CFCA Webinar: Responding to elder abuse: Rights, safety and participation

CFCA Webinar: Responding to elder abuse: Rights, safety and participation


Good afternoon everyone and welcome to today’s
webinar, Responding to elder abuse: Rights, safety and participation. I’m Rachel Carson, a senior research fellow
with the family law and family violence team here at the institute. I would like to start by acknowledging the
traditional custodians of the land on which we meet in. In Melbourne the traditional custodians are
the Wurundjeri people of the Kulin nation. I pay my respects to their elders past, present
and emerging and to the elders from other communities who may be participating today. Today’s webinar will present an overview of
elder abuse in Australia with a focus on what it is, emerging evidence on its prevalence,
its effects and risk factors and the implications for policy and practice. We encourage you to send your questions through
during the webinar for our presenters Adam and Megan to answer during the Q&A session
at the end of today’s presentations. Those we can’t get to will be answered in
the forum. Please let us know if you don’t want your
question published in the online forum following the presentation. CFCA webinars are recorded. The slides are available in the handout section
of the GoToWebinar. And the audio, slides, transcript and recording
of the webinar will be available on our website in the coming week. Now to our presenters. Adam Dean is the senior research officer in
the CFCA. He works across a range of knowledge translation
activities, including with sector professionals to share research and practice expertise across
the child family and community welfare sector. Indeed, it is Adam that coordinates many of
the CFCA webinars. Adam is the author of a recent paper on elder
abuse that he will be discussing today. Megan Frost is a seasoned social worker, lawyer
and mediator with over 25 years of experience working in the community services sector. Megan currently works in direct service delivery
and in program design, coordination and with management – and management with Relationships
Australia New South Wales. Megan is coordinating the implementation of
a new elder mediation and support service, funded by the New South Wales Government’s
Domestic and Family Violence Innovation Fund. I will now hand over to Adam, please give
him a warm virtual welcome. Well thank you very much Rachel for your introduction
and hello to everyone listening today. So I’ll just move on to my first slide. So as Rachel said my part of today’s presentation
is based on a CFCA paper that I authored entitled, ‘Elder abuse: Key issues and emerging evidence’. And this is available via the CFCA website
for anyone interested. The paper explores three main areas and these
are the key issues involved in how elder abuse is defined, emerging evidence on its prevalence,
impact and risk factors. And it also looks at implications for policy
and practice. So I’ll be looking at these three broad areas
today, beginning with a brief overview of the population of older people in Australia. So in Australia older people are generally
defined as adults aged 60 to 65 years and older for non-indigenous Australians. And due to a difference in average life expectancies
and cultural understandings, 45 to 50 years and older for Aboriginal and Torres Strait
Islander peoples. In 2016, people aged 65 and older represented
about 15 per cent of the overall population in Australia. And that’s a rate that’s increased from about
5 per cent in 1926 and is expected to increase to 22 per cent of the population by 2056. This trend is known as Australia’s aging population
and as I discuss in the paper we should be careful about how we talk about the challenges
associated with an aging population in order to avoid older people – or characterising
older people as a burden to society or devaluing their role and status in the community. So older people in Australia are of course
a diverse population. They represent diverse cultural backgrounds,
lifestyles and abilities. In relation to an older person’s risk of abuse,
there’s a few key points worth mentioning here in relation to this adversity. Firstly, older people are much more likely
to have a disability or a severe or profound core activity limitation compared to younger
people. In 2015, around half of all older people had
a disability. Secondly, like disability, the risk of dementia
also increases with age. The vast majority of people living with dementia
are 60 years or older. Thirdly, most older people live in private
households, with only a small proportion living in care accommodation. For people living in households, about a quarter
lived alone in 2015, with women more likely than men to live alone. And lastly, the need for assistance increases
with age, with many older people needing assistance with a range of daily activities as they get
older. So it should be noted, however, that these
factors are not intrinsic to aging itself. And while these factors can represent vulnerability
for older people, it’s the combination of other factors such as poor quality relationships
or low social support that can exacerbate the risk of abuse for older people. So moving to the question of what elder abuse
is, it should be noted at the outset that there isn’t any universal consensus about
how it should be defined. However, some definitions are more widely
used than others. So a widely accepted definition is one that’s
been adopted by the World Health Organization and it defines elder abuse as, and I quote,
‘A single or repeated act or lack of appropriate action occurring within any relationship,
where there is an expectation of trust which causes harm or distress to an older person.’ In this definition there is a focus on the
kinds of relationships that exist between potential perpetrators of abuse and older
people. And that’s one where there is an expectation
of trust. So this will include those relationships built
on trust with non-professionals, such as family, friends and informal carers as well as relationships
with professionals who occupy positions of trust. Included in this definition are relationships
with other older people, who may also be potential perpetrators of abuse, such as spouses or
partners, friends and, more debatably, peers. Beyond this general definition, there are
other aspects that I don’t have time to cover today unfortunately, but these include whether
potential victims of abuse should be defined purely in terms of age, for example, all adults
aged 65 years or older or whether it would be better to focus on particular at risk populations
and how we define potential victims of abuse. There is also the question of how elder abuse
relates to family violence. And these are some topics that are covered
in more detail in the paper. So there are different types of elder abuse. It covers a range of potential harms to an
older person. So typically, five types of abuse are recognised. There’s physical abuse, psychological or emotional
abuse, sexual abuse, financial abuse and neglect. There is some debate about these categories
and whether others should be included. For example, other types of abuse may include
social abuse, chemical and medical abuse, self-neglect or abandonment. However these are generally included in the
five main types of abuse and neglect outlined here. These forms of abuse can of course occur together. For example emotional abuse and financial
abuse may co-occur in a pattern of polyvictimization. And it’s also worth highlighting that various
forms of abuse and neglect can be perpetrated and experienced in varying degrees of severity
and frequency. So moving now to the question of prevalence. The first thing to note is that we don’t have
national prevalence data on elder abuse in Australia as yet. Most of what we know is based on international
population studies. A recent meta analysis of prevalent studies
from around the world, including from lower income countries, estimated that 15.7 per
cent of older adults, 60 years and older living in community settings, have experienced some
form of abuse in the past 12 months. Prevalence rates for particular sub-types
of abuse were lower than that pooled average and ranged between about 1 per cent and almost
12 per cent, depending on type, with psychological abuse found to the be most prevalent. International data also indicates that higher
rates of abuse are likely to occur in institutional care settings and for people with disability. So we have some idea about its prevalence
elsewhere in the world but what about Australia? So as I’ve just mentioned there is currently
no national prevalence data for elder abuse in Australia, but based on international data
in countries similar to Australia, it has been estimated that between 2 and 14 per cent
of older people in Australia may experience some form of elder abuse every year. We also have data collected from elder abuse
helplines in Australia that give us some insights into the incidents of abuse, but not its prevalence
per se. So this data tends to indicate that firstly,
financial and psychological abuse are the most frequently reported types. And that sons or daughters are the most frequently
reported perpetrators of abuse. Elder abuse of course has negative impacts
on older people. Broadly, negative impacts can be conceptualised
as having the common effect of reducing an older person’s quality of life. More specifically, it’s known to have a range
of particular negative impacts for older people, depending on the nature and circumstances
of the abuse or neglect perpetrated. And this includes, but not limited to, psychological
distress and emotional difficulties, destructive relationships and restrictions on autonomy,
compromised health, physical injury and in the extreme cases, premature death. And it’s also about a loss of assets and finances
among others. There hasn’t been a lot of research on the
particular impacts of elder abuse and we should remember that this includes not only the impacts
it can have on older people, but also on the family members. We do know, however, that its impact can often
go undetected and is sometimes difficult to quantify. In one of the few studies looking at its impacts,
it was found that victims of elder abuse experienced higher rates of depression, post-traumatic
stress disorder, anxiety and poor health compared to non-victims, with these effects enduring
over long periods of time. So turning now to look at the emerging evidence
on risk factors associated with elder abuse. Again, what is known about risk factors is
largely based on international studies. And these factors relate to older people,
the perpetrator’s relationship types and characteristics and also broader community and societal context. So these shouldn’t be seen in isolation to
each other, rather the risk of abuse often involves a combination of all these factors
associated with victims of perpetrators in the context that they live in. So I’ve got a diagram on the screen there. And as it shows, this an ecological model. And it’s a common framework used to understand
how these factors can relate to each other. So that is, there are factors relating to
both, an older person and a potential perpetrator that can increase the risk of abuse. And these are moderated by relationship characteristics. So it’s represented by the first circle around
the older person and perpetrator. And lastly these factors may be influenced
by broader environmental factors at the community social and cultural levels that can increase
or moderate this risk. So looking firstly at factors that are known
to increase the risk of abuse for older people, the main factors to have emerged consistently
across a range of studies are cognitive impairment and disability, poor mental health, social
isolation of older people as well as the history of abuse, family violence or conflict. There are also other factors and these are
identified in prevalent studies and these have included frailty, alcohol use, trauma,
lower income or poverty, problem behaviours, personality traits, as well as incontinence. Unfortunately, I don’t have time to get into
much detail about each of these, so I’d encourage you to read the paper if you’re interested. So there’s also risk factors associated with
perpetrators, less is known about these. The main factors found in the research include
caregiver stress, financial or emotional dependency on an older adult, poor mental health, the
use of alcohol and other drugs as well as attitudes of entitlement. There are also factors associated with relationship
types and characteristics that can moderate this risk. The available evidence indicates the different
types of relationships are associated with different types of abuse. In some population studies, family relationships
are found to be the most common relationship type in overall cases of abuse. Other studies have found that adult children
are more likely to neglect older people’s care needs. On the other hand available evidence suggests
that intimate partners are more likely to be physically or psychologically abusive than
other perpetrators. In addition to relationship types are also
relationship characteristics that have been found to increase the risk of abuse. In general, emerging evidence indicates that
elder abuse is more likely to occur where there’s a history of family conflict in relationships,
in poor quality relationships, as well as in situations of dependence or inter-dependence. That is where someone, and it’s usually a
family member, has an emotional or a financial dependence on the older person and vice versa. Overall there is evidence to suggest that
the quality of relationships and access to social supports are the most consequential
factors influencing the risk of elder abuse. Finally there are also factors that operate
at the level of community and societal context that may be associated with the abuse of older
people. At the community level, these factors include
social isolation and exclusion. So researchers have suggested that an older
person’s alienation from community can increase their vulnerability to abuse. And this can occur in various ways, including
through the loss of friends or families, or in the absence of formal support networks
that can keep older people connected to their local community. Factors relating to institutional care settings
include opportunities for peer to peer abuse, in particular the
co-habitation of older adults who maybe have increased risk of potentially perpetrating
abuse, but also an increased vulnerability of victimisation. Also where present, the lack of institutional
resources, unregulated use of restrictive practices used in ways disproportionate to
need, caregiver stress and the lack of appropriate carer skills, may increase the risk of abuse
in institutional care settings. Lastly, societal factors that increase this
risk may include ageism, inadequate health and social support services, economic pressures
and finally, inter-generational conflict. So moving now to the last part of my presentation,
I’ll give a short summary of approaches to the prevention and intervention of elder abuse
in Australia. So one way to think about prevention and intervention
strategies is from a public health perspective. This approach focuses on three levels of intervention. Firstly, there’s primary or universal interventions
which target whole communities or populations to prevent elder abuse. There are also secondary interventions that
target particular at risk populations to prevent or intervene early before problems get worse. And there’s also tertiary interventions, respond
to victims or perpetrators of elder abuse. Before looking at these in more detail, I
think it’s worth framing this discussion with some guiding principles that I think are helpful
to consider when we think about how we should respond. So in 2017, the Australian Law Reform Commission
published its final report on the enquiry into protecting the rights of older Australians
from abuse. As part of its enquiry, the Commission made
a series of recommendations that aim to balance two guiding principles. The first is the principle of dignity and
autonomy and the second is the principle of protection and safeguarding. As the report recognised, these principles
are sometimes intention. So on one hand there is the principle to recognise
the dignity and autonomy of older people, which includes recognition of an older person’s
right to make decisions about their own life and their capacity and agency to do so. On the other hand there is the principle of
protection and safeguarding which aims to respond for an older person’s rights to safety
and well-being in those cases where they are at risk of abuse and may not have the capacity
to ensure that their rights are respected. So balancing these principles can be a challenge
for practitioners and policy makers working with older people. And it’s worth keeping these principles in
mind when thinking about prevention and intervention strategies. So primary interventions. Primary interventions are mainly focused on
preventing elder abuse. Prevention strategies tend to operate at a
national or a state and territory level and these can include legislation that’s relevant
to the prevention or remediation of forms of elder abuse. This includes both Commonwealth and state
and territory based legislation. There’s also policy and practice frameworks. These exist more at a state and territory
level and seek to guide practice in the areas of health, social welfare and related areas
of practice. Education and awareness strategies. These can be directed to older people, to
the broader community or particular professional sectors. And finally there are
sector-wide workforce development strategies that aim to increase the capability and support
for particular professional sectors to help prevent abuse. So a major development in this area of national
policy has been the national plan to respond to the abuse of older Australians, which was
released earlier this year. And you can find a copy of the plan available
on the Attorney-General’s Department website. And we’ll also have a link to that plan on
our website following this webinar. So secondary interventions. These involve two main kinds of strategies. The first is screening and risk assessment
strategies. These are typically used in healthcare settings,
although they may be used elsewhere. They aim to screen older people for known
risk factors, make an assessment of the nature of risk and determine an appropriate course
of action in response to that risk. The other main kind of secondary intervention
is social support and capacity building strategies. And these include caregiver and family support
services, financial management and related services, legal assistance and elder abuse
helplines. The evidence is still emerging across all
these strategies. However, what seems to be clear in the research
is that social support is a key protective factor that helps reduce an older person’s
risk of abuse. I’ll move on to the next slide. Tertiary interventions aim to address the
incidents and impact of elder abuse after it has occurred and typically targets either
older adults who have been victims of abuse or the perpetrators. There are two main challenges in this emerging
area. First is the complexity of elder abuse that
occurs in its multiple forms and combinations, as well as there’s a lack of strong evidence
that would inform effective programs and practices. Tertiary interventions may target different
groups, including older people, carers and perpetrators of abuse as well as families. So just looking at tertiary interventions
targeting older people. The main types of interventions that appear
in the research and policy literature focus on multi-disciplinary and coordinated approaches. These strategies aim to bring together different
kinds of professionals, such as social workers, legal professionals and health and mental
health practitioners to provide a holistic and tailored response to particular forms
of abuse. There’s also case management and advocacy
strategies. These may be similar to
multi-disciplinary approaches, but rather than being managed by a team, they’re facilitated
usually by a case manager to assess an older person’s support needs. There are also elder abuse helplines which
are another type of intervention that can advocate for an older person by providing
advice and assistance referred to other support services. And finally emergency shelters which can cater
to the unique needs of older adults. So tertiary intervention is targeting carers
– I’m just running out of time, so I’ll keep it quick. Less is known about interventions targeting
carers, but the main kinds of interventions include psychoeducative support groups, anger
management and counselling. Broadly, the evidence to support these interventions
is still emerging. But the positive results associated with these
programs and practices relate more to improve knowledge and awareness or reduce anxiety
or depression among carers, but not necessarily a reduction in the incidents of abuse itself. So finally, interventions that target families,
again to be – they appear to be a relatively new and emerging area. These can include family mediation, family
care conferences and family focused psychological or counselling approaches. So like interventions targeting carers or
perpetrators, there’s not a strong evidence base to demonstrate the effectiveness of these
interventions in reducing the incidents or impacts of elder abuse as yet. But there’s always research and evaluation
going on in this space, so watch this space. However, as mentioned earlier, available evidence
does indicate that healthy relationships with family members is a key protective factor. And so there’s a good argument that family
focused interventions are an important side of intervention and should be developed further. So just to conclude, elder abuse is a complex
phenomenon involving a range of abusive behaviours and experiences. Practitioners, policy makers and researchers
are encouraged to consider the various prevention and intervention strategies that we know,
in particular to think about working with others to develop coordinated approaches to
address and respond appropriately to the abuse of older people. Thank you for listening and I’ll hand over
to Megan. Well thank you very much Adam for that very
comprehensive presentation. We are now going to hear from Megan Frost. Megan has a video to show us so bear with
us while we get this going. If you cannot see the video, we will provide
a link to it in our resources section of the ‘Join the conversation’ page. and I’m the coordinator of the Let’s Talk
Elder Mediation and Support Services. This is a project designed to mitigate the
risk and respond early to elder abuse. In my presentation today, I’m hoping to describe
the Let’s Talk project to you, give you a sense of the work that we’ve done so far and
raise some of the challenges we face in working in this space. You’ve seen a video. So the Let’s Talk Elder Mediation and Support
Service is funded by the New South Wales Government’s Domestic and Family Violence Innovation Fund. We’re funded for three years and this is ending
in June 2021. We actively seek feedback from clients and
stakeholders and we’ll continually revise, adapt, change and develop a service throughout
this period and share our learnings. As with all the projects funded on the innovation
fund, Let’s Talk will be externally evaluated and we do hope to be contributing to the evidence
base for work in this space. Relationships Australia New South Wales is
a not-for-profit organisation and our goal is to promote relationships that are safe,
healthy and strong. Backed by 70 years of experience, we offer
judgment, pre-support to people of all cultural backgrounds, family structures, gender and
sexual orientation. Let’s Talk is anchored in and builds on Relationships
Australia New South Wales counselling and mediation services. And as mentioned before, the aims of Let’s
Talk is to mitigate the risk of and to respond earlier to elder abuse. So why Let’s Talk? The name Let’s Talk came for this project
emerged during conversations with the New South Wales elder abuse helpline and resource
unit as we were developing our proposal for funding. As just one example of the many changing and
evolving aspects of the work, the helpline, as of 1 July this year, is now the New South
Wales aging and disability abuse helpline. The helpline became and still is a key partner
in the Let’s Talk project. We wanted to know if the helpline thought
there was a need for mediation, counselling services in New South Wales specialised in
working with older people, their families, carers, friends and support people. Meeting with the helpline we learned about
the people who called the helpline. 46 per cent of the callers were a concerned
family member, 18 per cent the older person themselves and 14 per cent a concerned bystander. All categories of elder abuse were reflected
in the calls. Sexual, physical, psychological, financial
and neglect, with the most frequent type of abuse being financial at 39 per cent and psychological
at 58 per cent. And as mentioned by Adam, these often co-exist. When speaking with callers, the helpline noticed
a predominant theme, is that people want to preserve family relationships. They want to be safe, they don’t want to lose
relationships. One of the questions the helpline frequently
asks callers is, ‘Have you thought about talking with the other people concerned? Have you thought about talking with your adult
child, whom you love and are fearful of losing? Have you thought about talking with your parent
who you don’t want to frighten about their money? Have you thought about talking with your sibling,
who you haven’t spoken to for three years, to see if they actually do have a power of
attorney? Have you thought about talking to your sister-in-law
who your aunt lives with now and you can’t see your aunt anymore?’ ‘It’s too hard, I don’t know where to start. They wouldn’t want to talk to me. I don’t want to make things worse.’ Yes there is a need to help people come together
to have important and sometimes difficult conversations. There is a need to help families manage conflict
and make decisions. The Let’s Talk service can help bring families
together to start the conversation about age-related issues, such as
inter-generational relationship challenges, risk safety and
well-being, planning for the future, powers of attorney and guardianship, end of life
planning and decision making. Let’s Talk ensures the voice of older people
are heard, the rights of older people are known and upheld, the wishes of older people
are respected and relationships are supported and strengthened. It’s also important to know and help connect
people to what other services might be able to assist in. A brief out view of Let’s Talk in what clients
can expect, is just that no pathway is exactly the same. We understand that people have different needs
and wishes, so we ensure that we spend time to understand why the person has contacted
our service. We tailor the service and how it is delivered
to the needs of each client group. That said, there are some key service connection
points. So someone can come to the Let’s Talk service
either by calling or contacting the service them self. They might be an older person. They might be a family member. We’ve also worked hard at developing relationship
with other services and referrals may actually come from another service provider. We call the first appointment that a client
has with our service the initial consultation and this is conducted with a family advisor
who’s got training and skills in counselling and also in elder mediation. In this phone call we are seeking to understand
the concerns, what we might be able to offer, refer to other support, give information about
going forward, talk about who else might be involved in moving forward and who else might
need some information. If people choose to go forward from that,
we then arrange a face-to-face appointment, so we can do appointments over the phone as
well. And this will either be what we call a pre-mediation
interview, or it might be that the decided pathway forward for this particular group,
is that counselling might be the best pathway forward. As I said, it can be by phone, but most often
in one of our Relationship Australia offices. We are flexible and have arranged to use other
people’s offices, meet in community rooms to be closer to clients. More information about moving forward and
what support people might need, perhaps counselling before coming together in mediation and what
– also information people might need about making decisions, legal, medical, financial
and other supports. We look at who needs to participate and how. We invite other people in for the same pre-mediation
or counselling appointment. Other mediation is a forum for decision making
where family members are encouraged to express their concerns. Decisions are confidential and take place
in a private and safe setting. The court principle guiding elder mediation
is that the voice of the older person is heard, their rights upheld and their wishes represented. For mediation to be effective it is preferable
for all interested parties to attend or be represented, though at times this is a challenge. Agreements reached are based on goodwill and
not legally binding. Services are voluntary and confidential and
limits to confidentially are discussed at the outset and include reporting if they are
concerned about safety or otherwise we’re compelled by law. There’s some links here too. The Let’s Talk Elder Mediation Support Service,
and this is a New South Wales Service, though Relationships Australia New South Wales is
part of a national network of Relationships Australia services and they have senior relationships
services as well. In fact four of our states are trial sites
for the Federal Attorney-General’s Elder Mediation and Case
Management. Let’s Talk was launched on 12 June this year
and we’re able to offer it in the city metropolitan area in Mandarin and Cantonese as well as
we have two mediators who speak both Mandarin and Cantonese. We’re committed to providing work in regional
parts of New South Wales as well. From Relationships Australia
New South Wales, we have two mediators and counsellors trained in elder mediation based
from our office in Bathurst and one of our other key partners is Relationships Australia
Canberra and region, so Let’s Talk is also offered in the Riverina from Wagga and in
the far south coast from Moruya. The design of Let’s Talk was informed by a
national trial that Relationships Australia ran in 2016. Key learnings from that trial included the
need to build strong collaborative partnerships with key stakeholders and service providers. As well as the challenge and priority to work
creatively, thoughtfully and safely, when inviting older people, family members and
support networks to come together to talk. And the paper of that trial written by Paula
Mance is a link on your slides. Let’s Talk is also building on the international
body of work that has been undertaken in elder mediation. Elder mediation is relatively new in Australia,
particularly when compared with other countries such as Canada. And I’ve chosen an article here for you, written
by Judith McCann-Beranger as it describes various
models of mediation and different ways that elder mediation can be used in working with
older people and their families, different contexts. Judy was one of the key note speakers at the
National Mediation Conference in Canberra this year. And she’s also one of the trainers of advanced
elder mediation that I attended with Relationships Australia colleagues this year and greatly
appreciate learning from her. Let’s Talk is delivered by qualified mediators
and counsellors who have also had specialised elder mediation training. We are committed to growing in our knowledge
and skill. We already have one elder mediator who is
applying for international accreditation as an elder mediator. This bar is really high and at last, look,
only three Australians have this accreditation. And we expect others to be in a position to
apply later this year. Our initial elder mediation training was delivered
by Dale Bagshaw and Dale is one of those three
people, and is one of the leaders of elder mediation and working in elder abuse in Australia. She was also involved in the revision of the
International Elder Mediation Code of Ethics which is reading for you. One of the key elements in elder mediation
training and elder abuse training is recognising ageism and understanding ageism. Ageism can impact how we see and value older
people. It can also impact whether we see or listen
to older people. And I note that Adam mentioned ageism in his
presentation. I’d like to draw your attention, in case you
haven’t heard of it yet, to the Every Age Counts campaign. A campaign to tackle ageism faced by older
Australians. For me a disturbing illustration of ageism
appears in research undertaken with social workers. I became aware of this research in the Helplines
training for professionals on elder abuse. In a study of social workers in 2013, two
groups of social workers were shown an identical account of domestic violence against a woman. The only difference in the case study that
they were shown is, one woman was aged 77 years old and then the other, 37 years old. Results found that the abuse was considered
significantly less serious when the victim was older. The only difference was the age of the female
victim. Ageism and the prejudice against our future
selves it’s been called, can limit people recognising elder abuse. And it can also influence the way the practitioners
conceptualise a case and plan their work. For example, who we speak to and who we invite
to be in part of a process. As part of the Let’s Talk project, all Relationships
Australia in New South Wales will be trained in elder abuse recognition and responding. We will ensure that older people are visible. That when exploring the impact of domestic
and family violence, as well as attending to the impact of children, we explore whether
or not there may be an older person who might also be affected. Older people will be visible. Let’s Talk has a commitment to hear directly
from the older person. However there’s a challenge. Are there times when we would not speak directly
with the older person? If we have made that choice with careful planning
and consideration, how do we ensure that the voice and the wishes of the older person are
represented and are present? I’ll give you a case example, a family member
approached the Let’s Talk service on the suggestion from a worker at Dementia Australia. The caller was an adult child who was concerned
about the care of their parent who had been diagnosed with one of the dementias. The concern was serious that the parent was
at risk of not being adequately cared for as the caller was the main carer and could
no longer provide the care needed. The caller thought the parent needed to be
moved into a home. For this family, the caller, their siblings
and the older persons spouse, all agreed that they were the ones who needed to talk together. The worker from Dementia Australia met with
a mediator before the mediation and agreed to attend the beginning of the mediation to
speak with the family to let them know what the care needs might look like in the future. And what support might be needed and also
where assistance can be found. There were multiple challenges, the adult
children hadn’t seen eye to eye for a while. One felt like they carried the burden of care,
the other felt excluded. And there were pressures for everyone in other
aspects of their lives, whether it be personal relationships, care of other people or work. Let’s Talk helped these people make decisions
that enabled the older person to stay at home. There was a better understanding of each persons’
needs and fears. A better understanding of service options. There were action plans to follow up support
service. The initial caller was able to let people
know that they were feeling over-burdened. This enabled others to offer more help. And the adult siblings have entered counselling
to improve their relationships. Let’s Talk also is committed to ensuring that
the rights of older people are known and are upheld. When I’m thinking about rights, we can think
about things in lots of ways and one of the areas I don’t want to skip, but can’t spend
much time on is just thinking about human rights. For those of you who may have been at the
National Elder Abuse’s conference there was a speaker in Brisbane earlier this year, Bethany
Brown who is a researcher of older people’s rights at the United States Human Rights Watch
was a key note speaker. And her key note address was entitled, ‘Human
rights don’t evaporate when we get old. Our rights to dignity, self-determination,
liberty, security, equality, non-discrimination don’t evaporate when we
get older.’ And again, although I’m in New South Wales
I do notice that South Australia does have a charter of rights and freedoms of older
people. In terms of one of the areas that we’ve noticed
with a lot of our calls is – and so far we’ve conducted over initial consultations. Issues of concern that have prompted the call
have included financial abuse and concern about the management of finances and assets
as well as family relationship conflict. We’ve noted there’s a lot of uncertainty amongst
callers about, what in New South Wales we have a power of attorney and also we have
guardianship. What they entail are many – report the misuse
of these powers leading to reports of financial abuse. It’s really important when working in this
space, as professionals that we understand legal documents in our context, that we understand
what documents give powers of decision making, what those decisions can be and also how people
might be able to change those instruments. So the limits, the nature of the decisions,
when it can be changed. People need some information about this, we’ve
had for example someone who thought, because their parent had gone into an aged care facility,
that the aged care facility was then the guardian of that person and got to make all the decisions. So getting information to people about their
legal status, the status of decision making, is really important. If you don’t understand legal documents or
if you’re not sure, ask for help. I know each day has legal services that produce
a lot of information and advocacy services as well. For example, in New South Wales, the New South
Wales Legal Aid website is fantastic, it’s got lots of facts sheets and resources. And one of the sheets, that I think is one
of – the helpline has mentioned is most downloaded is adult children living at home. How to get them to leave. The New South Wales Trustee and Guardian also
has lots of resources on their website and include things to help people consider planning
ahead. What documents might they need, to ensure
that the decisions that they want to be made for them, should they not be able to make
the decisions themselves, are made. And also, in terms of advanced care directed
service worker. So just thinking around there’s a lot of information
and resources out there. Giving people legal information doesn’t mean
they’re starting legal action, it doesn’t mean they’re fighting a legal battle, it means
that people understand the context in which decisions are made. And people need that information when they’re
making decisions and thinking and planning for the future. Let’s talk safety. Relationships Australia is committed to positively
and appropriately addressing issues of safety, including family and domestic violence, elder
abuse and the abuse and neglect of children and young people. So we, our Let’s Talk follows our client safety
procedures which include, and I’ll touch on them, screening, ongoing assessment of risk
and suitability of the service, safety, planning and referral. As mentioned before referral might be for
legal support or legal information. It might be that we’ve heard something that
has us being concerned about the safety or well-being of someone that might be a situation
of possible elder abuse. And there’s a New South Wales aging and disability
abuse helpline. And as of the 1st of July in New South Wales,
we have an Aging and Disability Commissioner and that Commissioner has investigative powers
with respect to elder abuse. So this is new for us, again part of the changing
landscape. We may also go to the police if there are
emergencies or crimes and we do have in New South Wales that’s just starting, is that
the New South Wales police are establishing specialised elder abuse liaison officers. So in New South Wales we already have domestic
and violence liaison officers, and multi-cultural liaison officers who have been able to work
with and speak with around cases and we are now also having elder abuse liaison officers. I’d like to refer you to the New South Wales
elder abuse toolkit. It’s linked in and it is, as I said, a source
of much information. It has a five step approach to identify in
responding to the abuse of older people. It includes tools for screening and assessment,
heaps of information and practical support. For example, a policy checklist if you’re
wanting to write an agency policy in relation to the abuse of older people. We have as a challenge, in working with safety,
the fact that we’re dealing with older people and adults who are able to make decisions
and family members may not like some of the decisions that people make, they might not
think they’re the best decisions, but people are entitled to make bad decisions. So some of the dilemmas are, when is something
someone’s choice, their autonomy, their decision to do what they want with their money, their
decision not to tell their adult children what their plans are with their will, their
decision to choose who their executors might be, or who they might give powers of attorney
to. And when is it something that’s actually impacting
their safety and safety and that the contexts of support and other services actually needs
to be there to safeguard people. We don’t have all the answers to this, but
we do grapple with this challenges and I think while working in this space, these are challenges
to grapple with. We cannot do this work in isolation. We are developing referral pathways and building
working relationships with many services. These include the aging and disability abuse
helpline, seniors rights service, Dementia Australia, New South Wales police, general
practitioners, and apologies for that apostrophe if anyone’s noticed it. We’ve actually found talking to GPs with consent
from clients has really helped us bridge the gaps that some people have with their understanding
of My Aged Care, how to get assessment, how to actually start entering into the My Aged
Care system to get the support and the services. A lot of people don’t know and sometimes they’ve
had assessment but hadn’t realised that they had their assessments. So again and with permission with people,
we’ve been able to help them get the information they need to then access services for themselves. We also have designated community engagement
work in Bathurst, Wagga, Moruya and metropolitan Sydney. And this is to help to raise the awareness
but also to build working relationships with other services. When thinking about this work, we’ve been
thinking around each family and in each family planning is unique and the time it’s taken
to listen, to plan, to think, to follow up, particularly on referrals and making sure
that people have landed with the services able to support them. We’ve noticed and are concerned about a lot
of people and particularly the older people being referred to a service that may not quite
be the right one for them and they tend to bounce around a little bit. So we’re trying to do a lot of work in making
sure before they arrive that we actually have picked the right service for them. And if it hasn’t been, that we’re able to
work out what might be of benefit for them. Being aware of ageism, keeping this in front
of mind, our own experiences, our own thoughts are impacted by living in an ageist world
and working with clear statements that help challenge ageist assumptions that inform and
maybe even define the issue of the caller. For example the adults, children sense of
entitlement to parents’ financial resources. We might reframe the conversation to say,
for example, ‘Your Mum and Dad may or may not choose to let you know their plans for
their money or how they spend it’. And just again acknowledging that for workers
and for us all in this space that it’s often very close to home. These issues and challenges are close in our
families, in our friends, with our neighbours and it is important that as always we ensure
that we don’t impose our own values, our own thoughts, or our own choices that we’ve made
on others as well as ensuring that we take care of staff, working in this space, with
good support and good supervision. I’d like to leave you with some statements
that our clients have made. ‘I really feel hopeful that things might improve. I’m so glad I contacted you.’ ‘I thought there was nothing I could do, you
feel so helpless, it’s great to know that there are options and people who can help.’ ‘I feel I’m moving forward and have a plan,
I feel more confident to contact my son and try to work things out now that I have some
support.’ ‘Thank you for keeping us safe and on-track.’ Thank you Rachel, over to you. Thanks very much Megan for that very informative
and insightful presentation. And now we’re going to turn to questions from
the audience. We’ve had a question that asks whether you
could talk a little more Megan about the potential risks in responding to elder abuse with mediation
and whether it puts responsibility on the older person who’s the victim. Yes. So as with all our mediation services, whether
it be family dispute resolution or elder mediation, before we even decide on going down that pathway,
we make sure that it is safe to do so. So if there is a situation where people aren’t
safe, or they aren’t that confident that they’re safe, we would not be bringing people together
to have those conversations. We might contact a person and then refer them
for support and work with that family, but we – and again, depending on what kind of
situation it is, it’s hard to say exactly which pathway we take forward but we definitely
don’t proceed unless we are confident that people are safe either with their living and
with planning. And if we are aware of concerns we actually
do, with the consent of the person usually, make connections with the elder abuse helpline. Excellent. We’ve had some questions about the alleged
perpetrators and working with alleged perpetrators, so I might group these questions together
if that’s okay Megan and address them to you. Sure. The first question asks, ‘I’m wondering if
you know if there’s much evidence on how to work with, in parentheses, “male perpetrators
of elder abuse”. Would it be similar or the same as the model
for working with perpetrators of general family violence?’ The questioner goes on to say, ‘I’m curious
as I know the model for working with perpetrators is underlined by gender, however I’m guessing
for elder abuse it would be more informed by an understanding of ageism.’ And then another questioner asks about Relationships
Australia’s work with the alleged perpetrators and the framework that you use in working
with those perpetrators.’ Okay. I’d like to just make some general statements
and if I don’t fully answer your question, and with some more reflection, I’ll make sure
that the written responses fully address the questions. Some points to start with, is in elder abuse,
yes, there are some classic presentations of intimate partner violence and domestic
and family violence that we’re used to working in a lot of our services. We also see in terms of working with the families,
and where there are allegations of elder abuse, that potentially people are not so intentional
of their abuse. For example, I’ll give you an example of financial
abuse. Absolutely you might be a rat bag out there
to fleece your older parent but sometimes what happens is you don’t actually realise
the limits of what you should be doing. People’s sense of entitlement, they don’t
realise that it’s actually wrong to pocket the change. We did it as teenagers but actually as we’re
getting older, if we’re shopping for people – and the use of the technology for banking
for example. So some of the areas of abuse and some of
the perpetrators, once you actually let them know and reinstate rights and choices, people
can sometimes realise going forward that things need to change, particularly if things have
been raised by siblings. So the challenge is to get the person who
might’ve been accused by their family members together to the table to listen. In terms of the – I can’t remember the second
part of your question, I’m really sorry. So that was in relation to – – –
It was around the – it was the gendered work. So in terms of who the perpetrators are as
well, it’s daughters as well as sons. So some of the gendered work is a bit different
in elder abuse. There still seems to be more women victims
to male victims. I don’t have a full understanding of that. But it is different, it is different to our
classic work with domestic and family violence but then at different times, it’s the same
as well. So the principles around safeguarding, safety
planning and screening and assessment, and ongoing assessment of, ‘Is this the right
service and what else might people need?’ underpins the work. Okay, well thank you very much Megan. I’m afraid we don’t have any time for further
questions but thank you for attending today and please follow the link on your screen
to our website to continue the conversation. And as you leave the webinar, a short survey
will open up in a new window and we would greatly appreciate your feedback. Please note that any unanswered questions
may be published along with your first name on the CFCA website for a response from presenters
after the webinar. Please let us know if you don’t want your
question or your first name to be published on our website. Thank you Megan, thank you Adam and thank
you everyone for joining us today. Good afternoon.

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