TenancyWA Boarders and Lodgers Working Group. Eileen is a Member of the Law Reform Commission of Western Australia. </span></em></p>In a period of declining housing affordability and precarious employment, older people are sitting on a “nest egg”.Eileen O'Brien, Professor, Curtin Law School, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/849912017-10-02T18:40:09Z2017-10-02T18:40:09ZHow can we prevent financial abuse of the elderly?<p>Throughout Australia older people are losing their savings, property and homes through financial abuse, usually at the hands of persons close to them such as an adult child or grandchild. </p>
<p>A sense of entitlement, ‘<a href="http://www.smh.com.au/money/planning/how-to-stop-elder-financial-abuse-at-the-hands-of-loved-ones-20160217-gmwwhz.html">Inheritance impatience</a>’ or opportunism can encourage people to 'help themselves’ to an older person’s assets. </p>
<p>Elder abuse is not a new problem. It has been occurring in Australia and elsewhere for generations - but its only now that serious steps are being taken to address it. </p>
<p>While the extent of elder abuse in Australia is unknown, conservative estimates suggest at least 9% of older Australians suffer from financial abuse. However, we know that because of the hidden nature of the problem, the majority of cases go unreported. </p>
<p>Sadly, a majority of elder financial abuse occurs within families, and is <a href="http://www.who.int/mediacentre/factsheets/fs357/en/">defined</a> as the illegal or improper use of a person’s finances or property by another person with whom they have a relationship implying trust.</p>
<h2>Government taking long overdue action</h2>
<p>On October 1 this year the Commonwealth Attorney General <a href="https://www.attorneygeneral.gov.au/Mediareleases/Pages/2017/FourthQuarter/International-Day-of-Older-Persons-Supporting-older-Australians.aspx">announced</a> ) a suite of measures to address elder abuse. These will include initiating a new peak body focused on elder abuse, an online knowledge hub, and education materials to better support older Australians.</p>
<p>But, as Michael Riley, CEO of the elder advocacy group Greysafe, <a href="https://www.greysafe.org.au/greysafe-calls-for-urgent-national-summit-to-develop-elder-abuse-action-plan/">notes</a>: “We know the problems, we now need an action plan and timelines put in place to come up with solutions.”</p>
<p>Financial elder abuse can take <a href="https://theconversation.com/close-to-home-financial-hazards-for-older-people-in-family-accommodation-16382">many forms</a> but common examples include misappropriation of the older person’s money; misuse of enduring powers of attorney; inappropriate dealing with an older persons property through a guarantee or an unauthorised mortgage; and failed assets for care arrangements. </p>
<p>The opportunities for elder financial abuse are exacerbated by the de-personalisation of banking services. An increase in electronic services means that older people are more vulnerable to such exploitation than in the past.</p>
<p>Although criminal law addresses matters such as theft and fraud, low conviction rates indicate the difficulty of bringing an elder abuse matter before a court. Furthermore, many older people do not want to pursue relatives in criminal proceedings – despite the experience they wish to maintain family relationships.</p>
<h2>How banks can help</h2>
<p>Part of the solution may rest with banks and financial institutions which are often at the front line when instances of elder financial abuse arise. </p>
<p>There has been some <a href="https://theconversation.com/the-problems-with-asking-banks-to-police-financial-abuse-79187">reluctance</a> on the part of banks and financial institutions to address elder abuse citing concerns regarding inter alia privacy obligations, legal liability, and the absence of a consistent reporting framework.</p>
<p>To date, some bank staff receive training to deal with elder abuse detection and banks follow the industry guideline, <a href="https://www.bankers.asn.au/images/uploads/ArticleDocuments/207/Industry_Guideline_Protecting_vulnerable_customers_from_potential_financial_abuse2.pdf">Protecting Vulnerable Customers from Potential Financial Abuse</a>. Banks have the capacity to identify suspect in-bank and electronic transactions. </p>
<p>While there is limited material publicly available regarding instances where banks have uncovered abuse, in the few reported <a href="http://www.theaustralian.com.au/national-affairs/state-politics/elderly-woman-suffered-immeasurably-after-neglect-by-daughter/news-story/5b59a003c3a4af12eceef2868203688b">cases</a> where significant physical abuse and neglect have been the subject of legal consideration, misappropriation of the older person’s funds has been a common factor.</p>
<p>In the absence of a broad national reporting framework, at present there is no cohesive strategy as to how to deal with the elder financial abuse. Furthermore, there are no whistleblower protections for bank employees who may be exposed to legal action from families in the event that financial abuse is not proven. This can make bank employees reluctant to report suspected abuse.</p>
<p>To address this, the Australian Law Reform Commission (ALRC) recommended that the <a href="https://theconversation.com/the-problems-with-asking-banks-to-police-financial-abuse-79187">Code of Banking Practice</a> should ensure that banks be obliged to take ‘reasonable steps’ to prevent the financial abuse of vulnerable customers. </p>
<p>Such <a href="https://www.alrc.gov.au/publications/recommendations-5">steps</a>) include training staff to detect (through software or other means) and appropriately respond to abuse; ensuring ‘Authority to Operate’ forms are not obtained fraudulently and providing a framework for reporting abuse. </p>
<h2>Federal Government must work with banks</h2>
<p>Addressing elder financial abuse must be a centrepiece of the federal government’s overall elder abuse strategy. The test will be how, and to what extent, the banks will collaborate with government, relevant agencies, and each other. </p>
<p>As it stands, the requirement to take ‘reasonable steps’ lacks definition; it could encompass significant reform or the bare minimum. Furthermore, a comprehensive internal reporting framework within the banks is essential. If this national initiative is to succeed - mandatory reporting by banks of suspected abuse should be seriously considered.</p>
<p>Finally, public education campaigns targeting older people themselves, persons entering into power of attorney arrangements, and bank staff is the key to preventing such conduct in the first place. </p>
<p>Elder financial abuse has the potential to devastate individuals at the most vulnerable point in their lives - as well as have a detrimental impact on society as a whole. </p>
<p>While the federal government efforts to address elder abuse are to be applauded - we must ensure the opportunity is fully utilized and includes proper regulations within the banking sector.</p><img src="https://counter.theconversation.com/content/84991/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Webb receives funding from: Queensland Government (Department of Communities), Review of the prevalence and characteristics of elder abuse in Queensland - With Dr Barbara Blundell, Dr Joe Clare, Dr Mike Clare and Dr Emily Moir; 2017 - 2018 AHURI Older Australians and the housing aspirations gap - With Dr Amity James and Professor Steven Rowley; 2017 Bankwest Curtin Economics Centre Grant Strategies to enhance tenure security for WA's older renters - With Dr Amity James and Associate Professor Helen Hodgson; 2016 - 2017 AHURI Can social impact investment make a difference to housing and homelessness outcomes? Supporting vulnerable households to achieve their housing goals: the role of impact investment - Project C -With Professor Gill North and Professor Richard Heaney Eileen is a Foundation member of the Australian Research Network on Law and Ageing (ARNLA) and a member of the Western Australian Ministerial Committee on Consumer Law; ShelterWA Board; ShelterWA Advisory Committee on Homelessness; and TenancyWA Boarders and Lodgers Working Group. Eileen is a Member of the Law Reform Commission of Western Australia.</span></em></p><p class="fine-print"><em><span>Teresa Somes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The federal governments efforts to tackle the financial abuse of elders is to be welcomed - but will banks be properly empowered to act?Eileen O'Brien, Associate Professor, Curtin Law School, Curtin UniversityTeresa Somes, Associate Lecturer, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759262017-06-15T00:59:10Z2017-06-15T00:59:10ZElder abuse report ignores impact on people’s health<figure><img src="https://images.theconversation.com/files/172656/original/file-20170607-5695-1x30mfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Elder abuse covers physical, sexual, psychological, emotional and financial abuse.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=qLGUben2CIC-F6xAluzo_g-1-2">from www.shutterstock.com</a></span></figcaption></figure><p>The good news is that Australia is doing something positive to improve the lives of our parents and grandparents. The bad news is we can no longer pretend there are golden years awaiting us all in old age.</p>
<p>The release today of the long awaited Australian Law Reform Commission (ALRC) report into <a href="https://www.alrc.gov.au/inquiries/elder-abuse">elder abuse</a> is a substantial step forward in addressing physical, sexual, psychological, emotional and financial abuse of the elderly.</p>
<p>As expected, the report only addresses the legal aspects of elder abuse. What is missing is the impacts of elder abuse on health and well-being, particularly as older people who are victims of abuse and neglect are <a href="http://www.tandfonline.com/doi/abs/10.1080/08946566.2016.1142920">more likely to die earlier</a>.</p>
<p>Despite this gap, we need to be brave enough to read the 428 page report, and act on the 43 recommendations.</p>
<p>Australia’s recent examples of confronting other sources of abuse and neglect – including the harm to the <a href="https://www.humanrights.gov.au/publications/bringing-them-home-report-1997">Stolen Generation</a>, <a href="http://www.childabuseroyalcommission.gov.au/about-us">child sexual abuse</a>, <a href="http://www.rcfv.com.au/Report-Recommendations">family violence</a> and abuse of people with a <a href="https://www.humanrights.gov.au/report-national-inquiry-human-rights-people-mental-illness">mental illness</a> – should prepare us to take this next step.</p>
<h2>Aged care a major target</h2>
<p>A total of 14 out of the ALRC’s 43 recommendations are about improving aged care, in both residential settings and the home.</p>
<p>Recommendations include improving the reporting and monitoring of serious incidents, such as sexual or physical abuse, with the process to be overseen by an independent body. While a reporting system will not prevent abuse, it is an essential and welcome first step.</p>
<p>Another recommendation addresses the perennial matter about quality of care and staffing in residential aged care services, including looking at optimal staffing models and levels.</p>
<h2>How little we know</h2>
<p>We know older people are at greater risk of abuse and neglect than the general population because of their physical frailty, cognitive impairment, multiple illnesses, social isolation, and need for assistance with personal or domestic tasks.</p>
<p>Yet, there is currently little information about the overall number and severity of incidents of elder abuse and neglect in Australia. Our recent <a href="https://www.mja.com.au/system/files/issues/206_10/10.5694mja16.00873.pdf">analysis</a> of coroners’ investigations into extreme incidents leading to death goes part way to addressing that issue.</p>
<p>So we welcome the report’s recommendation of a national study to tell us how common elder abuse in Australia is. Perhaps what is most confronting is that we do not already collect this information, even though we know it is occurring.</p>
<p>For instance, there’s evidence of nursing home residents who <a href="https://www.ncbi.nlm.nih.gov/pubmed/25630802">assault other residents</a>, <a href="https://academic.oup.com/gerontologist/article-abstract/doi/10.1093/geront/gnx022/3572447/A-Systematic-Review-of-Sexual-Assaults-in-Nursing?redirectedFrom=fulltext">sexual assault</a> and the use of <a href="https://academic.oup.com/ageing/article-abstract/doi/10.1093/ageing/afw246/2801280/Physical-restraint-deaths-in-a-13-year-national?redirectedFrom=fulltext">physical restraint</a> in aged care. But we have no overall picture of what’s happening.</p>
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<a href="https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172658/original/file-20170607-5680-6qaqdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Inappropriate care, including unnecessarily restricting where and when older people walk, also needs to be addressed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/628433834?src=42ps9k91dsoIOz-e10wIUw-1-0&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Also not included in the report is whether providing inappropriate health care is a form of abuse. Examples include using resuscitation <a href="http://www.resuscitationjournal.com/article/S0300-9572(15)00129-X/pdf">against someone’s wishes</a>, or in residential aged care where a frail older person is <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajag.12014/abstract">restricted from walking alone</a> even though they want independence and accept an increased risk of falling.</p>
<h2>Sexual assault remains hidden</h2>
<p>Of all the hidden aspects of abuse and neglect, sexual assault is the least acknowledged, detected, and reported type, especially in people living in residential aged care. While this is mentioned in the report, it deserves far more attention. This is especially important considering the role of health sector and health professionals who should be working to improve identifying, reporting, managing and responding to sexual assaults.</p>
<p>Our recent <a href="https://academic.oup.com/gerontologist/article-abstract/doi/10.1093/geront/gnx022/3572447/A-Systematic-Review-of-Sexual-Assaults-in-Nursing?redirectedFrom=fulltext">review</a> identified care staff and health professionals are poorly equipped to appropriately identify and respond to sexual assault. This situation was not helped by the lack of supporting policies in aged care facilities to investigate and support victims.</p>
<p>These situations persist because of community inaction. We are reluctant to accept the possibility of these incidents because they are too horrific to contemplate. We reassure and rationalise our inaction by saying the perpetrators are a very small minority of criminally minded individuals, which is not the reality. In fact the perpetrators are more often a person who is in a <a href="https://www.ncjrs.gov/pdffiles1/nij/grants/226456.pdf">position of trust</a> such as a family member or carer.</p>
<h2>Screen, identify and intervene</h2>
<p>The ALRC report comes 15 years after the World Health Organisation made its <a href="http://www.who.int/ageing/projects/elder_abuse/alc_toronto_declaration_en.pdf">declaration</a> for the global prevention of elder abuse.</p>
<p>The fact that such a report is needed is, in part, a reflection of Australia’s complex, fragmented arrangement of health, aged care and legal systems. This leads to a divergent, discordant or contradictory approach towards older people that unnecessarily impinges on their rights, choices and freedoms.</p>
<p>So, the greatest challenge in preventing elder abuse is equipping the law, health and aged care sectors to be better at screening, identifying and intervening to protect their rights. Incredible sensitivity is also required as the vast majority of children, partners and care staff are fabulous advocates and supporters of older people.</p>
<p>More research is also needed to inform decisions about social policy, aged care practice and resource allocation. This requires a dedicated, co-ordinated, multidisciplinary approach and the necessary technical expertise in aged care, law, health care, public health, injury prevention and public policy.</p><img src="https://counter.theconversation.com/content/75926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim receives funding from the Federal Department of Social Services, the Victorian Department of Health and Human Services (Ageing and Aged Care Branch), and the Department of Forensic Medicine, Monash University.</span></em></p><p class="fine-print"><em><span>Lyndal Bugeja receives funding from the federal Department of Social Services, the Department of Forensic Medicine, Monash University and Monash Nursing and Midwifery. </span></em></p>A report that recommends 43 ways to prevent elder abuse acknowledges we don’t even know how often it occurs in Australia.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLyndal Bugeja, Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/791872017-06-15T00:33:26Z2017-06-15T00:33:26ZThe problems with asking banks to police financial abuse<p>The Australian Law Reform Commission wants to give banks the responsibility to protect vulnerable customers from financial abuse. But there are a number of issues with this approach. Its success depends on the good faith of the banks, and could leave some customers uncovered and the banks with no one to report abuse to. </p>
<p>In a <a href="https://www.alrc.gov.au/publications/elder-abuse-report">new report</a> on elder abuse, the commission recommends that the <a href="http://www.bankers.asn.au/industry-standards/ABAs-code-of-banking-practice">Code of Banking Practice</a> be amended so that banks take “reasonable steps” to prevent financial abuse. </p>
<p>But the code is voluntary and some banks have been lax in the past, meaning some customers won’t be covered. “Reasonable steps” still needs to be defined, to ensure all banks meet a standard. And we need transparency to know what financial abuse banks are dealing with, how and when. </p>
<p><a href="https://aifs.gov.au/publications/elder-abuse/export">Around 9%</a> of older people living in the community are financially abused. It is likely the number is even higher among those with cognitive impairment or who live in institutions. Financial exploitation of older people is <a href="https://aifs.gov.au/publications/elder-abuse/export">increasing</a> and <a href="http://www.advocare.org.au/uploaded/files/client_added/Examination%20of%20the%20Extent%20of%20Elder%20Abuse%20in%20Western%20Australia.pdf">mostly perpetrated</a> by those close to the victim, including family members.</p>
<p>The amendments to the code will include measures such as enhanced staff training to recognise elder financial abuse, an obligation to report suspected abuse, and recommendations to tackle the problem of forced guarantees for mortgages and other loans to relatives.</p>
<h2>Can the banks protect vulnerable people?</h2>
<p>Elder financial abuse is difficult to detect. However, banks and financial institutions are in a unique position to see it. Banks have face-to-face contact with customers, play a role in providing third-party authorisations, monitor electronic transactions and oversee lending. </p>
<p>But the Code of Banking Practice is voluntary, and <a href="http://www.ccmc.org.au/code-of-banking-practice-2/code-subscribers/">many in the industry are not signed on</a>. This could lead to troubling gaps in coverage. Institutions that do not sign up to the code will be under no obligation at all.</p>
<p>Although some have imposed protocols to address elder financial abuse, a <a href="http://www.australianageingagenda.com.au/2015/11/04/financial-institutions-need-to-take-a-greater-role-in-combating-elder-abuse-lawyer/">recent interview with Kirsty Mackie</a>, chairwoman of the Elder Abuse Committee of the Queensland Law Society, noted that training of front-line banking staff, collaboration between institutions, understanding of the bank’s legal position, and preparedness to act in the customer’s best interest were all lacking.</p>
<p>The commission also settled on a standard that requires banks to take “reasonable steps” to prevent financial abuse, despite <a href="https://www.alrc.gov.au/sites/default/files/subs/352._legal_aid_nsw.pdf">Legal Aid NSW recommending</a> that a higher standard be adopted. The proposed alternative was to require banks to “take all steps” to prevent financial abuse. </p>
<p>A standard based on what is “reasonable” is problematic as context matters; what one bank may regard as a reasonable response to suspicions of elder abuse may differ from what a court or the general public thinks.</p>
<p>In the <a href="https://seniorsrights.org.au/wp-content/uploads/2014/03/A4-financial-abuse-of-older-persons-small-for-websites.pdf">United States</a>, some states impose mandatory reporting of elder financial abuse, but Australia looks <a href="http://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=/laca/olderpeople/chapter2.htm#fraud">set to make reporting voluntary</a>. This leads on to the issue of transparency.</p>
<p>We need to know under what circumstances banks will keep matters “in house”, to decide if these are appropriate. Criteria for reporting suspected financial abuse need to be established, as well as a body to report to. The commission has recommended the implementation of an adult guardian to which complaints could be referred. All these issues remain unclear and will require more discussion. </p>
<p>A related concern is the potential ramifications for people who make reports. In Australia, whistle-blower protection remains inadequate. Indeed, the Australian Banking Association <a href="https://www.alrc.gov.au/sites/default/files/subs/107._australian_bankers_association_aba.pdf">submission</a> to the Australian Law Reform Commission suggested that immunity be granted to banks that report instances of elder financial abuse.</p>
<p>Finally, given that banks will deal internally with most instances of elder financial abuse, it is important that we ensure the bank’s response balances the autonomy of older people while addressing elder financial abuse. </p>
<h2>Where to from here?</h2>
<p>The commission recommendation is welcome and will bolster the safeguards already in place. More discussion will be needed in the aftermath of the inquiry to ensure the recommendations are implemented and their potential realised.</p>
<p>The reality is that success will rest largely on the good faith of the banks. There must be willingness to build a collaborative and consistent approach to acting on elder financial abuse and to ensure rigorous internal procedures are put in place and followed. Employees who make reports of elder abuse must also have adequate protection. </p>
<p>This, in turn, must feed into an appropriately resourced entity where the most serious matters can be directed.</p><img src="https://counter.theconversation.com/content/79187/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Webb receives funding from: Queensland Government (Department of Communities), Review of the prevalence and characteristics of elder abuse in Queensland - With Dr Barbara Blundell, Dr Joe Clare, Dr Mike Clare and Dr Emily Moir; 2017 - 2018 AHURI Older Australians and the housing aspirations gap - With Dr Amity James and Professor Steven Rowley; 2017 Bankwest Curtin Economics Centre Grant Strategies to enhance tenure security for WA's older renters - With Dr Amity James and Associate Professor Helen Hodgson; 2016 - 2017 AHURI Can social impact investment make a difference to housing and homelessness outcomes? Supporting vulnerable households to achieve their housing goals: the role of impact investment - Project C -With Professor Gill North and Professor Richard Heaney Eileen is a Foundation member of the Australian Research Network on Law and Ageing (ARNLA) and a member of the Western Australian Ministerial Committee on Consumer Law; ShelterWA Board; ShelterWA Advisory Committee on Homelessness; and TenancyWA Boarders and Lodgers Working Group. </span></em></p>The Law Reform Commission has recommended that banks take ‘reasonable steps’ to protect vulnerable Australians.Eileen O'Brien, Associate Professor, Curtin Law School, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/575292016-04-18T09:40:30Z2016-04-18T09:40:30ZWhy elderly deaths from abuse are part of wider pattern of violence against women<figure><img src="https://images.theconversation.com/files/125583/original/image-20160607-15034-1w51ci2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hidden abuse.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It is a commonly cited statistic that on average <a href="http://www.refuge.org.uk/get-help-now/what-is-domestic-violence/domestic-violence-the-facts/">two women are killed every week</a> by a partner or ex-partner. However it is perhaps less well known that a significant proportion of these women are aged over 60. </p>
<p>There have been a number of <a href="http://www.bbc.co.uk/news/uk-england-berkshire-35764056">murders involving an elderly woman victim</a> (sometimes referred to as “eldercide”) <a href="http://www.mirror.co.uk/news/uk-news/elderly-couple-found-dead-home-7499167">reported in the national news</a> since the start of the year. In fact, there have even been <a href="http://hsx.sagepub.com/content/17/2/123.full.pdf">dedicated journal editions</a> examining elderly homicide, such is the prevalence of these shocking crimes. </p>
<p>National data reveals that there were 1,601 victims of murder between 2011-12 and 2013-14 – the majority of which were men (1,077). While official data shows men are still murdered <a href="http://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/compendium/focusonviolentcrimeandsexualoffences/2015-02-12/chapter2violentcrimeandsexualoffenceshomicide#victims">at a higher rate than women in later life</a> – 122 men aged 60 and over between 2011-12 to 2013-14 compared to 111 women – women who are at the eldest end of the spectrum (aged 75 and over) are disproportionately at risk compared to men: 39 men aged 75 and over were killed in the years 2011-12 to 2013-14, compared to 61 women. </p>
<h2>Eldercide</h2>
<p>Little is known about the victim and perpetrator characteristics and the contexts of these homicides as national data does not provide such information by age group. Most of the studies examining this area have emerged from the US and there is an overall lack of research examining crimes against older people in the UK. </p>
<p>Similar to other forms of violence against women, there are myths and stereotypes around elder homicide which centre around the <a href="http://onlinelibrary.wiley.com/doi/10.1002/bsl.779/abstract">“stranger danger” scenario</a> of a man who attacks a vulnerable elderly person, often linked to burglary or theft offences.</p>
<p>However, the important work of Karen Ingala-Smith – who collects information on women killed by men in the UK through her project <a href="https://kareningalasmith.com/counting-dead-women/">Counting Dead Women</a> – provides some insight into the contexts of homicides involving older women, and challenges these dominant myths. Her data shows that most of the women aged over 60 were killed by a male family member, either a spouse or a son/grandson. </p>
<p>This is consistent with female victims generally, with national data revealing <a href="http://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/compendium/focusonviolentcrimeandsexualoffences/2015-02-12/chapter2violentcrimeandsexualoffenceshomicide">women are most likely to be killed by a spouse, ex-partner or son</a>. The most common reported methods of killing were strangulation or head injuries, and the majority of murders occur in the victim’s home. </p>
<p>This paints a similar picture to fatal offences against younger women, but little else is known about the offences that have taken place against women over 60, which have not received significant attention from researchers or policy makers. </p>
<h2>Violence against women</h2>
<p>It is widely accepted that <a href="http://link.springer.com/referenceworkentry/10.1007%2F978-1-4614-5690-2_474">offending and victimisation decreases with age</a>, often referred to as the “age-crime” curve. It has also been suggested that respect of elderly people in society has led to an overall assumption that <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1475-682X.2004.00077.x/abstract">older people are unlikely victims of violence</a>.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126616/original/image-20160614-22418-17vyauy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">shutterstock.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-11546263/stock-photo-woman-with-a-downcast-look-on-blue-background.html?src=L7FmeTZd-fPvs-6LXLgLwA-3-96">Abuse spans all age groups.</a></span>
</figcaption>
</figure>
<p>But this is simply not true: recent research is challenging this notion that the elderly are not at risk. I have drawn attention recently to the <a href="http://bjc.oxfordjournals.org/content/early/2015/12/18/bjc.azv116.full.pdf+html">levels of recorded rape offences involving an older victim</a>, and there is increasing recognition that <a href="http://www.sciencedirect.com/science/article/pii/S014067360860522X;%20https://repositorium.sdum.uminho.pt/bitstream/1822/16541/1/avow%20study%20-%20final%20report.pdf">domestic violence spans across all age groups</a>. The increase in research and policy attention to child-to-parent abuse has also raised awareness of the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/420963/APVA.pdf">prevalence of abuse experienced by people in mid-to-later life</a>. However, abuse of the elderly (“elder abuse”) is often viewed as distinct from other forms of violence and is gender-neutral, so it is typically not viewed on the violence against women continuum. </p>
<p>In my opinion, it is clear that society, researchers and policy-makers need to view elderly homicide as a form of violence against women and not elder abuse. The pre-occupation with age may lead to some homicides of older people going unrecognised, as chronic illness and physical health problems may mean <a href="http://journals.lww.com/amjforensicmedicine/Abstract/2006/06000/Elder_Homicide__A_20_Year_Study.20.aspx">some murders get wrongly categorised as age-related deaths</a>. Furthermore, the lack of research attention towards eldercide may restrict, or distort, our understandings of homicide more generally.</p>
<p>It is only by framing fatal violence against older women as part of a continuum of violence that women experience throughout their lives, that thorough analysis of the issues can be conducted. </p>
<p>As the world population continues to age, it is likely that increasing numbers of older women will be victims of fatal violence by men. There is now an urgent need to recognise and respond to the risks that older women face – and save their lives.</p>
<p><em>This article was amended on June 7 2016 at the request of the family of a woman originally mentioned in the article. We are happy to make the change and apologise for any upset caused.</em></p><img src="https://counter.theconversation.com/content/57529/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Bows receives funding from the ESRC to conduct her research examining sexual violence against older people</span></em></p>Women over 60 are being killed in their own homes - but little more is known about these crimes.Hannah Bows, Researcher (Sexual Violence and Violence against Women), Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/553742016-02-24T23:42:34Z2016-02-24T23:42:34ZExplainer: what is elder abuse and why do we need a national inquiry into it?<figure><img src="https://images.theconversation.com/files/112825/original/image-20160224-16416-1eoxn1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An inquiry into elder abuse will look at legislative measures to protect elderly Australians while protecting their rights and freedoms.</span> <span class="attribution"><span class="source">AAP/Dan Himbrechts</span></span></figcaption></figure><p>Attorney-General George Brandis has <a href="https://www.attorneygeneral.gov.au/Mediareleases/Pages/2016/FirstQuarter/24-February-2016-Safeguarding-Older-Australians.aspx">announced an inquiry</a> into laws and frameworks to safeguard older Australians from abuse. </p>
<p>The Australian Law Reform Commission inquiry will assist the federal government to identify the best way to protect older Australians, while at the same time promoting respect for their rights. </p>
<p>It is anticipated that the inquiry will report in May 2017.</p>
<h2>Why is it needed?</h2>
<p>There is rising concern about the incidence and extent of “elder abuse” in Australia. </p>
<p>The inquiry was launched in the wake of several inquiries into elder abuse in various Australian states, and an inquiry into employment discrimination against older Australians. It has also been discussed at Victoria’s <a href="http://www.rcfv.com.au/">Royal Commission into Family Violence</a>. Brandis’ announcement coincided with a major national conference on elder abuse hosted by Seniors Rights Victoria. </p>
<p>The latest inquiry <a href="https://www.attorneygeneral.gov.au/Speeches/Pages/2016/FirstQuarter/24-February-2016-Address-at-the-National-Elder-Abuse-Conference-Pullman-on-the-Park-Melbourne.aspx">will</a>:</p>
<blockquote>
<p>… scrutinise existing Commonwealth laws and frameworks which seek to safeguard and protect older persons from misuse or abuse by formal and informal carers, supporters, representatives and others. </p>
</blockquote>
<p>The inquiry will be broad in scope and consider regulation of areas of federal jurisdiction such as financial institutions, superannuation, social security, aged care and health. </p>
<p>As many laws affecting older people come within the purview of the states and territories – for example the regulation of powers of attorney, wills, and estates – the inquiry will also examine how federal laws interact with relevant state and territory laws.</p>
<h2>What is elder abuse? Why is it increasing in prevalence?</h2>
<p>Although there is no single satisfactory definition of elder abuse, it incorporates a range of physical, psychological, sexual and financial abuse and neglect. </p>
<p>In most cases elder abuse is invisible. It occurs within the trusted confines of family, friends, care facilities and neighbourhoods. </p>
<p>In a <a href="https://aifs.gov.au/publications/elder-abuse">recent report</a>, the Australian Institute of Family Studies notes that the intergenerational nature of elder abuse differentiates it from other forms of family violence. Abuse within families, particularly adult children abusing parents, is the most prevalent scenario.</p>
<p>It is estimated that between 2% and 10% of older Australians may be subject to elder abuse. The report predicted that the prevalence of elder abuse is expected to rise as Australia’s population ages.</p>
<p>However, statistics as to the incidence of elder abuse remain sketchy. It is probably under-reported. A combination of fear, shame and (some may say misguided) loyalty on the part of the affected older person sees a reluctance to seek help and contact the authorities about abusive family members.</p>
<p>Even if such incidents are reported, the prospect of negotiating the court system is a major deterrent for complainants. Yet if similar abuse occurred on the street, it would be reported immediately. </p>
<p>The reasons why elder abuse occurs are complex and varied. However, as <a href="https://www.attorneygeneral.gov.au/Speeches/Pages/2016/FirstQuarter/24-February-2016-Address-at-the-National-Elder-Abuse-Conference-Pullman-on-the-Park-Melbourne.aspx">Brandis noted</a>, elder abuse is a “symptom of attitudes” that:</p>
<blockquote>
<p>… fail to respect and recognise the rights of older Australians.</p>
</blockquote>
<p>Such failure can be seen in relation to common instances of financial abuse. Australians are living longer due to improvements in health and lifestyle outcomes. This, combined with many older people having considerable assets due to the rising value of real estate and the accumulation of superannuation over several decades, can lead to an “impatience” to receive inheritances. </p>
<p>A sense of entitlement to older people’s real and personal property may see some adult children accessing their parents’, assets through “tactics”, ranging from emotional pleas to overt pressure to fraud.</p>
<h2>What is likely to come from the inquiry?</h2>
<p>The inquiry is tasked with examining myriad Commonwealth, state and territory laws. The scope of the inquiry is vast and, at this stage, it is impossible to predict the ultimate recommendations.</p>
<p>But there are several areas that warrant consideration – and reform – as a matter of urgency.</p>
<p>First and foremost, it is essential to agree on a national approach to elder abuse – with the Commonwealth, states and territories co-operating through laws.</p>
<p>Second, one of the main areas of concern is powers of attorney – the authority to act for another person in specified or all legal or financial matters. Such powers are often misused to perpetrate financial abuses. </p>
<p>Each jurisdiction has its own – often differing – legislation that regulates powers of attorney. There are considerable shortcomings in the legislation, such as that powers of attorney do not have to be registered, and are difficult to revoke. This is an area that would be ripe for a national approach, including a national register of powers of attorney.</p>
<p>Third, the issue of access to justice for older people should be a pivotal consideration. There is a reluctance from many older people to report abuse or, if they do so, pursue the matter through the courts. In appropriate circumstances, alternative forms of dispute resolution should be considered.</p>
<p>Finally, any legislative changes need to acknowledge that seniors, like the rest of us, live in a range of circumstances and come from diverse backgrounds. Therefore, their experience and understanding of elder abuse will also vary widely, particularly for culturally and linguistically diverse seniors and those living in rural and regional areas.</p><img src="https://counter.theconversation.com/content/55374/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Webb receives funding from COTAWA for the research project, Secuity of Tenure for Western Autsralia's Ageing Population and from National Seniors for the project, Seniors Downsizing on their Own Terms. Eileen is a foundation member of the Australian Network on Law and Ageing (ARNLA).</span></em></p>With incidence of elder abuse, mostly within families, on the rise, the government is looking for much-needed legislative measures to combat it.Eileen O'Brien, Associate Professor, Curtin Law School, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/509942015-11-25T10:35:55Z2015-11-25T10:35:55ZIt’s not just the young who suffer sexual violence – older people get raped too<figure><img src="https://images.theconversation.com/files/103160/original/image-20151125-23830-173c3kv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The rape of older people has been missed off national statistics.</span> <span class="attribution"><span class="source">Kristo-Gothard Hunor/www.shutterstock.com</span></span></figcaption></figure><p>Sexual assaults do not just happen to young women. Despite the pervasive <a href="http://www.thisisnotaninvitationtorapeme.co.uk/">stereotypes</a> of what constitutes a “real rape” – a young woman being attacked by a stranger – my <a href="http://bjc.oxfordjournals.org/content/early/2015/11/24/bjc.azv116.abstract?sid=3887000c-2334-4721-8a91-ec8e6ecb93b9">new research </a> has uncovered how many people over 60 in the UK are victims of sexual violence. </p>
<p>In the UK, data on sexual violence victimisation comes from the Crime Survey for England and Wales (CSEW) and official police recorded data. The CSEW is thought to be more accurate, due to the high level of under-reporting of sexual offences to the police. The <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214970/sexual-offending-overview-jan-2013.pdf">CSEW</a> estimates that 404,000 women and 72,000 men experience sexual violence each year in England and Wales. </p>
<p>Yet a major limitation of this data is that the CSEW has an upper age limit of 59 on the “intimate violence” module which collects data on domestic and sexual violence victimisation. As a result, we have no national data on the prevalence of sexual violence among those aged 60 and over. </p>
<p>There have been <a href="http://www.tandfonline.com/doi/abs/10.1080/14789940701561750#.VlCRTLSf-JU">three studies</a> in the <a href="http://www.tandfonline.com/doi/abs/10.1080/14789940500096115#.VlCRMLSf-JU">last decade</a> which have <a href="http://jiv.sagepub.com/content/26/11/2303.short">explored</a> sexual violence against older people, but none have examined national data. </p>
<p>My new research, published in the <a href="http://bjc.oxfordjournals.org">British Journal of Criminology</a>, aims to address that gap. Using freedom of information requests, I collected data from 45 out of the 46 UK police forces on the number of recorded rapes and sexual assault by penetration offences between January 1 2009 and December 31 2013 involving a victim aged 60 or over at the time of the offence. </p>
<p>Of the 87,230 recorded offences during this period, 655 involved a victim aged 60 or over, representing 0.75% of the total. Of these, 474 were rape offences and 181 were sexual assault by penetration. </p>
<h2>Who are the perpetrators</h2>
<p>The study also examined the characteristics of victims, perpetrators and offences. The majority – 93% – of victims were female, while 85% of the perpetrators were male. In general, 80% of the victims were aged between 60 and 79, whereas 66% of perpetrators were under the age of 60.</p>
<p>Perpetrators were generally known to the victim: 26% were an acquaintance and 20% a partner. 20% of cases, however, involved a stranger. The vast majority of victims and perpetrators identified as “white”. Just over half of the assaults happened in the victim’s home, but 21% happened in a care home or hospital. </p>
<p>These findings share similarities and differences with the national data on rapes of younger victims. For example, the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214970/sexual-offending-overview-jan-2013.pdf">CSEW</a> reports that victims are also usually female and perpetrators male, and typically the victim knows the perpetrator either as an acquaintance or partner.</p>
<p>Yet while perpetrators in the national data are typically older than victims, the present study found that the majority of perpetrators were younger than victims. A higher number of stranger rapes were also observed in my study: 20% of people over 60 were raped by a stranger, compared to <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214970/sexual-offending-overview-jan-2013.pdf">15% nationally</a>. </p>
<p>While 56% of younger victims are <a href="http://webarchive.nationalarchives.gov.uk/20110218135832/rds.homeoffice.gov.uk/rds/pdfs05/hors293.pdf">raped</a> by a partner or ex-partner in either a public place or the victim’s home, my research suggests that victims over the age of 60 are more likely to be raped by an acquaintance either in their own home or a care home. These differences pose a number of implications for practitioners, particularly those working in care or nursing homes. </p>
<h2>Challenging the ‘real rape’ stereotype</h2>
<p>A stereotype dominates media and public perceptions about what constitutes “real rape”. According to this model, rape typically involves a young, attractive female who is attacked by a male stranger in a public place, late at night. This links rape to sexual desirability. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/103022/original/image-20151124-18230-1qvitx4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smashing the stereotype about rape.</span>
<span class="attribution"><span class="source">BladeTucker/www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Despite the efforts by feminists to <a href="http://rapecrisis.org.uk/mythsvsrealities.php">debunk</a> this stereotype and <a href="http://webarchive.nationalarchives.gov.uk/20110218135832/rds.homeoffice.gov.uk/rds/pdfs05/hors293.pdf">research</a> consistently demonstrating rape is typically perpetrated by a partner in a private space, this stereotype persists. </p>
<p>Older victims of sexual violence <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1466-7657.2006.00457.x/abstract">do not fit</a> this “real rape” stereotype. Ageing is generally viewed negatively as a process of decline, decay and deterioration and there is a tendency to re-frame sexual violence against older people as “elder abuse”, a term which may be more comfortable for society to accept. </p>
<p>Where rape of older people is included in media reporting, it tends to be limited to <a href="http://www.bbc.co.uk/news/uk-scotland-glasgow-west-30150340">sensationalised cases</a> which involve extreme violence against an older woman by a young stranger, who is targeted because of her apparent or assumed “vulnerability”. </p>
<p>While the overall number of reported offences involving an older victim is small compared to younger victims, my findings challenge the stereotype that it is only younger victims who are attacked, based on their attractiveness and sexual desirability. It is time to recognise and include rape against older people, not as elder abuse, but as a form of violence against women.</p><img src="https://counter.theconversation.com/content/50994/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Bows receives funding from the Economic and Social Research Council for her doctoral research.</span></em></p>New research reveals how many people over the age of 60 have been raped in the UK – and it is time to act.Hannah Bows, Researcher (Sexual Violence and Violence against Women), Durham UniversityLicensed as Creative Commons – attribution, no derivatives.