Abuse and neglect in aged care

4.36     Some stakeholders submitted that the majority of elder abuse occurs in the community, rather than in formal aged care.[58] 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’.[59]

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’.[60] 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.[61] A number of stakeholders reported the results of other projects that capture reports of abuse or neglect in aged care,[62] and there is some evidence available relating to deaths in nursing homes.[63]

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’.[64] 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.[65]

4.40     Stakeholders reported many instances of abuse of people receiving aged care. These included reports of abuse by paid care workers[66] and other residents of care homes,[67] as well as by family members and/or appointed decision makers of care recipients.[68] 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.[69]

4.41     The ALRC also received reports of other forms of abuse, including sexual[70] and financial abuse.[71] Restrictions on movement[72] and visitation[73] were also reported. Many submissions also identified neglect of care recipients.[74]