159 The health system is often at the front line in identifying and responding to instances of suspected elder abuse. This includes a variety of institutions and professionals, including the hospital system and health professionals such as general practitioners, nurses, and allied health professionals.
160 Older people may be reluctant to report or raise concerns about elder abuse, or seek legal assistance. However, people may be more willing to discuss concerns with their health care providers. Further, older people experiencing abuse may use health services regularly. This presents an opportunity both for identifying and reporting suspected elder abuse, and responding to such situations.
161 The first step in responding to elder abuse involves identifying whether a person is at risk of, or a victim of, elder abuse. To be effective, this requires appropriate training to ensure health professionals are able and confident to identify and respond to at-risk adults.
162 Health service providers may be reluctant to ask about elder abuse for a number of reasons, including: not knowing what questions to ask; an inability to assess risk; and not knowing how and where to refer someone.
163 The WHO’s Clinical and Policy Guidelines on Responding to Intimate Partner Violence and Sexual Violence Against Women (WHO Guidelines) provide a useful approach to training requirements. The WHO Guidelines recommend that in-service and pre-qualification training should be provided to enable health practitioners to provide first-line support, enquire about and identify violence, and collect forensic evidence where necessary. Following the training, health practitioners should have better communication and clinical skills, and be better able to identify referral pathways. The WHO Guidelines recommend intensive multi-disciplinary training, which incorporates health care providers, police and advocates.
Question 35 How can the role that health professionals play in identifying and responding to elder abuse be improved?
Question 36 How should professional codes be improved to clarify the role of health professionals in identifying and responding to elder abuse?
164 Health-justice partnerships are a new model of collaboration between legal and medical practitioners, in which a lawyer is integrated within a health or allied health practice. Such a model may give vulnerable and disadvantaged clients easier access to legal advice while they are seeking medical assistance. This may assist in responding to elder abuse because:
- medical and legal appointments can be coordinated;
- the lawyer, the health practitioner and the older person can communicate more easily; and
- the lawyer can develop informal relationships with health professionals, facilitating greater rates of referral and interaction.
165 An example of such a partnership is one established between Justice Connect Seniors Law and cohealth in north western Melbourne to help older people experiencing elder abuse.
Question 37 Are health-justice partnerships a useful model for identifying and responding to elder abuse? What other health service models should be developed to identify and respond to elder abuse?
166 Where an older person attends a hospital, there is an opportunity to identify and respond to suspected elder abuse. In 2013, St Vincent’s Hospital in Melbourne introduced a hospital-wide elder abuse policy, which included:
- the establishment of a coordination and response group with high-level participation to review data relating to suspected cases of abuse, and advise on ongoing policy development;
- a model of care which supports staff to identify pathways for intervention based on the will and preferences of the patient, and undertake safety planning;
- notification of all suspected, confirmed or witnessed cases of elder abuse to the coordination and response group; and
- a training framework focused on addressing the different roles and responsibilities of staff, including clinicians.
167 St Vincent’s Hospital Melbourne has seen significant improvements in practice, with increased notification of elder abuse, and increased data collection, including in relation to the types of abuse, risk factors, level of ongoing risk, interventions delivered and case outcomes. The Victorian Royal Commission into Family Violence suggested that such a framework should be adapted for use in other hospitals, and other environments such as aged care facilities.
168 Implementing such a model may require further consideration of issues such as clinician-patient confidentiality and the operation of privacy laws.
Question 38 What changes should be made to laws and legal frameworks, such as privacy laws, to enable hospitals to better identify and respond to elder abuse?