Adjunct, School of Psychology, Social Work & Social Policy, University of South Australia
Conducted research and wrote the State Plan for the SA Government’s Office for the Ageing:
Conducted research and wrote the State Plan for the SA Government’s Office for the Ageing:
Our Actions for the Prevention of Abuse of Older South Australians
Associate Professor Dale Bagshaw: Manager
Dr Sarah Wendt
Dr Lana Zannettino
http://www.sapo.org.au/pub/pub11143.html
Preventing the financial abuse of older people by a family member: Designing and evaluating an older person-centred model of family mediation.
Preventing the financial abuse of older people by a family member: Designing and evaluating an older person-centred model of family mediation.
Associate Professor Dale Bagshaw (UniSA): Manager
Associate Professor Dale Bagshaw (UniSA): Manager
Dr Sarah Wendt (UniSA)
Dr Lana Zannettino (Flinders University)
Dr Valerie Adams (UniSA Research Associate)
in partnership with
SA Dept for Families & Communities (Disability, Ageing and Carers Branch),
Relationships Australia SA,
Office of the Public Advocate,
Alzheimer’s Australia SA
Guardianship Board and
supported by the Aged Rights Advocacy Service.
We used the phrase
We used the phrase
‘abuse of older adults’ not
‘elder abuse’
out of respect for our Indigenous Elders.
Images and concepts of ageing are changing.
Images and concepts of ageing are changing.
Some of my peers (war babies) say that 60 is now the new
‘middle-age’
The baby boomers will
make a difference
Varies from 45-65 depending on the researcher, organisation or service
Varies from 45-65 depending on the researcher, organisation or service
Australian Bureau of Statistics (ABS) – starts at 45, which reflects the lower life expectancy of Indigenous adults.
Commonwealth Age pension – 65+ for males, 60-65 for females, depending on when they were born
World Health Organisation – 60+
For our research we used 65+
Social and cultural (rural, ethnic, professional) constructions of ‘ageing’, ‘gender’ and ‘abuse’ influence how the community, older people and service providers understand and respond to abuse and abusive relationships.
The most commonly used definition of abuse of older people in Australia is:
The most commonly used definition of abuse of older people in Australia is:
Any act occurring within a relationship where there is an implication of trust, which results in harm to the older person. Abuse can be physical, sexual, financial, psychological, social and/or neglect.
The vast majority supported the need for a broader understanding of abuse and for the definition to include:
The vast majority supported the need for a broader understanding of abuse and for the definition to include:
imbalance of power and control (80%) (central to definitions of domestic and family violence).
the gendered nature of abuse of older people (86%)
abuse of an older person’s rights (86%)
cultural abuse (86%)
spiritual abuse (85%)
abuse of an older person’s pets (85%)
abuse of an older person’s pets (85%)
and
abuse can also involve a negligent act or a failure to act, as in cases of neglect (73%).
It is likely that many members of the community may not have heard the term ‘elder abuse’ or may only believe that behaviour is abusive if it is physical.
It is likely that many members of the community may not have heard the term ‘elder abuse’ or may only believe that behaviour is abusive if it is physical.
Non-physical forms of abuse are often subtle and hard to detect.
The older person may be subjected to several different kinds of abuse at the same time, to a lesser or stronger degree.
It can involve an act of commission (abuse) or omission (neglect) which can be
intentional, wilful, deliberate or malicious, or
unintentional, benign, passive or reckless.
Physical abuse can include being pushed, hit, sexually assaulted, burned or physically restrained
Physical abuse can include being pushed, hit, sexually assaulted, burned or physically restrained
Psychological abuse can include humiliation, insults, threats or being treated like a child.
active neglect: withholding of items that are necessary for daily living, such as food and medicine, or placing an older adult in isolated or sub-standard care.
Medical abuse can include the inappropriate use of restraints or the withholding or careless administration of drugs, failure to treat an illness, etc
Medical abuse can include the inappropriate use of restraints or the withholding or careless administration of drugs, failure to treat an illness, etc
Social and environmental abuse can include a failure to provide necessary human services and involuntary social isolation
making improper use of an older adult’s property or money without his or her knowledge or permission and can include
making improper use of an older adult’s property or money without his or her knowledge or permission and can include
forgery
stealing
forced changes to a will
involuntary transfer of money or property to another person
withholding funds from the older person and the
failure to repay loans.
Can also include the misappropriation of enduring powers when a trusted person (usually a family member) is legally appointed with enduring powers to manage the financial affairs of the older person.
With the ageing population and the increasing complexity associated with financial management, this type of abuse is likely to increase.
We found that the abuse of older people
We found that the abuse of older people
is an under-researched and hidden problem
occurs across the spectrum of our society and
is often unrecognised, unreported, and hard to detect.
Australian and overseas studies estimate that between 3 and 5% of older people aged 65 years and over and living at home suffer from various forms of abuse or neglect (Kurrle 2004, p.809).
Australian and overseas studies estimate that between 3 and 5% of older people aged 65 years and over and living at home suffer from various forms of abuse or neglect (Kurrle 2004, p.809).
These figures vary with the methods and definitions used.
Most victims are women
(Rabiner, O’Keefe & Brown, 2004).
The Australian Institute of Criminology - ‘4.6% of older people are victims of physical, sexual or financial abuse, perpetrated by family members and those in a duty of care relationship’
The Australian Institute of Criminology - ‘4.6% of older people are victims of physical, sexual or financial abuse, perpetrated by family members and those in a duty of care relationship’
(Kinnear & Graycar 1999, p.1).
There is a strong link between the abuse of older people and dementia.
There is a strong link between the abuse of older people and dementia.
Dementia is rapidly increasing in Australia, specifically in the older age groups.
A 2011 report estimated that the the number of Australians with dementia over 60 years of age will triple from 2011 to 2050 (from 266,574 to 942,624) (Deloitte Access Economics, 2011).
Financial abuse is emerging as a significant form of abuse
(Office of Seniors Victoria, 2005 & 2012)
Researchers have found that psychological and financial abuse—non-physical forms of abuse—are the most likely forms of abuse to be reported by people 65 and over
(Schofield et al 2002: 25).
Research indicates that the people most likely to commit financial abuse are the older person’s relatives, in particular their adult son or daughter
Research indicates that the people most likely to commit financial abuse are the older person’s relatives, in particular their adult son or daughter
(Brill, 1999; Cripps, 2001; Boldy, Webb, Horner, Davey, & Kingley, 2002; Faye & Sellick, 2003; Johnson 1997; Cavanagh 2003).
The Office of the Public Advocate in Western Australia found that, during 1995-1998, 10% of applications alleged financial abuse, with relatives most often the alleged perpetrators.
Another 2004 study – 80-90% of abusers of older people in Australia were close family members. (Kurrle 2004, p.809).
Another 2004 study – 80-90% of abusers of older people in Australia were close family members. (Kurrle 2004, p.809).
In addition, adult children or other family members are most likely to provide the assistance required by the disabled or dependent elderly person. (Kinstle, Hodell and Golding, 2008)
The 2001 SA Aged Rights Advocacy Service study found financial abuse in one third of 100 cases over a period of 2 years - the majority of victims were women aged over 75 years (James & Graycar, 2000; Cripps, 2001).
The 2001 SA Aged Rights Advocacy Service study found financial abuse in one third of 100 cases over a period of 2 years - the majority of victims were women aged over 75 years (James & Graycar, 2000; Cripps, 2001).
Other studies have found that abuse of older people within the family is still largely the abuse of older women by older and younger men
Older women are particularly at risk of financial abuse, physical abuse, and sexual abuse
(e.g. see Penhale 1999; Boldy et al. 2002; Faye & Selleck 2003; Nerenberg 2008).
The 2006 Australian Bureau of Statistics research - one in four women who have experienced an incident of physical violence is aged 45 years and older
The 2006 Australian Bureau of Statistics research - one in four women who have experienced an incident of physical violence is aged 45 years and older
Supported by other Australian research (e.g. Morgan Disney & Associates 2000).
However, the gendered nature of the abuse of older people is still relatively invisible in Australia
The domestic violence sector has tended to focus on younger women and their dependent children.
Abuse of older adults is highly likely to be ‘spouse abuse grown old’ or continuing domestic violence
(see Nerenberg 2008; Leisey, Kupstas & Cooper, 2009; Brandl, 2000).
Tend to live longer
Tend to live longer
More likely to be financially abused after their partner dies (Brozowski & Hall 2004)
More likely to be abused by a broader range of family members than men (Livermore, Bunt & Biscan 2001).
Less likely to have access to superannuation and, therefore, more likely to rely on the Aged Pension
(Association of Superannuation Funds of Australia 2011).
Financial abuse is the most common form of reported abuse experienced by older Australian Aboriginal people (Office of the Public Advocate, 2005).
Financial abuse is the most common form of reported abuse experienced by older Australian Aboriginal people (Office of the Public Advocate, 2005).
Partly due to colonisation, dispossession and oppression
Often called ‘humbugging’ in the NT
… says a culture of bullying among Indigenous communities is being fed by harsh Native Title laws and feelings of dispossession.
… says a culture of bullying among Indigenous communities is being fed by harsh Native Title laws and feelings of dispossession.
He describes lateral violence…..which occurs when people who are victims of a situation of dominance, turn on each other instead of confronting the system that oppresses them - a major problem in Indigenous communities.
poor English skills
poor English skills
social isolation
dependency on family members
cross-generational factors which result in differing expectations of care and support
fear of being shamed by and excluded from their communities
(Office of the Public Advocate in Western Australia, 2006)
face additional challenges in re-settlement
face additional challenges in re-settlement
For example:
family unemployment
poverty
the changed roles and rights of older people (particularly older women)
lack of family support and intervention
social isolation, and
inter-generational conflicts
(Bonar & Roberts 2006).
Research approved by UniSA’s Human Research Ethics Committee
Extensive review of the literature
National online survey of CEOs organisations servicing older people and of family mediation agencies
National online survey of service providers in those organisations
2-day phone-in with older people and their relatives
National on-line survey of older people and their relatives
CEOs and service providers were asked to check the factors which contributed to the financial abuse of older people (multiple responses were possible) and to add other factors if they wished.
CEOs and service providers were asked to check the factors which contributed to the financial abuse of older people (multiple responses were possible) and to add other factors if they wished.
Respondents were asked to rank 12 strategies that may enhance the prevention of financial abuse of older people by a family member, in order of importance
Respondents were asked to rank 12 strategies that may enhance the prevention of financial abuse of older people by a family member, in order of importance
Responses were received from 132 CEOs & 123 service providers = total 255 responses.
diminished cognitive capacity
diminished cognitive capacity
mental or physical disability
poor or restricted mobility
lack of awareness of what constitutes abuse
lack of knowledge of their rights or resources
social isolation or fear of alienation
need to preserve a family relationship
need to preserve a family relationship
dependency on others in the family
stigma and shame associated with abuse
literacy and language barriers
religious, generational and cultural barriers
fear of reprisal from the perpetrator and a
perceived or actual lack of options or access to services.
Negative, historical experiences of interventions which led to separation and loss for many people.
Negative, historical experiences of interventions which led to separation and loss for many people.
Older Indigenous people mostly want to stay in their families and communities and fear removal if they say anything about the abuse.
Lack of knowledge of the law and services
Reliance on family members and their communities for support
Communication and language difficulties
(Bagshaw, Wendt & Zannettino 2007; Bonar & Roberts 2006).
Domestic violence research has shown that all forms of abuse are often interconnected and are part of a complex, shifting kaleidoscope or mosaic of abuse, often with the misuse or abuse of power and control at the centre (Bagshaw 2003).
Domestic violence research has shown that all forms of abuse are often interconnected and are part of a complex, shifting kaleidoscope or mosaic of abuse, often with the misuse or abuse of power and control at the centre (Bagshaw 2003).
Abuse of older people is a public issue requiring a community response and in serious cases a criminal justice response.
Specific education and resources needed for legal, health care and social service providers (eg doctors, carers, household help, police, clergy) to assist them to
Specific education and resources needed for legal, health care and social service providers (eg doctors, carers, household help, police, clergy) to assist them to
Raising awareness of the problem is the first step towards reducing it
Raising awareness of the problem is the first step towards reducing it
Public education will help combat ageist beliefs.
Need to establish or strengthen informal forms of social support for older people to maintain their independence and quality of life
Participatory models hold the most potential to address the ageist context in which abuse occurs - allow older people to own responses instead of relying on professional expertise.
Participatory models hold the most potential to address the ageist context in which abuse occurs - allow older people to own responses instead of relying on professional expertise.
Interagency collaboration is essential as the abuse of older people is a legal, medical, and mental health issue as well as a social phenomenon.
Relationships Australia (Adelaide and Berri offices),
Relationships Australia (Adelaide and Berri offices),
the SA Office of the Public Advocate and Mark Braes (Mt Gambier) offered a free service to older people and their families for this trial.
To design, pilot & evaluate a specialised older-person-centred model of family mediation which focuses on the best interests & safety of older adults, directly or indirectly includes their voices in decision-making and builds resilient, supportive and protective family relationships.
To design, pilot & evaluate a specialised older-person-centred model of family mediation which focuses on the best interests & safety of older adults, directly or indirectly includes their voices in decision-making and builds resilient, supportive and protective family relationships.
when an older person wishes to involve family members in decisions or plans about their finances and assets, and/or
when an older person wishes to involve family members in decisions or plans about their finances and assets, and/or
when family members believe that an older person is vulnerable to, or is experiencing neglect, exploitation or abuse, and/or
where family conflict involves an older person’s finances or assets.
Older people and their families were asked to identify the potential advantages and disadvantages of organising family mediation early in the ageing process to address an older adult’s concerns about the management of their finances, property or other assets now or in the future
61 responses were grouped under four main themes:
61 responses were grouped under four main themes:
enhancing the rights and wishes of older people
opening and facilitating communication between family members and between family members and older people
enhancing the accountability and responsibility of family members &
reducing family conflict.
Of 57 respondents, 12 said there were no disadvantages. Three themes emerged from the other responses:
Of 57 respondents, 12 said there were no disadvantages. Three themes emerged from the other responses:
it may be hard to get families to commit to the process or to see the value in prevention
family members could misuse the financial and other information provided in the mediation
the older person may feel uncomfortable discussing financial matters with family members.
Any older person and family members who wished to have difficult conversations and/or make plans to protect the older person’s finances and assets.
Any older person and family members who wished to have difficult conversations and/or make plans to protect the older person’s finances and assets.
Primary prevention
We hypothesised that family mediation may be more useful where financial abuse had not yet occurred or where financial exploitation by a family member has been unintentional, benign, passive or reckless .
In some cases, where there has been intentional, wilful, deliberate or malicious financial exploitation or abuse or a family history of abuse, plans could be put in place by the older person and/or non-abusive family members to safeguard the older person and his/her assets in the future.
In some cases, where there has been intentional, wilful, deliberate or malicious financial exploitation or abuse or a family history of abuse, plans could be put in place by the older person and/or non-abusive family members to safeguard the older person and his/her assets in the future.
UniSA’s Human Research Ethics Committee.
UniSA’s Human Research Ethics Committee.
Participation voluntary and confidential
Support persons and advocates included if needed.
Potential participants first seen separately
Screening tool developed to identify violence or abuse
Mediator’s focus: ensuring that the voices of older people were heard, directly or indirectly, and their safety, rights and best interests were upheld.
What are the advantages and disadvantages of offering facilitated family meetings (family mediation) as a potential strategy for prevention or early intervention where older adults are being, or are at risk of being, financially exploited by a family member?
Opens communication
Opens communication
Brings the issues into focus
Can educate older people and their families about the nature of abuse
Can bring financial abuse into the open where it can be better understood - some people might be unaware they are abusing (unintentionally) and so will stop that behaviour.
Can strengthen supportive networks - including workers, families and others
Older people can become more aware of their rights and options
Older people can become more aware of their rights and options
Provides an access point for supportive family members to be involved
May be a catalyst to bring family members together – may encourage the involvement of estranged family members who could be very helpful to the older person
Can empower older people and redistribute power where there is a power imbalance
Can reduce destructive family conflict and assist families to problem-solve in a constructive way
Can reduce destructive family conflict and assist families to problem-solve in a constructive way
May create an improvement even if it doesn’t solve all the problems
Major decisions made in haste could be prevented
May avert a crisis
Protective mechanisms can be put in place where the older person is vulnerable or at risk
The abusers can learn about their behaviour and check their interpretations or ignorance.
The abusers can learn about their behaviour and check their interpretations or ignorance.
Meetings act as a warning light to the family – that abuse is serious and that society doesn’t tolerate it and is supporting the rights of the older person
Mediators are usually seen as independent and impartial
Early family mediation may circumvent the escalation of legal recourse and prevent the case appearing at the Guardianship Board
Having the whole family involved
Having the whole family involved
Increases the family’s awareness of available support services
Defuses domination by one family member
Provides a forum to discuss end-of-life decisions and other related matters
Untangles confusion and identifies the real issues of concern
Gives the older person a voice in an open forum
Gives the older person a voice in an open forum
Prevents future conflict
Clears the air on issues that may be impacting on people’s behaviour
Can organise the older adult’s and their family’s future
Can help to raise awareness of the particular needs of the older person
Families can develop a code of conduct that families can refer to e.g rules for communication, such as each person has a turn to speak, roles, respecting rights etc
Families can develop a code of conduct that families can refer to e.g rules for communication, such as each person has a turn to speak, roles, respecting rights etc
Families can learn how others handle matters or get an idea about what community expects older people to be treated.
Can be used as a way for families to talk confidentially - doesn’t go on a formal record.
The family meetings need to occur in a safe place suitable for the older person.
The family meetings need to occur in a safe place suitable for the older person.
Flexible processes need to be offered – eg shuttle mediation (older person seen separately and the mediator goes between, use of advocates etc).
Mediators should always assume the older person has capacity unless assessed by an expert as not having capacity.
Preferably occurs when the older person is independent and has full cognitive ability
Need more than one meeting to get results
Useful if it is a free service and well-advertised in different languages
If use mediation with patriarchal families, the mediator needs be in control and establish and enforce firm norms.
Language issues: SPs stated that the terms ‘abuse’ and ‘mediation’ may have turned people off or been misunderstood. May have been more useful to use the terms such as ‘exploitation’ and ‘facilitated meetings’ instead
Language issues: SPs stated that the terms ‘abuse’ and ‘mediation’ may have turned people off or been misunderstood. May have been more useful to use the terms such as ‘exploitation’ and ‘facilitated meetings’ instead
Other possible reasons were outlined in the following focus group comments about the potential disadvantages of mediation
.
May be difficult where the older adult has mental health issues, mild cognitive impairment or dementia
May be difficult where the older adult has mental health issues, mild cognitive impairment or dementia
Can escalate the abuse
May have negative repercussions and increase the older adult’s isolation if the perpetrator withdraws the client from the service. Really need safety measures and checks beyond the meeting.
May pressure family members to have a relationship with each other that they do not want, which may worsen the family dynamics and precipitate a crisis
May pressure family members to have a relationship with each other that they do not want, which may worsen the family dynamics and precipitate a crisis
May have an adverse impact on the older adult’s health if bringing the matter to mediation is too stressful
Difficult to organise if the older adult has impaired mobility – need to provide home-based service option
Everyone has to agree to come. Big families may be unable to get all members to agree
Inter-state and overseas family members may be left out or may disrupt proceedings unnecessarily - they may not have any insight into the thoughts, feelings and wishes of the older person
Inter-state and overseas family members may be left out or may disrupt proceedings unnecessarily - they may not have any insight into the thoughts, feelings and wishes of the older person
Someone with a Power of Attorney could complicate matters.
Need well educated, skilled and trained facilitators/mediators– these people are rare, in particular in rural/remote areas. Also may need two mediators in some situation.
Other necessary resources may not be available – e.g. a neutral and safe space, access to legal advice, financial advisors etc
Other necessary resources may not be available – e.g. a neutral and safe space, access to legal advice, financial advisors etc
May be difficult to substantiate allegations in some cases
Potential repercussions for the organisation if the alleged abuse is not substantiated
There may be different levels of cultural awareness, different cultural perceptions, different levels of education in relation to what constitutes financial abuse.
Where abuse already exists and there is significant power imbalance - mediation may not be appropriate, or may need special safeguards (e.g. two mediators, separate meetings, an advocate or support person, firm ground rules)
Where abuse already exists and there is significant power imbalance - mediation may not be appropriate, or may need special safeguards (e.g. two mediators, separate meetings, an advocate or support person, firm ground rules)
There may be ramifications for the older persons, especially if they are vulnerable – need to assist the victims first and ensure they are safe
An agreement may not be reached
An agreement may not be reached
Can escalate conflict
If the older person has been abused, s/he may not feel comfortable communicating with the abusers
The concept of mediation may be foreign or scary to some older people and may connote that a problem exists
Older people may be reluctant to have their personal and private business enter into ‘government’ arenas.
Older people may be reluctant to have their personal and private business enter into ‘government’ arenas.
Older people don’t necessarily want formality and things recorded, they may prefer informal and friendly meetings.
Getting an abuser to come to the meeting may be difficult
Family pressure not to meet, especially when the abusers have a lot of power – they won’t give up their power to create equality or admit wrong.
Families have long-standing norms, roles, beliefs that are hard to change e.g. son is the heir, sense of entitlement, rewarding those who are carers, parents right to decide – so interpretation of ‘best interests’ can be contested in families and amongst siblings.
Families have long-standing norms, roles, beliefs that are hard to change e.g. son is the heir, sense of entitlement, rewarding those who are carers, parents right to decide – so interpretation of ‘best interests’ can be contested in families and amongst siblings.
Difficult to get family together if there is physical distance.
Often children don’t know about parents’ finances fully – often something that is not spoken about.
For CaLD older people, the term ‘mediation’ implies that there are already issues – ‘family meetings’ may be a more appealing term
For CaLD older people, the term ‘mediation’ implies that there are already issues – ‘family meetings’ may be a more appealing term
A professional interpreter needs skills in mediation as the translation of cultural meanings are just as important as the translation of language.
Elder mediation can be a useful preventative approach in some cases, however
Elder mediation can be a useful preventative approach in some cases, however
there needs to be more information available to the community, service providers and older people about what it involves and its benefits, and
an increase in the number of professionals who are specially educated and trained in elder mediation.
Using a strengths-oriented perspective, mediators can promote positive, respectful language and communication, empower older people and emphasise older people’s contributions and worth to society
Using a strengths-oriented perspective, mediators can promote positive, respectful language and communication, empower older people and emphasise older people’s contributions and worth to society
No two cases of abuse of older people are alike
No two cases of abuse of older people are alike
A variety of assessment tools and preventative approaches are needed to meet the needs of each situation
The safety and empowerment of the older adult should be given the highest priority
Need to develop models of prevention that address the ageist and gendered contexts in which abuse occurs
Where there is abuse is also essential to
Where there is abuse is also essential to
provide a coordinated, multiple service system response to the victim, the perpetrator and the social network surrounding the victim.
Dale’s email address:
Dale’s email address:
Dale.Bagshaw@unisa.edu.au
Dale’s University Homepage: http://www.unisanet.unisa.edu.au/staff/homepage.asp?name=dale.bagshaw
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