As a worker, your response to a situation of suspected or known abuse of an older person will depend on the position you hold and the requirements of the organisation you work for. It’s important to manage any suspicion sensitively, making sure that your actions do not cause further harm. This means working respectfully and respecting the rights of the older person and their carer/s.
Organisations funded to provide health or community care services should have clear, established frameworks including policies and procedures covering how workers are expected to respond to clients’ needs. These should include frameworks for responding to emergency care needs such as those arising from situations of family violence or elder abuse. Your organisation should ensure you and all staff are aware of these requirements. Further information is available in With Respect to Age 2009
The basic responsibilities of all workers if they suspect elder abuse are:
Safety is the most important concern – safety for the older person, their carer/s and for yourself and any other workers involved (see Safety in emergencies).
In many instances a direct care worker will be the first person to recognise or suspect the abuse of an older person. Direct care workers may suspect that something is wrong by witnessing the abuse first hand, or by noticing several risk factors affecting an older person.
In the first instance, direct care workers should report suspicion of abuse or risk of abuse to their supervisor. It is important to gather as much relevant evidence as possible and to document this by making clear notes. Your service may have service coordination tools you should use.
Ensure that actions do not cause more harm, and do not undermine the rights of an older person or their carer/s.
A worker’s safety is the subject of their organisation’s occupational health and safety policies and procedures, which should be complied with at all times. Whether abuse is suspected or confirmed, worker safety is of utmost importance. Workers should be supported by their employers to develop appropriate self-care strategies.
Workers from outside the aged and disability sector may not have internal frameworks specifically for elder abuse, but are likely to have duty of care, safety or security policies that may apply. Often these will require a formal risk assessment process. It is likely that any tools available for workers outside the aged and disability sectors provide limited information about working with older people. See ‘Working With Older People’ or contact Seniors Rights Victoria for advice.
Duty of care is a legal term to describe the obligation workers have to avoid causing harm to another person. The extent of your duty of care will depend on your work role, but you should be aware of your obligations. Health and aged care workers have a duty of care to the older people they are assisting. If a worker breaches their duty of care, they have failed to meet the expected standards of care.
The following explanation of duty of care provides a more detailed example of how duty of care is determined.
A duty of care encompasses a duty not to be careless or negligent, and arises from a relationship between people from which it is inferred that an obligation to take care exists in some form.
A duty of care involves a legal obligation to avoid causing harm to another person. This only arises when it is reasonably foreseeable in a particular situation that the other person would be harmed by an action or omission, without the exercise of reasonable care.
Duty of care refers not only to the actions of a worker but also to the advice the worker gives or fails to give.
The scope or extent of your duty of care will depend on a number of factors.
A duty of care is restricted to the role or duties for which the worker is employed. For example a community bus driver is not expected to take the same actions as a nurse.
Workers have a duty of care to older people they are assisting. A worker is not negligent in failing to take precautions against a risk of harm unless
If a worker breaches their duty of care, they have failed to meet the expected standards of care. If harm occurs to the older person as result of this breach of duty of care, the worker may be legally liable for damages arising from this harm.
Whether a duty of care exists in a particular situation and whether it has been breached between the worker and the older person depends on the role of the worker. In particular a number of salient features will be taken into account, these include:
The best questions to ask are those that can’t be easily given a ‘yes’ or ‘no’ answer. Your questions should be direct and non-judgemental. Questions that focus on family relationships, caring roles and dependencies may reveal tensions and difficulties. Information gathering may need to proceed slowly and carefully and may take time.
An effective way to begin the discussion may be to ask the older person to describe, in a general way, how things are at home and how they spend their day. For example:
Listen to the older person’s story. Acknowledge what they have said. Let them know they don’t have to put up with abuse, that help is available and that other people also experience abuse. Give them information about how to get further help and offer to assist them with this.
It is important to be sensitive to an older person’s values and cultural differences and to respect those differences. The meaning of certain verbal or non-verbal behaviour should be understood in the context of their culture. For example, some cultures value eye contact in certain circumstances while others value avoidance of eye contact.
With the older person’s permission, contact other workers and organisations to assist with understanding different values and cultural differences as well as effective and acceptable methods and approaches for supporting someone. See this Tool Kit’s section on ‘Working with people from culturally diverse backgrounds’ for more information.
Self-neglect is not considered a form of elder abuse, although it can be a sign that someone is experiencing abuse, for example the person may feel depressed and hopeless due to an abusive situation. Self neglect may include living in unhygienic or unsafe conditions, refusing to seek or comply with treatment for injury or illness or failing to eat or drink adequately.
Any support and assistance you offer should be respectful of the older person’s right to choose how they wish to live.
With Respect to Age 2009: 1.3.4 Self-neglect or self-mistreatment (p. 6)
A free basic elder abuse e-learning program is available through the Victorian Department of Health and Human Services’ website
A more comprehensive program of elder abuse training is available through the Bouverie Centre
Seniors Rights Victoria delivers professional education on an as requested basis. Sessions include identifying and responding to elder abuse. For further information email Gary Ferguson