The revelations about sexual assaults in a Victorian nursing home in recent times are frightening. Our elderly people simply deserve better: and as horrific as it sounds this most recent event is unlikely to be an isolated occurrence. At the same time it must be recognised that abuse of elderly people is not limited to residential care settings. On the contrary, evidence suggests such abuse is widespread in the general community.
In a report commissioned by the Office of Senior Victorians and the Minister for Ageing, Gavin Jennings, published in December 2005, abuse of elderly people was found to be more prevalent in the homes of victims than in residential or hospital settings. The report made numerous recommendations and these centred on better co-ordination of services, public awareness and education along with empowerment of elderly people rather than mandatory reporting.
It must also be recognised that nursing homes have come a long way over recent years. Even before the “kerosene bath” fiasco several years ago abuse of elderly people, either through sins of commission or omission, was widespread. But under a rigorous program of government-driven audits and systems of accountability, standards have improved both in the quality of care and the over all quality of accommodation. However, even in recognising those improvements it is clear more needs to be done.
Where once our nursing homes were mere silos housing frail and elderly people, most nursing homes are now much more vibrant places. Under the provisions of the Aged Care Act 1997 homes are required to, and by and large do, have a focus on quality of life issues where the maintenance of lifestyle pursuits and links to the community and family form an integral part of nursing home life.
Under the auspices of the Aged Care Standards Association, the Aged Care Complaints Resolution Scheme and community visitor’s schemes, residential aged care facilities are subjected to rigorous surveillance. Similarly under the present funding scheme the validity of the claims for funding are routinely scrutinised to determine if the cost of care claimed for can be substantiated. This process has the dual effect of not only ensuring a level of financial accountability but it opens the activities of the care staff to further external scrutiny. But bad things continue to happen.
To its credit one of the focuses of this Federal Government has been an emphasis on staff training and education. Nursing homes are required to demonstrate on-going programs of education and quality improvement. Most enterprise bargaining agreements and industrial awards have provision for both paid and unpaid study leave and most registering bodies of health professionals have expectations that their members maintain contemporary levels of knowledge about their discipline. Education is widely available. If the employer does not offer it, there are many educational opportunities on offer for those working in the aged care sector. In spite of all that, abuses persist.
Acts of physical violence and sexual assaults are horrendous crimes: when these are perpetrated upon our most frail and vulnerable people, they adopt an even crueller dimension. It has been suggested that mandatory reporting might provide another means to curtail such abuses but mandatory reporting is an after-the-fact response. Mandatory reporting is also unlikely to provide an answer to what seems to be a problem with attitudes and values.
Abuse of elderly people however can take many forms less obvious than those overt acts of criminality we are faced with today. Failing to respect an individual’s privacy and dignity - one of the mandated standards under the provisions of the Aged Care Act 1997 - for example, represents a form of abuse. Failing to recognise a person’s presence and personhood while undertaking a nursing or medical intervention at the same time as talking to a colleague on an unrelated matter, excluding them from a conversation or isolating them socially and emotionally are other examples.
Referring to an individual who requires assistance with eating and drinking merely as a “feed” is another form of degradation not unlike the de-humanising reference to an individual as “the gall bladder in bed ten” that might occur in an acute care setting. Where the person suffering from gall bladder disease might be in a position to stand up for themselves or know that they will soon be in a kinder environment, most people in nursing homes do not have that luxury.
Many of these acts are subtle. Some can be brushed off as momentary lapses of judgment or forgetfulness. Sometimes they constitute a dominant culture and gross misunderstanding of the complexity of caring for elderly people and are institutionalised patterns of behaviour. In all instances they are inexcusable but these acts reveal a deeper malaise: they reveal a widespread undervaluing of our elders by the community and not merely by those employed in the nursing home industry.
Abuse of elderly people is a blight not restricted to activities within nursing homes. The popular press can point us to countless stories where elderly people have been financially disadvantaged by their own families, shonky trades and sales people are regularly unearthed ripping off vulnerable elderly people. They are seen by the criminal element as soft targets for theft, criminal assault and rape. Our elderly people are at risk at every level of our community and in all walks of life.
The pool of workers engaged in residential aged care facilities is representative of community values and attitudes. Most if not all of them are exposed to training and education relevant to their scope of practice. But it is clear that in some instances they are coming to the industry, or have been a long time in the industry, with rusted-on prejudices and attitudes that no amount of education can erode. While the industry can weed out those who clearly demonstrate inappropriate attitudes it often sadly happens after the damage has been done.
Steps do need to be taken to eliminate further abuse of elderly people in our nursing homes. It would be regrettable, however, to only see a knee-jerk reaction to these most recent and horrific revelations without parallel efforts aimed at addressing attitudes within a community that would seem clearly to foster these forms of abuse.
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