ACT Elder Abuse Prevention
Dealing with Abuse of Clients and
their Carers
A Training Kit
Dealing with Abuse of Clients and their Carers – A Training Kit
Dealing with Abuse of Clients and their Carers – A Training Kit
It is with kind thanks from the ACT Government to the NSW Department of Ageing, Disability and
Home Care for their permission to adapt the contents of the NSW Dealing with Abuse of Clients and
their Carers – A Training Kit to the ACT context and giving permission to reproduce the video Behind
Closed Doors, for use in this format.
Any requests or inquiries concerning reproduction should be addressed to:
Department of Ageing, Disability and Home Care
Level 5, 83 Clarence Street
SYDNEY NSW 2000
Tel:
02 8270 2000
Fax:
02 8270 2361
Website:
www.add.nsw.gov.au
The Chief Minister’s Department is committed to producing publications of a non-technical nature
in plain English.
This publication is available on the ACT Office for Ageing website at:
www.ageing.act.gov.au
The Department has carefully prepared this document so that it is as accurate and relevant as
possible. However, the document should not be used as the only source of advice when making
decisions that could affect a person's rights or responsibilities.
The Department cannot accept responsibility for the way in which the document is used.
Professional advice should be obtained when making decisions about how to use the information
contained in the document.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Message from the Chief Minister
I am delighted to commend to you this training kit Dealing with Abuse of Clients and their Carers.
The ACT Government values the importance of our older people.
As part of the ACT Government’s commitment to eliminating elder abuse in our community a
Whole of Government Elder Abuse Policy Framework has been developed. The Framework
directly responds to the Standing Committee for Health and Community Care (4th Assembly)
Report No 11: Elder Abuse in the ACT.
The Framework complements other ACT Government strategies that strive to protect, promote and
enhance the rights of all older residents in the ACT.
This Framework comprises the training kit Dealing with Abuse of Clients and their Carers; a Whole of
Government Elder Abuse Policy; and an information and education resource that form a suite of
documents. These documents will enable ACT Government agencies to develop protocols to assist staff
when responding to situations of elder abuse or suspected elder abuse within their work environment.
In particular the training kit draws together information from a wide variety of sources, both from
within Australia and overseas. It will be an invaluable resource to service providers, educators,
health and other professionals, and other people working with older people and their carers.
I am confident that the Dealing with Abuse of Clients and their Carers – A Training Kit will assist
the community to better understand the role and direction of the Government in ameliorating elder
abuse in our community.
Jon Stanhope MLA
Chief Minister
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Dealing with Abuse of Clients and their Carers – A Training Kit
Contents
Section 1 ............................................................................................................................................ 10
Human Rights Principles ................................................................................................................... 10
Principles governing the implementation of elder abuse prevention strategies for the ACT ............ 10
Section 2 ............................................................................................................................................ 13
Defining Abuse ................................................................................................................................... 13
Section 3 ............................................................................................................................................ 16
Factors Contributing to Abuse ........................................................................................................... 16
Section 4 ............................................................................................................................................ 22
The Extent of Abuse............................................................................................................................ 22
Section 5 ............................................................................................................................................ 25
The Signs of Abuse ............................................................................................................................. 25
Section 6 ............................................................................................................................................ 31
People with Special Needs ................................................................................................................. 31
Section 7 ............................................................................................................................................ 34
Issues for Service Providers ............................................................................................................... 34
Section 8 ............................................................................................................................................ 40
Approaching the Situation ................................................................................................................. 40
Section 9 ............................................................................................................................................ 51
Developing An Agency Protocol ........................................................................................................ 51
Section 10 .......................................................................................................................................... 67
Assessment ......................................................................................................................................... 67
Section 11 .......................................................................................................................................... 73
Interventions....................................................................................................................................... 73
Section 12 .......................................................................................................................................... 90
Developing a Local Interagency Protocol ......................................................................................... 90
Section 13 .......................................................................................................................................... 97
Intervention Records .......................................................................................................................... 97
Identification of Abuse Form ............................................................................................................. 98
Abuse and Neglect ............................................................................................................................ 103
Assessment Record ........................................................................................................................... 103
Abuse and Neglect Case Plan .......................................................................................................... 109
Case Evaluation ............................................................................................................................... 114
Final Case Review and Closure ....................................................................................................... 116
Agency Protocol Review .................................................................................................................. 118
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 14 ........................................................................................................................................ 120
Monitoring and Evaluation .............................................................................................................. 120
Section 15 ........................................................................................................................................ 122
Prevention Strategies ....................................................................................................................... 122
Workshop 128- Information on Abuse of Clients and their Carers ................................................. 128
Workshop 2 - Outline & Trainer's Guide......................................................................................... 131
Workshop 3 - Developing Internal Policies and Procedures in Response to Abuse ....................... 138
Workshop 4 - Outline & Trainer's Guide......................................................................................... 141
Workshop 5 - Developing an Interagency Protocol......................................................................... 145
Part 1................................................................................................................................................ 148
Trainer's Script ................................................................................................................................ 148
Act One ............................................................................................................................................. 151
The Firbanks .................................................................................................................................... 151
Act Two ............................................................................................................................................ 154
The Cheungs ..................................................................................................................................... 154
Act Three .......................................................................................................................................... 157
The Cratheys .................................................................................................................................... 157
Act Four ........................................................................................................................................... 160
The Carer's Story ............................................................................................................................. 160
Part II -............................................................................................................................................. 163
Towards an Elder Abuse Protocol ................................................................................................... 165
Workshop 1 Evaluation Sheet .......................................................................................................... 174
Workshop 2 Evaluation Sheet .......................................................................................................... 175
Workshop 3 Evaluation Sheet .......................................................................................................... 177
Accredited training available to aged care services workers .......................................................... 179
Acknowledgments ............................................................................................................................. 184
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Dealing with Abuse of Clients and their Carers – A Training Kit
Introduction
Elder Abuse is any behaviour within a relationship of trust that harms an older person.
Why this kit was developed
Abuse has previously been a hidden problem for older people and their carers. Home and
community care services, health and medical professionals, the police and the legal profession are
now finding that a significant problem exists in Australia. This is supported by local and overseas
research that indicates, for instance, that approximately 3 – 5% of older people are victims of some
form of abuse.
On 11 May 2000 the ACT Legislative Assembly referred the matter of abuse of older people for
inquiry by the Standing Committee on Health and Community Care. As a direct result of that
inquiry the Standing Committee on Health and Community Care released Report No 11 Elder
Abuse in the ACT outlining 14 recommendations to address elder abuse in the ACT.
The Government welcomed the report and agreed to all 14 recommendations.
These recommendations were that:
1) The Government examine all the material produced by the NSW Advisory Committee on
the Abuse of Older People to assist in developing policy and service delivery responses. In
particular, the committee recommends that the Government adopt and explicate in policy
documents the principles outlined in paragraphs 2.7 and 2.10, of the report, as a basis for
policy development and interventions.
2) The Government take a whole-of-government approach in developing policy and service
delivery responses in the area of elder abuse.
3) The Government develop inter-agency protocols for detecting and addressing instances of
elder abuse.
4) The Government establish a single contact telephone number for members of the public,
family and friends and other service delivery agencies and individuals to report instances of
elder abuse as well as to provide an information and education resource for older people and
their loved ones concerning elder abuse prevention and redress/intervention.
5) The Government investigate and initiate programs to reduce the incidence of social
isolation.
6) The Government increase access to appropriate forms of crisis accommodation for older
women who are victims of physical abuse.
7) The Government require mandatory police checks for all workers in aged care institutions
and for all workers who make home visits in aged care institutions.
8) The Government make representations to the ACT Law Society to ensure that legal
practitioners in the ACT are taking reasonable steps to guarantee that people signing over an
enduring power of attorney are, in fact, competent to understand the implications of this and
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Dealing with Abuse of Clients and their Carers – A Training Kit
that, where necessary, the opinion of a medical specialist be required to make a
determination as to competence.
9) The Government:
a)
investigate provisions for compulsory registration of all Powers of Attorney;
b)
make representations to the Federal and State and Territory Governments to undertake
a review of Power of Attorney Acts operating in each jurisdiction in order to provide
some consistency and to look at cross-border issues;
c)
develop safeguards to assess the capabilities of the person handing over the Power of
Attorney;
d)
institute a requirement that the person handing over the Power of Attorney be given
comprehensive information on the legal issues involved, including information on how
to report abuse;
e)
develop a systematic mechanism to monitor for abuses of Powers of Attorney; and
f)
develop a widespread education program in all areas of elder abuse which would
include comprehensive information on Powers of Attorney.
10) The Government increase the number of respite care services and places available in the
ACT.
11) The Government consult with the NSW Government and NSW Departmental officials to
examine a means of utilising Dealing with Abuse of Clients and theirs Carers, A Training
Kit in the ACT.
12) The Government:
a)
fund a campaign to educate professionals working in the field of elder abuse or likely
to come in contact with victims of elder abuse to recognise and deal with elder abuse
in an appropriate fashion; and
b)
fund a broad based community education campaign on elder abuse in an attempt to
raise general public awareness about elder abuse issues.
13) The Government establish education and training standards for workers in aged care
institutions.
14) The Government consult with the ACT Division of General Practice to help raise the issue
of elder abuse with General Practitioners and to promote effective strategies for addressing
the issue.
In August 2003, the ACT Government established the ACT Elder Abuse Prevention
Implementation Taskforce. The Taskforce provided advice and input to the implementation process
for the Government’s elder abuse prevention agenda and assisted with the development of options
to respond to the individual recommendations in the Standing Committee’s Report No. 11.
Members of the Taskforce were drawn from relevant ACT and Commonwealth Government
agencies, the ACT Ministerial Advisory Council on Ageing, the Community Advocate’s Office,
Office of the Public Trustee, the Victims of Crime Unit, the Council of the Ageing, and the ACT
General Practitioners Advisory Body.
How this kit was developed
The developers of this resource did not want to re–invent the wheel and so, it has been designed by
drawing together the best of Australian and New Zealand resources into one comprehensive
information and training resource.
The process involved:
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Dealing with Abuse of Clients and their Carers – A Training Kit
• consulting with a wide range of service providers in metropolitan and rural areas to find what
would be useful for their agencies and staff;
• reviewing existing research from Australia and overseas and resources from NSW, Victoria,
Western Australia, Queensland and New Zealand;
• collating these resources into one comprehensive draft information package; and
• designing three workshops targeting direct service providers, agency policy makers and across
agency assessment and intervention workers;
All original sources can be found at the end of each section and acknowledgments at the end of the
information package.
Who this kit is for
This Kit provides information, tools and resources that will assist service providers from many
disciplines and professions to recognise and respond appropriately in cases of abuse involving older
people and their carers.
Different parts of the kit have been designed for different end users. Basically you select what you
need. This Training Kit has been designed for:
• direct care workers including personal care assistants, home aides, respite workers, volunteers,
carers and aged care and disability service workers who are new to the field or who have not
completed previous training on abuse issues;
• paid staff and management with responsibility for following–up potential and actual abuse
situations reported by direct service providers and/or the development, ratification,
implementation and monitoring of agency policies and procedures;
• assessment, case management and intervention workers including aged care assessment teams,
general practitioners, hospital social workers, mental health teams, community nurses,
community health staff, the police, private and public guardians, solicitors, magistrates and staff
at local and district courts, public trustees, community legal centres, legal aid workers and
specialist services like domestic violence services, client and carer advocacy services and
advocates, Aboriginal workers and ethno-specific support workers.
What is in this kit?
Background Information
The background reading consists of 16 separate sections or modules. Each section looks at one
aspect of abuse including:
1.
Human rights and its links to abuse
2.
Definitions of various forms of abuse
3.
Factors that contribute to abuse
4.
National and international research findings
5.
Signs of each form of abuse
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Dealing with Abuse of Clients and their Carers – A Training Kit
6.
Issues for people with dementia and their carers, Aboriginals and Torres Strait Islanders,
people living in remote and isolated areas and people from non–English speaking
backgrounds
7.
Issues faced by service providers when they encounter abuse situations
8.
How to approach a situation involving abuse
9.
How to develop an agency policy in response to abuse
10.
Guidelines for the assessment of abuse
11.
Guidelines for intervention
12.
Guidelines to develop an Inter-Agency Protocol
13.
Sample identification, assessment, care planning and review tools
14.
Monitoring and evaluation guidelines
15.
Preventative strategies to address abuse
Sample Agency Protocol
The Sample Agency Protocol is a guide to best practice in responding to potential, suspected and
actual abuse of adult clients and their carers. It sets out a model for agency roles and
responsibilities within a local area, in terms of identification, assessment and case management.
Trainer's Guide
The Trainer's Guide contains an outline of three workshops and a PowerPoint presentation to assist
in conducting elder abuse awareness / training sessions. The workshops are designed for different
target groups and can be used with the training DVD Behind Closed Doors produced by the NSW
Advisory Committee on Abuse of Older People in their Homes. A synopsis of the four case studies
in the DVD is included for those who do not have access to a DVD player.
In summary, the three workshops are:
• Information on Abuse of Clients and Carers. This 3 hour workshop is an introductory
information session. The workshop is for paid and unpaid workers who are either providing
services in the home or working directly with clients and carers. It will give participants an
understanding of types of abuse, their possible causes and common warning signs. At the end of
the workshop, participants will be able to recognise situations where abuse may be occurring,
know what to do in potential abuse situations and be able to deal with their own personal
dilemmas.
• Developing Internal Policies and Procedures in Response to Abuse. This 3 hour workshop can
be run as either an internal workshop for the management committee and staff of one agency or
as across agency training for policy makers from different organisations. It assumes that
participants have completed Workshop 1 and can be run as the second part of a one-day
workshop with Workshop 1 run in the morning.
It includes information and exercises on the policy and procedural requirements for appropriate
intervention and interagency protocols for referral, assessment, case management and
intervention.
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Dealing with Abuse of Clients and their Carers – A Training Kit
• Developing an Agency Protocol. This one-day workshop has been developed for individuals,
agencies and service providers who have responsibility under the Agency Protocol for
assessment, case management and legal and other interventions in cases of abuse. It has been
designed in two parts that can either be held on the same day or over two meetings. Part I is a
two hour exercise for all agency players that explores a range of abuse situations, potential
interagency responses and gaps and issues to be considered in the development of an appropriate
and effective protocol. Part II is a follow–up workshop for the key agencies and personnel
involved in assessment, case management and intervention actions. It has been designed so that
participants will have the basis of an Agency Protocol, which can be further developed, after the
workshop.
How this kit can be used
The resource has been designed so that it can be easily adapted to the needs of each end user.
You can use it:
• to run internal or across agency training;
• to train yourself;
• as handouts and information packages for staff;
• to develop appropriate policies and procedures for your agency;
• to produce identification, assessment, care management, monitoring and evaluation tools for use
in your agency and area; or
• to review the interagency protocol developed for your local area.
A word on terminology
This kit has drawn from many sources and some terms have been standardised for consistency.
Previously published material has focussed on the abuse of older people, commonly called 'elder
abuse'.
All legislative and legal references apply only to the ACT as this resource was commissioned for ACT
service providers.
Throughout this resource, we will use the following terms:
Clients
older people who are seeking or receiving support services.
Carer
a person who provides or has provided, unpaid care and support to a person
who has needs associated with ageing.
Worker
paid or unpaid staff who provide direct or indirect services to clients and
their carers.
Victim
a person who has been or is suspected of being abused by another person.
Abuser
a person who is or is suspected to be the perpetrator or is doing the abusing.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 1
Human Rights Principles
Elder abuse is a human rights issue requiring an effective response from Government and the
community. The Human Rights Act 2004 (ACT) states that human rights are necessary for
individuals to live lives of dignity and value, and that respecting the rights of individuals improves
the welfare of the whole community. The ACT Elder Abuse Prevention Implementation Task Force
established a set of principles to provide the framework within which the Government’s
commitments to address elder abuse will be implemented.
The principles are based on those identified in the Standing Committee on Health and Community
Care, Report No. 11, Elder Abuse in the ACT (August 2001), which were extracted from the Legal
Issues Manual of the NSW Advisory Committee on Abuse of Older People, and the Queensland
Government's Strategic Plan for the Prevention of Elder Abuse.
Principles governing the implementation of elder abuse
prevention strategies for the ACT

Safety
Older people have a right to live safely in their own homes, free of violence, abuse,
neglect and exploitation.

Self-determination
Older people are entitled to make their own decisions on matters affecting their lives.
Older people are entitled to participate in the development and implementation of
services, policies and programs affecting them.

Autonomy
Older people are entitled to autonomy and dignity.

Older Person’s Rights
The welfare rights and interests of older people should be of paramount consideration in
decisions affecting them.

Access to Information
Older people are entitled to comprehensive, accurate and accessible information and
advice about their rights and options, to enable them to make informed decisions.

Cultural Diversity
Older people should be provided with assistance, which is culturally and linguistically
appropriate.
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Dealing with Abuse of Clients and their Carers – A Training Kit
United Nations Principles for Older Persons
Independence
1.
Older persons should have access to adequate food, water, shelter, clothing and health care
through the provision of income, family and community support and self-help.
2.
Older persons should have the opportunity to work or to have access to other incomegenerating opportunities.
3.
Older persons should be able to participate in determining when and at what pace withdrawal
from the labour force takes place.
4.
Older persons should have access to appropriate educational and training programs.
5.
Older persons should be able to live in environments that are safe and adaptable to personal
preferences and changing capacities.
6.
Older persons should be able to reside at home for as long as possible.
Participation
7.
Older persons should remain integrated in society, participate actively in the formulation and
implementation of policies that directly affect their well being and share their knowledge and
skills with younger generations.
8.
Older persons should be able to seek and develop opportunities for service to the community
and to serve as volunteers in positions appropriate to their interests and their capabilities.
9.
Older persons should be able to form movements or associations of older persons.
Care
10.
Older persons should benefit from family and community care and protection in accordance
with each society's system of cultural values.
11.
Older persons should have access to health care to help them to maintain or regain the
optimum level of physical, mental and emotional well-being and to prevent or delay the onset
of illness.
12.
Older persons should have access to social and legal services to enhance their autonomy,
protection and care.
13.
Older persons should be able to utilise appropriate levels of institutional care providing
protection, rehabilitation and social and mental stimulation in a humane and secure
environment.
14.
Older persons should be able to enjoy human rights and fundamental freedoms when residing
in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs
and privacy and for the right to make decisions about the care and quality of their lives.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Self-Fulfilment
15.
Older persons should be able to pursue opportunities for the full development of their
potential.
16.
Older persons should have access to the educational, cultural, spiritual, and recreational
resources of society.
Dignity
17.
Older persons should be able to live in dignity and security and be free of exploitation and
physical or mental abuse.
18.
Older persons should be treated fairly regardless of age, gender, racial or ethnic background,
disability or other status, and be valued independently of their economic contribution.
Major References
ACT Elder Abuse Prevention Implementation Taskforce:
Principles governing the implementation of elder abuse prevention strategies for the ACT
NSW Advisory Committee on Abuse of Older People.
United Nations General Assembly (1991), United Nations Principles for Older Persons, Resolution
No. 46/91.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 2
Defining Abuse
Elder abuse is any behaviour within a relationship of trust that harms an older person. There are
different categories of abuse, and it is very important that the specific type of abuse is identified, as
there are different contributory factors and interventions for each type of abuse.
Financial Abuse or Mistreatment
The illegal or improper use of a person's property or finances
Examples include:
• misappropriation of money valuables or property;
• forced changes to a will or other legal document;
• denial of the right of access to, or control over, personal funds including withholding pension
cheques;
• forging of signature on cheques; or
• misusing power of attorney.
Psychological Abuse or Mistreatment
The infliction of mental anguish, involving actions that cause fear of violence, isolation or
deprivation, and feelings of shame, indignity and powerlessness.
Examples include:
• verbal intimidation;
• humiliation and harassment;
• shouting;
• threats of physical harm or institutionalisation;
• withholding of affection; or
• removal of decision making powers.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Physical Abuse or Mistreatment
The infliction of physical pain or injury or physical coercion.
Examples include:
• any form of assault such as hitting, slapping, pushing, burning;
• physical restraint such as tying an older person in a chair or bed; or
• under/over medication.
Sexual Abuse or Mistreatment
The use of sexually abusive or exploitative behaviour.
Examples include:
• rape;
• indecent assault; or
• sexual harassment.
Neglect
Neglect is the failure of a carer to provide the necessities of life to a person for whom she or he is
caring. Neglect can be intentional or unintentional.
Unintentional neglect can occur when a person lacks the skills and knowledge to provide adequate
care, is unaware of available community support services or is ill and unable to fulfil required
needs.
Neglect includes:
• abandonment;
• non-provision of adequate food, clothing, shelter, medical care or dental care;
• inappropriate use of medication;
• poor hygiene or personal care; or
• refusal to permit other people to provide adequate care.
Social Abuse or Mistreatment
Preventing an older person from having contact with family members or friends.
This can include:
• refusal to permit family or friends to visit the older person;
• refusal to permit older people to engage with the wider community; or
• removal of the telephone and telephone book from the older person’s reach.
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Dealing with Abuse of Clients and their Carers – A Training Kit
What Isn't Included Under the Definitions
• self neglect - failure to provide for their own needs and well-being; or
• crimes by unknown assailants.
Major Reference
Kurrle, S. and Sadler, P. (1994) Assessing and Managing Abuse of Older People: A Handbook for
the Helping Professions, Alpha Biomedical Communications, p. 6.
Other References
Kingsley, B. (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council of the
Ageing (WA) Inc. Steering Committee on Elder Abuse.
Fielding, W.S. (1995), Elder Abuse Is Too Polite A Word For It: An Education Manual for
Professionals Who Work With Older People.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 3
Factors Contributing to Abuse
There is no clear reason for abuse or mistreatment. Its causes are both complex and concealed.
Similarly, the problem is not specific to any age, gender, socio-economic, religious or cultural
group. However, experience suggests certain factors are related to abuse, and that the existence of
more than one of these factors places a person at high risk of abuse. Government policies are
advocating community care, and in the light of limited resources are possibly placing extra strain on
family carers. Abuse of clients and their carers can share some characteristics with other forms of
family violence.
Abuse and neglect of clients and their carers is easier to conceal and harder to detect than other
forms of family violence due to:
• the lack of general awareness of abuse and neglect;
• the belief in the right to privacy;
• the diminishing networks of clients and carers; and
• their physical and/or mental health.
These factors may also mean that abuse in these situations is overlooked by those who come into
contact with the victim and it means that prevalence is extremely difficult to gauge.
Key Risk Factors
Carer stress
Caring for a person who is frail or who has special needs is stressful. In many cases, other
contributory factors are also present and this additional stress on the carer appears to be the factor
that triggers the abuse.
The following factors may contribute to an abusive relationship:
• financial difficulties;
• lack of respite care;
• inadequate support to give high quality care;
• heavy physical or emotional costs of being a carer;
• lack of recognition for the role of carers takes a heavy toll on the health and well-being of the
carer;
• personal stress, the carer may be looking after two generations, his or her own children and a
dependent parent. This "sandwich" effect can create extreme stress; or
• unfamiliarity with the caring role and its responsibilities.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Dependency
Clients are at risk of abuse from people with whom they live and share a relationship of
dependency. This dependency may be due to physical impairments from a stroke or Parkinson's
disease, or cognitive impairments such as dementia and these impairments may hinder the person
leaving the abusive situation or reporting the situation. Some abusers who are dependent on the
person may feel trapped or powerless and abuse because of frustration or fear.
Whilst clients who are abused are often dependent on others for all or part of their day-to-day care,
the abuser may also be dependent on the person in order to meet their own physical, psychological,
social, emotional or financial needs.
Family conflict
Abuse is often a continuation of domestic violence, family violence or sexual abuse, which
re-emerges as abuse in the caring situation. Similarly, a child who was previously abused may now
be a primary carer and repeat the cycle of abuse to a dependent parent or child.
In some families violence is considered the normal reaction to stress, and it may continue from
generation to generation. People are also at risk when two or more generations live together and
intergenerational conflict exists. In cross-cultural situations where two or more generations hold
different cultural values or roles, tension and conflict can place dependent people at risk of abuse.
Isolation
The client or carer may be isolated and lack social contacts or support. The following factors
increase the risk of abuse:
• physical isolation;
• social isolation;
• emotional isolation; or
• the absence of adequate support or relief for the carer.
Psychological problems
In many cases of physical and psychological abuse, the mental health of the abuser is implicated as
the major contributory factor. Abuse may occur when either party has:
• a period of mental illness;
• a history of mental problems;
• difficulty in controlling anger and/or frustration; or
• low self esteem or feelings of low self worth.
The person being cared for may act abusively to the carer in situations where the person:
• has dementia;
• has a mental illness; or
• fails to recognise that the carer also has the same rights as outlined in the United Nations
Principles on page 11 and 12.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Substance abuse
Alcohol or drug dependency increases the risk of abuse and can involve substance abuse by either
the person or their carer.
Factors Hindering Detection
Why incidents of abuse are so often unreported
Abuse has been described as invisible or hidden. Knowing why will help you to treat suspected
cases with sensitivity and understanding.
Reasons for under reporting include the following:
• people who are cared for by families may be more easily isolated and hidden from public view;
• family members often help to keep abuse hidden so as to conceal or deny the problem;
• victims are reluctant to report abuse;
• lack of awareness of the issue by professionals and the public;
• the symptoms and signs of abuse may easily be attributed to age related changes or disease; and
• societal attitudes including the negative stereotyping of the older person and person with
disabilities as non-productive may also lead to lack of recognition of the problem.
Reasons for non–disclosure by victims
Victims may be reluctant to disclose incidents of abuse because:
• they may want to protect their families standing in the community;
• they may have a sense of shame or guilt at having raised children or being raised by or with
people who wilfully harm them. This is particularly likely in cultures where older people are
highly esteemed or, in families, where a strong value is placed on family caring responsibility for
a person with a disability;
• they may be unable to express themselves due to communication and language barriers, severe
illness, depression or dementia;
• they may fear retaliation;
• they may consider family violence as "normal" behaviour;
• they may lack awareness of their rights and services available;
• people may have been socialised to turn inward for strength instead of seeking outside help.
They may have been taught to keep family problems in the family. Also, some cultures have
sanctions against revealing family problems to outsiders;
• they may believe that the legal process is ineffective in solving domestic abuse situations;
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Dealing with Abuse of Clients and their Carers – A Training Kit
• they may not want to risk having their mental competency challenged for fear of losing their
independence and right to make their own decisions;
• they may fear that intervention will seriously damage family relationships to the point where
they may be forced to leave the home and enter an institution; or
• there may be distrust and disrespect of people perceived as being in authority due to past
experiences.
Reasons for non–disclosure by people who suspect or identify abuse
Any person can first identify suspected or actual abuse, this can include extended family members,
neighbours, banking staff, or others. Few, however, will report their suspicions.
Some reasons for this are:
• they may not want to interfere in what they consider to be a family matter;
• they don't know who to talk to about their concerns;
• they may fear and be reluctant to be drawn into any legal intervention;
• they fear that anyone else knowing will be too traumatic for the victim;
• they are afraid of the abuser and fear on–going contact will be effected if they disclose their
concerns to another; or
• they may believe that intervention can or will do nothing to improve the situation.
Reasons for non–disclosure by service providers
Many service providers do not hesitate to report incidents of abuse where there is strong evidence of
criminal behaviour. Yet, some may be reluctant to involve assessment and intervention agencies
for reasons already mentioned.
They may also not disclose the abuse because:
• they do not feel that further intervention is necessary;
• they fear that disclosure will breach client confidentiality and destroy trust;
• they are concerned that the abuser will prevent the service provider from having further contact
with the victim;
• they fear accusing a suspected abuser wrongfully and later being sued;
• they lack knowledge or do not know of procedures to help them deal with the problem; or
• they suspect the abuser may be another worker from within their agency or from another agency.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Profile of Victims
Typical victims
• people who are dependent on others for all or part of their care and are abused by their carers;
• people who are carers and are abused by those for whom they care;
• vulnerable people who are abused by family members who are not their carers;
• people who live in violent families or have a background of family tension or conflict;
• people who exhibit particularly difficult and/or inappropriate behaviour, confusion or memory
loss either as a result of developmental disability, mental or psychological disturbances or due to
recent conditions such as impairment through a stroke, dementia, etc;
• those with whom communication is difficult or impossible;
• people who are socially and culturally isolated irrespective of their level of dependency;
• people whose carers have inadequate support, relief, time away, training, are stressed by their
caring role or who have other co-existing stresses;
• people who have family members with problems such as mental illness or disability, personality
disorder or substance abuse; or
• those who have feelings of low self esteem.
A Canadian study conducted by Podnieks (1990) found that characteristics of victims varied
according to the type of abuse. Results indicate the following:
• victims of financial abuse and neglect are more likely to be widowed and living alone; and
• victims of psychological and physical abuse tend to be married and living with their abuser.
Many of these factors, which seem to place people at risk of abuse are more pronounced among
some minority and migrant groups. Poor health and disability are more common and may increase
vulnerability. Relocation and adaptation to different cultures may create additional stresses as a
result of language barriers, discrimination and increased dependency on younger family members.
Older migrants who come to Australia may find the process of relocating, the loss of support
systems and the decline in stature within the family to be extremely traumatic. While some groups
have established strong networks or communities in this country, more recent immigrant groups
may be spread out, resulting in isolation and loneliness.
Profile of Abusers
The majority of abusers (80% to 90%) are close family members, either the victim's spouse, adult
child or other close relative, and they usually live with the victim. They may be financially
dependent on the person they are abusing. Research suggests that spouses tend to be involved more
in physical abuse and children in financial abuse. Australian and overseas studies suggest that
between 45% and 60% of abusers will have significant problems of their own, including physical
and mental health problems.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Although poor financial circumstances, poverty and lack of resources may play a part in the
occurrence of abuse, it is seen in all social and economic groups, in urban and rural settings, and in
all religious and cultural groups.
People at risk of perpetrating abuse include those:
• experiencing stress as a result of their caring role due to inadequate support, supervision and/or
training;
• who are resentful of the carer role;
• experiencing stress in other areas of their lives, such as unemployment, financial or health
problems;
• who may be dependent on the victims for money, housing or emotional support;
• who have experienced previous family conflict or tension;
• who have a background of mental health problems or have dementia;
• who have a background of alcohol or drug related problems;
• who have poor support and/or social networks;
• who have difficulty controlling feelings of anger, frustration; or
• who have feelings of low self-esteem.
Major References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those Who Care for Them, Module 4: The nature and extent of elder abuse and neglect, Section 4.3.
Fielding, W.S. (1995), Elder Abuse Is Too Polite A Word For It: An Educational Manual for
Professionals Who Work With Older People, pp. 15-16, 18-23.
Kingsley, B. (ed) (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 6.
Fielding, W.S. (1995), Elder Abuse Is Too Polite A Word For It: An Education Manual for
Professionals Who Work With Older People, pp. 17.
Kurrle, S. and Sadler, P. (1994), Assessing and Managing Abuse of Older People: A Handbook for
the Helping Professions., Office of Ageing (1994), Responding to Abuse of Older People in
Queensland: A Kit for Developing Agency Elder Abuse is any behaviour within a relationship of
trust that harms an older persons, Draft, Section 6, Queensland Department of Family Services and
Aboriginal and Islander Affairs.
Podneiks, Elizabeth et al (1990), National Survey on Abuse of the Elderly in Canada, Ryerson
Polytechnical Institute, Toronto
21
Dealing with Abuse of Clients and their Carers – A Training Kit
Section 4
The Extent of Abuse
There are some similarities and overlaps between domestic violence, child abuse and the abuse of
clients and their carers. There are indications that all are pervasive, yet remain to a large extent
hidden. For example, it has been estimated that between a tenth and a third of domestic
partnerships experience episodes of domestic violence and that child sexual assault occurs in a
quarter of families.
However there are many differences between these forms of abuse. It must be emphasised that
unlike children, adults have substantive legal rights and responsibilities and are presumed to have
the right and ability to make decisions concerning their own lives.
Overseas Research
Overseas studies suggest that 4-10% of clients of aged care services are victims of abuse, while 34% of all people aged 65 years and over living at home suffer abuse and/or neglect (McCreadie, C
1991, Pillemer KA, Finkelhor D, 1988).
• Approximately 4 % (98 000) of older people in Canadian private dwellings have been abused.
• Ogg and Bennett (1992) found that in a population study of 2,000 older people in Britain, 5%
were victims of verbal abuse and a smaller percentage were victims of other forms of abuse.
• A study in Finland by Kivelä (1992) concluded that 5% of older people were victims of abuse.
• In China, there are increasing concerns about incidents of maltreatment of elderly people.
Similar evidence of neglect and abuse has emerged in Hong Kong and Africa.
• Reports of elder abuse in Japan centred on the daughter-in-law/mother-in-law relationships.
Australian Research
In 1992, Kurrle, Cameron & Sadler undertook a systematic attempt to establish a prevalence rate for
elder abuse in Australia, estimating that approximately 4.6% of older people are abused in some
way.
Most Australian research has involved studies of service providers (McCallum et al., 1990; Barron
et al., 1990; Kurrle & Sadler, 1993;) and agency case records (Kurrle et al., 1992).
Australian studies support the overseas work, and have found that:

over three quarters of carers looking after relatives suffering from dementia in the community
reported verbal aggression and over one half claimed to be victims of physical aggression
including sexual aggression (Cahill and Shapiro 1993).
 over a one year period 4.6% of people aged over 65 years presenting to the Hornsby
22
Dealing with Abuse of Clients and their Carers – A Training Kit
Ku-ring-gai Geriatric and Rehabilitation Service had experienced abuse (Sadler, Kurrle &
Cameron 1992); and

Elder abuse was recorded in 1.2% of all referrals to four Aged Care Assessment Teams. The
ACATs came from 3 states, and covered both urban and rural areas. Risk factors contributing to
the abuse were: mental health/alcohol abuse issues of the abuser (30%), dependency of the
person experiencing abuse (25%), domestic violence (19%), carer abuse (18%) and financial
dependence (8%) (Kurrle, Sadler, Lockwood et al 1997).
Research suggests the majority of victims are women (Pillemer KA, Finkelhor D, 1988). The
majority of abusers are family members, spouse, adult child or other close relative, and they usually
live with the victim.
ACT Profile
Below are statistics collected from the ACT Office for Ageing, Elder Abuse Prevention Information
Line database. (18th June 2004 – 30th June 2005)
Abuse type
Psychological
27
Physical
12
Financial
18
Neglect
6
Abused gender
Male
22
Female
40
Unknown
4
23
Total
66
Social
3
Total
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Dealing with Abuse of Clients and their Carers – A Training Kit
Major References
Age Concern New Zealand Inc. (1992), The nature and extent of elder abuse and neglect.
Promoting the Rights and Well–Being of Older People and Those Who Care for Them, Module 4: p.
4.
Barron. B et al. (1990), No innocent bystanders: A study of Abuse of Older people in our
Community. Office of Public Advocate, Victoria.
Cahill. S & Shapiro. M. (1993), ‘“I think he may have hit me once”: aggression towards caregivers
in dementia care’, Australian Journal of Ageing, vol 12, pp.10-15.
Kurrle. S.E, Sadler. P.M & Cameron. I. D. (1992), Patterns of Elder Abuse. Medical Journal of
Australia, vol 157, pp 673- 676.
Kurrle. S.E, Sadler. P.M, Lockwood et al (1997) Elder Abuse: intervention and outcomes in
patients referred to four Aged Care Assessment Teams, Medical Journal of Australia, vol 166,
pp119-122.
McCreadie. C. (1991) Elder Abuse: an Exploratory Study. London: Age Concern Institute of
Gerontology.
Office on Ageing (1992), Abuse of Older People in Their Homes, Discussion Paper, NSW Task
Force on Abuse of Older People, p. 12.
Pillemer. K. A, Finkelhor. D. (1988), The prevelance of elder abuse: a random sample survey.
Gerontologist, vol 28 (1): pp.51-57.
Sadler, P. (1994), Older People as Victims of Family Violence, paper presented at the Families and
Violence Conference, Centacare Australia and the Australian Catholic University.
ACT Office for Ageing Elder Abuse Prevention Information Line statistics.
Other References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those Who Care for Them, Module 4: The nature and extent of elder abuse and neglect, p. 4.]
ACT Research
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 5
The Signs of Abuse
One of the major problems in dealing with abuse is the difficulty in recognising it. It is necessary to
be on the alert because symptoms and signs are subtle and are attributed to the ageing process (eg.
because the person is old and frail) or to the disability. People may be reluctant to admit that a
person on whom they rely for their basic needs is abusing them.
It is important to remember that the presence of one or more of the signs listed below does not
necessarily establish that abuse is occurring.
It should also be noted that the severity of abuse could vary substantially. In some cases one
incident may constitute abuse (eg. theft or physical assault), in other cases one incident may not be
abuse (eg, the case of a stressed carer shouting once at a relative with dementia). However, the
presence of any of the signs listed below should alert you to the possibility of abuse.
Behavioural Signs
Abuse and neglect can sometimes be detected from the behaviour of people involved as well as the
more obvious signs and symptoms. It is important to be aware of sudden and unusual behaviour
patterns in the client, not only at home, but in other situations and settings – for example, suddenly
not attending church or a group after regular attendance.
Behavioural signs of victims
Behaviours that a person may exhibit can include:
• showing signs of being afraid of a particular person/people;
• appearing worried and/or anxious for no obvious reason;
• becoming irritable or easily upset;
• appearing depressed or withdrawn;
• losing interest;
• sleep disturbances;
• changed eating habits;
• having thoughts of suicide;
• frequent shaking, trembling and/or crying attacks;
• rigid posture;
• presenting as helpless, hopeless or sad;
• making contradictory statements not resulting from mental confusion;
• reluctance or hesitation to talk openly;
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Dealing with Abuse of Clients and their Carers – A Training Kit
• waiting for the carer to answer for them; or
• avoiding physical, eye or verbal contact with carer or service provider.
It is more effective to observe these behaviours in the home. However, it is important to be aware
of them in other situations as well.
It is also important to observe the behaviour of people with whom the client has contact. Are they
willing to touch, talk, listen to or look at the client? Do they react strongly to suggestions regarding
the client care? Do they use discriminatory remarks or put-down comments?
Behavioural signs of abusers
Behaviours that may be exhibited by a person inflicting abuse can include:
• blaming the victim for his/her behaviour (eg, wandering, incontinence);
• not wanting the older person to be interviewed alone;
• refusing treatment for the victim;
• seeking medical attention from a variety of doctors/medical centres;
• responding defensively, making excuses, being hostile or evasive;
• being excessively concerned or unconcerned;
• minimal eye, physical or verbal contact
• treating the victim like a child;
• using threats, insults or harassment;
• taking control of the victim's money or other resources; or
• difficulty managing his or her own life.
Environmental Signs
Living arrangements and standards will vary. What is acceptable for one person may not be for
another. It is therefore important that personal standards do not influence our judgement.
Consideration should be on the effect the living arrangement or standards have on the client or
carer.
Environment signs include:

If the home is hazardous to the client's or carer's health or safety due to disrepair, level of
cleanliness, fire safety etc, this may be a sign that the carer is unable or unwilling to provide
adequate care and may signal abuse or neglect; or

Inadequate heating, inability to reach food or water, inadequate sleeping or sanitary facilities are
other signs that may indicate abuse or neglect.
The presence of any of the above behavioural or environmental indicators does not necessarily
imply that abuse or neglect is taking place, but it does mean that further investigation is warranted.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Signs of Financial Abuse
This is the improper use of a person's money, property, or assets by someone else. Money can be a
very sensitive subject. Fear of not having enough money for future care or feeling obligated to
others can leave a person vulnerable. These feelings can be reinforced and used as a threat. This
may be more easily detected when clients are visited in their own homes.
Signs include the following:
• a loss of money ranging from removal of cash from a wallet to the cashing of cheques for large
amounts of money;
• sudden or unexplained withdrawal of money from a bank account;
• a sudden inability to pay bills, buy food or participate in social activities;
• failure to pay rent or other bills on behalf of the person being cared for;
• loss of bank books, credit cards and cheque books;
• the reluctance to make a will or have budget advice;
• loss of jewellery, silverware, paintings or furniture;
• an unprecedented transfer of money or property to another person;
• the making of a new will in favour of a new friend or another family member. Power of
Attorney may be obtained improperly from a person who is not mentally competent; or
• management of a competent person's finances by another person.
Signs of Psychological Abuse
This is said to have occurred when a person suffers mental anguish as a result of being shouted at,
threatened, humiliated, emotionally isolated by withdrawal of affection, or emotionally
blackmailed. It may be verbal or non-verbal. Psychological abuse is usually characterised by a
pattern of behaviour repeated over time and intended to maintain a hold of fear over the victim.
Signs may include:
• the person may be huddled when sitting and nervous with the family member or carer nearby;
• insomnia, sleep deprivation and loss of interest in self or environment; or
• fearfulness, helplessness, passivity, apathy, resignation and withdrawal.
Look for paranoid behaviour or confusion. Look for anger, agitation, or anxiety. Many of these
signs may be attributed to psychiatric disorders.
Watch how the person behaves when the client/carer enters or leaves the room. There may be
ambivalence towards a family member or carer. Often there is reluctance to talk openly, and the
person will avoid eye contact with both practitioner and client/carer.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Signs of Physical and Sexual Abuse
Because the results of physical abuse are often visible, this can be one of the easiest forms of abuse
to identify. However, the signs of physical pain, injury or force may not always be visible so the
general appearance, attitude and behaviour of the client should be taken into account.
This type of abuse includes punching, kicking, beating, biting, burning, pushing, dragging,
scratching, arm-twisting, sexual assault and any other physical harm to a person. It includes
physical restraint such as being tied to a bed or chair, or being locked in a room.












Look for a history of unexplained accidents or injuries. Has the person been to several different
doctors or hospitals? It is important to check on conflicting stories from the client and carer,
and on discrepancies between injury and the history. There may have been a long delay
between the injury occurring, and reporting for treatment.
Any person labelled as "accident prone" should be viewed with suspicion, as should multiple
injuries, especially at different stages of healing, and untreated old injuries.
Medical and nursing staff should undertake a good physical examination where possible.
However, in the absence of a formal physical examination, other practitioners can note the
presence of bruising and abrasions on exposed areas such as the face, neck, forearms and lower
legs.
On the head, look for bald patches, and signs of bruising on the scalp. This may be indicative of
hair pulling.
Watch for black eyes and bleeding in the white part of the eye. Look at the nose and lips for
swelling, bruising and lacerations. Are there any missing teeth? Fractures of the skull, nose and
facial bones, should always alert one to the possibility of abuse.
On the arms look for bruising, especially bruises of an unusual shape. Think of belt buckles,
walking sticks, hairbrushes or ropes as instruments of injury. Look for pinch marks and grip
marks on the upper arms, victims of abuse are sometimes shaken. Look for bite marks or
scratches.
Look for burns from cigarettes, or chemical burns from caustic substances. Glove or stocking
burns suggest immersion in hot or boiling water.
Look for rope or chain burns, or other signs of physical restraint, especially on the wrists or
around the waist. A victim of abuse may be tied to a bed, to a chair, even to a toilet.
On the lower limbs observe for bruising, rope burns, abrasions, lacerations, or evidence of past
or present fractures.
On the trunk look for bruises, abrasions and cigarette burns. Ribs may be fractured if the victim
is pushed or shoved against an object or a piece of furniture.
Sexual abuse can include rape, sexual assault, sexual harassment and inappropriate touching. It
can be very difficult to identify as embarrassment and shame may prevent the subject from
being raised.
Medical or nursing staff should examine the genital areas for bruising, bleeding, and painful
areas. Check for torn, stained or blood stained underwear. Look for evidence of sexually
transmitted disease. Watch for difficulty in walking or sitting. Any of these signs may be
indicative of sexual abuse.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Signs of Social Abuse
This is where a person is restricted from having social contact or access to social activities. Social
abuse involves intrusion, isolation, possessiveness, jealousy and prevention from having any
independence. This type of abuse includes constantly checking up on, wanting to know the older
persons every move, preventing from seeing family or friends through either threats or
manipulation, accusing of having some other wrong-doing, and manipulating and controlling.
Examples include:

moving the older person far away from the immediate family;

cutting the older person off from the support of friends and family members;

not allowing the person to use the telephone or monitoring the older persons calls;

not allowing the person to socialize or meet neighbours; or

claiming that the older persons friends or family are interfering.
Signs include the following:

loss of interaction with others;

sadness and grief of people not visiting;

worried or anxious after a particular visit by specific person(s);

the older person feels ashamed as if they are unworthy of people’s company;

low self esteem, or is very sad; or

the older person appears to be withdrawn, passive and not wanting to participate in anything.
Signs of Neglect
This is where the carer deprives a person, or the carer is unable to provide the necessities of life.
Some indicators are:
• if food or drink are being withheld, there is malnutrition, weight loss, wasting and dehydration,
all without an illness-related cause. The person may have constipation or faecal impaction;
• isolation, lack of mental, physical, social or cultural contact;
• inadequate supervision, the person is abandoned/unattended for long periods or locked in the
house without any supervision;
• there may be evidence of inadequate or inappropriate use of medication, for instance, the person
may be over-sedated in the middle of the day;
• there may be evidence of unmet physical needs such as decaying teeth or overgrown nails;
• the person may be lacking necessary aids such as spectacles, dentures, hearing aids or walking
frame;
• clothing may be in poor repair or inadequate for the season;
29
Dealing with Abuse of Clients and their Carers – A Training Kit
• there may be poor hygiene or inadequate skin care. The victim may be very dirty, smell strongly
of urine or be infested with lice. There may be a urine rash with abrasions and chafing;
• in some cases when people are immobile, they may develop pressure areas over the pelvis, hips,
heels or elbows; or
• hypothermia, recent colds, bronchitis or pneumonia.
Signs of Self-neglect
Self-neglect is often reported by neighbours because they are concerned about the safety of the
person or because they find the behaviour difficult to understand or cope with. The dilemma that
self-neglect raises, is the effect this lifestyle has on the safety of others versus the person's right to
determine how he/she lives.
The following signs do not necessarily indicate self-neglect, and even when they do, careful
consideration should be given to the consequences that may result from any intervention.
• reclusive behaviour;
• frugality;
• shrewdness, fear, distrust;
• inappropriate eating habits;
• malnutrition, dehydration;
• filthy and unhealthy living environments;
• collecting and/or hoarding rubbish;
• absence of basic hygiene and personal care;
• a menagerie of pets; or
• inability and/or refusal, to pay bills.
Major References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those Who Care for Them, Module 7: Signs of Elder Abuse and Neglect, pp. 3-5.
Kurrle, S. and Sadler P. (1994), Assessing and Managing Abuse of Older People: A Handbook for
the Helping Professions, Alpha Biomedical Communications, p. 11–14.
Other References
Office of Ageing (1994), Responding to Abuse of Older People in Queensland: A Kit for
Developing Agency Elder Abuse is any behaviour within a relationship of trust that harms an older
persons, Draft, Section 7, Queensland Department of Family Services and Aboriginal and Islander
Affairs.
30
Dealing with Abuse of Clients and their Carers – A Training Kit
Section 6
People with Special Needs
People with Dementia and their Carers
People who have dementia (Alzheimer's disease or a related disorder) and their carers require
special attention where abuse or neglect is occurring. People with dementia may be at greater risk
of abuse because of the high levels of assistance required. Research suggests that people with
dementia may be at particular risk of financial abuse and neglect. Carers looking after someone with
dementia are often subject to physical or verbal abuse.
People from a culturally and linguistically diverse background
There is relatively little Australian research information on the extent of abuse of clients and carers
from culturally and linguistically diverse background.
Abuse in different cultural groups can raise difficult issues of family responsibility and varying
views about what does, or does not, constitute abuse or neglect. This does not mean that abuse
should be condoned in any instance.
Issues of abuse should be dealt with sensitively, and advice sought from people experienced with
the particular cultural background of the family concerned. Culturally appropriate, ethno-specific
welfare organisations with trained workers or counsellors should be approached, if available, and
should be linked to Aged Care Assessment Teams (ACAT’s) or others involved in assessment and
intervention. If there are no appropriate cultural groups, then it is important that assessment and
intervention teams are informed about the client’s or carer's country of birth, ethnicity and language
spoken.
The patterns and types of abuse occurring in the various ethnic communities appear to be different.
This in part relates to the circumstances of migration, length of time living in Australia, level of
contact with the wider Australian community, family circumstances and living arrangements and
changes in the values held by different generations.
The key issues include:
• the added disadvantage of cultural and language barriers;
• limited opportunities to disclose abuse; and
• links within communities at times mean that individual privacy is limited.
Where they are using mainstream services, people with difficulties in using English will require
interpreter services. The Translating and Interpreting Service (TIS) phone number is 131 450.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Aboriginal and Torres Strait Islander People
There are a lot of different views about what protocol is when dealing with Indigenous peoples and
communities. Protocol simply means following the customs and lores of the people or community
you are working with and communicating in a way that is relevant to them. Remember to be aware
that each community has its differences and that each community has its own protocols that should
be followed.
An awareness and sensitivity to the social, cultural and economic circumstances of Aboriginal and
Torres Strait Islander communities is imperative. Many Indigenous households are not nuclear
family households but may include two to four generations of a family and extended family
members such as grandparents, parents, children, grandchildren, cousins, aunts and uncles.
It should be recognised that individual Aboriginal and Torres Strait Islander communities interpret
the term abuse and neglect differently. Abuse may be financial, physical, social, spiritual,
psychological, sexual or through neglect. Incidences of abuse often occur during ‘pay week’.
The most common form of abuse appears to be financial abuse or taking advantage of an older
person’s personal income. It is usually perpetrated by immediate family members and more often
by grandchildren.
Physical abuse and sexual abuse does occur, although rarely reported because of ‘shame’ factors.
Most abuses occur as a result of excessive alcohol consumption, but underlying this is a history of
social and economic disadvantage when compared to mainstream Australia.
Much of the abuse between grandparents, parents and children is tolerated (in some cases) due to an
overwhelming fear of past Government policies that removed children from their families and the
resulting trauma which has been passed down to today’s generations.
Provision of care appropriate to Aboriginal and Torres Strait Islander people can include the
following;

having male and female staff available for gender sensitive issues;

maintaining a good level of Indigenous staff;

regular connections between older persons and their country/community; and liaison with local
Indigenous community organisations irrespective of their association with aged care services, as
the majority of the community knows someone who knows someone, therefore keeping an eye
out for each other.
Aboriginal and Torres Strait Islander health and community workers should be consulted and
involved at all stages.
32
Dealing with Abuse of Clients and their Carers – A Training Kit
People in Rural and Remote Areas
The problems of distance, isolation and relatively small numbers of older people spread over vast
areas, in rural and remote regions, may make it difficult to organise support workers and services
for victims of abuse and their families. There may also be problems for workers in attempting to
intervene in small communities.
While identification of abuse is difficult enough in small isolated communities, assessment and
intervention present special problems. Many areas have limited access to assessment services such
as Aged Care Assessment Teams, community services and community nurses.
In some cases, the only service provider able to do an urgent assessment could be the local police
officer or General Practitioner.
Situations of abuse may become well known through the local community and word can spread
rapidly. Victims and abusers can be easily labelled and judged by others. Confidentiality can be
difficult to maintain in these circumstances. It is critical that service providers are sensitive to these
special difficulties and maintain confidentiality. It may be appropriate to seek help from a service
outside a community in particularly difficult cases.
Case management and support services can be more limited in remote and isolated areas. Service
providers will often need to be innovative and flexible in developing suitable support structures for
clients and carers. It may be the case, for instance, that the same person identifies, assesses,
supports and provides case management to the client and/or carer. When this happens, the service
provider must ensure that he or she establishes a debriefing and personal support and advice system
with other service providers with expertise in dealing with abuse situations.
Major Reference
Kurrle, S. and Sadler P. (1994), Assessing and Managing Abuse of Older People: A Handbook for
the Helping Professions, Alpha Biomedical Communications, p. 25–26.
Other References
Office of Ageing (1994), Abuse of Older People, Resource Paper No. 9, Queensland Department of
Family Services and Aboriginal and Islander Affairs, pp. 102-103.
NSW Advisory Committee on Abuse of Older People (1994), Conference Proceedings.
33
Dealing with Abuse of Clients and their Carers – A Training Kit
Section 7
Issues for Service Providers
Rights and Responsibilities of Workers
Workers' rights
• Workers have the right to physical safety and a safe system of work.

Workers have a right to support and information from their agency or department, employers
have an obligation to their workers to provide appropriate legal advice and support.
• Workers have a right to be informed by their organisation of the organisation's elder abuse
protocol for dealing with situations of abuse.
Workers' responsibilities

Workers have a responsibility to their clients to provide competent professional complaints
assistance.
• Workers have a responsibility to be aware of their organisation's complaints mechanism and to
assist people to lodge a complaint it they are not satisfied with the service provided.
• Workers have a responsibility to follow agency protocols endorsed by their agency as a standard
of best practice.
General responsibilities of all ACT Government staff
Section 9 of the Public Sector Management Act 1994 (ACT) sets out the general obligations of
public employees. In relation to elder abuse these obligations include:
• exercising reasonable care and skill;
• acting with probity;
• being courteous and sensitive to the rights, duties and aspirations of others; and
• complying with the Act, the standards and all other laws of the Australian Capital Territory.
Failure to comply with this section may constitute misconduct.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Duty of care
Many workers have a fear of being sued because of some action or inaction on their part during the
course of their employment. While the possibility of being sued is sometimes overstated, workers
and their agencies do have a duty of care to their clients and others who may be affected by the
worker's actions or inaction.
The duty of care refers not only to the actions of a worker, but also to the advice the worker may
give or fail to give. Workers should be careful about giving advice, which is beyond their
competence, or beyond what would normally be expected in their position.
The standard of care expected from each worker will vary depending on the type of work they are
doing. The standard of care expected of a worker in home-based care may not be the same as that
of a social worker in an Aged Care Assessment Team. The standard of care expected is that of a
careful and competent worker of that particular type.
Workers have a legal duty to take reasonable care to prevent another person being harmed.
Negligence can result if a worker's actions, or failure to act, fall below a reasonable standard and
result in foreseeable harm. In circumstances where there is an imminent risk to the life or physical,
mental or emotional health of the person concerned or another person the use and disclosure of
information, which would otherwise be prohibited, may be permitted if such use or disclosure is
necessary to prevent or lessen that risk. Where there is uncertainty about privacy and confidentiality
issues it is desirable to seek legal advice from the ACT Government Solicitor.
Becoming aware of an abusive situation and not acting, for example not seeking advice from your
supervisor, or not referring the matter to an agency able to deal with the issue, could amount to a
breach of the duty of care.
Confidentiality
Confidentiality refers to the obligation of non-disclosure by professionals of personal information
unless they have the consent of the person concerned. It is an important element of client
relationships and includes all personal information gained in a professional/client relationship.
Many workers – doctors, social workers, nurses, and community workers are bound by professional
codes of ethics with respect to client confidences. Workers in organisations such as home care are
also bound by organisational rules relating to confidentiality. Confidentiality is relevant to all
worker/client relationships, and therefore it is important for workers, prior to being in a situation
where they suspect abuse, to find out what rules their organisation has about confidentiality.
Workers need to be honest with themselves and their clients however, as to the extent of
confidentiality in a given setting. In most organisations, confidentiality is between the person and
the organisation, not the individual worker. Files or records kept are usually the property of the
organisation. Other workers, or the worker's supervisor, may have access to the information
contained within them.
Workers may be compelled to disclose information in some situations, eg: where there is a
subpoena. In other circumstances there may be considerations which over-ride confidentiality, for
instance:
• there is an obligation not to conceal a completed or intended crime;
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Dealing with Abuse of Clients and their Carers – A Training Kit
• disclosure may be required when in the person's interest, eg. where the person is suicidal; or
• there may be a duty to warn a third party who is in danger.
The best defence against breaches of confidentiality is to obtain the person's consent or at least warn
the person that confidentiality cannot be maintained in some circumstances.
In the situation of an older person having, or suspected of having, impaired decision making ability,
details concerning the older person and the alleged abuse are referred onto the Office for the
Community Advocate. The Community Advocate is legally mandated to investigate reported cases
and may apply to the Guardianship and Property Management Tribunal for orders protecting these
people.
Key Issues
Abuse is a complex problem and each situation will be unique. Personal beliefs and professional
values, social, cultural and family experiences all influence perceptions of what constitutes abuse
and neglect.
When making decisions about situations of possible abuse of clients and their carers, the following
issues need to be considered.
Worker's judgements
Services making judgements about abuse of clients and their carers have a responsibility to ensure
their workers have the knowledge and skills, or access to the resources and networks, needed to
make the best assessment of the situation.
The client or carer's capacity
An assessment of the capacity of the victim to make his or her own decision should be the primary
consideration. Where the person is unable to make his or her own decision, steps need to be taken
to ensure that an alternative decision making structure is in place.
Affects
The nature, intensity and degree of the abuse will influence the affect on the victim.
• Frequency.
For some types of abuse, even a single incident is harmful.
• Duration.
In some instances there may be no harmful affect on the victim, if the
behaviour is repeated over an extended period of time, however it can
constitute abuse.
• Severity.
The severity of an abusive act will influence the degree of harm experienced
by the victim.
Intention
For the purposes of identifying and defining abuse of clients and their carers, the focus should be on
the affects on the victim rather than the intention of the abuser.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Documentation
It is important to document accurately observation or information received about the situation of
suspected abuse or neglect. Description of behaviour is essential, and needs to be clearly
distinguished from any interpretation by the worker. Description of behaviour is usually best
recorded by a direct quotation from the client, or a paraphrase of what was said. Information from a
third party (eg. family member or neighbour) ought to be recorded only if it is directly relevant and
the source is clearly identified.
Workers need to be aware of the confidentiality and privacy and records management guidelines,
which apply to their organisation or profession.
Personal Dilemmas
Cases of abuse can arouse feelings in the professional worker ranging from anger to sadness.
Recognising and understanding your feelings and dealing with them appropriately is essential if you
are to be effective in your interactions with victims of abuse.
Clients are expected to be treated with compassion and concern. Confronting abusive situations
may arouse feelings of anger, distrust and disbelief within you. You may also feel a personal need
to rescue the victim.
Identification with the victim or abuser
The victim or abuser may resemble someone in your own personal life and this may affect the way
you feel and react toward that person. Feelings of victimisation may also be aroused.
Evaluating the situation based on personal experiences
Life experiences and cultural differences may be factors that influence how situations are perceived.
You may feel that a situation is unacceptable, yet the people involved may not recognise the source
of their difficulties or may not consider their situation to be a problem.
Intervention process
You may feel powerless and ineffective in dealing with abusive situations, particularly if the person
and/or family do not consent to intervention or to services that will assist them. The fact that
intervention is a complex, often extensive, process with no set pattern or time frame can also be a
source of frustration.
Staff Supervision and Debriefing
In any community service agency, a prime objective is to give high quality service. Workers are the
means of providing this service and unless they are given adequate training, support and supervision
they will not be able to give optimal high quality care to their clients.
If adequate training, support and supervision are given, and if practitioners have a regular chance to
share ideas and experiences with other members of the team, there will be less risk of stress and
burnout. If, on the other hand, workers receive insufficient supervision or support, the stresses of
this work can trigger a number of the following reactions.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Physical Reaction
Social Reaction
Cognitive Reaction
Emotional
Reaction
hyperactivity
irritability
forgetfulness
guilt
disrupted sleep
withdrawal
slow thinking
anger
eating disorders
isolation from others
unproductive effort
depression
sexual dysfunction
anti-social behaviour
low mental energy
loss of feeling
tendency to illness
can't be alone
loss of concentration
hypersensitivity
increased smoking or
drinking
loss of enjoyment
with usual interests
loss of problem solving
skills
feelings of emptiness
Because work is often carried out in isolation and dealing with abuse can be traumatic, the
supportive role of supervision is paramount to the maintenance of worker well being. Adequate
supervision implies there are appropriate administrative policies and procedures in place to guide
workers in their work and to protect their safety in dealing with abuse. It also implies that workers
are given the skills and strategies to carry out their work, that they are supported in their day-to-day
work, and that they receive regular supervision and guidance to give high quality service.
Workers need regular opportunities to:
• discuss the problems and issues relating to the case;
• discuss these issues in a climate of trust and confidentiality;
• share some of the frustration and concerns relating to the case;
• evaluate the nature and quality of agency/worker input to the case;
• determine the progress of the case to date and explore future directions;
• decide on future directions and actions necessary to resolve the case;
• learn and share new ideas, skills and techniques for dealing with abuse of clients and their carers;
and
• decide how to continually develop and improve agency/community worker responses to abuse.
Debriefing involving abuse situations
Debriefing between direct care workers and their supervisors/coordinators should occur as soon as
possible after the initial identification of suspected or actual abuse. In many cases, it will need to
happen immediately after identification.
The debriefing session ought to be held in a comfortable and confidential setting. Ideally, there are
no distractions such as telephones or interruptions from other people.
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Dealing with Abuse of Clients and their Carers – A Training Kit
The direct care worker and the supervisor/coordinator should discuss the following three things
during the debriefing. They can be remembered as the three F's of debriefing:
The Facts
• what actually happened, was seen or was heard?
• what was said or done by the direct care worker?
• what documentation/reporting is required under agency policy?
The Feelings
• how did the direct care worker feel about his or her actions, words or
inaction at the time?
• what emotions are still affecting the direct service worker?
• what does the direct service worker need to do or say to process these
emotions and feelings?
The Future
• what do you think the client wants?
• what follow–up is appropriate?
• how will this situation be handled now by the agency?
• what further information or referral is necessary?
• what are the next steps?
Major References
NSW Advisory Committee on Abuse of Older People (1995), Legal Issues Manual, Ageing and
Disability Department, pp. 7-8.
NSW Advisory Committee on Abuse of Older People (1995), Abuse of Older People: Inter-Agency
Elder Abuse is any behaviour within a relationship of trust that harms an older person, Ageing and
Disability Department, pp. 7–8.
Fielding, W.S. (1995), Elder Abuse Is Too Polite A Word For It: An Educational Manual for
Professionals Who Work with Older People, p. 28.
Kingsley, B. (ed) (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 22.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 8
Approaching the Situation
The Fundamental Principles
Principles for response
Abuse of older people, and their carers is a human rights issue. Clients and their carers do not need
to put up with abuse. The ACT Elder Abuse Prevention Implementation Taskforce established a set
of principles that provide a framework for intervention in situations of abuse. Responses in cases of
abuse of clients and their carers need to achieve, simultaneously and in order of importance:
• safety;
• self determination;
• autonomy;
• older person’s rights;
• access to information; and
• cultural diversity.
Principles for intervention

Self determination is to be encouraged. Individuals are to be encouraged and assisted to make
their own decisions, provided with information about all relevant options and given the option
to refuse services if able to do so. Even where people cannot make all of their own decisions,
their views should be taken into account.

The interests of the victim take precedence over those of the victim's family, or of other members
of the community.

Intervention must be victim focussed with a view to ensuring safety and ongoing protection from
violence and abuse.

Victims of violence, abuse, threats, intimidation and harassment must be offered protection
through legal remedies.

Assault and some other forms of abuse (eg. theft and fraud) are criminal offences.

Confidentiality of information is to be respected in accordance with professional ethics, agency
policy and legal obligations.

The desire of the older person for an independent advocate of their own choice needs to be
respected.
These principles were accepted and endorsed on behalf of the ACT Government by the
Chief Minister in 2004.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Roles that Agencies Play
There are five separate areas where each agency may have a role to play.
Identification
Recognising a possible case of abuse.
Assessment
Assessing the situation to determine the nature and extent of abuse.
Case Management
Monitoring the situation of abuse and arranging appropriate services.
Other Interventions
Provision of health, welfare and accommodation services.
Legal Intervention
Where appropriate, taking legal action.
Roles of workers in individual home and community care agencies
It is important for agencies to recognise that the roles of workers in the agency may be different
according to their jobs. In most cases this means there is a difference between the roles and
responsibilities of:
• direct care workers such as volunteers, personal care assistants and home aides; and
• their supervisors and coordinators.
What direct care workers do
Direct care workers are often the first people to identify actual or suspected abuse situations, as they
are the people who work most closely with clients and carers. All direct care workers involved with
the care of older people and their carers should be able to recognise suspected or actual cases of
abuse and know how to refer to the most appropriate person in the organisation.
Direct care workers who identify actual or suspected situations of abuse should:

if possible, inform the client or carer of their concern and the need to discuss their concerns with
their supervisor or coordinator;

inform their supervisor or coordinator about the situation, what happened and what they did or
said;

complete any documentation required under agency policy; or

ask for a debriefing session with their supervisor or coordinator.
What supervisors and coordinators do
Supervisors and coordinators need to know how their local Interagency Protocol, or agreement, in
responding to situations of abuse works. They know what agencies in their area can respond
promptly for assessment, case management and intervention and the information and
documentation required for an effective referral.
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Dealing with Abuse of Clients and their Carers – A Training Kit
In general, the role of supervisors and coordinators is to:

identify reasonable grounds for belief that abuse is occurring;

establish the wishes of the victim;

establish, in their opinion, the capabilities of the victim;

document according to agency policy;

provide adequate debriefing and support for direct service workers who identify or are providing
services in an environment where abuse may be occurring; and

refer, if necessary and with client permission, to appropriate agencies or professional groups for
assessment.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Internal Agency Procedures
Requests for help can be received from service providers, clients, and their family, neighbours, or
friends. Some will be made in person but many will come by telephone from a person who is
concerned about the safety or welfare of a client or carer whom they feel is either at risk of abuse,
or whom they suspect is experiencing abuse.
On the basis of the initial information, the worker must assess the urgency of the situation. The
following table provides a brief checklist for this assessment procedure and then outlines the action,
which might be appropriate in situations that are classified as emergency, urgent (but do not
constitute an emergency), or non-urgent.
Emergency
Urgent
Non-Urgent
Find out:
Find out:
Find out:
•Is the client and/or carer in
•Is immediate help required?
•Is the client and/or carer aware of
danger?
•Can anyone provide help?
request for help?
•Is urgent treatment required?
•Is the client and/or carer
•Is any other person or service
•Is anyone with the person?
aware of request for help?
agency aware of or involved in the
situation?
Action Plan:
Call emergency services if this is
required and has not been done.
Ask if anyone can stay with the
person.
Give them your name and contact
number.
Action Plan:
Action Plan:
Give the caller your name and Complete the Identification of Abuse
contact number.
Form (section 13) and refer to
relevant community worker for
Address immediate needs
assessment and action.
contact appropriate agencies
if this has not already been
done.
Complete the Identification of
If possible keep caller on the phone Abuse Form (section 13) and
refer case to relevant workers
while you alert relevant
for ongoing action.
services/health providers and
complete the Identification of
Abuse Form (section 13)
Community Service Options:
Police;
Ambulance;
Hospital;
Refuges;
Respite Care services;
Mental Health Crisis Team;
Office of the Community
Advocate.
Community Service Options:
Police;
Doctor;
Refuges;
Legal services;
Respite Care services;
Office of the Community
Advocate;
Guardianship & Property
Management Tribunal;
Community services.
43
Community Service Options:
Police;
Doctor;
Legal services;
Respite Care services;
Office of the Community Advocate;
Guardianship & Property
Management Tribunal;
Community services.
Dealing with Abuse of Clients and their Carers – A Training Kit
Assessment for case identification
The presence of one or more risk factors as indicators does not necessarily mean abuse has occurred
or is occurring. Every case is unique and detailed assessment is required to identify cases. As a
precautionary measure, it is strongly suggested that all assessment of clients and their families be
undertaken with awareness of the possibility of abuse.
As part of any assessment, it is important to determine:
• what the victim can and can't do (functional status);
• his or her understanding of what is occurring; and
• his or her willingness to consent for intervention to take place.
Although accurate determination of competency is a complex process, which may require referral to
an ACAT and/or an application to the Guardianship and Property Management Tribunal - the
following is offered as a guide for workers who identify abuse.
A victim may be identified as being:
• Competent and consenting to intervention:
the person is capable of making decisions,
understands what has happened (is happening), and is willing to accept assistance to terminate
the abuse.
• Competent but not consenting to intervention: the person is capable of making decisions and
understands what has happened (is happening). He/she doesn’t however, consent to any form of
intervention to terminate the abuse.
• Not Competent but consenting to intervention: the person has demonstrated an impaired
understanding of what has happened (is happening). He/she may, however, acknowledge the
abuse and be prepared to accept assistance to terminate the abuse.
• Not competent and not consenting to intervention: the person has demonstrated an impaired
understanding of what has happened (is happening). He/she may or may not acknowledge the
abuse but is unwilling, or unable, to consent to any form of intervention to terminate the abuse.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Communicating with Clients and their Carers
How you can communicate effectively
Due to disability, language or other factors special arrangements (eg interpreters, translators) will be
required for successful communication with people who are unable to communicate effectively.
When dealing with a victim of abuse, there are a number of pointers that you will find of assistance:
• identify yourself and explain why you are there and what you are going to do;
• provide suitable lighting and allow time for the person to adjust to changes in light level;
• when speaking to the person, position yourself 2 to 3 metres in front so she or he can see you;
• if communicating to the person in writing, use large, clear and well-spaced lettering;
• hold reading materials steady to lessen the need for rapid eye movement;
• restrict your movements and do not make sudden quick moves;
• speak directly into the good ear (if necessary);
• control noise interferences;
• use short, simple sentences; and
• encourage participation by allowing the person enough time to answer your questions.
Skills and techniques required for effective identification and assessment
Some valuable techniques when dealing with clients and their carers are:
• approach them from the front;
• ask for and gain their consent prior to entering their private space;
• consider asking the person what he or she would prefer to be called;
• believe their report and say so;
• reassure the victim that you are determined to help him/her;
• acknowledge their wishes; and
• do not talk down to them.
An atmosphere of trust and genuine respect and dignity is a key factor for effectiveness.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Collecting Information
In order to assess the urgency of the situation it is important to consider the following.
Direct requests for assistance
When the request is from a client or a carer, either by telephone or in person, assure the caller that
help is available and work through the following checklist:

record the caller's name, telephone number and address;

record details about what has happened, or is likely to happen, including if the person is
currently safe;

check if anyone else is involved or aware of the situation: for example, family, doctor, nurse,
social worker;

if you cannot directly help, tell the caller you will contact someone who can help them;

give the caller your name and a telephone number they can use if needed; and

immediate action must be taken to refer the matter to someone who can follow up and arrange
an assessment.
Indirect requests for assistance
When a request for assistance is received from family, neighbours, friends, other agencies, service
providers, or significant others, work through the following checklist.

record details of the caller eg. name, address, telephone number and relationship to the client;

record details of the person who has been or is likely to be abused and/or neglected and who
may be responsible for this;

record details of exactly what has been observed and when;

check if the alleged victim, or other significant person, is aware of the concern and that a
request for assistance is being made;

check if the caller is able to provide help or support for the client, carer or other person/s
involved;

check if anyone else is aware of the situation or has contact with the alleged victim, eg. doctor,
nurse, social worker, etc; and

if you are unable to assist the caller, explain that you will contact someone who can help and
then immediately action the matter.
Action after a request for assistance is received
Decide who needs to follow up eg the direct care worker's supervisor or co–ordinator, Aged Care
Assessment Team, or a person trained to undertake the assessment.
The trained person responding will need to decide the urgency of the situation and what action is
required. In most cases, it will be necessary to make an appointment to visit the alleged abused,
their carer and/or others to gather more information and assess what action, if any, is required.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Emergency situations
Having a list of steps to follow and key people to contact such as nurses, doctors, hospitals, lawyers,
police, etc, will enable a service provider to respond quickly in an emergency.
It is important to find out the facts, for example:
• if the client or carer has been harmed;
• if urgent treatment is required;
• if the client or carer is at risk of serious harm or death;
• who is with the client or carer; and
• if anyone else has been notified about the situation, eg. Police, Ambulance, Doctor, etc.
If the client or carer is considered to be in imminent danger or has been harmed, the police and/or
ambulance must be called immediately.
Sometimes what appears to be an emergency may not require crisis intervention after all. In any
crisis, it is important to find out the facts and to discuss the options and course of action with a
trained person (eg. member of the Aged Care Assessment Team or abuse response team/network).
Always remember the person's rights. Quick solutions may have adverse affects in the long term.
For example, removing the victim from his or her home may cause enormous stress and other
repercussions. When deciding on the action to take consider the following questions:
• is it appropriate to offer the victim refuge?
• what is the least disruptive option for the victim?
• will the action being considered cause further harm?
• have the rights of the victim been considered?
The victim may refuse intervention. This can be extremely difficult for service providers if there is
fear for that person's safety, but ultimately the rights of the person must be respected. If there is
evidence that the client is making an informed choice, the benefit of doubt must be in his or her
favour.
If the client is not able to make his/her own decisions, or if this is in doubt, there are legal powers
available for intervention and the provision of protection.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Step 1. Initial Response
Establish Client Needs
Non-Urgent
 Implement
service within
24 – 72 hours
 Establish a
relationship of
trust.
Emergency
Urgent
 Implement
service within 24
hours
 Establish a
relationship of
trust.
 Do not place
yourself in
danger by
remaining if the
situation is
unsafe.
Emergency
Resolved
Step 2. Assessment and
Documentation









 Contact
appropriate
emergency
service
Focus on the effects of abuse on the older person rather than the intention of the alleged abuser;
determine nature and degree of abuse, its frequency, duration and severity;
assess the level of care required, including medical, physical and emotional. Determine if this
can be realistically received in the current environment;
assess the availability of alternative services, including waiting lists for respite care or
residential care;
obtain written consent from the older person to liase with their General Practitioner;
if the older person is unable to communicate effectively in English, best practice requires that a
professional interpreter be engaged to assist. Family members or friends are not adequate
substitutes;
under no circumstances place the older person in a more vulnerable position by discussing the
abuse with the alleged abuser, unless you have the older person’s permission. Then, if
appropriate, interview the suspected abuser separately, in a neutral environment, to determine
likelihood of resolution of abuse with suitable help and treatment;
staff must record verbatim the details of any disclosure of abuse, allegation or witnessed event,
including names, dates and times. This is to be clearly distinguished from any interpretation by
the health professional; and
record the history of abuse from the older person if appropriate and document any injuries,
evidence of neglect, threats or allegations of violence.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Step 3. Intervention

Determine mental competence – mini mental assessment
Diminished Mental
Capacity
Mentally Competent
No Consent
If the person is at
risk of further abuse
of a severe nature,
contact the
Community
Advocate who can
apply for a
guardianship order
to oversee the health
care,
accommodation and
provision of services
necessary for the
older person. The
advocate can seek a
medical assessment
to determine the
person’s level of
competency.
Consent
 Assure the older
person of
continued
support and
provision of
assistance, offer
culturally
appropriate
information.
 Respect the
older person’s
decision.
 Document and
withdraw if
older person
will not accept
intervention and
is not in any
imminent
danger.
 Provide
information in a
culturally and
linguistically
appropriate
format regarding
available options.
 Encourage selfdetermination.
 Arrange
community
services, respite
care or alternate
accommodation if
necessary.
 Assist with legal
intervention if
appropriate.
 Arrange for the
person to be
referred to other
agencies
appropriate to
their needs.
Step 4. Debrief and Evaluate



Staff encountering suspected or sustained cases of elder abuse are to
report the matter to their manager;
Staff to debrief either through peer support, or through individual
counselling offered by their work place.
Evaluate – Reflect on the intervention and outcome; was this the
preferred intervention.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Major References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those Who Care for Them, Module 11: Responding to a request for assistance, pp. 3-6.
Fielding, W.S. (1995), Elder Abuse Is Too Polite A Word For It: An Educational Manual for
Professionals Who Work with Older People, pp. 33-36.
Kingsley, B. (ed) (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 18–19.
NSW Advisory Committee on Abuse of Older People (1995), Legal Issues Manual, Ageing and
Disability Department, pp. 4–5.
NSW Advisory Committee on Abuse of Older People (1995), Abuse of Older People: Inter-Agency
Elder Abuse is any behaviour within a relationship of trust that harms an older person, Ageing and
Disability Department, pp. 9, 12.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Section 9
Developing An Agency Protocol
Purpose
This section explains why written protocols responding to elder abuse are useful, with aspects to cover
in an agency protocol highlighted. A template (on page 52) is provided to assist organisations in
developing their elder abuse protocol.
Often processes within organisations are understood through ‘rule of thumb’, verbal agreement, or
through broad policies. This can result, however, in ambiguity or confusion originating from sources
such as:

processes and/or responsibilities of staff not having been discussed;

new staff not knowing correct organisational processes; and

differences of opinion between staff about what is appropriate or how to implement an intervention.
Documenting a protocol in your organisation can reduce confusion by outlining an approved
framework and processes. It also provides a central written source to refer to. It can clearly set out
matters such as the:

role of the organisation and staff;

range of appropriate interventions; and

organisations that staff need to link with during interventions.
Developing a protocol assists staff to be aware of issues that are specific to your organisation such
as:

the role the organisation plays in responding to elder abuse;

the roles and responsibilities of staff have;

any interrelated policies, processes or protocols;

any statutory obligations;

the appropriate response / intervention to be involved in;

the type of clients likely to contact your organisation;

organisational restraints;

safety procedures during home visits;

what is deemed to be an emergency and how to handle it;

key organisations to link with in certain interventions;

when and how you refer clients; and

how to communicate client/case information.
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Dealing with Abuse of Clients and their Carers – A Training Kit
Development of organisation protocols enables staff to easily articulate the processes they use to
other organisations they link with. This not only assists information sharing between organisations,
but also promotes integrated responses across sectors.
Prior to developing your organisations elder abuse protocol it is important to keep in mind that each
organisation is different. Your protocol, therefore, may be similar to other organisations but unique
in itself.
A sample agency protocol to address elder abuse for adoption by your agency follows.
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..................................................…………………………………………..
(Name of Service)
Elder Abuse
Agency Protocol
This pro-forma was produced by
ACT Office for Ageing
Cabinet and Policy Group
Chief Ministers Department
2005
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Contents
Purpose of the protocol
Guiding principles
Definition and types of elder abuse
Role of this service in responding to elder abuse
Responding to elder abuse
Assessment and intervention flow charts
Support for staff
Key services to link / refer to
Appendix
The United Nations Principles for Older People, 1991.
Purpose of the protocol
The purpose of this section is to introduce the use of this protocol within your service. This
may include comments on:


the importance of having the protocol, and
the format of the protocol.
An example is given below.
This agency protocol is designed for use by staff of the
(insert name of agency/organisation)
in identifying, responding to and/or intervening in situations when older people are experiencing or are
at risk of elder abuse.
It is acknowledged that situations of elder abuse are complex and differ in each instance. Therefore
instances are unique and will require an individual response and /or intervention. This agency protocol
however, provides a framework that is to be generally applied across elder abuse situations.
This agency protocol emphasises the need to respond appropriately to situations of elder abuse, using a
holistic framework and approach that integrates with other services responding to older people who are
experiencing, or are at risk of, abuse.
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Guiding principles
The 1991 United Nations Principles for Older People (Appendix 1) and the following principles
provide a philosophy to guide work with older people who are experiencing, or who are vulnerable to,
abuse.
Presumption of legal capacity (ability to make decisions)
All adults are assumed to be capable of making informed choices and decisions regarding their own
lives, unless shown otherwise.*
Decisions on behalf of an older person can only occur when directed by that person, or when a
determination has been made regarding the older person’s legal capacity.*
In all situations, decisions should be in the best interests of the older person and in accordance with the
law and cultural practices.
Confidentiality
Information about older people and their situations must be treated confidentially and respected at all
times, in accordance with legal obligations, professional ethics and cultural practices.
Interests of the older person
The rights, safety, dignity, autonomy and well being of older people are paramount. It is
acknowledged, however, that the interests of an older person should be balanced with the service
provider’s duty of care to clients.
Cultural appropriateness
The language and cultural practices of an older person should be respected.
Older people are entitled to expect, as a right, comprehensive, accurate, accessible information on
which to base decisions.
Interventions
Interventions must promote safety of older people and prevent further abuse. They need to be holistic;
considering the whole of the older persons situation and needs, preserving their relationships and
consider the abusers needs. The older person has a right to the support of a person of their choice when
interventions are necessary.
It is recognised that some forms of elder abuse may be criminal offences.
Encourage Self-reliance
It is recognised that older people understand their situation best, hence service providers need to
provide support, information, referrals and encourage self-reliance of the older person; unless the
situation is severe and requires external intervention.
Access to Information
Older people are entitled to accessible, comprehensive, and accurate information about their rights and
options.
*Concerns about a person’s legal capacity or the need for a substitute decision maker should be referred to the ACT Public
Advocate’s Office and/or the Guardianship and Management of Property Tribunal.
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Definition of elder abuse
The nationally recognised definition of elder abuse is “any act occurring within a relationship where
there is an implication of trust, which results in harm to an older person” (Australian Network for
the Prevention of Elder Abuse, 1999).
Examples of people who may be in this type of relationship with an older person include sons or
daughters, spouses, other relatives, friends and neighbours. The term elder abuse is commonly
understood not to include abuse in institutional settings, or from members of the public.
The term ‘older person’ is generally understood to be a person 65 years or older, but can differ in some
circumstances and cultures.
Types of elder abuse
Psychological abuse: Causing psychological or emotional suffering or fear through, name-calling,
treating the adult as a child, insulting, frightening, humiliating, threatening, and/or isolating.
Financial abuse: The illegal or improper use of an older person's property, finances and other assets,
without the consent of the older person. Pawning an older persons property without their knowledge or
accessing more than permissible amounts of money.
Physical abuse: Inflicting pain, injury, physically restraining and/or pushing.
Sexual abuse: Sexual assault, indecent exposure, sexual harassment and/or forcing to view sexually
explicit material.
Social Abuse: Purposely isolating the older person from their family/friends and support network,
not allowing them to use the telephone, or monitoring his/her calls.
Neglect: The failure of a family member/carer to provide the necessities of life to an older person.
Neglect can be intentional or unintentional. Neglect is often difficult to identify, except in extreme
situations.
Note:
An older person’s self-neglect is excluded from this definition.
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Role of this service in responding to elder abuse
The following information provides a background for understanding our service's role in responding to
the needs of older people who are experiencing, or are at risk of, abuse
Insert relevant details for your service.
Mission statement of this organisation
Key relevant areas of organisational responsibility
Levels/areas of contact between this service and older people who are experiencing or are at risk
of abuse
Examples: Direct face to face with clients, contact only by counselling staff.
Service limitations in responding to older people who are experiencing or at risk of abuse
Examples: No case management, no after-hours responses.
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Responding to elder abuse
In this section you need to insert an explanation about the different levels and types of
responses/interventions staff may be involved in.
This differs for every service and needs to be tailored to your service – based on previous
situations or anticipated situations you may encounter.
Who requested assistance/alerted service to situation?
Examples: older person sought assistance for themselves, family, neighbours or friend sought
assistance for an older person, service provider is concerned about abuse older person is experiencing.
Is abuse suspected, observed or disclosed?
Response to be provided:
Examples:

older person sought assistance for themselves – information was provided during telephone call
and referrals were made to relevant agencies; or

emergency alerted by relative in house with older person who has been abused –consent sought
and emergency services contacted.
The flow chart on the following page can be used to guide your
responses/interventions.
Please see Section 8 of this kit, Approaching the Situation, for further explanation of
assessment and interventions processes.
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Table for Planning Responses
Based on Kingsley,B.(ed.) 1993. Responding to elder abuse: a protocol for non-government agencies. Council of Ageing (WA) Inc. Mt
Lawley W.A.
EMERGENCY
Find out:
URGENT
Find out:
is urgent treatment required?
is immediate help required?
who is involved?
if anyone can provide
immediate help?
where is the older person?
is the older person and/or
family/friends aware of request
for help?
is any other person or agency
aware of / involved in the
situation?
Action Plan:
Call emergency services if this is
required and has not been done.
Ask if anyone can stay with the
older person and give them your
name and contact number.
If possible keep caller on the
phone while you alert the relevant
service / health providers.
Action Plan:
Give the caller your name or
agency name and contact
number.
NON-URGENT
Find out:
is the older person and/or
family/friends aware of
request for help?
has the older person agreed
to the involvement of a
service agency?
is any other person or
service agency aware of /
involved in the situation?
Action Plan:
Discuss with supervisor.
Follow agency procedure
for action.
Discuss with supervisor.
Address immediate needs
contact appropriate agencies if
this has not been done.
Discuss at agency meeting
or interagency meetings.
Refer to appropriate
agency.
Refer to appropriate agency.
Discuss with supervisor.
Community Services:
Police
Ambulance
Hospital
Refuge
Emergency Respite Care
Legal services
Public Advocate’s Office
Follow up.
Community Services:
Hospital
Doctor
Refuge
Emergency Respite Care
Legal services
Public Trustee of the ACT
Public Advocate’s Office
For others see ACT Community
Resources List
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Community Services:
Police
Doctor
Legal services
Respite Care services
Public Advocate’s Office
Guardianship & Property
Management Tribunal
ACT Elder Abuse Training and Information Resource
Support for staff
This service recognises that dealing with situations of abuse can be traumatic and that debriefing and
professional supervision can assist the wellbeing of staff.
You will need to adapt this section from suggestions below or add others.
Staff within this service are encouraged to:

discuss the problems and issues relating to the case in a climate of trust and confidentiality;

share with appropriate personnel the frustration and concerns relating to the case;

seek debriefing / professional supervision as required;

evaluate, at regular intervals, the nature and quality of input into the case, and plan future
directions; and

be involved in developing and improving organisational and worker responses to abuse of older
people.
The procedures to be used to support staff of this service are:

administrative policies and procedures to guide the work undertaken in responding to
abuse;

training for staff to gain necessary skills and strategies for dealing with situations of abuse;

regular team meetings to be held to allow for the opportunity to discuss situations;

individual supervision sessions for staff to be held;

debriefing sessions at the end of each case, or within 48 hours of any worker being
involved in a critical incident or traumatic event or when requested by worker; and

tandem case work will occur when staff are required to undertake home visits for clients
who are believed to be experiencing or at risk of abuse.
Key services to link with / refer to
Below is a list of the key organisations that our service will liaise with and/or refer to in situations of
elder abuse.
Note: a list of useful government and community services and resources is also contained in the ACT
Elder Abuse Information and Education Resource.
Adapt this list of key services that you have identified your service will link with or refer to
during responses to elder abuse. You may wish to add to, or vary this list according to
different types of interventions eg. emergency, information only.
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ACT Community Resources
Crisis/Counselling
Aust Federal Police ACT Region
Responsible for law enforcement in the ACT
ph: 131 444 or 000
ACT Ambulance
Provides a 24 hour emergency pre-hospital care service within the ACT
ph: 6207m9980 or 000
Calvary Hospital
Public Hospital provides 24-hour emergency service
ph: 6201 6111
The Canberra Hospital
Public Hospital provides 24-hour emergency service
ph: 6244 2222
Canberra Rape Crisis Centre
ph: 6247 2525 (crisis line) or 6247 8071; tty: 6247 1657
Sexual assault counselling for women and children. Provides 24-hour support, advocacy,
counselling and Aboriginal Outreach Workers.
Conflict Resolution Service
ph: 6295 5889(9:00-5:00pm)
Provides dispute resolution strategies for neighbourhood, family, workplace and other disputes.
Provides outreach programs and mediation training.
Domestic Violence Crisis Service
ph: 6280 0900; tty: 6228 1852
Provides services to all people affected by domestic violence. Services include: 24hr/7days a week
direct crisis intervention and crisis telephone support services, court support, access to safe
accommodation, support for family and friends and education programs in schools and in the
community.
Lifeline
ph: 131 114
Free, anonymous, confidential 24 hour phone service for people under stress, in crisis, or with any
problem.
Mental Health Crisis Team
ph: 6205 5142 or 1800 629 354
Home based crisis assessment and treatment service. Accepts referrals from the triage assessment
service and provides assessment, treatment and support to mental health clients with a moderate to
severe condition within the community
Relationships Australia Canberra & Region
ph: 6122 7100
Counselling, mediation and group programs for people wanting to build better relationships.
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Support Services
Aged Care Assessment Team (ACAT)
ph: 6207 9977
Aged care assessments are required to access Community Aged Care Packages, Residential Aged
Care options, Extended Aged Care at Home (EACH) Packages and respite care.
Alzheimer's Australia ACT
ph: 6255 0499
Provides information, education and support to people with all forms of dementia, their families and
carers. Support groups for people diagnosed with dementia are held weekly and support groups for
family carers are held monthly.
Betty Searle House
ph: 6230 5222
Long-term transitional accommodation (ensuited bedrooms with shared living and kitchen
facilities) for women 55 and over escaping elder abuse, family breakdown or financial hardship.
Carers ACT
ph: 1800 059 059
(24hrs)
Offers respite, counselling support and information to all people who provide care and support to a
family member or friend, who has a long term physical or mental disability or is frail aged.
Members have access to the video and book library and receive the Carers ACT bi-monthly
newsletter. Respite care 7 days a week. Carers Emergency Resource Centre, offers counselling,
support groups, other services.
Lifeline Canberra Emergency Accommodation Service Crisis Line (CEAS) ph: 6257 2333
Provides 24 telephone support, referral and information for people at risk of or experiencing
homelessness.
Anglicare Canberra Emergency accommodation Service (CEAS)
ph 6230 1486
Provides support to people at risk of or experiencing homelessness including accommodation and
financial assistance (housing costs).
Community Liaison and Advisory Safety Project (CLASP)
ph: 6282 3777
Identifies security problems and helps older people reduce safety and security risks in and around
their home. This allows older people to be both safe and more secure.
Council Of The Ageing (COTA)
ph: 6282 3777
Protects and promotes the well being of all older people. It is run by and for older Australians.
Elder Abuse Prevention Information Line
ph: 6205 3535
Provides information and referral to individuals and service providers with regards to elder abuse.
Erindale Ngunnawal Community Aged Care
ph: 6231 3144
Provides aged care packages for Aboriginal and Torres Strait Islander people, can also provide
assistance in homecare and medical services.
Guardianship and Management of Property Tribunal
ph: 6217 4282
Provides legal authority in the form of guardianship and/or management orders to family members
or friends of adult persons who have a decision-making disability so that the person's affairs,
personal or financial, may be conducted appropriately.
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Public Advocate Office
ph: 6207 0707
Represents the best interests and protects the rights of adults with a disability at threat of abuse,
exploitation or neglect; where necessary represent them before courts, tribunals and with service
providers. The Public Advocate via the Management Assessment Panel also facilitates service
coordination where complex service needs exist
Older Persons Mental Health Service (Over 65)
ph: 6205 1957
Provides specialist mental health assessment and treatment services to people aged 65 and over that
have a mental health problem.
Protection Unit – ACT Magistrates Court
Provides assistance in obtaining a domestic violence or protection order.
ph: 6207 4444
Victim Services Scheme ACT
ph: 1800 822 272
Assists victims of crime to recover from the consequences of a criminal act committed in the ACT.
Offers information, counselling, advocacy, support and referral.
Women's Information and Referral Centre
ph: 6205 1076
Provides information, referral and support for women on any issue. Conducts information seminars
and workshops. Runs a support group for women affected by domestic violence and a Relationship
Separation Support Group. Produces free calendar of community courses and activities, provides
library resources and free Internet access.
Health
Health First
ph: 6207 7777
Provides information and advice that will help you better manage the health issues concerning you
and your family and provide you with health contacts from the ACT and surrounding NSW region.
Migrant Health Services
ph: 6298 9233
Counselling available to all migrant people for advice on health and social matters, support and
advocacy for clients of a culturally and linguistically diverse backgrounds. Bilingual (Macedonian)
counsellor available.
Migrant Health Unit
ph: 6205 3333
Provides on site health care interpreting in Bosnian, Croatian, Serbian, Cantonese, Mandarin,
Spanish and Vietnamese. Interpreters available Mon-Fri 9am - 2pm.
Winnunga Nimmityjah Aboriginal Health Service
ph: 6284 6220 or 6284 6222
Provides primary health care services initiated and managed by the local Aboriginal community to
provide a culturally safe holistic health service to the Aboriginal and Torres Strait Islander people
of the Australian Capital Territory and surrounding areas in New South Wales.
Legal
Legal Aid Office ACT
ph: 6217 4299
Provides legal advice, information, assistance and representation to those people who are
disadvantaged in their access to the law. Provides a free legal advice telephone service 9am to 4pm
Mon to Fri.
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Public Trustee of the ACT
ph: 6207 9800
Prepares wills, acts as an attorney under powers of attorney, administers deceased estates, holds and
invests money for minors and persons with a disability, and manages property under orders made
by the Guardian and Management of Property Tribunal, also an agent for unclaimed monies.
Complaints mechanisms
Aged Care Rights Service
ph: 1800 700 600
Provides information and advice about older peoples rights and responsibilities. Assists in resolving
problems or complaints in relation to aged care services.
Aged Care Complaints Resolution Scheme
Resolves complaints about Commonwealth funded aged care services.
ph: 1800 550 552
ACT Community & Health Services Complaints Commissioner
ph: 6205 2222
The Commissioner handles complaints about services provided to the aged, people with a disability
and their carers and consumers of any health services provided in the Australian Capital Territory.
ACT Ombudsman
ph:1300 362 072
The ACT Ombudsman considers complaints about the administrative actions of government
departments and agencies and aims to foster good public administration by recommending remedies
and changes to agency decisions, policies and procedures. The Ombudsman also makes
submissions to government on legislative and policy reform.
Interpreting services
Centrelink Multicultural Service
ph: 131 202
Provides a national service that allows people to speak to and do business with Centrelink in
languages other than English
National Relay Service (NRS)
ph: 133 677 or 1800 555 677
If you are deaf or have a hearing or speech impairment and / or you use a TTY or a computer with a
modem, you can access anyone in the wider telephone network through the NRS.
Translating and Interpreting Service (TIS)
ph: 131 450
Provides a Translating and Interpreting Service (TIS) for people who do not speak English and for
English speakers needing to communicate with them.
Other services
Centrelink:
ph: 131 021
A Government agency delivering a range of Commonwealth services to the Australian community.
Centrelink staff can give you information about payments and other services, or you can arrange to
speak to a Centrelink social worker.
Commonwealth Carelink Centre
ph: 1800 052 222
Provides accurate information about referrals to agencies providing community care and other
services by coordinating information about the full range of services available in the ACT region.
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APPENDIX THE UNITED NATIONS PRINCIPLES FOR OLDER PERSONS
Independence
1.
Older persons should have access to adequate food, water, shelter, clothing and health care
through the provision of income, family and community support and self-help.
2.
Older persons should have the opportunity to work or to have access to other incomegenerating opportunities.
3.
Older persons should be able to participate in determining when and at what pace withdrawal
from the labour force takes place.
4.
Older persons should have access to appropriate educational and training programs.
5.
Older persons should be able to live in environments that are safe and adaptable to personal
preferences and changing capacities.
6.
Older persons should be able to reside at home for as long as possible.
Participation
7.
Older persons should remain integrated in society, participate actively in the formulation and
implementation of policies that directly affect their well-being and share their knowledge and
skills with younger generations.
8.
Older persons should be able to seek and develop opportunities for service to the community
and to serve as volunteers in positions appropriate to their interests and capabilities.
9.
Older persons should be able to form movements or associations of older persons.
Care
10.
Older persons should benefit from family and community care and protection in accordance
with each society's system of cultural values.
11.
Older persons should have access to health care to help them to maintain or regain the optimum
level of physical, mental and emotional well-being and to prevent or delay the onset of illness.
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12.
Older persons should have access to social and legal services to enhance their autonomy,
protection and care.
13.
Older persons should be able to utilise appropriate levels of institutional care providing
protection, rehabilitation and social and mental stimulation in a humane and secure
environment.
14.
Older persons should be able to enjoy human rights and fundamental freedoms when residing
in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs
and privacy and for the right to make decisions about their care and the quality of their lives.
Self-fulfilment
15.
Older persons should be able to pursue opportunities for the full development of their potential.
16.
Older persons should have access to the educational, cultural, spiritual and recreational
resources of society.
Dignity
17.
Older persons should be able to live in dignity and security and be free of exploitation and
physical or mental abuse.
18.
Older persons should be treated fairly regardless of age, gender, racial or ethnic background,
disability or other status, and be valued independently of their economic contribution.
Major References
Office of Ageing (1994), Responding to Abuse Of Older People In Queensland: A Kit for
Developing Agency Elder Abuse is any behaviour within a relationship of trust that harms an older
persons, Queensland Department of Family Services and Aboriginal and Islander Affairs, p. 1.
Sadler, P. and Ralphs, L. (1995), Securing the Future: Coordinating Service Delivery in Cases of
Elder Abuse, paper presented at the 2nd National Conference on Abuse of Older People,
Queensland Taskforce on Abuse of Older People in association with the Queensland Council of
Carers, pp. 99-100.
Home Care Service of NSW (1994), Mistreatment of vulnerable adults in their homes, draft internal
policy document.
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Section 10
Assessment
Assessment must commence as soon as possible after the agency becomes aware that abuse may be
taking place. Where possible, the major factors contributing to abuse need to be identified in each
situation, so that appropriate referrals and interventions can be planned.
The safety of the worker and the older person needs to be the primary consideration when making
an assessment of the situation.
• Competence. Although accurate determination of competency is a complex process, which may
require a referral to an appropriate agency, an initial judgement may need to be made. The
following is a guide.
•
Competent: the older person is capable of making decisions and understands what has
happened (is happening).
•
Not competent: the older person has demonstrated an impaired understanding of what has
happened (is happening).
• Consent. Is the abused person prepared to accept initial assistance to terminate the abuse? The
person's right to refuse assistance should be recognised. If permission for intervention is denied
the worker has the responsibility to continue to support the client or carer.
• Type and intensity. The type, frequency, duration and severity of the abuse are important factors.
The effects of the abuse on the victim and the extent of any care provided are also important to
note.
• Health and functional status. The extent and level of any disability, the level of care, if any,
required by the victim and the extent of care provided are important to note.
• Relationship of the abuser to the victim.
The nature of the relationship, the housing
arrangements and any other relevant points should be noted.
• Supports. The range of informal as well as formal supports currently in place must be noted.
• Role of other services. It is important to clarify the role of all services involved and to determine
who the lead agency is and what actions each service will undertake.
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Personal privacy
Personal privacy can be described as the interest individuals have in maintaining a degree of
freedom from interference with their person and their personal space. Any uninvited assessment of
suspected abuse is an invasion of privacy. This must be kept in mind when considering
commencing an assessment.
Gaining access
Identification, reporting and any subsequent assessment of a person who may be a victim of abuse
is dependant on the worker having gained access to find out what has been happening. Often, a
worker's ability to offer help or to carry out any assessment will depend on the degree of
cooperation by the client or carer.
A worker has no automatic right of access to the person. The best way to proceed is to request
permission of the client or carer to enter the house. A worker cannot enter the house against the
will of the owner or occupier unless there is a specific legal authority to do so. If a worker were to
force their way into the house without legal authority they would be trespassing.
If there is evidence that the person is being abused, is incapable, and service providers are denied
access to the person, it is possible to apply to the Guardianship and Property Management Tribunal.
A legally appointed financial manager will have the power to authorise access to premises owned or
rented by the client. Such power does not extend to premises owned by others.
Carrying out an assessment or examination
Workers do not have an automatic right to carry out an assessment or medical examination of a
person who may be a victim of abuse. The person must consent to any medical examination,
treatment, or assessment. Carrying out a medical examination against the wishes of the person, or
attempting to remove them against their will for the purposes of carrying out an examination could
result in trespass, assault or false imprisonment.
If the medical treatment is "urgent and necessary", and the patient is unable to consent, the medical
practitioner can treat without consent. Where a person is unable to consent, the Guardianship Act
1991 (ACT) and the Guardianship Tribunal's Guide to Applicants sets out the provisions regarding
substitute consent to medical treatment.
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People from culturally and linguistically diverse backgrounds
There is relatively little Australian research information on the extent of abuse of clients and carers
from a culturally and linguistically diverse backgrounds.
Abuse in different cultural groups can also raise difficult issues of family responsibility and varying
views about what does, or does not, constitute abuse or neglect. This does not mean that abuse
should be condoned in any circumstance.
Issues of abuse need to be dealt with sensitively, and advice sought from people experienced with
the particular cultural background of the family concerned.
Culturally appropriate, ethno-specific welfare organisations with trained workers or counsellors
could assist with cultural interpretations of situations of abuse. The Ethnic Affairs Commission or
Ethnic Communities Council need to be approached and linked to the Aged Care Assessment Team
(ACAT) or others involved in assessment and intervention. If there are no appropriate cultural
groups, then it is important that assessment and intervention teams are informed about the clients or
carers country of birth, ethnicity and language spoken.
The patterns and types of abuse occurring in the various ethnic communities appear to be different.
This in part relates to the circumstances of migration, length of time living in Australia, level of
contact with the wider Australian community, family circumstances and living arrangements and
changes in the values held by different generations.
The key issues include:

the added disadvantage of cultural and language barriers;

limited opportunities to disclose abuse; and

links within communities at times mean that individual privacy is limited.
Where they are using mainstream services, people with difficulties in using English will require
interpreter services.
The Translating and Interpreting Service phone number is: 131 450
Aboriginal People and Torres Straight Islanders
Again cultural differences will require special sensitivity when situations of abuse and neglect in
Aboriginal families are addressed. Aboriginal workers should be involved if they are available.
People with dementia and their carers
A full multi-disciplinary assessment by a geriatric health service or aged care assessment team is
essential in cases of abuse involving a person with dementia. Interventions such as respite care,
carer support services and dementia care counsellors will be particularly useful in these cases.
Legal options such as Domestic Violence Orders are inappropriate when the abuser has dementia
however, an application to the Guardianship and Property Management Tribunal may be
appropriate.
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People in rural and remote areas
Confidentiality can be difficult to maintain in these circumstances. It may be appropriate to seek
help from a service outside such a community in particularly difficult cases.
The Assessment Process
Assessment should commence as soon as possible after a worker or agency becomes aware that
abuse is or may be taking place. From the very beginning, workers must establish a relationship of
mutual trust and open communication with both the client and carer. The safety, wellbeing and
rights of the victim are of primary considerations, and although complete confidentiality cannot
always be guaranteed, the victim must be assured that it will be safeguarded at all times.
Establishing a positive working relationship can be time consuming but it is an essential precursor
to effective intervention.
Whilst undertaking assessment, it may be useful to consider the following points.
Gaining access
Gaining access can be difficult as the abuser or another person may obstruct access to the victim.
Conversely, the victim may be unwilling to involve an agency or worker in his or her situation. If
at first access is denied, further attempts should be made. It may be helpful to work through people
such as nurses, doctors, social workers or other service agencies who are known to the family and
who may be able to assist with gaining access to the victim.
Gaining consent for interventions
Even if access is gained, victims may not give consent for any form of intervention on their behalf.
It must always be remembered that victims who are competent to make decisions have the right to
decline offers of assistance to terminate the abuse. If permission is denied, the worker retains an
ongoing responsibility to assess and support the victim in an attempt to halt the abuse.
Planning the assessment
Assessment provides an opportunity to gather key information about the victim, the abuser and the
abusive situation. It therefore requires careful planning.
The following guidelines will assist in planning the assessment:
• determine if any other agencies are involved with the victim and the family;
• if more than one agency is involved, decide who will carry out the initial assessment;
• if more than one agency is involved, decide who will be the key agency for intervention and
service provision;
• ensure no unnecessary personnel enter the home, try to have only the essential workers involved
in the case;
• clarify the role of each worker to ensure that victims are not subjected to "multiple assessment"
wherever possible;
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• prepare a check-list of points to be assessed; and
• arrange to interview the victim, abuser and/or family members separately and in private.
Gathering information
When a request is made for assistance the following questions can be useful to gather information
about any suspected abuse:
• What actually happened or is likely to happen?
• Who is the abuser, what relationship do they have with the victim?
• Why did this happen or why is it likely to happen?
• How often, for how long and how severe are/were the episodes?
• Are the behaviours or episodes wilful or unintentional?
• What are the affects or outcomes of the abuse on the victim?
• What is the health/functional status of the victim?
• Is the victim able to take care of and protect himself/herself?
• What community services are received/available to the victim and/or abuser?
• What can be done to ease the situation?
During the assessment interview
• put the interviewee at ease;
• state clearly the reason for the visit;
• note any evidence of neglect or abuse;
• ask open questions, allow sufficient time for an answer;
• allow the interviewee to tell their story at their own pace;
• provide information about community services and support;
• consider all possible options and discuss the consequences of each option;
• where it is apparent that criminal offences have occurred, advice the victim;
and/or abuser that police involvement may be necessary;
• offer all necessary support to ensure safety of the victim; and
• arrange a follow-up meeting, specify date, time, and agenda.
Workers may occasionally find themselves in a situation where they feel threatened or at risk.
Although agencies have a responsibility to ensure the safety of staff, workers also have a
responsibility to act with care and caution when they enter any unstable situation.
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If the situation is unstable
• inform a colleague of the visit or be accompanied by a colleague;
• do not show fear, or argue or make verbal or physical challenges;
• always maintain eye contact with the person with whom you feel ill at ease;
• avoid being cornered by the person you feel ill at ease with; and
• wherever possible, conduct the interview out of doors.
When a carer discloses abuse
Although workers will identify some cases of abuse during the course of their work and have other
cases referred to them, there will be occasions when a carer admits abuse. This admission is often a
cry for help by a carer who can no longer cope alone with the burdens of the caring role. In this
situation workers will work with the abuser to gain recognition and ownership that behaviours are
abusive and contract for the immediate cessation of the abuse. At the same time practitioners will
make every effort to support the carer and offer all services necessary to reduce the likelihood of reoffending. However, a considerable number of cases will not be resolved by abuser self-resolution
nor by purely supportive measures, and some abusers will require specialised counselling,
therapeutic intervention, separation from the victim or punitive action to stop the abuse. If required
referral should be made to specialised counsellors, or in cases where the abuse may constitute
criminal behaviour referral should be made to the police for legal action.
Major References
Kingsley, B. (ed) (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 13–14.
NSW Advisory Committee on Abuse of Older People (1995), Legal Issues Manual, Ageing and
Disability Department, pp. 14–15.
NSW Advisory Committee on Abuse of Older People (1995), Abuse of Older People: Inter-Agency
Elder Abuse is any behaviour within a relationship of trust that harms an older person, Ageing and
Disability Department, pp. 15 – 16.
Office of Ageing (1994), Responding to Abuse Of Older People In Queensland:
A Kit for
Developing Agency Elder Abuse is any behaviour within a relationship of trust that harms an older
persons, Queensland Department of Family Services and Aboriginal and Islander Affairs, p. 8.1.
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Section 11
Interventions
The Intervention Process
Setting the objectives
When developing objectives, remember they must be behavioural, which means they must describe
what behaviours will show that abuse has ceased. They must also be realistic to the specific
circumstances of the people involved and the context within which care is given.
The objectives for a case could include one or all of the following:
• prevention of abuse;
• termination of current abuse;
• prevention of abuse re-occurring; and
• resolution of the underlying causes of the abuse.
Choosing the intervention
People have the right to know all the options available to them. These may include doing nothing,
introducing support or counselling services, arranging respite care, separating the victim from the
abusive situation, finding alternative accommodation or taking legal action.
When considering the options:
• consider all possible interventions to stop abuse – from supportive to restrictive;
• consider positive and negative outcomes of all optional interventions;
• determine which are most likely to resolve the cause of abuse;
• choose options which give maximum benefit for minimum disruption to the victim; and
• choose a preferred course of action and gain consent from the victim.
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The least intrusive interventions for the person must be used wherever possible. This is well
illustrated by the intervention pyramid designed by John McCallum. He suggests the interventions
higher up the pyramid (the more restrictive alternatives) are best used with caution, and it is
preferable to resolve cases of abuse using the interventions closer to the bottom.
Crimes/Family Act
Domestic Violence Orders
Guardianship Orders
Professional/agency Intervention
Family/Community Resolution of Conflict
Self Resolution by abuser because of bad conscience or
fear of social disapproval
Adapted from McCallum 1993
There are a range of interventions available.
• Crisis care. This might involve admission to an acute hospital bed, or perhaps urgent respite
care in a nursing home or hostel, depending on the needs of the victim. In cases of severe
physical abuse, the victim often needs to be immediately separated from the abuser.
• Provision of community support services. The full range of community support services such as
home nursing, housekeeping help, continence needs, and Meals on Wheels can be used to
alleviate situations where abuse is occurring. Assistance with shopping and transport is of
practical help to the carer.

Case management is often required due to the complexity of the situation and the likelihood that
multiple services will be involved. The key worker may be an ACAT social worker, community
nurse, or community services worker. They will be responsible for the coordination of services
provided to the victim.
• Provision of respite care. This may be in-home respite, day-centre respite, or institutional
respite. This is particularly helpful when carer stress is an issue and where there has been a
situation of neglect. If the victim is quite dependent, then often nursing home respite care is the
only alternative.
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• Counselling. This may involve individual counselling or family therapy. The aim is to help
victims cope with their situation, and assist the victim to find a way to be safe from their abusers.
Group therapy may be utilised in such situations as carer support groups. In some cases where
domestic violence is the main cause of abuse, a referral may need to be made to the appropriate
services for victims of domestic violence. Counselling of a violent abuser must not be attempted
unless he or she has agreed to cease the violence. Counsellors need to have appropriate
expertise.
• Treatment of the abuser. It is important to acknowledge the needs of the abuser. Psychological
counselling which allows them to talk openly about their behaviour may be beneficial. In cases
where the abuser's mental state is a major causative factor, admission to hospital may be
necessary to address psychiatric illness or substance abuse problems.
• Alternative accommodation. This may be necessary on a permanent basis. One Australian study
found that 65% of cases of abuse resulted in the separation of victim and abuser over a three year
period. Realistically, this means institutionalisation, often nursing home placement, for the
victim of abuse. In some situations where carer abuse has occurred, it has been the abuser who
has required nursing home placement.
• Legal interventions. These are hopefully a last resort, but may be the first line of intervention
where criminal charges need to be laid in cases of financial abuse or severe physical abuse
(particularly where there is a history of domestic violence). People who are competent to make
their own decisions can, with support if necessary, access mainstream legal services, for example
to revoke Power of Attorney or evict an unwelcome person from their home. Chamber
Magistrates or police may need to be involved if a Domestic Violence Order or Protection Order
is sought. Applications to the Guardianship and Property Management Tribunal can be made
where victims are unable to make a decision for themselves. Guardianship boards or tribunals
are currently functioning in Victoria, NSW, South Australia, Western Australia, Tasmania and
the ACT. They provide substitute decision-making functions for people who are unable to make
decisions because of a disability. This disability may be a dementing illness, head injury,
psychiatric illness, or physical or intellectual disability. Guardianship Tribunals can be accessed
by any individual or service providers who have a genuine concern for the welfare of the person
with a disability.
It is important that the major factor contributing to abuse is identified in each situation, so that
interventions can be designed accordingly. This assists the worker to choose the most appropriate
and effective interventions.
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Worker support after intervention
Dealing with cases of suspected abuse or neglect can be very demanding on workers, resulting in
stress similar to dealing with other traumatic incidents such as sudden deaths or natural disasters.
Health and welfare professionals often work alone or in isolated situations and it is important that
appropriate support and supervision are offered. Debriefing best occurs within 24-48 hours of any
worker being involved in a traumatic event and needs to be offered at the completion of each case.
When planning interventions always ask
• Have the rights of the victim been considered?
• Has client confidentiality been maintained?
• Has the victim been consulted throughout the process?
• What is the minimum intervention for the maximum effect?
• Will the action cause further harm to an already traumatised victim?
• Does the victim fully understand and consent to interventions?
• Can the victim make these decisions or, if not, is everyone in agreement with the proposed
intervention? If not, an application to the Guardianship and Property Management Tribunal may
need to be considered.
Putting the plan into action
When the objectives have been set, all options considered and the most appropriate interventions
chosen and when the victim has given informed consent for interventions, then the action plan is
carried out. Agency teams should develop a written action plan to detail the interventions and then
work together to co-ordinate and monitor the implementation.
Intervention/action plans should include:
• the actions to be undertaken in order of priority;
• who is responsible for each action;
• when the actions will take place; and
• how the victim and involved agencies are to be kept informed of the actions.
Police Intervention
Role of the ACT Policing
ACT Policing work in partnership with the community to create a safer and more secure Australian
Capital Territory through the provision of quality police services.
Police have a duty to investigate a report of a suspected crime, including a report that a person may
be in immediate physical danger. Officers are specially trained to deal with family violence.
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Workers need to be aware, however, that each police officer has the discretion to decide the
appropriate course of action in accordance with the individual circumstances of each case.
In most cases, supervisors and coordinators will be responsible for liaison with the Police. Direct
care workers must only contact the Police in emergency situations.
When should a report of suspected abuse be made to the police?

There are no mandatory laws that require you to report suspected incidents of abuse of adults to
the police. You should carefully consider the following questions when you decide not to report
the incident to the Police:

If I decide not to report the incident, will the abuse continue?

What effect will my decision to report/not report the incident have on the victim?

Are there any elder abuse protocols in existence at my workplace that require such incidents to
be reported?

Am I required to report my concerns to a higher authority within my workplace?
Most of the above questions can only be responded to by yourself. Because there are no legal
requirements placed upon you to report suspected cases of abuse you must make a decision based
upon either or both your own moral judgements, or Protocols in place within your work
environment.
You must keep in mind that if police are involved in such incidents measures can be taken to
prevent similar incidents from taking place again. Domestic Violence and Protection Orders can,
under some circumstances, be taken out on behalf of the victim to prevent further abuse.
Action prior to police attending
If the incident is such that requires the police to attend, there are a number of things you may do to
assist them in their investigation.
1. Calm all parties so that accurate and reliable information can be obtained. This can be
accomplished by:

presenting a business like approach. How you deal with the situation may set the pattern with
the police, the victim may see you as an authority figure, so be careful of a too gentle or a too
harsh approach.

acknowledge the difficulty of the situation to the victim. Make sure, in maintaining
professionalism and impartiality by making neutral statements, that empathy is still created, and
ensure you do not use language inferring that you are taking sides.

modelling – you can have a direct calming effect on the victim if you respond calmly to the
situation yourself. This can be conveyed by sitting down and speaking at a normal pace and
level tone while ensuring that the person can hear you.
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
reassurance – will help to calm the victim. Try to avoid using clichés such as "everything will be
fine now", or "come on now, cheer up". Statements like these often serve to belittle the victim
rather than to help.

encourage talking – this lessens the likelihood that the victim will continue to yell, scream or
behave in an emotional way. Distraction by offering encouragement to speak about matters
unrelated to the problem can be helpful. If they continue to remain upset, seeking general
background information is also a useful strategy.

using trusted others - in some situations it may be appropriate for you to ask someone else to
either assist in, or take full responsibility for, calming the victim (eg. trusted friend, relative or
neighbour). This may be necessary when the victim is fearful of you; when there is a language
barrier; or when other methods of calming have failed.
You will need to be flexible in the use of these procedures, depending on the circumstance
presented.
2. Gather basic information that will be of use to the police when they arrive, so they can gain a
basic understanding of the victim's thoughts and feelings concerning the abusive situation. Areas to
be explored include:

factors of risk - what is at risk (eg. life, health, property) and how imminent is the danger?

level of functioning - is the person able to take care of and/or protect himself/herself?

support system – does the person have family, neighbours or friends who can help?

is the victim willing to accept help or changes?
Guidelines for speaking to the victim

speak to the victim first in a calm unhurried manner. If an interpreter is required, police should
be advised of this fact and they will arrange for one.

when speaking to the victim, write down notes of your conversation. These notes must be
verbatim, as far as possible, as you may be required to make a statement to the police based upon
your conversations with the victim.

your conversations with the victim should be non-threatening and designed to put the person at
ease (eg. "How long have you lived here?).
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
people want their privacy to be respected and thus, may react defensively when probed too
intensely with questions such as: "Who, Why, What, When, Where and How". It is important to
proceed slowly into their private lives by combining interest with such statements as…"Tell me
about...." or "Let's talk about...."

move onto more sensitive, direct questions as the conversation progresses. It may be helpful to
ask the victim to comment on any recent crises in family life, (eg. alcohol and drug use, abuse in
the family and any illnesses and behavioural problems). Very few people will refuse to answer
specific questions about the abuse, providing they are asked in the right way. Make sure that you
avoid blaming the victim for the victimisation; either directly or by implication.

the conversation needs to end with a clear explanation as to what the next step will be (eg. "I am
now going to notify the police").
When speaking to an alleged abuser
When you are speaking to an alleged abuser you must bear in mind that he/she may be an offender
(abuser) or completely innocent of any blame. Always keep an "open mind" as to which category
the person fits into.
If police involvement is imminent you need to avoid, as far as possible, speaking to the alleged
abuser prior to the police arrival. If a criminal investigation is required and you have spoken to the
alleged abuser, you will most likely have to supply the police with a statement as to what you said
to the person and what he/she said to you.
Domestic Violence Orders
What are Domestic Violence and Personal Protection Orders?
Domestic Violence and Personal Protection Orders are orders made by the Court to protect people from
future assaults, threats of violence, property damage, stalking, harassment and offensive behaviour.
They protect the applicant (the person who applies for the order) by ordering the respondent (the person
who the order is made against) from doing certain things.
An application can be made to the ACT Magistrates Court for Domestic Violence and Personal
Protection Orders. The type of order that can be applied for will depend on the relationship between the
applicant and respondent. Court staff will be able to assist you with this.
What can the orders do?
Protection Orders are made by the Court. The Court can order a person to stop threatening and hurting
the applicant. They may also order a person to stay away from where the applicant lives, works, studies
or from other places where they often go. Protection orders are about personal safety.
What is the process to obtain an order?
To commence the process, the applicant must go to the Magistrates Court. They can also go to seek
advice from the Legal Aid Domestic Violence Office or a solicitor to make an application for
protection. The applicant will need to complete the application form and include the reasons why they
need protection and what conditions they are seeking. If the situation is urgent, Court staff may
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arrange for the applicant to appear before a Magistrate to request an interim (temporary) order until the
Court is able to deal with the matter. The Magistrate will hear the applicant’s evidence and decide if
they are to be granted an interim order and, if so, the conditions that are to be temporarily imposed on
the respondent. The applicant will be advised of a date within 2 – 35 days that they need to come back
to Court. This date will depend on whether an interim order has been granted.
What happens next?
Between lodging an application and the date that the applicant has been advised to return to Court, the
police will try to serve the respondent as soon as possible with the application and interim order, if the
applicant has one. The interim order will take effect as soon as the police serve the respondent with a
copy. Once they are served with the interim order and or application, the respondent must obey the
order. The respondent must be served with the order to allow them the opportunity to contest the
allegations, or to object to an interim order becoming a final order, if they wish.
What should the applicant do once the order is made?
Once the Court makes the order, the applicant and the respondent will receive a copy of the order. The
applicant should keep a copy of the order with them at all times.
What does the applicant do if the order is broken?
The applicant is urged to report any breach (breaking) of the order to the police immediately. A
telephone call can be a breach of the order if the order says that the respondent must not contact the
applicant. If the police officer believes that an offence has occurred, the person may be charged.
What if the applicant wants to change or cancel the order?
If the applicant wants to change or revoke the order at any time, they can make an application to the
court. The court will decide based on the evidence before it, whether the order should be amended or
revoked.
How long does an order last?
Personal Protection and Workplace orders can last up to 1 year. Domestic Violence orders can last up
to 2 years. If after this time the applicant believes they still need an order in force, they can apply to
extend the order but will need to make sure they do this within 21 days before the order expires.
What if a person needs an order when the Court is closed?
If an incident occurs outside the sitting hours of the Court, people are strongly advised to contact
police. In some circumstances, a police officer can make an application for an emergency protection
order on a person’s behalf. Emergency protection orders last a very short time (as little as 2 days). If
the applicant wants them to continue they must attend the Court and make an application for a
protection order.
What can I do to protect myself from harm?
Violence can be physical, sexual, psychological and emotional. There is no excuse for violence. There
are a number of things a person may choose to do to protect themselves from someone who is violent:




call the police if someone is threatening or hurting you.
apply for a Domestic Violence or Personal Protection Order whether a person has been charged
with a criminal offence or not.
speak to victim services about other ways of keeping safe.
leave home. Go to a refuge, or the police station, or a friend’s place.
Stay somewhere safe.
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Resources
Emergencies
ph: 000
Police Attendance Line
ph: 131 444
The Protection Unit of the ACT Magistrates
Court assists in Domestic Violence Applications
ph: 6217 4284
The Legal Aid Office (ACT)
Domestic Violence & Personal Protection Unit
ph: 6217 4299
May arrange free legal advice and duty lawyer representation for people affected by family
violence.
Public Advocate Office
ph: 6207 0707
Represents the best interests and protects the rights of adults with a disability at threat of abuse,
exploitation or neglect; where necessary represent them before courts, tribunals and with service
providers. The Public Advocate via the Management Assessment Panel also facilitates service
co-ordination where complex service needs exist.
Domestic Violence Crisis Service (DVCS)
ph: 6280 0900
Crisis support service agency, provides a 24-hour, 7 days a week service giving assistance to
people affected by family violence. DVCS can assist in the lodgement of a Domestic Violence
Order if required.
The Guardianship and Property Management Tribunal
ph: 6217 4444
Assists in Guardianship Orders for older people who are not competent to make decisions on
their own.
The Mental Health Tribunal
ph: 6217 4277
Assists in the application of Mental Health Orders for older persons who are suffering from a
mental illness or disorder.
Victim Liaison Officers
ph: 6245 7441
Provide supplementary support for victims and assist with preparing victim impact statements.
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Relevant Legislation
There are laws in the ACT that help protect people from family violence including:

the Domestic Violence and Protection Orders Act 2001 (ACT) lists all of the relationships
which may be affected by family violence and describes which actions constitute family
violence;

the Crimes Act 1900 (ACT) also lists all of the actions that are considered Domestic Violence
Offences; and

the Victims of Crime Act 1994 (ACT) which outlines the rights that victims of crime should
expect from agencies in the ACT.
Mental Health Law
Mental Health service providers treat clients with respect and dignity in accordance with the
Discrimination Act 1991 (ACT) and the Human Rights Act 2004 (ACT).
The objectives of the Mental Health (Treatment and Care) Act 1994 (ACT) are to provide
treatment, care, rehabilitation and protection for mentally ill or mentally dysfunctional persons in a
manner that is least restrictive of their human rights.
The Act defines mental illness as a condition that seriously impairs (either temporarily or
permanently) the mental functioning of a person and is characterised by the presence of any of the
following symptoms:

delusions;

hallucinations;

serious disorder of thought form;

a severe disturbance of mood; or

sustained or repeated irrational behaviour indicating the presence of the symptoms referred to
above.
The Act defines mental dysfunction as a disturbance or defect, to a substantially disabling degree of
perceptual interpretation, comprehension, reasoning, learning, judgment, memory, motivation or
emotion.
How is a mentally ill person assessed?
There are several ways in which a person can be assessed.
The Tribunal can order an assessment of a person upon application for a mental health order where
there are reasonable grounds to suggest that the person may be suffering from a mental illness or
mental dysfunction.
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Where a person is in the community and there is a need for emergency action, a Mental Health
Officer (appointed under the Act) or a doctor may initiate emergency detention procedures. After
observation if it is believed, on reasonable grounds, there is evidence of mental illness or mental
dysfunction, and

as a consequence a requirement for immediate treatment or care, or;

the person’s condition will deteriorate within 3 days to such an extent there would be a
requirement for immediate treatment or care;

the person has refused to receive that treatment or care; and

detention is necessary for the person’s own health and safety, social or financial wellbeing, or
for the protection of members of the public; or

adequate treatment or care cannot be provided in a less restrictive environment;

the person may be conveyed to the Canberra Hospital for assessment within 4 hours by a
doctor.
A police officer may apprehend a person and convey them to the Canberra Hospital for assessment,
if they have reasonable grounds for believing the person has a mental illness or dysfunction and has
attempted, or is likely to attempt, to suicide, or to inflict serious harm on themselves or another
person. An assessment must be conducted by a doctor within 4 hours.
If, in a proceedings before the Magistrates Court, the magistrate has reasonable grounds for
believing that an accused requires immediate treatment or care by reason of his or her being
mentally dysfunctional or mentally ill, the Magistrates Court may, without requiring the accused to
submit to the jurisdiction of the Tribunal, order that the accused be taken to an approved health
facility for examination by a medical practitioner for the purpose of determining whether the
accused is mentally dysfunctional or mentally ill.
Non-Compliance with Assessment Orders
If the person has failed to attend an assessment appointment and there is evidence to suggest that
the order was served correctly, the Tribunal has the power to issue an Order for Removal and an Inpatient Assessment Order. The Police, in conjunction with the Crisis Team, have the power to
remove the person to an approved facility - being the Psychiatric Services Unit - and to reside there
for a period of up to 7 days for the purposes of assessment. The assessing doctor must provide a
report to the Tribunal within 7 days of the assessment being conducted.
Mental Health Treatment and Care orders
When considering the appropriateness of an order, the Act states that the Tribunal must take into
account several factors. Some of these considerations include, but are not limited to:

whether the person consents, refuses to consent or has the capacity to consent to the proposed
course of treatment, care and/or support;

the views and wishes of the person as so far as they can be found out;

that the person’s welfare and interests should be appropriately protected;
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
that the person’s rights must not be interfered with except to the least extent necessary; and

the person’s religious, cultural and language needs are taken into consideration.
Whenever possible, the Tribunal will consider the views and wishes of the persons responsible for
the day-to-day care of the person subject to the application.
Psychiatric Treatment Orders
A Psychiatric Treatment Order is made when a person is determined to be suffering from a mental
illness. In making such an order, the Tribunal must also consider:

whether there are reasonable grounds for believing that, by reason of illness, the person is likely
to do serious harm to themselves or others, or is likely to suffer serious mental or physical
deterioration unless subjected to involuntary psychiatric treatment;

whether psychiatric treatment is likely to reduce the harm mentioned above and result in an
improvement in his/her psychiatric condition; and

whether treatment cannot be adequately provided in a way involving less restriction of the
freedom of choice and movement of the person than would result from the person being an
involuntary patient.
The order may specify a health facility to which the person subject to an order may be taken. In
addition, the order can include directions that the person be required to undergo psychiatric
treatment (other than convulsive therapy or psychiatric surgery) and/or whether the person is to
undertake a counselling, training, therapeutic or rehabilitation program.
If a person is subject to a Psychiatric Treatment Order, the Chief Psychiatrist or nominated delegate
is responsible for the treatment and care of the person. The Chief Psychiatrist is to determine:

the times during when and the place at which the person is required to attend to receive
treatment, care or support or undertake a counselling, training, therapeutic or rehabilitation
program;

the nature of the psychiatric treatment to be given; and

the place at which the person subject to an order is to reside.
Community Care Orders
A Community Care Order is made when a person is determined to be suffering from a mental
dysfunction. The Tribunal must also be satisfied that:

there are reasonable grounds for believing that, by reason of that dysfunction, the person is
likely to do serious harm to him/herself or others;

care and support is likely to reduce the harm mentioned above; and

community care cannot be adequately provided in a way involving less restriction of the
freedom of choice and movement of the person than would result from the person being an
involuntary patient.
The order may specify that the person is to be given or provided care and support, or to undertake a
counselling, training, therapeutic or rehabilitation program.
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If a person is subject to a Community Care Order the Care Coordinator, or nominated delegate, is
responsible for the care of the person. The Care Coordinator is responsible for making decisions
relating to:

the times during which, and the place at which, the person subject to an order is required to
attend to receive treatment, care or support, and whether he/she shall undertake a counselling,
training, therapeutic or rehabilitation program.
Restriction Orders
Both Involuntary Psychiatric Treatment Orders and Community Care Orders may have a
Restriction Order attached if the Tribunal is satisfied that it is in the interests of the safety of the
person or in the interests of public safety.
A Restriction Order may require the person to live but not be detained at a specified place (if
suffering from mental illness), or live but not be detained at a community care facility (if suffering
from a mental dysfunction). It may also direct the person to be detained at an appropriate facility.
The Restriction Order may also direct the person not to approach specified people, places, or
engage in specific activities.
Duration Of Orders
The Tribunal may make a Mental Health Order for a period of up to, but not exceeding, 6 months.
The duration of the order is nominated at the time of hearing.
Restriction Orders cease to have effect after 3 months of making the order and must be reviewed by
the Tribunal prior to expiry.
Prescribed Drugs Or Clinical Procedures
The Tribunal cannot make any orders with regard to the administration of a particular drug, or the
way in which a particular clinical procedure is to be conducted.
[Note: This does not apply to Electro-Convulsive Therapy or Psychiatric Surgery]
Review
The Tribunal may review a Mental Health Order by way of application or of its own motion and a
review may occur at anytime during the life of the order.
The Tribunal may revoke the original order where there is sufficient evidence to suggest that a
person is no longer mentally ill or mentally dysfunctional, or the person remains mentally ill or
mentally dysfunctional but the person’s health or safety would not be substantially at risk and
he/she is unlikely to do serious harm to others.
If the person remains mentally ill or mentally dysfunctional and it is appropriate to do so, the
Tribunal may make an additional Mental Health Order for a period not exceeding 6 months.
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Breach Action
Where a person is subject to a Mental Health Order and he/she refuses to comply, the Chief
Psychiatrist or the Care Coordinator (depending on the nature of the order) or their nominated
delegate is authorised to initiate breach action.
Prior to taking such action, the Chief Psychiatrist or Care Coordinator (or their delegate) shall
inform the person verbally of their failure to comply and the consequences of their refusal to
comply. If non-compliance continues after taking the above actions, a police officer, mental health
worker or doctor may apprehend the person and take them to an approved health facility to be
medicated, detained, or both.
The Tribunal and the Office of the Community Advocate must be notified in the event of such
action.
Summons To Appear
The Tribunal may issue a summons for a person to appear if satisfied that it is necessary for the
purposes of the proceedings.
If a person is in the custody of another person, the Tribunal may order that the other person ensure
the attendance of the person subject to the summons.
Arrest For Failing To Appear
If a person fails to comply with a summons to appear before the Tribunal, the President may order
the issue of a warrant for their apprehension. The warrant also authorises the apprehending officer
to bring that person before the Tribunal and may also authorise the detention of that person at a
specified place until he/she is released by order of the Tribunal.
A warrant may be executed by a Police Officer.
This action is, as with Orders for Removals, used as a last resort
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Guardianship
What is the Guardianship and Management of Property Tribunal?
Consistent with the Guardianship and Management of Property Act 1991 (ACT), the role of the
Tribunal is to provide legal authority in the form of guardianship and management orders to family
members or friends of adult persons who have impaired decision making ability, so that the
person’s affairs, personal or financial, may be conducted appropriately.
It might be that someone close to you has a condition such as an intellectual disability, mental
illness, brain damage or senility. If he or she has such a condition the person may be unable to
make reasonable decisions about his or her personal life or finances. That person may be making
decisions that cause injury to him/herself, or may leave him/herself open to abuse and neglect. In
such circumstances a guardian and/or manager may need to be appointed to safeguard the person’s
interests.
Before an order can be made, the Tribunal must be satisfied there is a need for the legal authority of
a guardian and/or manager, and also that if an order is not made either the person’s needs will not
be met or the person’s interests will be significantly adversely affected.
Making an Application
Guardianship and Management of Property Tribunal orders are only effective for persons aged 18
years or over.
In most instances, the informal arrangements of family networks do guard against harm and abuse
and provide adequate management of a person’s finances. If this is the case an Order from the
Tribunal may be unnecessary unless there is a need to deal with financial institutions. Where there
is no such support or family consensus, however, an application may be made to the Tribunal to
appoint a guardian and/or manager granting the guardian and/or manager the legal authority to act
on behalf of the person with a disability.
An application may be made by a person who is concerned for the welfare of the person with
impaired decision-making ability. Generally a close family member or friend will apply. In the
case of an emergency, the Community Advocate will apply. The Community Advocate protects the
interests of the parties involved in guardianship matters and may be guardian of last resort.
In making any Order, the Tribunal is obliged to observe a number of principles:

the protected person’s wishes, as far as they can be worked out, must be given effect to, unless
making the decision in accordance with the wishes is likely to significantly adversely affect the
protected person’s interests;

if giving effect to the protected person’s wishes is likely to have significant adverse effects on
the person’s interests, the decision maker must give effect to the protected person’s wishes as
far as possible without significantly adversely affecting the protected person’s interests;

if the protected person’s wishes cannot be given effect to at all, the interests of the protected
person must be promoted;

the protected person’s life (including the person’s lifestyle) must be interfered with to the
smallest extent necessary;
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
the protected person must be encouraged to look after himself or herself as far as possible;

the protected person must be encouraged to live in the general community, and take part in
community activities, as far as possible.
It is therefore very important that these matters be discussed with the person concerned, in order to
allow them an opportunity to fully consider and express their views and wishes in relation to the
proposed orders.
Who should be Guardian and/or Manager?
Guardians will generally be a family member or friend. Where no suitable person is available, the
Tribunal can appoint the Community Advocate.
The manager will generally be a person or organisation able to administer, sensitively and soundly,
the financial affairs of the person. The Public Trustee of the ACT may be appointed as manager if
there is no individual who is suitable and willing to perform the functions of manager.
The Tribunal must be satisfied that the proposed guardian or manager will follow the decisionmaking principles as stated above. The Tribunal will also take into account:

the views and wishes of the person for whom a guardian or manager is to be appointed;

the desirability of preserving existing family relationships;

whether the two persons are compatible;

whether the proposed guardian or manager lives in the Territory;

whether the proposed guardian or manager will be available and accessible to the other person;

whether the proposed guardian or manager is competent to exercise the functions and powers
given in the order; and

whether the interests and duties of the proposed guardian or manager are likely to conflict with
the other person’s interests to the detriment of the person’s interests.
The Tribunal can appoint two or more persons as joint guardians and managers. An order made by
the Tribunal can specify that the guardians or managers act jointly and/or separately when necessary
if required.
How long after the Application has been made will the Hearing take place?
Applications are given priority according to the urgency of the matter. An applicant may expect
that an application will be heard within 3 months of lodgement with the Tribunal. Various factors
contribute to hearing delays, including the fact that the Tribunal is a part time Tribunal and that
difficulties may be experienced in obtaining medical reports.
The Hearing
After you have lodged the application, the Office of the Community Advocate or the Tribunal may
contract you and the person for whom the order is proposed to gather further information for a
report to the Tribunal. All interested parties will receive a notice advising the date, time and place
of the hearing.
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The Tribunal is not a court. It operates with a minimum of formality and with as little regard to
legal technicalities as is just. In practical terms, this means that an applicant, the person for whom
the order is proposed, family and friends, encounter a hearing room, not a courtroom, no ceremony
and no judicial gowns.
What will the Tribunal Order?
There are two separate types of orders that the Tribunal can make – a Guardianship Order to cover
personal decision-making, and a management order to cover financial matters. Each type of order
may be a plenary (full), or a limited order. Other orders may be made in appropriate circumstances.
They include orders for prescribed medical procedures and orders to adjust property transactions.
A copy of any order made by the Tribunal will be provided shortly after the day of the hearing. The
authority of the guardian and/or manager commences immediately upon the Tribunal making its
decision.
Major References
Kurrle, S. and Sadler P. (1994), Assessing and Managing Abuse of Older People: A Handbook for
the Helping Professions, Alpha Biomedical Communications, p. 21– 24.
NSW Advisory Committee on Abuse of Older People (1995), Legal Issues Manual, Ageing and
Disability Department, p. 10, 12–13, 19–20, 29–30.
Fielding, W.S. (1995), Elder Abuse Is Too Polite A Word For It: An Educational Manual for
Professionals Who Work With Older People , p. 37–42.
Kingsley, B. (ed) (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 16–17.
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Section 12
Developing a Local Interagency Protocol
Five separate areas have been identified where each agency may have a role to play.
Identification
recognising a possible case of abuse;
Assessment
assessing the situation to determine the nature and extent of abuse;
Case Management
monitoring the situation of abuse and arranging appropriate services;
Other Interventions
provision of health, welfare and accommodation services; and
Legal Intervention
where appropriate, taking legal action.
Identification
What should be done?
• identify reasonable grounds for belief that abuse is occurring;
• establish the wishes of the person;
• establish, in general, the capacity of the person;
• complete agency documentation; and
• refer to appropriate agencies or professional groups for assessment.
Who must do it?
All direct service workers involved with the care of older people, younger people with disabilities
and their carers should be able to recognise suspected cases of abuse of clients and their carers and
know how to refer to the most appropriate person in the organisation.
Primary Agency
Where no other service is available for assessment or case management, aged care assessment
teams (ACATs) have the responsibility as they are multi–disciplinary and have a specialist
assessment function. It is not intended that all cases of suspected abuse or neglect are automatically
referred to these agencies.
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Assessment
What must be done?
Determination of the needs, wishes and capacities of people who are victims of abuse and their
carers and recommendation of appropriate interventions.
Who must do it?

primary agency: health services, incorporating ACATs

Emergency Services: police, mental health services and hospital emergency departments
(Emergency Departments for physical, psychological and sexual abuse and neglect cases only)

other agencies: General Practitioners, Office of the Community Advocate, Centrelink for some
cases of financial abuse and, in some cases of physical, psychological and sexual abuse with a
history of domestic violence, the Domestic Violence Crisis Service.
Also, in some cases, sexual assault services/rape crisis centres or community nurses may have a role
to play in assessment.
Case Management
What must be done?
Nomination of a key worker to ensure coordinated provision of appropriate services for clients and
carers who are victims of abuse, to monitor family needs, and to act as an advocate and broker.
Where more than one worker is heavily involved, co-case management may be appropriate. This
could be particularly useful in cases of suspected abuse of people from a non-English speaking or
people of Aboriginal or Torres Strait Islander ancestry.
Who must do it?
• primary agency: health services (incorporating ACATs), with a case management function
• Office of the Community Advocate
• other agencies: Community Services/ Programs or community nurses
Other Interventions
What must be done?
Provision of residential, health, or community care services.
Who must do it?
Generalist and specialist community support organisations such as community health and
community (including Home & Community Care) services, respite services, housing and residential
care services to victims of abuse and their families as appropriate.
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Legal Interventions
What must be done?
Different types of legal intervention may be appropriate in different situations. The least restrictive
legal interventions should be used where possible.
Examples of legal interventions include:

giving or revoking an Enduring Power of Attorney;

having the Guardianship and Property Tribunal appointed to manage a person's finances if the
person is incapable and being exploited;

calling the police where there is a real and immediate apprehension of violence (eg – breach of
the peace);

taking out a Domestic Violence Order (DVO) if there is fear of violence or intimidation; or

having a guardian appointed to make decisions if the person is incapable and there is specific
need.
Who must do it?
A range of agencies and professionals can offer legal assistance.
For example:

solicitors (in private practice, legal centres, Legal Aid, etc.) may give advice or assist with legal
action;

solicitors or the Public Trustee of the ACT can assist with Enduring Powers of Attorney and
wills;

police are the primary investigators of all criminal offences;

the police, solicitors, Office of the Community Advocate or the local court can assist with taking
out a Domestic Violence Order;

applications to the Guardianship and Property Management Tribunal or the courts may need to
be made by staff of agencies involved in assessment or case management for people who are
incapable.
The Family Violence Intervention Project
The Family Violence Intervention Project is a coordinated criminal justice and community response
to family violence. It aims to improve the criminal justice response to those matters that are
reported to police and that proceed to prosecution. Its principal aims are to improve victim safety
and increase perpetrator accountability through the development, piloting and evaluation of an
interagency criminal justice intervention into family violence.
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Charts
The following charts summarise the five levels of the Protocol.
Financial Abuse
All Service Providers
IDENTIFICATION
ASSESSMENT
ACAT
CASE MANAGEMENT
SUPPORT SERVICES
ACAT
Mental Health GP
Service
Community
Services
Community Health /
Community services
Centrelink
Community Health
staff / nurse
Accommodation GP
services
Police
Aboriginal / Ethnospecific worker
Welfare
agencies
Other
Legal Centre / Private Solicitor / Legal Aid / Police
LEGAL INTERVENTIONS
Guardianship Magistrate / Mental HealthSupreme Court
Tribunal
Review Tribunal
Local / District
Court
Private Financial Manager
Public Trustee
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Physical, Psychological, Neglect and Sexual Abuse
IDENTIFICATION
ASSESSMENT
CASE MANAGEMENT
SUPPORT SERVICES
LEGAL
INTERVENTIONS
All Service Providers
ACAT
GP
Emergency Dept/
Mental Health
Police DVCS
Health
Community Community Health Aboriginal / Ethno
-specific worker
Service / ACAT Service
staff / nurse
s
Accommodation
Welfare GP Other
Community Health /
services
agencies
Community services
Magistrate / Mental
Health/Review
Tribunal
Guardianship
Tribunal
DV CS/
OCA
Private / Public
Guardian
Local Court
District Court
Major Reference
NSW Advisory Committee on Abuse of Older People (1995), Abuse of Older People: Inter-Agency
Protocol, Ageing and Disability Department, pp. 9 – 14.
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The development and introduction of an agency protocol will require planning and negotiation. The
following strategies may assist this process.
Strategy One – Organise a planning meeting
You may find it useful to organise an initial meeting of key service providers including
representatives from the Aged Care Assessment Team, community services, the police, Community
Nursing and General Practitioners.
You could use this meeting to:
• review agency protocols and there implications for the area;
• have a look at the video, Behind Closed Doors, and its associated training kit as a potential tool
to assist in the development of a agency protocol;
• brainstorm who else might be consulted and involved in the development and agreement on a
agency protocol;
• list the tasks to be completed before agreement of an agency protocol can be reached; and
• timeline the tasks and allocate responsibility for them amongst the planning group.
Strategy Two – Form a Protocol Development Committee
You could start by recruiting a locally recognised and representative committee or task force which
aims to:

develop a draft agency Protocol and outline the available intervention models or preferred
model;

distribute the draft and model to all local service providers, agencies and services for comment
and consultation;

negotiate an agreed agency protocol and intervention model based on advice from the field;

develop, distribute and publicise the agreed agency protocol and model to all relevant parties;
and

develop a local training strategy.
You will need to ensure that all parties are represented on this committee and that the
representatives have delegated authority to make decisions on behalf of the service providers they
represent.
To work, this committee should have representation from:
• the Aged Care Assessment Team;
• other disability groups;
• community services providers;
• Community Nurses;
• Home and Community Care agencies;
• the police;
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• Mental Health services;
• General Practitioners;
• Aboriginal health or community services;
• Ethno–specific services;
• legal services such as Legal Aid, local solicitors, local Courts, Chamber Magistrate;
• the local hospital;
• domestic violence crisis services; and
• local advocacy and consumer groups.
Strategy Three – Organise Some Training
You may find that the issue of abuse of client and carers is not considered an important one by local
service providers. Alternatively there may not be a strong service provider network in your area. In
these cases, you may need to do some initial work to raise local awareness of the issue and get it on
to the agenda.
You may also need to organise and run some information and training sessions once the protocol is
in place. The agency protocol will not work effectively if:
• all service providers do not agree to refer according to the agency protocol;
• the full range of service providers do not know that an agency protocol is in place;
• agencies do not have internal policies and procedures that are in line with the agency protocol; or
• direct service workers and potential identifiers of abuse situations do not know how to recognise
abuse, respond appropriately to the situation, or report according to their agency's policies and
procedures.
This kit includes the necessary resources for a range of training options. The written information,
the DVD, the training workshops and the PowerPoint presentation can be used to:
• train direct service workers, within or across agencies, how to recognise, respond and report
situations of suspected or actual abuse;
• teach co–ordinators and management committees how to develop appropriate agency policies
and procedures; and
• run training for key protocol players like local meetings of General Practitioners and HACC
Forums.
Major References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those Who Care for Them, Module 10: Developing policies and practice procedures, pp. 2–4, 8
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Section 13
Intervention Records
This section contains some sample records that can be used in the identification, assessment,
intervention and case management of cases of abuse of clients and carers. You may already have
your own form or you can use this form as a map of what you need to document in your report.
Identification
The Identification of Abuse Form is designed for agencies that:
• may identify cases of abuse with clients and carers; and
• have no assessment, intervention or case management responsibilities.
Assessment
The Abuse and Neglect Assessment Record is designed for agencies that:
• receive referrals for assessment from agencies that have identified cases of abuse; and
• have responsibility to conduct assessments with clients and carers.
Intervention and Case Management
The remainder of the records and tools in this section are designed for agencies involved in
intervention and case management. These can be used either by individual agencies or groups of
agencies participating in the inter- agency protocol.
The records include:

an Abuse and Neglect Case Plan that identifies family members and service providers involved
in case planning, the objectives, allocation of tasks, dates for completion of tasks, contingency
plans and an initial evaluation plan;

a Case Evaluation form that identifies each case review, the progress to date and new actions and
services required; and

a Final Case Review and Closure form that is used for the final case review as a summary of
achievement against each objective and an agency review.
Each of the forms, except the Identification of Abuse form, have been adapted from:
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those who Care for Them. The forms are attached.
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Identification of Abuse Form
Agency Details
Name of Agency
Address
Phone & Fax
Case Contact Person
Phone
Fax
Client and Carer Details
Name of Person (Victim)
Address
Phone
Age
Country of Birth
Language Spoken
Aboriginal or Torres Strait Islander
Name of Client/Carer
Address
Interpreter?
Yes / No
Phone
Service commencement date
Services received
Details of Worker who first identified the case
Name of Worker
Position with Agency
Date of Identification
Date of This Report
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Identification Details
To be completed by the Worker who first identified the case
Name and relationship of the alleged abuser to the victim.
Please describe in your own words what you noticed, what happened and when it happened.
Did you tell the client or carer that you were required by your agency to discuss the situation with
your coordinator?
(please circle)
Client
yes
no
Carer
yes
no
Please describe any action that you took at the time or anything else you told the client or carer.
How, in your opinion, might the client or carer respond to a follow–up home visit from this agency?
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Follow–up Details
To be completed by the Co–ordinator or Supervisor if a follow–up visit was needed
Details of Worker who followed up the identification report
Name of Worker
Position with Agency
Date of Follow–up Visit
Date of This Report
Did the client or carer give permission for a home visit to be conducted?
If not, please describe what happened?
Who else was present and what is their relationship to the alleged victim?
Describe in your own words what happened during the visit.
In your opinion, are there reasonable grounds for the belief that abuse is occurring?
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Please detail the information that supports your belief.
Please provide details of any other agencies contacted and the outcomes of your contact regarding
this situation.
Agency
Outcome
Capacity of the Alleged Victim
(please circle)
In my opinion, the person is:
Competent and consenting to assessment and intervention
yes
no
Competent but not consenting to assessment and intervention
yes
no
Not competent but consenting to assessment and intervention
yes
no
Not competent and not consenting to assessment and intervention
yes
no
Not competent and unable to consent to assessment and intervention
yes
no
Please provide any information that supports your opinion.
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Did you provide information on the Interagency Protocol regarding assessment and intervention?
Please describe your understanding of the wishes of the alleged victim on assessment and
intervention.
Referral Details
Recommendation
(please circle)
No further action required
We will monitor situation
yes
yes
no
no
Referral for assessment required
yes
no
Referral Agency Details
Name of Referral Agency
Address
Phone & Fax
Phone
Fax
Referral Contact Person
Services Requested
Date of Referral
Signature
Has the referral agency agreed to provide feedback after the assessment has been completed?
(please circle)
yes
no
yes
no
Agreed Date for feedback
Feedback received
Date feedback received
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Abuse and Neglect
Assessment Record
Assessment Agency Details
Name of Agency
Address
Phone & Fax
Assessment Worker
Phone
Fax
Client and Carer Details
Name of Person (Abused)
Address
Phone
Name of Client/Carer
Relationship to Person
Address
Phone
Other Services involved
Has the alleged victim given his/her consent for the assessment?
(please circle)
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Details of what happened, when it happened and how often
Evidence of abuse and/or neglect
Note: In cases of physical abuse or when the person's health is a factor, a medical practitioner
or nurse should always be involved in the assessment.
Type(s)
(physical, psychological, sexual, material, active/passive, neglect, self-neglect)
Signs
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Person's dependence on carer:
Total
Partly
Independent
• Personal care including medication
........
........
........
• Emotional
........
........
........
• Finances
........
........
........
• Companionship
........
........
........
• Domestic (cooking, cleaning etc)
........
........
........
• Transportation
........
........
........
• Other - Specify
..................................................................................
............................................
Physical Environment
Problem
No Problem
• Repair
........
........
• Level of cleanliness
........
........
• Architectural barriers
........
........
• Usual facilities
........
........
• Living area used by the person
........
........
• Sleeping area used by person
........
........
• Fire safety
........
........
• Other-specify
........................................................................
........................................................................
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Risk factors
Person
Present
Suspect
Isolation
•Social
•Emotional
Stress
•Unemployment
•Insufficient income
•Inadequate accom.
•Illness
•Other - specify
Family Conflict
•History of violence
•Role change
•Other - specify
Violence
•Sexual/Physical
Substance abuse
•Alcohol
•Drugs
•Prescription drugs
Vulnerability
Cannot defend self
Cannot care for self
Lack of support services
Family
Friends/Neighbours
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Other person
Nil
Present
Suspect
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Assessment of causes
(For example, carer stress, inadequate support/help for person and/or carer, inadequate living
arrangements, financial difficulties, lack of privacy/time-out).
Assessment of needs of person
(For example, hospital assessment, home nursing services, day care, respite care, alternative care,
financial/legal advice, meals on wheels, visiting services).
Assessment of needs of other person
(For example, home help, time out for care, financial advice, education – regarding the needs of the
person, counselling, contact with specific support groups).
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Supports that can be activated
yes
no
• Family
• Friends
• Neighbours
• Other - specify
........
........
........
........
........
........
Recommended action
1.
2.
3.
4.
5.
Follow-up appointment date:
Name and Signature of Assessment Worker:
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Abuse and Neglect Case Plan
Core Information
Date of meeting
Name of key worker
Name of person abused
Address
Telephone number
Name of other person
Relationship to person abused
Address (if different)
Telephone (if different)
Current Situation
(Describe what action has been taken and the response of people involved)
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Client/Carer/Family/Advocate present at the meeting
Name
Address
Phone
Relationship to Person
Name
Address
Phone
Relationship to Person
Name
Address
Phone
Relationship to Person
Involved service providers and others present at meeting
Name
Agency
Phone
Role
Name
Agency
Phone
Role
Name
Agency
Phone
Role
Name
Agency
Phone
Role
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Objectives of the Case Plan
Objective 1:
Task 1:
Who?
By When?
Task 2:
Who?
By When?
Task 3:
Who?
By When?
Objective 2:
Task 1:
Who?
By When?
Task 2:
Who?
By When?
Task 3:
Who?
By When?
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Objective 3:
Task 1:
Who?
By When?
Task 2:
Who?
By When?
Task 3:
Who?
By When?
Contingency Plan
(in case of emergency)
Contact person/s
Telephone number/s
Review Date
Time
Ensure that all understand and agree with the plan.
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Evaluation of Plan
(To be completed before a new plan is drawn up.)
Objective 1: (comments)
Task 1 - outcome
Task 2 - outcome
Task 3 - outcome
Objective 2: (comments)
Task 1 - outcome
Task 2 - outcome
Task 3 - outcome
Objective 3: (comments)
Task 1 - outcome
Task 2 - outcome
Task 3 - outcome
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Case Evaluation
1st Case Review
Date:
By:
Progress to date/has the situation changed?
New Actions/Services Required
2nd Case Review
Date:
By:
Progress to date/has the situation changed?
New Actions/Services Required
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3rd Case Review
Date:
By:
Progress to date/has the situation changed?
New Actions/Services Required
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Final Case Review and Closure
Objective 1:
Outcome:
Objective achieved
Yes, fully
Partly
No, not at all
Impact on Abused:
Impact on Abuser:
Impact on Other:
Impact on Agency: (eg staff development, support, supervision, debriefing, changes to agency
practice)
Objective 2:
Outcome:
Objective achieved
Yes, fully
Partly
No, not at all
Impact on Abused:
Impact on Abuser:
Impact on Other:
Impact on Agency: (eg staff development, support, supervision, debriefing, changes to agency
practice)
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Objective 3:
Outcome:
Objective achieved
Yes, fully
Partly
No, not at all
Impact on Abused:
Impact on Abuser:
Impact on Other:
Impact on Agency: (eg staff development, support, supervision, debriefing, changes to agency
practice)
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Agency Protocol Review
1.
Has the abuse been terminated?
Comments:
yes
2.
Review the efficiency/success of the chosen intervention
3.
Have the underlying causes of abuse been addressed?
Comment:
yes
no
4.
Have the rights of the victim been upheld throughout the case?
yes
no
Comment:
5.
Comment on the quality of the agency/inter-agency actions.
6.
Comment on the quality of staff interactions.
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7.
Comment on the adequacy of resources to deal with the case (eg availability of respite care).
8.
Evaluate the overall efficacy of the Protocol during the case.
9.
List any recommended changes to the agency protocol (eg amended assessment or referral
procedures, agency procedures, staff training, staff supervision).
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Section 14
Monitoring and Evaluation
Monitoring the Situation
The key worker is responsible for ensuring services are delivered in accordance with the case plan
and needs to keep in regular contact with the victim and provide a contact number in case of an
emergency.
This key worker monitors whether the services are fulfilling the intended function and how the
victim feels about the service delivery. The main thing is to check whether or not the abuse and/or
neglect is still occurring and then to see if other areas have improved: for example, is the person
eating properly.
It is important to remember that problems are often not solved immediately. Sometimes the abused
may have difficulty relating to a worker or the presence of strangers in the home may cause more
stress and make the situation worse.
Services may have to be changed or adjusted and often it is a matter of trial and error before a
workable solution is found. If a crisis develops, the key worker will need to call a meeting to reassess the situation and decide on a different approach.
Reviewing Case Plans
The key worker will arrange for the person, client, carer, family and all other workers to attend a
case plan review on the date set in the original plan.
The purpose of the review is to:
• assess the effectiveness of the services by exchanging information about progress and
• determine if the situation has changed and whether new services are required.
An updated case plan should be prepared and the next review date set.
Closing Cases
This can be extremely difficult in situations of abuse and neglect, as often the key worker and other
workers will have established relationships upon which the victim has come to rely.
Even when the objectives have been achieved and the risk of abuse and/or neglect has been
overcome, workers may find it difficult to close the case. The person may still require assistance.
Some clients or carers may continue to become more dependent due to failing physical health and
increased disability and require ongoing assistance and services and, sometimes, an advocate.
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It is important, however, for the key worker to set limits once services are established. Regular
contact by the key worker may no longer be necessary and an occasional telephone call or visit may
be enough to reassure the person and maintain the relationship.
Evaluating the Outcomes
Monitoring the progress of the case and evaluating its outcomes is a vital element of casework.
Whilst the case is active, teams will meet regularly to monitor progress, consider what has
happened to date, and decide what still needs to be done to resolve the case. At the end of each
case, measuring the outcomes to see whether the objectives have been met is one type of essential
evaluation. This is an objective and quantitative measure of the degree of success in achieving the
desired outcomes. More subjective evaluation is also vital to consider the quality of the agency's
and the workers’ response to the abuse. This type of evaluation is essential to measure the
effectiveness of workers and agencies involved in dealing with abuse of clients or carers.
Final case evaluation should:
• verify that abuse has stopped;
• ensure that the rights of the victim have been upheld;
• review each objective and the extent to which it has been achieved;
• assess what impact the interventions have had on the victim;
• assess that all underlying causes of abuse have been addressed;
• ensure all measures are taken to prevent re-occurrence of abuse;
• assess the level/quality of inter agency co-operation in the case;
• assess the quality and effectiveness of agency/worker interaction in the case;
• decide if agency procedures/training/supervision were sufficient to deal with the specific needs
of the client and the circumstances of the case; and
• based on the above, determine if any changes are necessary to the agency or procedures.
Major References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those Who Care for Them, Module 13: Planning services and support, pp. 9 –10.
Kingsley, B. (ed) (1993), Responding to Elder Abuse: A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 17.
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Section 15
Prevention Strategies
Preventative Strategies to Address Abuse
The ideal solution to the problem of abuse is to prevent it in the first place. If abuse is to be
prevented, however, governments, society at large, the local community, service agencies, families,
older people and their carers must be involved. It is going to take a concentrated, long-term effort
to change the values and attitudes that condone abuse and discrimination against older people and
their carers. It is not the purpose of this section to prescribe what must happen to prevent abuse, but
the following lists give some general examples of the strategies that are necessary if we are ever
going to curtail the extent and seriousness of abuse of clients and their carers.
To Reduce the Likelihood of Abuse
Preventive measures are designed to secure the long-term safety of older people and their carers in
the community and to reduce their vulnerability to abuse. They aim for the prevention of abuse as
opposed to intervention and "cure".
They include,
Empowerment of clients by:
• asserting the right to live free from abuse;
• educating clients on protective personal behaviour;
• protecting client rights to freedom of choice and informed consent;
• providing information to clients regarding available services and resources;
• encouraging independence, and giving support to enable clients to live independently in the
community;
• increasing the opportunities for clients to gain help, advice, and legal information, or to make
complaints and express grievances; and
• enhancing existing protective measures by guardianship legislation to safeguard fairness and
equity for clients.
Empowerment of carers:
• to demand and expect services and support for the caring role;
• to say "No" if they cannot commence or continue giving care to a frail or disabled relative;
• through adequate financial reimbursement for the economic costs of caring (eg. increased
domiciliary allowance, increased carers benefit, tax rebate for carers);
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• through increased community health services;
• through the availability of regular respite services;
• through the provision of information, guidance and training for carers;
• through the establishment of more carer support groups; and
• through increased counselling services for carers.
Community Education to:
• affirm the worth and value of clients and their carers to society;
• eliminate negative social attitudes towards these groups;
• change the attitude that the family has total responsibility to care for older people;
• provide information about the rights of older people and their carers;
• provide information about choices, options, and what support is available for carers;
• increase recognition for the valuable work of family carers;
• raise awareness about the issues of abuse; and
• provide accurate and positive information about ageing.
Legislation to:
• eliminate negative discrimination against older people;
• introduce positive discrimination to advance the rights of these people;
• negatively sanction violence as a legitimate mode of conduct;
• increase police intervention powers in cases of suspected/actual abuse (eg. right of entry on the
basis of suspicion or report of abuse);
• increase funding to government departments and other agencies who deal with abuse;
• give government departments more authority to act in cases of abuse; and
• ensure the safety and protection of workers involved in abuse.
Community resources:
• through appropriate funding to grass roots agencies;
• through equitable provision of community services;
• through increased referral and information to agencies;
• through appropriate community health services for older people;
• through appropriate community support and respite services;
• to provide accessible refuges and alternative housing;
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• to offer financial relief and support for family carers; and
• to give practical and social support to family carers.
Professional awareness to:
• guard against discrimination in interactions with clients and carers;
• keep on hand new information regarding issues and initiatives for older people and carers;
• promote the rights of clients for self-determination and independence;
• work with clients, carers and advocates to plan alternative and creative strategies to meet their
needs;
• refer clients, carers and advocates to other agencies for information and service when the need is
evident; and
• take time to preserve their own health and well-being.
Personal Prevention Strategies
The provision of additional services, resources, and information are not, in themselves, sufficient to
ensure the prevention of abuse. The preventive process must be proactive and all adults should
make long term plans for their future.
The following gives a list of personal strategies to address abuse, to alert people to their rights and
to encourage them to adopt behaviours that will reduce the risk of abuse.
In the interests of increased awareness about the issue of abuse, workers are encouraged to
distribute the list of personal prevention strategies amongst clients.
Personal Strategies to Address Abuse
This list gives examples of some of the things you might wish to do to protect your independence
and to reduce the risk of abuse. You could:
• plan for your future while you are independent;
• discuss with family and friends how you would like to be cared for and how you want your
assets maintained should you become frail or disabled;
• be aware of your right to privacy and to make your own decisions about whether to accept or
refuse services or intervention;
• consider carefully before agreeing to live with anyone, especially if they have a history of
substance abuse or mental illness;
• consider carefully before accepting personal care in return for transfer of your property or assets;
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• recognise that verbal harassment, humiliation or neglect can be early warning signs of physical
abuse;
• have pension payments credited directly to your bank account;
• make out a Will, an Enduring Power of Attorney and instructions about your future health care
and review them regularly;
• keep an accurate up to date list of valuable possessions and bank accounts;
• protect your money and valuables by keeping them out of sight;
• discuss security needs with crime prevention officers, ask your local police about courses on
'protective behaviours', think about joining Neighbourhood Watch;
• notify the police if you will be away for long periods;
• develop friendships outside your immediate family;
• remain active and involved in community activities;
• take care of your own health and welfare;
• assert your right to be treated with dignity and respect;
• ask for help when you require it;
• demand adequate support and community services;
• expect efficient service from community workers and agencies; and
• remember that, as a valued citizen, you have the right to live free of abuse, neglect or
exploitation.
Planning and Implementing Education and Awareness Programs
Below are ways of planning education and awareness programs about abuse and neglect and some
suggested program outlines.
You will need to decide the prevention strategy you will use, who your target group is, and the
method you will use to get the message across.
Key Prevention Strategies
1.
Information and awareness programs about the nature and causes of abuse and neglect.
2.
Education through specific training programs on abuse and neglect.
3.
Providing practical support services, day-care and relief services, home support services,
separately considering and meeting the needs of the carer as well as the person for whom care
is provided.
4.
Effective prevention and protection through needs assessment and service provision,
including specialist help and ongoing review.
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5.
Access to independent advocates and help with conflict resolution.
6.
Monitoring the quality of services and care provided.
Target Groups
Target groups may include all or some of the following:
• people with disabilities and disability groups and services;
• older people and older people's groups and services;
• carers and carer support groups;
• families and significant others;
• neighbours;
• cultural groups and networks;
• volunteers;
• service providers;
• professionals (doctors, lawyers, accountants, etc);
• policy makers; and
• general public.
Some prevention strategies (such as information programs) may be suitable for all target groups.
Other strategies will need to be directed to particular groups.
Methods
The way in which you choose to action each prevention strategy will depend on the particular target
group and your interests and skills.
Some examples:
• leaflets;
• public meetings;
• seminars;
• planning and providing services;
• training / education programs;
• radio and other news media; and

referring to Your Guide to Engaging with the Community: ACT Government Community
Engagement Manual.
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Major References
Age Concern New Zealand Inc. (1992), Promoting the Rights and Well–Being of Older People and
Those who Care for Them, Module 8: Preventing elder abuse and neglect at home, pp. 5–7.
Kingsley, B (ed) (1993), Responding to Elder Abuse, A Elder Abuse is any behaviour within a
relationship of trust that harms an older person for Non-Government Agencies, Council on the
Ageing (WA) Inc., p. 33-35.
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Workshop 1
Information on Abuse of Clients
and their Carers
Workshop Description
This 3 hour workshop is an introductory information session on abuse of older people who are
living at home and their carers. The workshop has been designed for paid and unpaid workers who
are either providing services in the home, or working directly with older people. It will give
participants an understanding of types of abuse, their possible causes and common warning signs.
At the end of the workshop, participants will be able to: recognise situations where abuse may be
occurring; know what to do in potential abuse situations; and be able to deal with their own
personal dilemmas.
This workshop can be conducted in face-to-face training and also be completed by individual
learners.
Workshop Target Groups
This workshop has been designed as an introduction for:
• personal care assistants and home carers;
• respite workers;
• volunteers and direct service workers assisting with meal provision, shopping, transport,
gardening, home maintenance and modification, home visiting and information services;
• carers; and
• aged care service workers who are new to the field or who have not completed previous training
on abuse issues.
Workshop Objectives
At the conclusion of the workshop, participants will be able to:
• define the term "abuse" and identify the types of abuse experienced by older clients, clients with
disabilities and their carers;
• describe and recognise symptoms and signs of abuse arising from direct work with clients and
their carers;
• describe their rights and responsibilities as workers;
• work according to their agency policy and procedures on abuse situations and refer appropriately
within the agency; and
• debrief with supervisors and managers.
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Workshop Resources
Trainers and participants who are working through the package as individual distance learners will
need to read and refer to the following parts of the Training Kit before running the workshop or
completing the exercises.
Background Reading and Information Packages
Section 1
Section 2
Section 3
Section 4
Section 5
Human Rights and its Links to Abuse
Defining Abuse
Factors Contributing to Abuse
The Extent of Abuse
The Signs of Abuse
Section 6
Section 7
Section 8
Section 13
People with Special Needs
Issues for Service Providers
Approaching the Situation
Intervention Records
Case Studies
Behind Closed Doors – may be used as a DVD presentation or as case studies. A synopsis of each
case is included in the workshop materials.
Power Point Presentation
Slide 1
A Trainers Guide - PowerPoint Presentation
Slide 2
Clients and their carers
Slide 3
Slide 4
Slide 5
Slide 6
Slide 7
Slide 8
Slide 9
Slide 10
Defining abuse
Defining abuse
Defining abuse
Contributing factors
Behavioural signs of victims
Behavioural signs of abusers
Environmental signs
Material and financial signs
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Slide 16
Slide 17
Psychological abuse
Physical and sexual abuse
Signs of neglect
Self-neglect
Issues for workers
Appropriate intervention
Dealing with the situation – Initial response & assessment documentation
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Slide 18
Dealing with the situation – Intervention & debrief & evaluate
Slide 19
Slide 20
Slide 21
Slide 22
Example of an interagency protocol
Developing an agency policy
Developing an agency procedure
Local intervention models
Equipment and Materials
Trainers who are presenting the workshop will also need:
• a whiteboard;
• flip charts or butchers paper;
• whiteboard pens;
• laptop and projector or printed copies of the power point presentation;
• DVD player and television;
• copies of relevant handouts; and
• name tags (everyone should write their first or preferred name in big print so that the trainer can
easily read them).
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Workshop 2
Outline & Trainer's Guide
Part 1 – Introduction
1. Introduction of Trainer (5 mins)
• introduce yourself to the group;
• complete any housekeeping issues; and
• set your ground rules for the workshop. Stress the importance of participation and asking
questions and the guidelines around confidentially within the workshop.
2. Introduction of Participants (10 mins)
Ask each participant in turn to state:
• his or her name;
• the agency they represent;
• how long he or she has worked with the agency; and
• what work he or she does for the agency.
3. Introduction to Workshop (20 – 30 minutes)
• ask participants to identify what they would like to learn from the workshop. Record what they
say on butcher's paper entitled ‘Expectations’;
• tell two or three short, relevant stories about abuse situations involving clients and carers from
your personal or working experience; and
• ask participants if anyone has encountered situations where abuse of clients and carers is, or
could be, happening in the course of their work or private lives.
When anyone speaks about situations they have encountered ask:
• what signs indicated to you that this may have been an abuse situation?
• what actually happened?
• what was the effect on you?
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• how do you think the situation was handled by any individuals or agencies that became
involved?
• what did you learn about abuse?
• if it happened again, what could have been done differently to get a better result for all involved
parties?
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Part 2 – Information About Abuse
4. Human Rights and its Links to Abuse (15 mins)
• see section 1 – Human Rights and its links to Abuse;
• use slide 2 to introduce the concept of rights of clients and carers;
• starting with ‘Safety’ move clockwise around the diagram, asking participants how they think
these principles apply in dealing with situations of abuse.
5. Defining Abuse (20 minutes)
• see section 2 – defining abuse, section 4 – the extent of abuse;
• use slide 3 to introduce and explain the types of abuse;
• choose some basic research data from section 4 to explain the extent of the issue in the
community;
• show scenario 1 on the video or hand out scenario 1 to participants; and
• after viewing scenario 1, ask the group the following questions and lead the group in a discussion
in response to the questions. You can use those below as a guide or add some of your own.
Questions
1.
Is abuse indicated? What types of abuse could we have just seen?
2.
What were the signs that Maria may have walked into an abuse situation?
3.
What could Mrs Firbank be feeling?
4.
What could Mr Firbank be feeling?
5.
If you were Maria, what would you be feeling?
6.
How do you think Maria handled the situation?
7.
What is Maria's position now that she has been asked to leave the house?
8.
What options are open to Maria? What could she do next about the situation?
9.
If you were in Maria's shoes and in the Firbank's house what would you do?
10.
What do you think your agency would like you to do if you ever found yourself in a similar
situation?
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6. Understanding Abuse (20 minutes)
• see section 3 – factors contributing to abuse, section 6 – people with special needs;
• use slide 4 – contributing factors and ask participants why and how each factor contributes to
abuse;
• ask which of these factors may have contributed to scenario 1;
• ask "what could be different for people with dementia and their carers, people from culturally
and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people and people
in remote and isolated areas?";
• show scenario 2 on the video or hand out scenario 2 to participants; and
• after viewing scenario 2, ask the group the following questions and lead the group in a discussion
in response to the questions.
Questions
1.
Is abuse indicated? What types of abuse could we have just seen?
2.
What were the signs this may be an abuse situation?
3.
If this was an abuse situation, what factors may have contributed to the abuse?
4.
As Mrs Cheung is from a culturally diverse background, what would you have to take into
consideration here?
5.
If you were Michael, what would you be feeling?
6.
What options are open to Michael? What could he now do about the situation?
7.
If you were in Michael's shoes, what would you do?
8.
What do you think your agency would like you to do if you ever found yourself in a similar
situation?
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Part 3 – Responding Appropriately in Abuse Situations
7. The Signs of Abuse (20 mins)
• see section 5 – the signs of abuse and section 7 – issues for service providers;
• explain that you are now going to look more deeply things that signify abuse could be
happening;
• use slides 5 – 12, the signs of abuse;
Present each list, read it out aloud and ask if there are any questions before moving on to the
next list:
• emphasise that these signs are just some indications that abuse may be occurring;
• ask, "if you see these signs and suspect that abuse may be happening, what should you do if you
are unsure?";
• lead into a discussion of what personal and work issues participants may need to address if they
encounter abuse situations;
• make a list of the major issues and compare to slide 13, issues for workers;
• show scenario 3 on the video or hand out scenario 3 to participants; and
• after viewing scenario 3, ask the group the following questions and lead the group in a discussion
in response to the questions.
Questions
1.
Is abuse indicated? What types of abuse could we have just seen?
2.
What were the signs this may be an abuse situation?
3.
If this was an abuse situation, what factors may have contributed to the abuse?
4.
If you had been the first person to find that abuse could be happening, what personal
dilemmas could you be experiencing?
5.
Would it be different if you had been working with the Cratheys for a while?
6.
What options would be open to you?
7.
What would you do?
8.
What do you think your agency would like you to do if you ever found yourself in a similar
situation?
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8. Approaching the Situation (30 mins)
• introduce the idea of approaching potential abuse situations appropriately by asking participants
what they think is appropriate action, what is inappropriate action and what are the boundaries of
their roles and responsibilities;
• use slide 14 – principles for intervention which gives basic intervention guidelines to all service
providers;
• use slides 15 and 16 – dealing with the situation, go through the flow chart, ask for questions and
lead the discussion;
• use slide 20 – the interagency protocol and explain briefly how the protocol works. Link back to
the previous scenarios and ask what would happen under the Elder Abuse Protocol;
• show scenario 4 on the video or hand out scenario 4 to participants; and
• after viewing scenario 4, ask the group the following questions and lead the group in a discussion
in response to the questions.
Questions
1.
Is abuse indicated? What types of abuse could we have just seen?
2.
What were the signs this may be an abuse situation?
3.
If this was an abuse situation, what factors may have contributed to the abuse?
4.
If you had been there, what personal dilemmas could you be experiencing?
5.
Is it an emergency, urgent or non–urgent? What things could have made it an emergency,
urgent or non–urgent situation?
6.
How would you deal with the situation in each of these situations?
7.
What do you think your agency would like you to do if you ever found yourself in a similar
situation?
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Part 4 – Closure (15 - 30 mins)
• go back to the list of expectations generated at the beginning of the workshop and check if all
expectations have been covered;
• ask participants if they have any further questions and if there is anything else they would like to
discuss;
• refer participants to the information in the training and information resource for further reading;
• refer participants to their agency policy and procedures to find out what their agency requires
from them in abuse and potential abuse situations;
• ask each participant, "If you had to choose one thing you learnt today from this workshop that
will help you in your work, what would that be?";
• ask participants to complete evaluation sheets on the workshop;
• thank participants for their attendance and participation; and
• close the workshop.
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Workshop 3
Developing Internal Policies and Procedures in
Response to Abuse
Workshop Description
This half day workshop can be run as either an internal workshop for the management committee
and staff of one agency or as cross-agency training for policy makers from different organisations.
This workshop assumes that participants have completed Workshop 1 and have a basic
understanding on the signs of abuse and response issues for direct service workers and agencies. It
can be run as:
• a stand-alone workshop after previous training has been completed; or
• as the afternoon session following Workshop 1. In this way, direct service workers and their
co–ordinators attend the morning session, while only the co–ordinators stay on for the afternoon
session.
The workshop includes information and exercises that detail the role of the agency in identifying
and responding to abuse situations, the policy requirements for appropriate intervention and
protocols for referral, assessment and intervention.
This workshop can be conducted in face-to-face training and can also be completed by individual
learners.
Workshop Target Groups
This workshop has been designed for:
• co–ordinators and supervisors with responsibility for following–up potential and actual abuse
situations reported by direct service providers;
• senior staff, including managers and co–ordinators responsible for the implementation and
monitoring of agency policies and procedures; and
• management committee members responsible for the development and ratification of agency
policy and procedures.
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Workshop Objectives
At the conclusion of the workshop, participants will be able to:
• produce, implement and monitor appropriate agency policy and procedures to deal with abuse
situations;
• describe the rights and responsibilities of their agency in relation to their response to abuse
situations;
• refer abuse cases according to the Interagency protocol;
• complete all necessary documentation; and
• support and debrief direct service workers reporting potential and actual abuse situations.
Workshop Resources
Trainers and participants who are working through the package as individual distance learners will
need to read and refer to the following parts of the Training Resource before running the workshop
or completing the exercises.
Background Reading and Information Packages
Section 1
Section 2
Section 3
Section 4
Human Rights and its links to Abuse
Defining Abuse
Factors Contributing to Abuse
The Extent of Abuse
Section 5
Section 6
Section 7
Section 8
Section 9
Section 12
Section 13
The Signs of Abuse
People with Special Needs
Issues for Service Providers
Approaching the Situation
Developing an Agency Protocol
Developing an Interagency Protocol
Intervention Records
DVD
Behind Closed Doors – may be used as a DVD presentation or as case studies. Each scenario is
also presented as a written case study.
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PowerPoint presentation
Slide 13
Slide 14
Slide 15
Slide 16
Slide 17
Slide 18
Slide 19
Slide 20
Slide 21
Slide 22
Signs of neglect
Self-neglect
Issues for workers
Appropriate intervention
Dealing with the situation – Initial response & assessment documentation
Dealing with the situation – Intervention & debrief & evaluate
Example of an interagency protocol
Developing an agency policy
Developing an agency procedure
Local intervention models
Trainers who are presenting the workshop will also need:
• a whiteboard;
• flip charts or butchers paper;
• whiteboard pens;
• Lap top and projector or copies of slides;
• DVD player and television;
• copies of relevant handouts; and
• name tags (everyone should write their first or preferred name in big print so that the trainer can
easily read them).
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Workshop 4
Outline & Trainer's Guide
Part 1 – Introduction (20–30 mins)
1. Introduction of Trainer (5 mins)
• introduce yourself to the group;
• complete any housekeeping issues; and
• set your ground rules for the workshop. Stress the importance of participation, asking questions,
and monitoring the guidelines around confidentially within the workshop.
2. Introduction of Participants (10 mins)
Ask each participant in turn to state:
• his or her name;
• the agency he or she represents;
• what work he or she does for the agency; and
• one role the agency does or should play in the identification and response to
potential and actual situations of, abuse of clients and their carers.
3. Introduction to Workshop (10 – 15 minutes)
• ask participants to identify what they would like to learn from the workshop. Record what they
say on butcher's paper entitled ‘expectations’; and
• ask participants who has encountered situations where abuse of clients and carers is, or could be,
happening in the course of their work.
When anyone speaks of a situation ask:
• what signs indicated to them that this may have been an abuse situation?
• what actually happened?
• how did their agency respond?
• overall, how do they think the situation was handled by their agency?
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• what referrals were made to other agencies for assessment and action?
• overall, how effective was that response?
• if it happened again, what could have been done differently to get a better result for all involved
parties?
Part 2 – Developing an Agency Policy (60 minutes)
4. The role of policy and procedures (5 mins)
• introduce the topic by asking "why have a policy and procedure on abuse? What are the benefits
for clients, their carers, direct service workers, agency staff and management and other
agencies?"
• ask participants "What is the policy development process in your agencies? How are policies
developed, produced, broadcast, implemented, monitored and reviewed?”
5. Policy and Procedures Exercise (30 mins)
Divide participants into either 2,4 or 8 groups of between 3–4 people per group:
• hand out copies of the case scenarios, butcher's paper and pens. If 4 or 8 groups, each group
receives and works on one case scenario. If 2 groups, each group will get 2 scenarios;
• ask each group to discuss and answer the following questions.
Questions
1.
What are the policy implications of the situation? What types of statements would your
agency need to cover in a comprehensive policy statement on abuse of clients and carers?
2.
If one of the direct service workers in your agency had been the first to identify this potential
or actual situation of abuse, what personal dilemmas would they be experiencing?
3.
What action and reporting would be appropriate for the direct service worker? What should
an internal procedure need to cover to ensure that your agency responds appropriately? What
types of things should the procedure detail?
4.
If the incident were reported to you, what would be the boundaries to the roles and
responsibilities of your direct service worker, you and your agency? What would your agency
do?
5.
To where would you refer for assessment and management of the situation? What needs to be
covered in a referral procedure?
6.
What does the Interagency Protocol indicate as the next step?
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• After the groups have completed the exercise ask each group to report back. Use a whiteboard,
butcher's paper or an overhead to create two lists, one on the inclusions of a policy and the other
on inclusions of a procedure. Write up these inclusions as the groups are reporting back.
Indicate where groups mention the same inclusions by placing ticks next to them.
• Ask the group for questions and comments after the lists have been completed. Note the
commonalities and the differences.
6. Developing Policies and Procedures (20 – 30 mins)
• show slide 18 – developing an agency policy and outline and discuss each element in numerical
order. Compare the slide to the list on policy;
• show slide 17 – developing an agency procedure and repeat the process;
• give out a copy of section 9 and allow participants enough time to read through the sample
document;
• give out a copy of Identification of Abuse Form from section 13, and allow time for reading;
• ask participants how this sample policy and documentation could be adapted by their agencies.
What would they need to change, to add or delete. Answer any questions; and
• spend some time discussing debriefing and documentation procedures with direct service
workers.
SHORT BREAK
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Part 3 – Linking Agency Policy to the Protocol (60 mins)
7. Identifying the Interagency Policy
The content of this session will vary according to whether a local protocol has been developed and
is operational.
In areas where a Protocol is operating, it would be useful to invite someone from a key assessment
agency, like an ACAT, or a representative of the local Committee to the training session. This
person will explain how the protocol is working in the area, the roles and responsibilities of
participating agencies, referral procedures and documentation requirements.
In areas where a Protocol is planned or not yet operating, it would be useful to invite a panel of
potential assessment, intervention and case management service providers to the session and ask
them to present information on what they can currently do in situations of abuse, their ideas on how
agencies can develop a co–ordinated response, what local response options are possible, what plans
there are for future development and what agencies should do in the meantime until a protocol is
established.
Part 4 – Closure (15 - 30 mins)
• go back to the list of expectations generated at the beginning of the workshop and check if all
expectations have been covered;
• ask participants if they have any further questions and if there is anything else they would like to
discuss;
• refer participants to the information in the training resource for further reading;
• ask each participant, "if you had to choose one thing you learnt today from this workshop that
will help you in your work, what would that be?";
• ask each participant, "what action will you now take in response to your attendance at this
workshop?";
• ask participants to complete evaluation sheets on the workshop;
• thank participants for their attendance and participation; and
• close the workshop.
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Workshop 5
Developing an Interagency Protocol
Workshop Description
This one-day workshop has been developed for individuals, agencies and service providers who
have responsibility for case management and legal and other interventions in cases of abuse of older
people and their carers. It has been designed in two parts that can either be held on the same day or
over two meetings.
Part I is a two hour exercise for all interagency players that explores a range of abuse situations,
potential interagency responses and gaps and issues to be considered in the development of an
appropriate and effective protocol. Other service providers and interested parties can also attend as
observers.
Part II is a follow–up workshop for the key agencies and personnel involved in assessment, case
management and intervention actions. It has been designed so that participants will have the basis
of an interagency protocol, which can be further developed, after the workshop.
Workshop Target Groups
The workshop has been designed as an information and training session for:
• ACAT workers;
• General Practitioners;
• Hospital Social Workers;
• Mental Health teams;
• Community Nurses;
• Other Community Health staff;
• Police;
• Domestic Violence Services;
• Office of the Community Advocate & other client and carer advocacy services;
• Community Services staff;
• Guardianship and Property Management Tribunal and private and Public Guardians;
• Solicitors;
• Magistrates and appropriate staff of the ACT Magistrates Court;
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• Public Trustee;
• Community legal centres and Legal Aid services;
• Aboriginal health and community workers; and
• Ethno–specific support services.
Workshop Objectives
At the conclusion of this workshop, participants will be able to:
• describe their roles and responsibilities in the assessment, case management or intervention in
cases of abuse of older people;
• outline the key elements of the assessment process and considerations for special needs groups;
• set intervention objectives, choose the most appropriate intervention strategy, plan the
intervention and put the intervention into action;
• monitor and evaluate the effectiveness of intervention action;
• describe the range of models that could be used as a local interagency protocol; and
• develop and produce an agreed local interagency protocol in response to abuse of older people
and their carers.
Workshop Resources
Background Reading and Information Packages
Section 7
Section 8
Section 9
Section 10
Section 11
Section 12
Section 13
Section 14
Section 15
Issues for Service Providers
Approaching the Situation
Developing an Agency Protocol
Assessment
Interventions
Developing a Interagency Protocol
Intervention Records
Monitoring and Evaluation
Prevention Strategies
Video
Behind Closed Doors – may be used as a DVD presentation or as case studies
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PowerPoint Presentation
Slide 15
Slide 16
Slide 17
Slide 18
Slide 19
Slide 20
Slide 21
Slide 22
Issues for workers
Appropriate intervention
Dealing with the situation – Initial response & assessment documentation
Dealing with the situation – Intervention & debrief & evaluate
Example of an interagency protocol
Developing an agency policy
Developing an agency procedure
Local intervention models
Equipment and Materials
Trainers who are presenting the workshop will also need:
• a whiteboard;
• flip charts or butchers paper;
• whiteboard pens;
• Laptop and projector or printed copies of overheads;
• DVD and television;
• copies of relevant handouts; and
• name tags (everyone should write their first or preferred name in big print so that the trainer can
easily read them).
If Part I is conducted as a public presentation in front of an audience, trainers should also consider:
• tables for the panel;
• microphones for each panel member and a lapel microphone for the trainer; and
• video camera to film the presentation for future reference.
All panel members should get a copy of the following sections of the Kit to read:
Section 9
Developing an agency protocol
Section 10
Section 11
Section 12
Section 13
Assessment
Intervention
Developing an agency protocol
Intervention records
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Part 1
Trainer's Script
Participants
Participants ideally should include:
• a coordinator of a HACC funded service that may identify abuse situations, collect initial
information and refer on to another service for assessment – a day respite service is ideal;
• a member of an Aged Care Assessment Team (ACAT);
• a representative from the local Police;
• a General Practitioner;
• an Aboriginal worker;
• an ethnic community services worker;
• a solicitor;
• a worker in the domestic violence field;
• a community nurse;
• a Guardianship and Property Management Tribunal representative; and
• an Office of the Community Advocate representative.
Introduction – The Interagency Protocol (45 minutes)
1. Introduction of Trainer (5 mins)
• introduce yourself to the group;
• complete any housekeeping issues; and
• set your ground rules for the workshop. Stress the importance of participation, of asking
questions and the guidelines of monitoring around confidentially within the workshop.
2. Introduction of Participants (10 mins)
Ask each participant in turn to state:
• his or her name;
• the agency he or she represents;
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• what work he or she does for the agency; and
• one role the agency does or should play in the identification and response to
potential and actual situations of abuse of clients and their carers
3. Introduction to Workshop (10 – 15 minutes)
Ask participants if anyone has encountered situations where abuse of clients and carers is, or could
be, happening in the course of their work. If people have encountered situations:
• what signs indicated to them that this may have been an abuse situation?
• what actually happened?
• how did their agency respond?
• overall, how do they think the situation was handled by their agency?
• what referrals were made to other agencies for assessment and action?
• overall, how effective was that response?
• if it happened again, what could have been done differently to get a better result for
all involved parties?
4. The sample interagency Protocol (10 – 15 minutes)
• Use Slide 20 to introduce the Protocol and hand out copies of a Sample Protocol.
• Talk through each step of the Protocol and ensure that, at the end of the discussion, all
participants can identify where agencies and service providers fit into the Protocol.
The Protocol in Practice – 4 Case Studies
Either one scene of the video Behind Closed Doors is shown or, if the DVD is not available, the
trainer reads the scenario out. There are five acts, one for each story in the DVD and a follow–up
using the interagency protocol. The first four acts proceed in the following way:
1.
part of the DVD clip that introduces the scene is shown or the trainer reads the scenario;
2.
the trainer asks a series of set questions to participants;
3.
further scenes are introduced; and
4.
questions are directed to participants after each scene.
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You may need to use the following slides and information to assist the discussion.
Section 13
Intervention Records (Hand this out prior to starting the case studies)
Slide 17
Dealing with the Situation –
initial response – assessment and documentation
Slide 18
Dealing with the Situation –
intervention and debrief – evaluate
Slide 19
Example of an interagency protocol
Slide 20
Developing an agency policy
Slide 21
Developing an agency procedure
Slide 22
Local intervention models
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Act One
The Firbanks
Scene One – The Phone Call
The telephone is ringing in a messy house. There is clothing scattered all over the floor, the
furniture is out of place and a dirty dinner plate is on the coffee table. It takes a while for Mr
Firbank to put his newspaper down and pick up the telephone. It is Maria from the Day-care centre,
she introduces herself, and asks after Mrs Firbank. Maria says that she hasn't seen Mrs Firbank at
the Day-care centre for 3 weeks and she is wondering if Mrs Firbank is all right. A colleague is in
the office with Maria listening to the call.
From the telephone conversation Maria finds out from Mr Firbank that she cannot speak to Mrs
Firbank because she is still ill. Maria asks if she can drop in and visit Mrs Firbank. It seems that
Mr Firbank is not happy with that suggestion, and that Mrs Firbank wouldn't want her to visit.
Maria says "that doesn't sound right, she always enjoyed her time with us" and again suggests that
she drop around to visit on her way home this afternoon. She hangs the telephone up.
Maria says to her colleague in the office that she can't stand Mr Firbank. She finds it odd that Mrs
Firbank comes here everyday for six months then no contact, no messages. All she could find out
from Mr Firbank is that Mrs Firbank is too tired to leave the house and that she hasn't been well.
The colleague who overheard the telephone conversation tells Maria that it sounded like Mr Firbank
doesn't like the idea of Maria visiting Mrs Firbank.
Scene Two – The Home Visit
That afternoon Maria knocks on the Firbank's door, Mr Firbank answers her knock. Maria
introduces herself and asks if she may come in and talk to Mrs Firbank. Mr Firbank takes Maria up
stairs to Mrs Firbank. Mrs Firbank is sitting up in bed. She is winding some wool into a ball. Mr
Firbank as he enters the room says, "you had a fall didn't you Valda" for Maria's benefit. Mrs
Firbank asks Maria if she would like a cup of tea, Mr Firbank gruffly says that they don't have any
tea, Mrs Firbank says "Yes we have, it is in the cupboard above the sink." Maria says that a glass of
water would be fine and Mr Firbank leaves the room to get her a glass of water.
"Are you all right Valda?", Maria asks. Mrs Firbank says she is fine and it is just her legs, she
needs Norm's (Mr Firbank's) help to get down the stairs. Maria tells Mrs Firbank that they have
been missing her down at the Day-care Centre; she offers to pick Mrs Firbank up if transport is the
problem. Mrs Firbank says very quietly "He won't let me, he doesn't like me going out. He's
moved the phone, and the phone books into the living room which is downstairs". Mrs Firbank says
that Mr Firbank is going funny; he thinks that people are talking about him behind his back. At this
point Mr Firbank enters the room, angry that they have been talking about him, "What about my
rights?" he shouts.
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Maria straightens up and addresses Mr Firbank, she tells Mr Firbank that Mrs Firbank should go to
hospital for some tests, and someone can come in and look after Mr Firbank while Mrs Firbank is
away. Mr Firbank is very angry with this suggestion, he shouts at Maria that he wants to be left
alone. In his shouting it comes out that he doesn't like being left at home while Mrs Firbank goes
out to the Day-care Centre. He seems resentful that she might be enjoying herself at the Day-care
Centre, and concerned that people might be talking about him there.
Maria is ordered from the house.
Scene Three – At the Day Care Centre Office
• Maria's dilemma – What does she do now that she is ordered from the house?
• What is her legal position?
• Maria's later calls are taken by Mr Firbanks who tells her to mind her own business and keep out
of their affairs. The Firbanks denied further access.
• Does Maria record the incident? How and what does she need to record?
• Can and does she refer on to an assessment agency?
• Who does she refer to and how does she make the referral? What information does she pass on?
• Is client confidentiality breached if she does?
• What can the assessment agency do if access is still denied?
What are the options for
intervention in this situation?
Scene Four – The 2nd Phone Call
Maria receives a call from Mrs Firbanks. Her husband has gone out to do the shopping and she has
struggled downstairs to the phone. She wants to come back to Day Care and is finding it intolerable
in the house.
• What can and does Maria do?
The call is interrupted when Mr Firbanks arrives home earlier than expected. He pulls the phone
out of her hand and disconnects the phone by pulling the plug out of the wall.
• What does Maria do?
• What does the Elder Abuse Protocol suggest as the next steps?
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Scene Five – The Protocol in Practice
• How would it work in this area?
• Who does the assessment? How is assessment approached?
• How could access be obtained?
• How are the Firbanks encouraged to participate in a case planning and management?
• Who and what agencies could be involved in the development and implementation of case plan?
• What are the objectives in a case plan?
• What are the desired outcomes for Mr and Mrs Firbanks?
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Act Two
The Cheungs
Scene One – The Bank
The bank teller, Michael, is telling Mr Cheung that he can't withdraw the large amount of cash that
he has requested, it is only a small branch and they don't keep that much cash there. Michael
suggests that he transfer the money instead of trying to withdraw the cash, and hands Mr Cheung a
transfer form. The teller tries to explain to Mrs Cheung, his mother, what the form is and what it
means. Mrs Cheung looks confused and the son interrupts and explains to Mrs Cheung in her own
language. The teller does not look happy and neither does Mrs Cheung. The teller doesn't appear
satisfied with Mr Cheung's explanation, because Mrs Cheung seems to be getting angry and looking
bewildered. At this point the teller asks Mr Cheung if he is sure that it is what his mother wants.
Mrs Cheung fills in the form, looking unhappy, and the transaction is completed.
After the Cheung's leave, Michael discusses the situation with a colleague, possibly his boss.
Michael expresses concern, he is not sure that Mrs Cheung understood what was happening and
what she has signed. He tells his colleague that it is the third time it has happened. The colleague
suggests that next time the Cheungs want to transfer money the bank could arrange for an
interpreter. Michael says that he doesn't think that there will be a next time, as Mr Cheung has
pretty much cleaned out his mother's account.
Scene Two – In the Street
On the weekend Michael is walking home and he sees Mr Cheung crossing the road carrying a
rolled up carpet, Mrs Cheung is on the other end of the carpet and she is yelling at her son as he
crosses the road with her in tow. It appears that Mrs Cheung does not want her son to take the
carpet. When they reach Mr Cheung's new car on the other side of road Mr Cheung jams the carpet
into the back of the car and Mrs Cheung falls over. Michael yells at them "What's going on? Is that
your carpet Mr Cheung? Or are you taking it like the money you have taken from her account?"
Mr Cheung picks his mother up off the road and quickly helps her into the car. He turns around to
Michael and asks him "What you know? It's a family problem, I take nothing from her".
"I take my mother into my house, that's the way of my people. I shop, I cook for her, I take care of
her. I quit my job to look after her, she is not good on her feet, I have to do things for her and it all
takes money!", Mr Cheung angrily tells Michael.
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Michael mentions the new car that Mr Cheung is driving, that it must have cost money. Mr Cheung
says that the car is not for him, it is for his mother, who is not good at walking.
"You don't understand" Mr Cheung yells at Michael. "Chinese people are not like you, when your
mother gets old you put her in a home and forget about her. Chinese people look after their family.
You do not understand".
Michael says, "Well maybe the police will." as Mr Cheung drives hurriedly away.
Scene Three – The Police Station
Later that day Michael goes to the police station and talks with the officer on duty. He explains
what he has seen. He tells the officer that he knows the son is robbing his mother. The officer
suggests that Mrs Cheung could come in and make a complaint. Michael is losing his patience, he
tells the officer that Mrs Cheung can hardly walk and that she doesn't speak English. The officer
then suggests that they could send someone around to talk to them. Michael tells the officer that he
can't see what good that would do, Mr Cheung would only deny that there are any problems and
that Mrs Cheung might not know or think that there is a problem.
The conversation ends at the police station with Michael telling the officer that he is not going to
tell the police how to do their job, but he knows that someone should be doing something.
Scene Four – Michael's Quest
Michael is determined to get some action and continues to search for someone who is willing to
intervene. He contacts a number of agencies that have participants present in the workshop and we
see what response results.
• Can they intervene?
• How will intervention occur?
• How will the language difficulties be handled?
Scene Five – Mr Cheung
Take some time to explore the intervention process and ask how workers could be predisposed to
make judgements about this case.
What if Mr Cheung is telling the truth? He has given up his job to care for his mother and though
he has used her money to buy a new car, it was with her permission.
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The carpet was being taken away for cleaning. Mrs Cheung, a hoarder, has long refused family
assistance to help clean her home and the family are very worried that she cannot take care of
herself. They want her to move in with them and have prepared for her move. It is likely that their
fears are justified.
• What happens in cases of self–neglect? What can Elder Abuse Protocols do?
• Is legal intervention (eg guardianship) appropriate and what is the process?
• Are records kept of this case?
• What impact has intervention had on this family?
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Act Three
The Cratheys
Scene One – The Doctor's Surgery
Mrs Crathey has taken Mr Crathey to a doctor's appointment. During the consultation, she asks the
doctor to prescribe a sedative for Mr Crathey. She wants something to keep him quiet at night. She
explains that Mr Crathey wanders and sometimes he forgets where the toilet is and she has to get up
and help him. The doctor doesn't think that the sedative is a good idea and asks Mr Crathey to roll
up his sleave so that he may take his blood pressure. There are red, sore looking marks around Mr
Crathey's wrist which the doctor notices. He asks Mr Crathey how he got these marks. Mrs
Crathey answers for her husband, she is in the habit of speaking for him and getting him to agree
with what she says. She says that the marks are burns.
"He's always burning himself, aren't you Bert?" Mr Crathey agrees and holds up his other wrist,
and shows the doctor the same type of marks. "You are always hurting yourself aren't you Bert?"
is Mrs Crathey's reaction to the other marks. The doctor asks Mrs Crathey if she would mind if he
examined Bert in private and would she sit in the waiting room? Mrs Crathey doesn't look happy
with this idea and as she moves to the door she says in a low voice, "He wanders all the time." She
looks tired and strained as she says this.
The doctor and Mr Crathey are now alone in the surgery. Mr Crathey tells the Doctor that it is a
lovely house and that he would like to buy it, but he couldn't afford it now. He does not appear to
know where he is. The doctor asks "What happened to your wrists Mr Crathey?" He applies
ointment to the wounds on Mr Crathey's wrists. Mr Crathey looks at the doctor and says "I don't
like it all, you know. She looks after me very well". The doctor says that he will send someone to
visit from the Aged Care Assessment Team and Mr Crathey says, "She looks after me very well".
Scene Two – The Assessor's Visit
The assessor arrives at the Crathey's house, it is neat and clean, Mrs Crathey is looking bright and
cheerful, she has make–up on and a bright summery dress. The assessor can see Mr Crathey sitting
in a deck chair out on the balcony. He is looking out at the view.
The assessor looks around the tidy living room and sees an armchair with light rope tied to the
arms. Mrs Crathey sees that the assessor has seen the chair, and she says "I have to do it, if I don't
tie him up he wanders around, he could hurt himself". Mrs Crathey tells the assessor that she hates
to do it. The assessor tells Mrs Crathey she doesn't have to do that, pointing at the chair.
Mrs Crathey pleadingly responds "I have to have some time to myself, just for an hour or two".
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The assessor tells Mrs Crathey that she could arrange for someone to come and give her a break
now and then. Mrs Crathey seems to be offended at this suggestion. She tells the assessor that she
is always around to cook Mr Crathey's meals; "It's all right for you" she tells the assessor "You don't
have to live with him, I'd go mad if I didn't get out on my own sometimes". The assessor tells Mrs
Crathey that she understands, but there is no need for the chair, as she points to it. "We can
organise respite care or other accommodation". Mrs Crathey is angry know "I know what you're
trying to do, take him away from me. Nobody would want him, or look after him the way I do.
Ask him!"
The assessor goes out to the balcony to talk to Mr Crathey, Mrs Crathey told her to ask him, so she
will. Mr Crathey tells her "She's a good woman deep down, I'd die without her, but I don't like
sitting in that chair all day." The assessor agrees with Mr Crathey, she tells him that he shouldn't
have to sit in that chair all day. Mr Crathey seems to be worried that Mrs Crathey will get into
trouble with the police, and he asks the assessor not to tell the police. The assessor replies that she
won't tell the police if Mr Crathey doesn't want her to.
"She's a good woman deep down, I'd die without her" Mr Crathey repeats.
• What can and does the assessor do?
• What are the elements of a case plan in this situation?
• Who and what agencies would be involved in the development and implementation of a case
plan?
• What are the objectives and likely strategies?
• What is the desirable outcome of the plan for the Crathey's?
Scene Three – The Respite Worker
Community agencies may be able to place a respite worker in the home so that Mrs Crathey can
continue to have her outings to the club. Things go all right for a couple of visits. Mr Crathey is no
longer restrained, though Mrs Crathey is often a little late returning after having a few drinks with
her friends.
A couple of weeks later, Mrs Crathey is away five hours though respite was for two hours. She is
noticeably drunk. The respite worker has stayed but is quite annoyed at Mrs Crathey. An argument
starts. Mrs Crathey gets abusive and throws the respite worker out and says that she will not have
anyone else looking after her husband. The respite worker reports this back to the co–ordinator of
the community agency.
• What can community agencies do? The client has refused service and further access is denied.
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Scene Four – The Neighbour
It is early evening and the Crathey's neighbour hears someone whimpering. It is Mr Crathey who
has been restrained in the chair on the balcony all day. He has had no food or water since
Mrs Crathey left early in the morning. He has soiled himself and is cold and uncomfortable.
Mrs Crathey is nowhere to be seen. The neighbour thinks that there has been a burglary and rings
the police.
• What is the Police response?
• When Mrs Crathey returns, is she charged?
• Will they know about the doctor and the ACAT's previous involvement?
• What are the mechanisms for the sharing of information?
• What is the likely outcome of this intervention?
• What are the implications for a local protocol?
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Act Four
The Carer's Story
Act One – The Daughter's Visit
It is a nice morning and Stephanie gets out of her car. She has arrived at her parents' home, as
organised, to go for a drive up to the mountains for the day. Stephanie's mother answers the door
and replies to Stephanie's inquiry as to how they are, "I'm fine and your father's fine too. He's been
looking forward to today, it was all he talked about yesterday". Stephanie follows her mother inside
to see her father. Her father is in a wheelchair in the lounge room. Stephanie says hello to her
father but he doesn't seem to recognise her. Stephanie goes to kiss her father, but he angrily pulls
away as her mother explains to him that it is Stephanie, their daughter. Her mother tells him
"Stephanie has come to take us for a drive to the mountains today" and her father gruffly answers
"I'm not going". Her mother leans towards Stephanie and tells her that "He comes and goes. Don't
worry dear".
"Now come on dear and we'll get your pills" says Stephanie's mother.
"Don't need f...... pills" her father yells. Her mother looks shocked at this reply and she
apologetically tells Stephanie that her father is in one of his moods.
"Where's my f...... stick?" he yells
Her mother replies "It's behind the door, we'll take it with us in the car".
"I want my f...... stick, and I want it f....... now" Stephanie's father is building up into a rage. As her
mother goes to get the walking stick she tells Stephanie that she is sorry "He's not normally like
this". Her mother hands him his stick and he grabs it from her and places it across his lap, her
mother moves to push her father out of the room.
"Do you need some help mum?" Stephanie asks
"No, its all right dear, we can manage", her mother replies as she wheels her father out of the room.
Stephanie stays in the living room digesting the changes in her father, she can hear her father still
going on about his pills. She hears her father shout "Leave me alone you stupid slut!" to her
mother. The next thing she hears is a noise that sounds like her mother being struck by her father.
Stephanie is attending to her mother's head in the kitchen and she is worried that it may need a
stitch. Her mother is upset and tells her that he was always such a gentle man, he never hurt a fly,
or used language like that. He'd certainly never...". Stephanie tells her mother that it is O.K., she
understands. Her mother tells her that the doctor said that the new medication might lead to mood
swings. Stephanie asks her mother what the nurse said, and her mother tells her that the nurse only
came a couple of times, her father wouldn't have the nurse again. Stephanie responds that they
could always get another nurse. Her mother tells her that they did, but her father grabbed the nurse
when she was bathing him. Stephanie says "Nurses are trained. Surely they've seen it all before".
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"So long as it's just me, I don't mind. Normally he's fine, its just sometimes he becomes someone
else". Her mother seems very sure of this. "I don't want anyone to see me like this. I'm sorry you
had to see him like this" she says to Stephanie. "Mum I'm your daughter.
"We are better off on our own. Just me and him." Her mother says resolutely.
• What options are open to the daughter given that her mother has indicated that she wants to be
left alone?
• How does she find out about them?
• What can agencies do to raise community awareness of the issues of abuse?
• What can agencies do to support this family?
Scene Two – The Bashing
Stephanie is woken at 2 o'clock in the morning. Her mother has had an accident and has been
admitted to hospital with broken ribs and a punctured lung. Her mother claims she fell. The
hospital notices her head wound and other bruises and abrasions. They want to know whether she
is the victim of domestic violence.
• What is the role of domestic violence services in this case?
• Are links made with abuse assessment services or does intervention proceed independently?
• Does the hospital know about any previous contact or intervention?
• What are the mechanisms for linking hospital emergency services and domestic violence services
into the Elder Abuse Protocol?
Scene Three – Stephanie Moves In
As her mother will be in hospital for a while, Stephanie moves in to her parents' house to care for
her father.
She finds the situation intolerable. Her father is abusive and tries to hit her though Stephanie is
quick enough to get out of his way. He doesn't know who she is and, one day, when she attempts to
bathe him, he makes a sexual advance. Stephanie cannot tell her mother what has happened and is
determined that her mother will never find out.
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In desperation, Stephanie contacts the community nurses who have previously visited.
• What can the community nurses do?
• If it is the medication, what contact do they have with his doctor?
• Who "owns" this patient?
• How could they link into a local Elder Abuse Protocol?
• What is the process for assessment, case management and intervention?
• Who and what agencies would be involved in the development and implementation of a case
plan?
• What are the objectives and strategies in a case plan?
• What are the desirable outcomes for this family?
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Part II
The Structure – What will the Protocol Structure look like (45 – 60 mins)
1.
Use Slide 22, Local Intervention Models to introduce the range of intervention models
available to local areas.
2.
Outline the potential local intervention model. Facilitate a discussion on:
• the advantages and disadvantages of the model;
• the appropriateness of the model to the local area; and
• a preferred model for the area.
3.
Hand out copies of Section 12, Developing a local interagency Protocol to all participants.
Outline the Principles for Intervention from the Protocol.
4.
When a preferred model is identified, brainstorm an agreed list of the roles and
responsibilities of the Protocol structure. These can be used later by key players as the basis
for an outline on the Protocol.
The Process – How will we develop a local interagency Protocol?_(60 – 90 mins)
Identifying the key players
Facilitate a discussion that answers the following questions. Ensure that a written record is kept of
key points, decisions and actions.
1.
What agencies will need to be represented on the interagency Protocol Team? Who will be
invited to participate in the development and ratification of a local interagency protocol?
2.
What are the key contact points (eg, Division of GPs, HACC Forum)?
3.
How can we get the issue on their agenda? What are our options?
Identifying a strategy
4.
Facilitate a discussion on current strategies in response to clients and carers. How are
suspected or actual situations of abuse with clients and carers currently handled in the area?
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5.
Facilitate a discussion on how close or how far the area is to developing and implementing an
agreed interagency Protocol. Use Section 12 as a guide and outline three suggested
strategies:
• organising a planning meeting;
• forming a development committee; and
• running further training as a preliminary.
6.
Reach consensus with the participants on the most appropriate strategy for the area.
Planning the next steps
7.
It is important that workshop participants leave with an agreed plan of action that moves
towards the development and implementation of an interagency protocol.
This plan should include:
• What tasks now need to be undertaken and completed?
• What are the priorities? In what order should tasks be undertaken?
• Who is going to do what?
• When is each task to be completed?
8.
Conclude with the following questions:
• When should we re–convene? Who will act as convenor for our next gathering?
• How are we going to consult with and inform local agencies about the interagency
protocol? What information will we need to give to them?
9.
Hand out copies of the planning questions to all participants. Explain that they can use these
questions as a focus for the development and implementation of an agency protocol.
Closure
10.
What have we achieved today?
workshop.
Ask each participant what he or she gained from the
11.
Complete workshop evaluation forms
CLOSURE
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Towards an Elder Abuse Protocol
The following questions will need to be resolved as local areas move towards the implementation of
an interagency protocol.
Key Players
1.
What agencies and service providers are key protocol players?
2.
What specific roles, responsibilities and tasks will each protocol player undertake? What will
they do separately? What will they do together? Is the differentiation between players and
their respective roles clear?
3.
How will they liaise and co–ordinate with each other? How and when will they need to meet?
4.
What provision is there to bring in other agencies and individuals at specific times? How will
this be done?
5.
What provision is there for clients, carers and advocates being involved in the Protocol?
What guidelines are needed?
Referrals to the Protocol
1. What information and identification measures should agencies provide and undertake before
referral to an assessment or intervention agency?
2. Will a standard identification tool be used? Is there already a local tool or can the one in the
training kit be used or adapted?
3. Ideally how would referrals be made to the Protocol? Should there be a central referral point or
various points according to the situation? Who refers what to where?
4. What will happen when referrals are made? What is the decision–making process for the
allocation of assessment responsibilities?
5. What is the timeline between a referral and an assessment?
Assessments
1. Will one key agency undertake all or some assessments? What provisions will there be for
joint assessment visits?
2. Will a standard assessment tool be used? What does this tool need to include? Can the form in
the training kit be used or adapted to your needs?
3. What things need to happen in an assessment visit? What are the underlying principles of the
assessment?
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4. What will happen after the visit when abuse has and has not been identified?
assessment tied to case management and intervention?
How is
5. What provision is there for feedback to the original source of the referral and the clients and
carers who have been assessed?
6. Who keeps the records of assessments?
Case Management and Intervention
1. Will a case plan be developed for every assessed case? How will a case plan be developed?
Who will need to be involved in its development?
2. Will a case manager be appointed? What process will you use to determine who the case
manager will be?
3. What will be the roles of the case manager? How will monitoring information be fed back to
other people and agencies involved in the case plan? Who will manage intervention?
4. Will a standard case management record be kept? Is there an existing one or can the example in
the training Resource be used or adapted?
5. What provision is there for feedback on the case plan to the original source of the referral and
the clients and carers?
6. Who keeps the records of case management? What will happen to the records after a case has
been closed?
7. How will the success of the Protocol be reviewed? When will this happen?
Community Awareness and Education
1. How will you ensure that agencies and service providers who may be identifying situations of
abuse know how the Protocol works? What written information do they need?
2. What training priorities have you identified for agencies and service providers? How will
training be offered?
3. How will you ensure that agencies develop, implement and follow policies and procedures for
responding to abuse that are in line with the Interagency Protocol?
4. How can you raise community awareness of the issue? Who will do this?
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Scenario 1 – Behind Closed Doors
The telephone is ringing in a messy house. There is clothing scattered all over the floor, the
furniture is out of place and a dirty dinner plate is on the coffee table. It takes a while for
Mr Firbank to put his newspaper down and pick up the telephone. It is Maria from the Day-care
centre; she introduces herself, and asks after Mrs Firbank. Maria says that she hasn't seen
Mrs Firbank at the Day-care centre for 3 weeks and she is wondering if Mrs Firbank is all right. A
colleague is in the office with Maria listening to the call.
From the telephone conversation Maria finds out from Mr Firbank that she cannot speak to
Mrs Firbank because she is still ill. Maria asks if she can drop in and visit Mrs Firbank. It seems
that Mr Firbank is not happy with that suggestion, and that Mrs Firbank wouldn't want her to visit.
Maria says "that doesn't sound right, she always enjoyed her time with us" and again suggests that
she drop around to visit on her way home this afternoon. She hangs the telephone up.
Maria says to her colleague in the office that she can't stand Mr Firbank. She finds it odd that
Mrs Firbank comes here everyday for six months then no contact, no messages. All she could find
out from Mr Firbank is that Mrs Firbank is too tired to leave the house and that she hasn't been well.
The colleague who overheard the telephone conversation tells Maria that it sounded like Mr Firbank
doesn't like the idea of Maria visiting Mrs Firbank.
That afternoon Maria knocks on the Firbank's door and Mr Firbank answers her knock. Maria
introduces herself and asks if she may come in and talk to Mrs Firbank. Mr Firbank takes Maria up
stairs to Mrs Firbank. Mrs Firbank is sitting up in bed. She is winding some wool into a ball.
Mr Firbank as he enters the room says, "you had a fall didn't you Valda" for Maria's benefit.
Mrs Firbank asks Maria if she would like a cup of tea, Mr Firbank gruffly says that they don't have
any tea, Mrs Firbank says "Yes we have, it is in the cupboard above the sink." Maria says that a
glass of water would be fine and Mr Firbank leaves the room to get her a glass of water.
"Are you all right Valda?", Maria asks. Mrs Firbank says she is fine and it is just her legs, she
needs Norm's (Mr Firbank's) help to get down the stairs. Maria tells Mrs Firbank that they have
been missing her down at the Day-care Centre and she offers to pick Mrs Firbank up if transport is
the problem. Mrs Firbank says very quietly "He won't let me, he doesn't like me going out. He's
moved the phone, and the phone books into the living room which is downstairs". Mrs Firbank says
that Mr Firbank is going funny, he thinks that people are talking about him behind his back. At this
point Mr Firbank enters the room, angry that they have been talking about him, "What about my
rights?" he shouts.
Maria straightens up and addresses Mr Firbank, she tells Mr Firbank that Mrs Firbank should go to
hospital for some tests, and that someone can come in and look after Mr Firbank while Mrs Firbank
is away. Mr Firbank is very angry with this suggestion, he shouts at Maria that he wants to be left
alone. In his shouting it comes out that he doesn't like being left at home while Mrs Firbank goes
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out to the Day-care Centre. He seems resentful that she might be enjoying herself at the Day-care
Centre, and concerned that people might be talking about him there.
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Scenario 2 – Behind Closed Doors
The bank teller, Michael, is telling Mr Cheung that he can't withdraw the large amount of cash that
he has requested, it is only a small branch and they don't keep that much cash there. Michael
suggests that he transfer the money instead of trying to withdraw the cash and hands him a transfer
form. The teller tries to explain to Mrs Cheung, his mother, what the form is and what it means,
Mrs Cheung looks confused and the son interrupts and explains to Mrs Cheung in her own
language. The teller does not look happy, neither does Mrs Cheung. The teller doesn't appear
satisfied with Mr Cheung's explanation, because Mrs Cheung seems to be getting angry and looking
bewildered. At this point the teller asks Mr Cheung if he is sure that it is what his mother wants.
Mrs Cheung fills in the form, looking unhappy, and the transaction is completed.
After the Cheung's leave, Michael discusses the situation with a colleague, possibly his boss.
Michael expresses concern, he is not sure that Mrs Cheung understood what was happening and
what she has signed. He tells his colleague that it is the third time it has happened. The colleague
suggests that next time the Cheungs want to transfer money the bank could arrange for an
interpreter. Michael says that he doesn't think that there will be a next time; Mr Cheung has pretty
much cleaned out his mother's account.
On the weekend Michael is walking home and he sees Mr Cheung crossing the road carrying a
rolled up carpet, Mrs Cheung is on the other end of the carpet, yelling at her son as he crosses the
road with her in tow. It appears that Mrs Cheung does not want her son to take the carpet. When
they reach Mr Cheung's new car on the other side of road Mr Cheung jams the carpet into the back
of the car and Mrs Cheung falls over . Michael yells at them "What's going on? Is that your carpet
Mr Cheung? Or are you taking it like the money you have taken from her account?"
Mr Cheung picks his mother up off the road and quickly helps her into the car. He turns around to
Michael and asks him "What you know? It's a family problem, I take nothing from her".
"I take my mother into my house, that's the way of my people. I shop, I cook for her, I take care of
her. I quit my job to look after her, she is not good on her feet, I have to do things for her and it all
takes money!", Mr Cheung angrily tells Michael.
Michael mentions the new car that Mr Cheung is driving, that it must have cost money. Mr Cheung
says that the car is not for him, it is for his mother, who is not good at walking.
"You don't understand" Mr Cheung yells at Michael. "Chinese people are not like you, when your
mother gets old you put her in a home and forget about her. Chinese people look after their family.
You do not understand".
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Michael says, "Well maybe the police will." as Mr Cheung drives hurriedly away.
Later that day Michael goes to the police station and talks with the officer on duty. He explains
what he has seen, he tells the officer that he knows the son is robbing his mother. The officer
suggests that Mrs Cheung could come in and make a complaint. Michael is losing his patience, he
tells the officer that Mrs Cheung can hardly walk and that she doesn't speak English. The officer
then suggests that they could send someone around to talk to them. Michael tells the officer that he
can't see what good that would do, Mr Cheung would only deny that there are any problems and
Mrs Cheung might not know or think that there is a problem.
The conversation ends at the police station with Michael telling the officer that he is not going to
tell the police how to do their job, but he knows that someone should be doing something.
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Scenario 3 – Behind Closed Doors
Mrs Crathey has taken Mr Crathey to a doctor's appointment. During the consultation, she asks the
doctor to prescribe a sedative for Mr Crathey. She wants something to keep him quiet at night. She
explains that Mr Crathey wanders and sometimes he forgets where the toilet is and she has to get up
and help him. The doctor doesn't think that the sedative is a good idea and asks Mr Crathey to roll
up his sleave so that he may take his blood pressure. There are red, sore looking marks around Mr
Crathey's wrist, which the doctor notices. He asks Mr Crathey how he got these marks. Mrs
Crathey answers for her husband, she is in the habit of speaking for him and getting him to agree
with what she says. She says that the marks are burns.
"He's always burning himself, aren't you Bert?" Mr Crathey agrees and holds up his other wrist,
and shows the doctor the same type of marks. "You are always hurting yourself aren't you Bert?"
is Mrs Crathey's reaction to the other marks. The doctor asks Mrs Crathey if she would mind if he
examined Bert in private and would she sit in the waiting room? Mrs Crathey doesn't look happy
with this idea and as she moves to the door she says in a low voice, "He wanders all the time." She
looks tired and strained as she says this.
The doctor and Mr Crathey are now alone in the surgery. Mr Crathey tells the Doctor that it is a
lovely house and that he would like to buy it, but he couldn't afford it now. He does not appear to
know where he is. The doctor asks "What happened to your wrists Mr Crathey?" He applies
ointment to the wounds on Mr Crathey's wrists. Mr Crathey looks at the doctor and says "I don't
like it all, you know. She looks after me very well". The doctor says that he will send someone to
visit from the Aged Care Assessment Team and Mr Crathey says, "She looks after me very well".
The assessor arrives at the Crathey's house, it is neat and clean, Mrs Crathey is looking bright and
cheerful and she has make–up on and a bright summery dress. The assessor can see Mr Crathey
sitting in a deck chair out on the balcony. He is looking out at the view. Mrs Crathey tells the
assessor that she hates to do it. The assessor looks around the tidy living room and sees an armchair
with light rope tied to the arms. Mrs Crathey sees that the assessor has seen the chair, she says "I
have to do it, if I don't tie him up he wanders around, he could hurt himself". The assessor tells
Mrs Crathey she doesn't have to do that, pointing at the chair. Mrs Crathey pleadingly responds "I
have to have some time to myself, just for an hour or two". The assessor tells Mrs Crathey that she
could arrange for someone to come and give her a break now and then. Mrs Crathey seems to be
offended at this suggestion. She tells the assessor that she is always around to cook Mr Crathey's
meals, "It's all right for you" she tells the assessor "You don't have to live with him, I'd go mad if I
didn't get out on my own sometimes". The assessor tells Mrs Crathey that she understands, but
there is no need for the chair, as she points to it. "We can organise respite care or other
accommodation". Mrs Crathey is angry know "I know what you're trying to do, take him away
from me. Nobody would want him, or look after him the way I do. Ask him!"
The assessor goes out to the balcony to talk to Mr Crathey, Mrs Crathey told her to ask him, so she
will. Mr Crathey tells her "She's a good woman deep down, I'd die without her, but I don't like
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sitting in that chair all day." The assessor agrees with Mr Crathey, she tells him that he shouldn't
have to sit in that chair all day. Mr Crathey seems to be worried that Mrs Crathey will get into
trouble with the police and he asks the assessor not to tell the police. The assessor replies that she
won't tell the police if Mr Crathey doesn't want her to.
"She's a good woman deep down, I'd die without her" Mr Crathey repeats.
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Scenario 4 – Behind Closed Doors
It is a nice morning and Stephanie gets out of her car. She has arrived at her parents' home, as
organised, to go for a drive up to the mountains for the day. Stephanie's mother, Mrs Newton,
answers the door. Her mother replies to Stephanie's inquiry as to how they are, "I'm fine and your
father's fine too. He's been looking forward to today, it was all he talked about yesterday".
Stephanie follows her mother inside to see her father. Mr Newton is in a wheelchair in the lounge
room. Stephanie says hello to her father but he doesn't seem to recognise her. Stephanie goes to
kiss her father, but he angrily pulls away as her mother explains to him that it is Stephanie, their
daughter. Her mother tells him "Stephanie has come to take us for a drive to the mountains today",
her father gruffly answers, "I'm not going". Her mother leans towards Stephanie and tells her "He
comes and goes. Don't worry dear".
"Now come on dear and we'll get your pills" says Stephanie's mother
"Don't need f...... pills" her father yells. Her mother looks shocked at this reply and she
apologetically tells Stephanie that her father is in one of his moods.
"Where's my f...... stick?" he yells
Her mother replies "It's behind the door, we'll take it with us in the car".
"I want my f...... stick, and I want it f....... now" Stephanie's father is building up into a rage. As her
mother goes to get the walking stick she tells Stephanie that she is sorry "He's not normally like
this". Her mother hands him his stick and he grabs it from her and places it across his lap, her
mother moves to push her father out of the room.
"Do you need some help mum?" Stephanie asks
"No, its all right dear, we can manage", her mother replies as she wheels her father out of the room.
Stephanie stays in the living room digesting the changes in her father, she can hear her father still
going on about his pills. She hears her father shout "Leave me alone you stupid slut!" to her
mother. The next thing she hears is a noise that sounds like her mother being struck by her father.
Stephanie is attending to her mother's head in the kitchen; she is worried that it may need a stitch.
Her mother is upset and tells her that he was always such a gentle man; he never hurt a fly, or used
language like that. He'd certainly never...". Stephanie tells her mother that it is O.K., she
understands. Her mother tells her that the doctor said that the new medication might lead to mood
swings. Stephanie asks her mother what the nurse said, and her mother tells her that the nurse only
came a couple of times, her father wouldn't have the nurse again. Stephanie responds that they
could always get another nurse. Her mother tells her that they did, but her father grabbed the nurse
when she was bathing him. Stephanie says "Nurses are trained. Surely they've seen it all before".
"So long as it's just me, I don't mind. Normally he's fine, its just sometimes he becomes someone
else". Her mother seems very sure of this. "I don't want anyone to see me like this. I'm sorry you
had to see him like this" she says to Stephanie. "Mum I'm your daughter”.
"We are better off on our own. Just me and him." Her mother says resolutely.
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Workshop 1 Evaluation Sheet
Location:
Date:
Before the workshop, I knew:
Enough
Some
Little
Nothing
Yes
Mostly
Partly
No
Yes
Mostly
Partly
No
About abuse of clients and carers
How to recognise abuse
What to do in an abuse situation
Who to tell in my agency
After participating in this workshop, I:
Can define the term "abuse"
Know about different types of abuse
Can recognise different signs of abuse
Understand my rights & responsibilities
Know what to do in an abuse situation
Know who to tell in my agency
Can debrief with my supervisor
Overall, I found the workshop to be:
Interesting
Useful to my work
The 3 most valuable things I learnt were
1.
2.
3.
I would recommend the following changes to the workshop design.
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Workshop 2 Evaluation Sheet
Location:
Date:
Before the workshop, I knew:
Enough
Some
Little Nothing
Yes
Mostly
Partly
About abuse of clients and carers
How to recognise abuse
What to tell direct service workers to do
What to do when it is reported to me
How to support and debrief workers
What should be in an agency policy
About the interagency elder abuse protocol
My agency's role in the elder abuse protocol
How to document abuse cases
After participating in this workshop, I can:
Define the term "abuse"
Identify different types of abuse
Develop & implement an agency policy
Brief my workers on what to do
Describe my agency's responsibilities
Describe my role in abuse situations
Refer cases using the elder abuse protocol
Complete necessary documentation
Support & debrief workers
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Overall, I found the workshop to be:
Yes
Mostly
Partly
Interesting
Useful to my work
The 3 most valuable things I learnt were
1.
2.
3.
I would recommend the following changes to the workshop design
I have taken the following sections of the Kit to read and review:
(Please circle)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
I would like to use this kit to:
(Please circle)
Train myself on the issue
Run training for direct service workers
Run training for my management
Plan across agency training
Use briefing material for new workers
Develop internal policies and procedures
Develop appropriate documentation tools
Assist the development of a local elder abuse protocol
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No
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Workshop 3 Evaluation Sheet
Location:
Date:
Before the workshop, I knew:
(Please circle)
Enough
Some
Little Nothing
Yes
Mostly
Partly
About the Interagency Protocol
My agency's role in the Protocol
The roles of other agencies
Key elements in assessment of abuse
Considerations for special needs groups
How to plan an intervention
How to monitor & evaluate intervention
The range of local elder abuse protocol models
How to develop a local elder abuse protocol
After participating in this workshop, I can:
Outline the Interagency Protocol
Describe the role of my agency
Describe the roles of other agencies
Assess appropriately
Respond to special needs groups
Plan an intervention
Monitor & evaluate an intervention
Negotiate an appropriate model
Assist in the development of an
elder abuse protocol
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ACT Elder Abuse Training and Information Resource
Overall, I found the workshop to be:
(Please circle)
Yes
Mostly
Partly
No
8
Interesting
Useful to my work
The 3 most valuable things I learnt were
1.
2.
3.
I would recommend the following changes to the workshop design
I have taken the following sections of the Kit to read and review:
(Please circle)
1
2
3
4
5
6
7
9
10
11
12
13
14
15
I would like to use this kit to:
(Please circle)
Train myself on the issue
Run training for workers
Run training for management
Plan across agency training
Use briefing material for new workers
Develop internal policies and procedures
Develop appropriate documentation tools
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Accredited training available to
aged care services workers
This section outlines a comprehensive list of qualifications and units of competency available to
assist aged care workers.
Community Services - Qualifications
Non-Residential Services
National Code
Qualification Name
CHC10102
CHC20202
CHC20302
CHC30202
CHC30702
CHC30802
CHC30902
CHC40502
CHC40802
CHC40902
CHC41002
CHC41102
CHC41202
CHC41302
CHC41402
CHC41902
CHC50602
CHC50702
CHC50902
CHC51002
CHC51202
CHC51402
CHC51502
CHC51602
CHC60302
CHC60402
CHC20102
CHC30102
CHC30302
CHC40102
CHC40202
CHC40302
CHC41602
CHC42002
CHC50102
CHC50802
CHC60102
Certificate 1 in Work Preparation
Certificate 11 in Community Services
Certificate 11 in Community Services (First point of contact)
Certificate 111 in Home & Community Care
Certificate 111 in Social Housing
Certificate 111 in Community Services Work
Certificate 111 in Telephone Counselling Services
Certificate 1V in Employment Services
Certificate 1V in Social Housing
Certificate 1V in Community Services Work
Certificate 1V in Telephone Counselling Skills
Certificate 1V in Mental Health Work (Non-clinical)
Certificate 1V in Community Services Advocacy
Certificate 1V in Community Mediation
Certificate 1V in Community Services (Information and Referral)
Certificate 1V in Community Development
Diploma of Social Housing
Diploma of Community Welfare Work
Diploma of Community Services (Case Management)
Diploma of Community Services (Financial Counselling)
Diploma of Community Services (Protective Intervention)
Diploma of Community Development
Diploma of Community Education
Diploma of Community Services Management
Advanced Diploma of Community Services Work
Advanced Diploma of Community Services Management
Certificate 11 in Community Services Support Work
Certificate 111 in Aged Care Work
Certificate 111 in Disability Work
Certificate 1V in Aged Care Work
Certificate 1V in Service Coordination (Ageing & Disability)
Certificate 1V in Disability Work
Certificate 1V in Community Services (Lifestyle & Leisure)
Certificate 1V in Community Services (Service Coordination)
Diploma of Disability Work
Diploma of Community Services (Lifestyle & Leisure)
Advanced Diploma of Disability Work
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Community Services - Units of Competency
Non-Residential Services
National Code
Qualification Name
CHCAC12C
CHCAC15A
CHCAC17A
CHCAC1C
CHCAC2C
CHCAC3C
CHCAC4B
CHCAC6C
CHCAC7C
CHCAD1C
CHCAD2C
CHCAD3A
CHCAD4A
CHCAD5A
CHCADMIN5C
CHCAL23C
CHCCD12D
CHCCD13C
CHCCD14B
CHCCD15B
CHCCD18A
CHCCD19A
CHCCD1B
CHCCD20A
CHCCD2B
CHCCD4C
CHCCD5C
CHCCD6B
CHCCD7B
CHCCD8B
CHCCD9B
CHCCM5B
CHCCN11C
Provide services to an older person with complex needs
Provide support which is responsive to the specific nature of dementia
Support the older person to maintain their independence
Provide support to an older person
Provide personal care
Orientation to aged care work
Assist in the provision of an appropriate environment
Support the older person to meet their emotional & psychological needs
Plan and monitor service delivery plans
Advocate for clients
Support the interests, rights & needs of client within your duty of care
Undertake systems advocacy
Provide advocacy and representation
Represent the client in court
Work within the administration protocols of the organisation
Manage home based care administration requirements
Apply a community development framework
Work within specific communities
Implement a community development strategy
Develop and implement a community development strategy
Facilitate the development of community capacity to manage
Establish and maintain community, government & business partnerships
Support community participation
Develop & implement a community renewal plan
Provide community education projects
Develop and implement community programs
Develop community resources
Establish & develop community organisations
Support community resources
Support community action
Support community leadership
Develop practice standards
Establish, manage & monitor the implementation of a safe & healthy
environment
Communicate with people accessing the services of the organisation
Communicate appropriately with clients and colleagues
Utilise specialist communication skills to build strong relationships
Develop, implement and promote effective communication techniques
Deliver service to clients
Facilitate client participation in the organisation
Develop a service delivery strategy
Deliver services to meet personal needs of clients
Deliver and monitor service to clients
Prepare for work in the community services industry
CHCCOM1B
CHCCOM2B
CHCCOM3C
CHCCOM4B
CHCCS0B
CHCCS10A
CHCCS12A
CHCCS14A
CHCCS1B
CHCCS201A
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CHCCS2C
CHCCS301A
CHCCS303A
CHCCS304A
CHCCS3C
CHCCS401A
CHCCS402A
CHCCS403A
CHCCS404A
CHCCS405A
CHCCS407A
CHCCS408A
CHCCS409A
CHCCS4C
CHCCS501A
CHCCS5B
CHCCS601A
CHCCS602A
CHCCS6B
CHCCS7C
CHCCS8A
CHCCS9A
CHCCSL602A
CHCCSL603A
CHCCSL604A
CHCCWI1B
CHCCW13B
CHCCWI4A
CHCDFV10B
CHCDFV1B
CHCDFV2B
CHCDFV3B
CHCDFV4B
CHCDFV5B
CHCDFV6B
CHCDFV7B
CHCDFV9B
CHCDIS10B
CHCDIS11C
CHCDIS12A
CHCDIS13A
CHCDIS15B
CHCDIS16B
CHCDIS1C
CHCDIS20A
CHCDIS2C
CHCDIS3C
CHCDIS4B
CHCDIS5C
CHCDIS6C
Deliver and develop client service
Work within a legal and ethical framework
Provide physical assistance with medication
Assist with self-medication
Coordinate the provision of services and programs
Facilitate cooperative behaviour
Respond holistically to client issues
Provide brief intervention
Facilitate family intervention strategies
Work effectively with culturally diverse clients and co-workers
Operate referral procedures
Establish and monitor participation plans
Meet the dietary and nutritional needs of clients in a culturally
appropriate manner
Manage the delivery of quality client service
Assess and respond to individuals at risk of self-harm or suicide
Identify and address specific client needs
Work with clients with unique needs
Work with families of clients
Assess and deliver services to clients with complex needs
Coordinate the assessment and delivery of services to clients with
particular needs
Provide first point of contact
Provide support services to clients
Facilitate the counselling relationship
Provide support for clients implementing a course of action
Reflect and improve upon counselling skills
Operate a case work strategy
Work with clients intensively
Design and supervise family intervention processes
Facilitate workplace debriefing and support processes
Recognise and respond to domestic and family violence
Manage own professional development in responding to domestic violence
Provide crisis intervention and support to those experiencing violence
Promote community awareness of domestic and family violence
Counsel clients affected by domestic and family violence
Provide domestic & family violence support in the indigenous community
Provide domestic & family support in the non-English speaking community
Work with users of violence to effect change
Provide care and support
Coordinate disability work
Provide care and support for students with severe physical disabilities
Support older people with disabilities
Provide behaviour support
Provide advanced behaviour support
Orientation to disability work
Introduction to disability work
Maintain an environment designed to empower people with disabilities
Provide services to people with disabilities
Design procedures for support
Contribute to positive learning
Plan and implement community integration
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CHCDIS7B
CHCDIS8B
CHCDIS9C
CHCES301A
CHCGROUP2C
CHCGROUP3C
CHCHC301B
CHCHC302B
CHCHPROM1A
CHCHPROM2A
CHCIC10C
CHCIC11B
CHCINF1B
CHCINF2B
CHCINF3B
CHCINF4B
CHCINF5B
CHCINF7B
CHCINF8B
CHCLEG401A
CHCMH1B
CHCMH4C
CHCMH7A
CHCMH8A
CHCNET1C
CHCNET2B
CHCNET3B
CHCNET4A
CHCOHS201A
CHCOHS301A
CHCOHS302A
CHCOHS401A
CHCOHS501A
CHCOHS502A
CHCORG10B
CHCORG11B
CHCORG12B
CHCORG13B
CHCORG14B
CHCORG15B
CHCORG16B
CHCORG19B
CHCORG1B
CHCORG20B
CHCORG21B
CHCORG22A
CHCORG23B
CHCORG24B
CHCORG25B
CHCORG26A
CHCORG27A
Design and adapt surroundings to group requirements
Support people with disabilities as workers
Maximise participation in work by people with disabilities
Work in the employment services area
Support group activities
Plan and conduct group activities
Work effectively in a home and community care environment
Provide personal care in a home & community care environment
Share health information
Implement health promotion and community intervention
Establish and implement plans for developing responsible behaviour
Implement and promote inclusive policies and practices
Process and provide information
Maintain organisations information systems
Coordinate information systems
Manage the organisations information systems
Meet statutory & organisational information requirements
Meet information needs of the community
Comply with information requirements of the aged care services
Utilise legislation
Orientation to mental health work
Provide non-clinical services to people with mental health issues
Provide, with consumers, support to meet the needs of carers
Provide interventions to meet the needs of consumers with mental health
issues
Participate in networks
Maintain effective networks
Develop new networks
Work with other services
Follow OHS procedures
Participate in workplace safety procedures
Participate in safety procedures for direct care work
Implement and monitor OHS policies & procedures for a work place
Manage workplace OHS management system
Evaluate and improve workplace OHS management system
Manage organisational change
Lead and develop others
Review organisational effectiveness
Manage organisational strategic and business planning
Manage a service organisation
Promote the organisation
Manage training
Develop and maintain the quality of service outcomes
Follow the organisations policies, procedures and programs
Promote and represent the service
Act as a resource to other services
Contribute to service delivery strategy
Coordinate work
Provide leadership in community service delivery
Recruit and coordinate volunteers
Manage a service level agreement
Provide mentoring support to colleagues
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CHCORG28A
Reflect and improve upon professional practice
CHCORG29A Provide coaching and motivation
CHCORG2B
Work with others
CHCORG3B
Participate in the work environment
CHCORG6B
Coordinate the work environment
CHCORG7B
Manage workplace issues
CHCORG8C
Establish and manage new programs or services
CHCORG9B
Manage projects and strategies
CHCPOL1A
Participate in policy development
CHCPOL2A
Contribute to policy development
CHCPOL3A
Undertake research activities
CHCPOL4A
Develop and implement policy
CHCPOL5A
Manage research activities
CHCPOL6A
Coordinate policy development
CHCPOL7A
Manage policy development
CHCPR10C
Design, implement and evaluate programs of the service
CHCPROT11B
Provide for care and protection of clients in specific need
CHCPROT12B
Coordinate work integrating statutory requirements & responsibilities
CHCPROT13C
Operate in a legal context
CHCPROT14B
Develop protocols for operating within a statutory environment
CHCRF21B
Promote equity in access to the service
CHCRH3B
Develop leisure and recreation programs for clients with special needs
CHCRH4B
Coordinate, implement & monitor leisure & health programs
CHCTC1A
Deliver a service consistent with the organisations missions & values
CHCTC2A
Undertake telephone counselling
CHCTC3A
Provide counselling in crisis situations
CHCTC4A
Provide competent suicide intervention over the telephone
CHCYTH7C
Respond to critical situations
* This is not an exhaustive list of the units of competency for further details go to
http://www.ntis.gov.au
A full list of training providers for Community Services can also be found at the
following website http://www.ntis.gov.au
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Acknowledgments
The Ageing and Disability Department, NSW
Elder Abuse Prevention Unit, Queensland
Seniors Interest Unit, Department of Families, Queensland
ACT Elder Abuse Prevention Implementation Taskforce
ACT Government Agencies
Office of the Community Advocate
Mental Health ACT
Mental Health Tribunal
Guardianship and Property Management Tribunal
Public Trustee for the ACT
ACT Policing
Protection Unit – ACT Magistrates Court
Health Services Complaints Commissioner
ACT Office of Aboriginal and Torres Strait Islander Affairs
ACT Health
Department of Justice and Community Safety
Department of Disability, Housing & Community Services
Department of Education and Training
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