4.36 Some stakeholders submitted that the majority of elder abuse occurs in the community, rather than in formal aged care. However, as with prevalence of elder abuse in the community, there is limited research about the rates of abuse of those receiving aged care. One research study has observed that those living in residential aged care are more vulnerable to abuse and neglect because they ‘tend to be frailer and more dependent on others to provide care’.
4.37 There is data available on numbers of alleged or suspected ‘reportable’ assaults in residential aged care notified to the Department of Health each year. However, as the Department has noted, this information ‘reflects the number of reports made by providers … and does not reflect the number of substantiated allegations’. Reportable assaults also capture a narrower range of conduct than may be described as elder abuse.
4.38 There is also data available relating to complaints made about home and residential aged care to the Complaints Commissioner or its predecessor schemes. There are two difficulties with this data. Not all episodes of concern are captured (due to a reluctance to complain); and not all of the complaints made relate to abuse or neglect. Further, not all complaints of abuse are substantiated. A number of stakeholders reported the results of other projects that capture reports of abuse or neglect in aged care, and there is some evidence available relating to deaths in nursing homes.
4.39 Some taxonomies of abuse also include ‘institutional abuse’ as a form of abuse—described as occurring when the ‘routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affects the whole setting and denies, restricts or curtails the dignity, privacy, choice, independence or fulfilment of individuals’. A number of the concerns raised in this Inquiry about aged care might be characterised as about institutional abuse, particularly in relation to adequate levels of staffing.
4.40 Stakeholders reported many instances of abuse of people receiving aged care. These included reports of abuse by paid care workers and other residents of care homes, as well as by family members and/or appointed decision makers of care recipients. For example, Alzheimer’s Australia provided the following examples of physical and emotional abuse:
When working as a PCA [personal care assistant] in 2 high care units, I witnessed multiple, daily examples of residents who were unable to communicate being abused including: PCA telling resident to ‘die you f—ing old bitch!’ because she resisted being bed bathed. Hoist lifting was always done by one PCA on their own not 2 as per guidelines and time pressures meant PCAs often using considerable physical force to get resistive people into hoists; resident not secured in hoist dropped through and broke arm—died soon after; residents being slapped, forcibly restrained and force-fed or not fed at all; resident with no relatives never moved out of bed, frequently left alone for hours without attention; residents belongings being stolen and food brought in by relatives eaten by PCAs.
4.41 The ALRC also received reports of other forms of abuse, including sexual and financial abuse. Restrictions on movement and visitation were also reported. Many submissions also identified neglect of care recipients.
See, eg, Resthaven, Submission 114; Aged and Community Services Australia, Submission 102.
Lynn McDonald et al, ‘Institutional Abuse of Older Adults: What We Know, What We Need to Know’ (2012) 24(2) Journal of Elder Abuse & Neglect 138, 139.
Department of Health (Cth), Submission 113.
Aged Care Complaints Commissioner, Submission 148.
See, eg, Seniors Rights Service, Submission 169; ARAS, Submission 166; Aged Care Crisis, Submission 165; Elder Care Watch, Submission 84; NSW Nurses and Midwives’ Association, Submission 29. See also NSW Nurses and Midwives Association, Who Will Keep Me Safe? Elder Abuse in Residential Aged Care (2016).
See further Professor J Ibrahim, Submission 63; Georgia Aitken et al, ‘Frequency of Forensic Toxicological Analysis in External Cause Deaths among Nursing Home Residents: An Analysis of Trends’ (2017) 13(1) Forensic Science, Medicine, and Pathology 52; Emma Bellenger et al, ‘Physical Restraint Deaths in a 13-Year National Cohort of Nursing Home Residents’  Age and Ageing; Noha Ferrah et al, ‘Death Following Recent Admission Into Nursing Home From Community Living: A Systematic Review Into the Transition Process’  Journal of Aging and Health; Tatiana Hitchen et al, ‘Premature and Preventable Deaths in Frail, Older People: A New Perspective’  Ageing and Society 1; Joseph E Ibrahim et al, ‘Nature and Extent of External-Cause Deaths of Nursing Home Residents in Victoria, Australia’ (2015) 63(5) Journal of the American Geriatrics Society 954.
Rochdale Borough Safeguarding Adults Board, Institutional Abuse <www.rbsab.org>.
Concerns related to staffing are discussed below.
See, eg, ACT Disability, Aged and Carer Advocacy Service, Submission 139; TASC National, Submission 91; Advocare Inc (WA), Submission 86; Elder Care Watch, Submission 84; Alzheimer’s Australia, Submission 80; Name Withheld, Submission 19.
See, eg, Name Withheld, Submission 189; C Jenkinson, Submission 188; Alzheimer’s Australia, Submission 80.
See, eg, Seniors Rights Service, Submission 169; L Barratt, Submission 155; State Trustees Victoria, Submission 138; Office of the Public Advocate (Vic), Submission 95; Law Council of Australia, Submission 61; Legal Aid ACT, Submission 58; Older Persons Advocacy Network, Submission 43.
Alzheimer’s Australia, Submission 80. For a number of other examples, see, eg, Australian Nursing & Midwifery Federation, Submission 163; ACT Disability, Aged and Carer Advocacy Service, Submission 139; Advocare Inc (WA), Submission 86; Elder Care Watch, Submission 84.
See, eg, ACT Disability, Aged and Carer Advocacy Service, Submission 139; Dr C Barrett, Submission 68. See also Rosemary Mann et al, ‘Norma’s Project: A Research Study into the Sexual Assault of Older Women in Australia’ (Monograph Series No 98, Australian Research Centre in Sex, Health and Society, La Trobe University, 2014).
See, eg, State Trustees Victoria, Submission 138; Older Persons Advocacy Network, Submission 43.
See, eg, ACT Disability, Aged and Carer Advocacy Service, Submission 139; Capacity Australia, Submission 134; Office of the Public Advocate (Vic), Submission 95; Law Council of Australia, Submission 61; Older Persons Advocacy Network, Submission 43.
See, eg, Law Council of Australia, Submission 61; Legal Aid ACT, Submission 58.
See, eg, Australian Nursing & Midwifery Federation, Submission 163; Capacity Australia, Submission 134; Queensland Nurses’ Union, Submission 47; NSW Nurses and Midwives’ Association, Submission 29; Aged Care Service, Murrumbidgee Local Health District, Submission 18.