15 June is World Elder Abuse Awareness Day, created by the United Nations General Assembly for all to voice opposition to the abuse and suffering inflicted on older people.
I know from working extensively with aged care providers the desire to eliminate elder abuse is strong. Yet abuse still occurs – in fact, a Department of Health report released last year showed reports of abuse increased by 10%. Total surveillance in aged care facilities is controversial and not always possible – providers will never be able to see and hear everything, and using CCTV brings its own ethical and legal challenges.
In many cases, particularly with at-home care, it comes down to the elderly resident or patient’s word against the employee’s.
Abuse cases can be devastating for families and aged care providers alike. But, there is much aged care providers can do to limit the risk. Providers that are well-prepared and successfully run a preventative environment all have several things in common.
Such providers understand how critical it is having well drafted policies and procedures, which set out the process for reporting a suspicion or allegation of abuse. When properly implemented, these procedures bring greater transparency and allow allegations to progress quickly. Without appropriate policies and procedures in place, abuse cases can more easily go undetected and fester into a much bigger problem.
These same policies and procedures dictate how and when investigations are to be conducted. Staff need to be well trained in these policies and any investigations must be consistently carried out in accordance with these policies.
Quality organisations also understand there is no substitute for comprehensive training and education of workers and astute managerial oversight. Countering abuse is not a set-and-forget deal, it is about attitudes and behaviours which providers need to imbed throughout the organisation.
Having the policies, procedures, and training in place means these providers are best placed to correctly handle investigations into aged care abuse. Investigations can be incredibly difficult. Elder abuse may occur in many ways: it may be physical or psychological abuse, or stealing and taking advantage – in one recent case a carer was alleged to have stolen $1.2 million from an elderly man in her care.
Understandably, elder abuse investigations are highly emotional, and potentially traumatising for all involved. Mishandling investigations comes with many risks, including potential for the provider to attract legal action, which can lead to financial penalties and a poor reputation.
Another common yet often overlooked risk for providers is being vulnerable to unfair dismissal claims, from dismissing staff too quickly: in aged care sector dismissals arising from elder abuse, we found the former employees won 70% of the time and were reinstated in 33% of the cases we reviewed.
Care providers must remember that even when a valid reason for termination exists, an employee will still have been unfairly dismissed where that termination is harsh, unjust or unreasonable.
An astute analysis of the findings needs to be undertaken. Providers cannot simply ‘err on the side of caution’ and dismiss an accused employee if the findings of the investigation do not support that course of action.
Is greater surveillance the answer?
We’re often asked, by both providers and families, about the potential to use technology such as CCTV for surveillance. Will this eliminate abuse? Using CCTV cameras has merit but is generally not the fix-all providers desire. For example, in public and common areas of residential facilities, CCTV is uncontroversial. But using CCTV cameras in private residences raises several legal and ethical issues.
These include compliance with current privacy and surveillance legislation. There are also questions regarding consent: if a resident is unable to provide their consent (for example, due to dementia), who can then consent to CCTV cameras?
Ethical complexity around consent was highlighted in a survey conducted in late 2014 by one of Britain’s largest aged care facility operators, HC-One. Of those surveyed, only 47% of residents supported the idea of CCTV cameras in aged care facilities, compared to 87% of relatives. These conflicting views become difficult where a resident can no longer consent to the use of CCTV cameras, yet a relative does so on their behalf – it’s highly likely this decision would be against the resident’s wishes were they able to consent.
If the aged care industry is to meet the goals of World Elder Abuse Awareness Day then each provider needs appropriate policies and procedures for identifying and reporting abuse claims. There needs to be training throughout the organisation, and a commitment to prevention, which is embedded in the organisation’s culture. Addressing these issues creates a safer environment, where elder abuse will not be allowed to go on undetected. If an isolated incident does occur, providers with these critical factors in place will handle any investigation quickly, ethically, and effectively.