Family violence across the lifespan: a hospital’s response to elder abuse Meghan O’Brien Social Work Grade 4 Elder Abuse Lead St Vincent’s Hospital Melbourne (SVHM )

Elder Abuse may look like……  Female aged over 80  Admitted to hospital following a fall  Receiving an Aged Pension  Widow  CALD background  Cognitive Impairment  Socially isolated  Nil services  Cared for by son and daughter in law

Definition of Elder Abuse (EA)  Elder abuse’ is a form of family violence  EA is defined “any act occurring within a relationship where there is an implication of trust, which results in harm to an older person”  Elder abuse may include physical, emotional, financial or sexual abuse and neglect

The literature Older adults who are subject to EA, neglect and exploitation face a greater risk of hospitalisation than other seniors (JAMA Internal Medicine 2013) For many older people at risk of EA - the hospital may offer a “window of opportunity” for help and support (Joubert & Posenelli 2009) Hospitals play an important role in identifying, reporting and preventing elder abuse (RCFV 2016)

Why do hospitals need to consider EA? Incidence of EA will increase as Australia's ‘baby boomer’ generation reaches old age Estimated that 5% of older people are at risk of EA EA is under reported – ‘tip of the iceberg’ Health professionals identified as having a role in EA Responding to EA starts with awareness raising Incidence of dementia can impact EA Attention on Family Violence from RCFV

Challenges for health professionals EA presents a complex range of issues Health professionals unlikely to be present when EA is occurring Health professionals are unlikely to act upon suspicion Multiple co-morbidities Capacity vs cognitive impairment Threshold of Risk Older people are reluctant to report

Barriers for older people Shame and embarrassment Desire to protect the person from the consequences of their conduct Fear of going into care Fear of losing independence Fear of retaliation Cognitive impairment or poor communication skills reduce reporting options EA is a form of family violence “growing old”

Barriers for addressing EA Definition and understanding of EA Knowledge of assessment, reporting and referral frameworks May compromise working relationship with family Consequences for older person & person of concern Issues around confidentiality ‘Too hard basket’

Current practice at SVHM No active screening – ‘usual care’ Targeted training provided for ‘responders’ Clinical leaders identified Organisational wide support Neglect more prominent in hospital presentations Focus on repeat presentations Red flags guide our response

Red flags for hospital clinicians Inappropriate interactions/body language Repeat hospital presentations ‘Doctor shopping’ Vague explanations/inconsistent stories Delays in seeking care/lack of follow up Unexplained injuries Poor grooming or hygiene Unexplained financial status Sudden appearance of a new caregiver

Translating evidence into practice Australian Research Council Linkage Project Study Tour of the UK – Safeguarding Approach Protection of SVHM Vulnerable Older Persons (VOP) Policy ratified in March 2013 Introduction of a new Model of Care (9 steps) Established Vulnerable Older Persons’ Coordination and Response Group (VOP C&RG) May 2013 Health Justice Partnership January 2016

SVHM Clinical Governance Framework Organisa tional Systems & Processe s Risk Management Performance Measurement Culture & Leadership Effective Clinical Care Organisational Systems & Processes Education & Training Performance Measurement Culture & Leadership

Data on notifications of suspected EA Year 1Year 2Year 3Year 4 (5 months) Total Number of cases Average per month

Data findings ( n= 184) Sources of Notifications Social Work60% ED Care Coordinators 18% Other HARP12% Community Programs 10% Types of Elder Abuse Financial53% Psychological48% Physical40% Neglect28% Sexual2%

Demographic information (n = 184) 48% aged 80 years and over 71% female 24% living alone 92% in receipt of the age pension 35% son was person of concern - 24% spouse 57% audited cases – disclosure by older person 71% from CaLD background (48% interpreters used) 62% living with person of concern)

Case Study Older person presents to ED VOP notification completed by ED Escalated to line manager Patient admitted to ward Assessments completed by team Family meeting VOP case review if needed Pt discharged with/without care plan

Principles of intervention 17 careautonomy competence self- determination privacy and confidentiality safety appropriate protection important relationships collaborative response culturally appropriate

Health Justice Partnership health legal social

Conclusions Learn to recognise the signs of EA Understand how and why EA can happen Be aware of your organisation’s policies and process for escalation Provide support to older people through assessment and care planning A governance framework can improve staff’s level of confidence to act on suspected EA