Recommendation 4–14 The Department of Health (Cth) should develop national guidelines for the community visitors scheme. The guidelines should include policies and procedures for visitors to follow if they have concerns about abuse or neglect of care recipients.
4.225 The ‘community visitors scheme’ (CVS) is a scheme in which recipients of both residential and home care, who are socially isolated or at risk of social isolation, are matched with volunteer visitors. Volunteers are coordinated by organisations funded by the Australian Government (auspices). Community visitors are not advocates, and are directed to report any concerns they have about care to their auspicing organisation.
4.226 The CVS provides an important role in reducing social isolation, which may itself be protective against abuse. In 2015–16, the Department of Health (Cth) funded over 220,000 visits by community to people receiving residential and home care. The ALRC does not propose any change to the community visitors’ primary function—providing companionship. Nor does it propose that community visitors take on a pro-active role in identifying elder abuse, but does envisage a more limited role should they become aware of it.
4.227 At present, the CVS lacks detailed national guidelines. Auspices are required to develop internal policies, but there is limited guidance on what these should contain, including limited guidance about how to respond to concerns about abuse or neglect.
4.228 The ALRC recommends that national guidelines applying to the CVS should be developed, with standardised policies and procedures for visitors to follow where they become aware of abuse or neglect. That national guidelines for the CVS should be introduced received widespread support from stakeholders. For example, Elder Care Watch argued that ‘the present reliance on auspicing organisations is not satisfactory and invites inconsistency’. The Queensland AIDS Council (QuAC) reported that volunteers with ‘concerns about abuse or neglect of Community Visitor Scheme care recipients can experience distress and concern in the event of witnessing or learning of a situation of elder abuse impacting the person they visit’.
4.229 Some submissions emphasised that any guidelines about dealing with abuse and neglect observed by community visitors should be carefully designed so as not to compromise a visitor’s relationship with a care recipient or care provider. QuAC noted:
volunteers are not trained advocates and should not act in that position. Advocating for people is a complex matter and it should be done by trained professionals. Volunteers are not trained to take more complex actions, and a good reporting system along with a strong working relationship between the volunteer, client and auspice should prevent any negligence.
4.230 QuAC and the Eastern Community Legal Centre recommended that visitors should report any concerns that they have regarding abuse or neglect to their CVS coordinator, who would be in a more appropriate position to take further action. ADA Australia suggested that relationships between advocacy services and the CVS could be strengthened, such that National Aged Care Advocacy (NACAP) services could deliver regular education sessions to CVS program coordinators and volunteers on the role of advocacy services and the rights of aged care recipients.
4.231 In 2016, the Department of Health reviewed the CVS. The ALRC suggests that Recommendation 4–14 be considered as part of the Department’s response to the CVS review.
4.232 In the Discussion Paper, the ALRC proposed that there be an ‘official visitors’ scheme established for residential aged care. It was suggested that such a program would offer an additional safeguarding mechanism for older people in residential aged care, providing independent monitoring of residential aged care to ensure that residents’ rights are being upheld, and to identify issues of abuse and neglect. A number of submissions were supportive of a visitors program with a rights-monitoring focus in aged care.
4.233 However, the ALRC has decided not to make a specific recommendation that an official visitors scheme be established. At this stage, the ALRC considers that reform efforts are better focused on establishing a robust serious incidents response scheme. It also considers that support for the existing body of highly trained aged care advocates should be continued. The NDIS Quality and Safeguarding Framework intends to undertake an independent evaluation of state and territory visitors schemes to consider how such schemes might integrate with other oversight mechanisms. Results of this evaluation should inform future consideration of the utility of an official visitors scheme in aged care.
4.234 The Australian Government has signalled its intention to ratify the Optional Protocol to the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) by December 2017. OPCAT’s objective is to establish a system of regular visits undertaken by independent international and national bodies to places where people are deprived of their liberty. Compliance with OPCAT will require the establishment of a ‘National Preventive Mechanism’ to conduct inspections of all places of detention. As the ACT Human Rights Commission noted in its submission, any place where people may not be free to leave, that is subject to the regulation or oversight of the state, could fall within the scope of a ‘place of detention’—including residential aged care facilities. Ensuring that residential aged care facilities are compliant with OPCAT will provide important additional oversight of human rights standards in aged care.
4.235 The National Aged Care Advocacy Programme (NACAP) provides assistance to people receiving Commonwealth-regulated residential care and home care. The NACAP was reviewed in 2015, and there are plans to redesign the aged care advocacy system. Consultation on a draft National Aged Care Advocacy Framework closed on 7 October 2016.
4.236 The ALRC therefore does not propose any changes to aged care advocacy services. However, submissions to this Inquiry highlighted the importance of an effective system of funded advocacy in providing safeguards for older people. For example, the Office of the Public Advocate (Vic) argued that advocacy services were ‘essential to protecting the rights of older people in care. This is particularly important when moving to a consumer directed model of care to enable consumers to get the full benefit of such a system’.
4.237 Stakeholders also pointed out that the effectiveness of advocacy services relied on their independence and accessibility. Accessibility for those with cognitive impairment, as well as those who may be isolated or physically frail, are key challenges that must be addressed to ensure that advocacy operates as a safeguard for older people. A number of submissions also emphasised the importance of ensuring that advocacy services should be inclusive of all older people receiving aged care, including Aboriginal and Torres Strait Islander peoples; culturally and linguistically diverse people; and lesbian, gay, bisexual, transgender and intersex people.
Aged Care Act 1997 (Cth) pt 5.6; Department of Social Services (Cth), Community Visitors Scheme (CVS) Policy Guide 2013–2016 (2013).
Department of Social Services (Cth), Community Visitors Scheme (CVS) Frequently Asked Questions—Auspices.
See further Rae Kaspiew, Rachel Carson and Helen Rhoades, ‘Elder Abuse: Understanding Issues, Frameworks and Responses’ (Research Report 35, Australian Institute of Family Studies, 2016) 8–9.
Department of Health (Cth), above n 9, 20.
CPSA was opposed to national guidelines because of a perception that the role of community visitors was to be changed, however this is not the intent of this recommendation: Combined Pensioners and Superannuants Association, Submission 281.
Department of Social Services (Cth), above n 313, 4–5.
See, eg, State Trustees (Vic), Submission 367; National Older Persons Legal Services Network, Submission 363; Eastern Community Legal Centre, Submission 357; COTA, Submission 354; Law Council of Australia, Submission 351; Queensland AIDS Council (on Behalf of the National LGBTI Community Visitor Scheme Auspices’ Network), Submission 331; Elder Care Watch, Submission 326; Seniors Legal and Support Service Hervey Bay, Submission 310; ADA Australia, Submission 283; Lutheran Church of Australia, Submission 244; Brotherhood of St Laurence, Submission 232; Aged and Community Services Association, Submission 217.
Elder Care Watch, Submission 326.
Queensland AIDS Council (on Behalf of the National LGBTI Community Visitor Scheme Auspices’ Network), Submission 331.
Ibid; Eastern Community Legal Centre, Submission 357.
ADA Australia, Submission 283.
Department of Health (Cth), Community Visitors Scheme <agedcare.health.gov.au>.
HammondCare and ACSA argued that national guidelines should be developed after consultation with the aged care sector and exiting auspices: HammondCare, Submission 307; Aged and Community Services Association, Submission 217.
See, eg, Office of the Public Advocate (Qld), Submission 149; Australian College of Nursing, Submission 147; United Voice, Submission 145; State Trustees Victoria, Submission 138; Office of the Public Advocate (Vic), Submission 95; Law Council of Australia, Submission 61.
Department of Social Services (Cth), NDIS Quality and Safeguarding Framework (2016) 53–54.
Julie Bishop MP and Senator George Brandis, ‘Improving Oversight and Conditions in Detention’ (Media Release, 9 February 2017); Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, Adopted on 18 December 2002 at the fifty-seventh session of the General Assembly of the United Nations by resolution A/RES/57/199 entered into force on 22 June 2006.
Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, Adopted on 18 December 2002 at the fifty-seventh session of the General Assembly of the United Nations by resolution A/RES/57/199 entered into force on 22 June 2006 art 1.
Ibid art 3.
ACT Human Rights Commission, Submission 337; Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, Adopted on 18 December 2002 at the fifty-seventh session of the General Assembly of the United Nations by resolution A/RES/57/199 entered into force on 22 June 2006 art 4(2).
Aged Care Act 1997 (Cth) div 81. Advocacy is also available for those receiving aged care through the CHSP: Australian Healthcare Associates, Department of Social Services Review of Commonwealth Aged Care Advocacy Services Final Report (2015) 15.
Australian Healthcare Associates, above n 332, 17.
Department of Health (Cth), Consultation on the Draft National Aged Care Advocacy Framework <www.consultations.health.gov.au>. A revised draft Framework was released in December 2016, updated with feedback from this consultation period. The Framework is to be finalised in mid-2017: Department of Health (Cth), (Draft) National Aged Care Advocacy Framework (Version 2.0) (2016).
Office of the Public Advocate (Vic), Submission 95. See also Office of the Public Advocate (Qld), Submission 149; Australian College of Nursing, Submission 147; ACT Disability, Aged and Carer Advocacy Service, Submission 139.
See, eg GLBTI Rights in Ageing Institute, Submission 132; Older Persons Advocacy Network, Submission 43; Alice’s Garage, Submission 36.