Working with older people

• What should I know about working respectfully with older people?
• What services may older people need and how can we get them?
• What should I know about working respectfully with older men
• What should I know about working respectfully with older women?
• What should I know about working respectfully with older gay, lesbian, bisexual, transgender and intersex (GLBTI) people?

In Australia, as in other parts of the world, perceptions of ageing can be based on negative stereotypes that lead to older people feeling isolated and powerless. Some common misconceptions about ageing include the belief that older people are all the same, that they are unable to make decisions for themselves, that they are likely to suffer ill health and that they are a burden for their families and the wider community.

It is important for those of us working with older people to challenge these misconceptions and to promote the rights of older people to independence, dignity and respect, as well as the right to fair access to services and community resources. When working with older people we need to respect these rights while being aware of some of the more common difficulties older people may experience so that we can adapt our work to meet their needs.

The process of ageing can result in physical and sensory changes as well as bring an increased risk of conditions such as dementia, stroke, diabetes and heart disease. We need to be aware of how these issues may affect an older person’s access to and use of services and adapt our work to ensure that any barriers are addressed.

Older people have the right to privacy and confidentiality.

It is important to work in ways that respect the older person’s privacy and dignity. This includes talking to the person not their family members. Sometimes this means taking extra time and effort to ensure the person understands. If English is not the person’s first language it is important to use an interpreter.

Older people have the right to make their own decisions

The law says that we have the capacity to make our own decisions unless proven otherwise. This is called having ‘capacity’ or ‘competence’. A person’s capacity can be temporarily affected by stress, anxiety, medication, illness, infection or injury, and then regained after a temporary illness or stressful situation passes.

Lack of capacity is not necessarily an indicator of dementia. Decision making capacity is also decision specific which means it can vary depending on the issue being decided. For example, it may be difficult for a person to understand complex banking arrangements, but they may be quite capable of deciding things such as medical treatment or where they want to live.

Encourage older people to make their own decisions by:

• Choosing a time when they are less tired, such as earlier in the day
• Choosing a place where they can relax and feel comfortable and safe
• Taking time to give them the information they need to make an informed decision – this may involve explaining things in plain English or in their own language through an interpreter
• Asking them what they want and don’t tell them what to do
• Listening to them and respecting their choices even if you don’t agree.

If it seems that an older person is not able to make a particular decision it may be necessary to arrange a formal assessment to determine their capacity. See ‘Supporting someone who may have decision making problems’ for more information.

Communicating with older people

Common age-related conditions that affect communication can include hearing difficulties and vision changes. When working with older people it is important to ensure that you can be heard and understood.

The following may help when communicating with an older person:

• Ask the person how you can best communicate with them
• Reduce background noise
• Visit in person rather than speaking on the phone
• Speak clearly and at a moderate pace
• Avoid shouting
• Use body language such as gestures
• Take the time to ensure the person has heard and understood you
• Ask them to repeat the information back to you so you can feel confident they have understood
• Provide written information in large print if necessary and in the person’s own language where possible
• Encourage the older person to obtain and use relevant aids, such as hearing aids
• Consider purchasing a hearing amplifier for your organisation. For more information contact an Independent Living Centre

Research by Seniors Rights Victoria found the following practices had a positive impact for older people contacting the service:

• Home visits
• Warm referrals, meaning that the worker contacted services to introduce a client to avoid the client having to navigate unfamiliar systems and doesn’t have to tell their entire story twice.
• Care coordination, assisting the client to navigate the service system.

There are a range of services available to help older people maintain their safety, dignity and independence. These include help to stay living at home, such as help with housework, meals, personal care, transport and social activities. They also include help with nursing care, allied health such as physiotherapy or podiatry, home modifications and aids. Support and assistance for carers is also available.

Older people who need more help with day-to-day tasks or health care may find the best way to receive the help and support they need is by living in an aged care home, either on a permanent basis or for a short stay (called ‘residential respite’).

Many services require an older person to undergo an assessment before they can access their services. Some assessments are conducted by the organisation providing the service. The Aged Care Assessment Service (ACAS) conduct holistic in-home assessments for older people to access community aged care packages and residential care. Waiting lists often apply after the assessment.

Find out more about aged care services at My Aged Care. The website provides up-to-date information about Australia’s aged care system and services. The National Contact Centre on 1800 200 422 provides prompt, reliable and confidential services, information in other languages and other formats for those with hearing difficulties or a vision impairment and help to find Government-funded aged care services.

My Aged Care can help you:

• Learn more about aged care assessment eligibility and processes
• Understand the type of care available, how to get it and costs
• Find services in a local area
• Get information about a range of health conditions and healthy living
• Access information in other languages

Abuse and mistreatment of older men tends to be a hidden problem, yet men make up a significant proportion of older people who are being abused. On average, 1 in 4 callers to Seniors Rights Victoria’s Helpline is male. There are strong social norms against men acknowledging that they might be at risk or experiencing elder abuse. These social norms can lead to men thinking they need to continue to be self-reliant, strong, a provider and able to resolve their own problems. Research in England in the early 2000s, indicated that men do want to talk about elder abuse. However they need to be asked or provided with a space that lets them do this in a way which is non-judgemental and respects their position.

Education targeting older men and breaking down ideas of masculinity, can assist older men to open up. For example, a campaign that looks at the issue of elder abuse within the context of improving health could include providing access to resources and forums for older men.

In Australia discussion about elder abuse of men is missing from men’s health programs and policy. Real change in addressing the invisibility of men as victim-survivors of elder abuse, needs to be demonstrated at the policy and program level.

Suggestions for how service providers can engage with older men:

· Talk directly with older men in the community to find out their needs

· Develop positive strategies and approaches to addressing elder abuse of men. This can be done by raising awareness of the risks and prevention.

· Create opportunities for men to come together socially and combine this with talks of future planning for seniors. Seniors Rights Victoria can provide free talks to community groups

· Check your own service to see if there are positive images of older men that are inclusive of this age group

· Identify male staff members who can be the 1st point of contact for men

· Design services, activities and events that speak directly to older men

· Think about outreaching some of your services to places where older men gather, such as Men’s Sheds and social and interest groups. COTA Victoria co-ordinates Older Men: New Ideas (OMNI) for older men

Violence against women is the most common form of family violence, with women more likely than men to experience violence at the hands of their partner or a family member.

Gender inequality and the way it is expressed in society has been identified as the social condition underlying violence against women.

As older women are subject to both ageism and gender inequality, they may be more likely to experience elder abuse than men.

As well as intergenerational abuse, research suggests that some abuse experienced by older women is intimate partner violence, which can be the continuation of an abusive relationship, the result of a new relationship, or a change in dynamics of an existing relationship. While older women report lower rates of physical and sexual intimate partner violence than younger women, they experience similar levels of verbal and psychological abuse, and controlling and limiting behaviour.

Ageing does not necessarily inhibit perpetrators: while many male perpetrators of intimate partner violence change their behaviours as they age, moving away from physical violence but maintaining or increasing levels of coercion, financial exploitation and verbal threats, older women can experience physical and sexual violence well into later life.

Generational expectations about gender roles and marriage may influence whether older women experiencing abuse feel able to seek help. Older women may not feel comfortable seeking assistance from specialist family violence services that focus on younger women and children, while sometimes service providers may not be aware of how older age can influence a woman’s experience of violence.

*Clinicians caring for older women can use straightforward questions to inquire about mental health. Examples include asking how much of the time the person feels energetic, enthusiastic about life, and able to participate in enjoyable activities.

If there is a recent deterioration in these states, then it is appropriate to inquire about experiences of abuse using the following screening questions:

1. Has anyone close to you tried to hurt you or harm you recently?
2. Are you afraid of anyone in your family?
3. Has anyone close to you recently called you names, put you down or made you feel bad?
4. Does someone in your family make you stay in bed or tell you you're sick when you know you're not?
5. Has anyone forced you to do things you didn't want to do?
6. Has anyone taken things that belong to you without your permission?

If older women are experiencing any of these behaviours, then it needs to be named and recognised as elder abuse. There are multiple pathways to assist, and the responses to abuse can be informal, formal or protective, depending on the circumstances and the woman's preferences:

• Informal responses include advising the woman of her rights, determining if she can self-advocate, or determining whether family or friends can be trusted or can provide support.
• Formal responses can involve local community services (such as aged-care assistance service packages, counselling and mediation) to reduce dependence on the perpetrator, and advocating for the woman so that other agencies are aware of the need for potential housing, assessment for services, and financial or legal assistance.
• Protective responses include alternative accommodation, reporting the abuse to the police and encouraging the person to seek legal advice (such as intervention orders and welfare checks).

*Advice for clinicians is by Professor Jane Fisher BSC (HONS) PHD MAPS, Clinical Psychologist, MONASH UNIVERSITY and was sourced from Jean Hailes

Lesbian, gay, bisexual, trans and gender diverse and intersex (LGBTI) older people experience the same risk factors for abuse as the wider population. In addition, the Royal Commission found that LGBTI communities experience unique forms of family violence, and can be negatively affected by the way family, friends, professionals and service providers treat them on the basis of their sex, gender identity and sexuality.

Because of prevailing attitudes of heteronormativity and histories of experiences of discrimination, criminalisation and abuse, some older LGBTI Australians continue to hide or modify their sexuality or affirmed gender identity in order to avoid upsetting family members, carers, service providers or others who may hold homophobic or transphobic views. The possibility of facing discrimination and harassment when help-seeking, or when accessing aged care and other health services, may also lead to people hiding this part of their identity or remaining silent about the ways they are being treated.

Some older LGBTI people may be estranged from family and friends who do not respect or acknowledge their gender identity or sexuality, and this can lead to high rates of social isolation or a lack of support, increasingly vulnerability to abuse. As older LGBTI people age or develop disabilities, their capacity to assert themselves with family can be a source of support.

Suggestions for how service providers may engage with older members of the LGBTQIA+ community:

• Identify the needs of older LQBTQIA+ people in the local community by talking with them directly and including them in any community consultations
• Develop positive strategies and approaches to addressing elder abuse of LQBTQIA+ people. This can be done by raising awareness of elder abuse through activities, campaigns and events, which are combined with positive outcomes (e.g. Pride Month)
• Create opportunities for LQBTQIA+ people to socialise over tea/coffee in your service and combine this with talks on future planning for seniors
• Review your own service to assess whether it’s inviting to older LQBTQIA+ people. Are there positive images of older LQBTQIA+ people in the service’s waiting areas, clinical rooms, meeting rooms and other areas?
• Identify LQBTQIA+ staff members who will be the first point of contact for older LQBTQIA+ people when they approach your service/agency
• Think about outreaching some of your service or/agency’s activities and programs to where LQBTQIA+ people get together
• Consider volunteer opportunities which can be specifically targeted at older LQBTQIA+ people
• Design and deliver activities and events that speak directly to older LQBTQIA+ people and are held at times when they are most likely to attend.

Please read our Elder Abuse, Gender and Sexuality Discussion Paper

Rainbow Door is a free specialist LGBTIQA+ (Lesbian, Gay, Bisexual, Transgender and Gender Diverse, Intersex, Queer, Asexual, BrotherBoys, SisterGirls) helpline providing information, support, and referral to all LGBTIQA+ Victorians, their friends and family during the COVID-19 crisis and beyond. 

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