One-in-five nurses has witnessed elder abuse by a next of kin, a report from the NSW Nurses and Midwives’ Association shows.
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Of the 323 registered nurses, assistants in nursing, enrolled nurses, managers and clinical educators surveyed, one in five said they had witnessed elder abuse by people acting as a next of kin.
The report, ‘Solutions from the frontline: Practical approaches to reduce the risk of abuse in aged and disability services’, contained 14 recommendations on the staffing and regulation of aged-care and disability services across the state.
The association warned patients were at risk unless protocols were changed.
“I work in an emergency department and looked after a man physically and emotionally abused by his brother, who (was) also a power of attorney, ” a NSW public hospital registered nurse said in the survey.
Almost 70 per cent believed there should be legislation to protect people who could no longer make their own decisions, while 75 per cent thought audits should identify overlooked areas of abuse, such as neglect, poor wound care and staffing shortfalls.
“Elder abuse is rife in the community but there is no mandatory reporting and no agency responsible for investigation or intervention,” another registered nurse said.
The report offered 14 recommendations, including protective legislation, tougher licensing and safer staff-to-patient ratios.
Nurses association general secretary, Brett Holmes, said the report highlighted the daily challenges staff faced in residential aged care facilities and the types of elder abuse encountered and experienced by those they care for.
“They face daily challenges managing aggressive behaviours and are often at risk of assault themselves,” Mr Holmes said.
“Members told us not only were they dealing with elder abuse on a daily basis but they also struggle to know how to advocate for people when their relatives, or the aged care providers caring for them are not making decisions in their best interests.
“By highlighting the issues facing frontline workers and the people they care for, we hope to inform the community and encourage the government to rethink the way some of these services are delivered.”
Report recommendations:
- A Commonwealth funded and coordinated Adult Protection Agency should be established to enable workers to seek independent support and advice regarding abuse.
- A single piece of legislation covering the range of potentially abusive practices against all adults is required.
- Legislation must require aged and disability service providers to ensure: Workers have the necessary skills to identify and act on actual or potential abuse; workers’ concerns are taken seriously and acted upon; reporters are not at risk of reprisal from employers.
- Legislation and policy that provides clear guidelines for the aged and disability sector workforce in relation to substitute decision-making and power of attorney is required.
- Staffing and skill mix in residential aged care and disability services must be reviewed as a matter of urgency to ensure safe care. Minimum ratios of registered nurses, enrolled nurses and assistants in nursing (however titled) must be provided to prevent neglect.
- All Assistants in Nursing (however titled; including disability care workers) must be licensed and subject to regulation to increase protections.
- Aged care funding must be sufficient to enable minimum safe staffing ratios and skill mix to be provided in aged and disability services.
- An urgent review of the Australian Aged Care Quality Agency (AACQA) guidelines regarding behaviour management must be undertaken so that: It is evidence based; promotes safe practice and recognises the role of adequate staffing in the prevention of abuse and implementation of protective behaviour management programs.
- The role of the AACQA must be strengthened to ensure: • A more proactive role in securing safe staffing in residential aged care facilities and community care as a means of preventing abuse. • Effective monitoring of substitute decision-making and power of attorney arrangements within regulated services.
- Additional safeguards are required with the introduction of Consumer Directed Care (CDC) and the National Disability Insurance Scheme (NDIS). These include: strengthening of regulation, support for consumers with budgeting and enhanced advocacy.
- Immediate action must be taken to initiate research that aims to quantify the cost of providing registered nursing services to people under CDC.
- Commonwealth funding of community care packages delivered under CDC and NDIS schemes must extend to a level required to secure the services of registered nurses in the community and intense home care packages, including psychological support for those with dementia-related illness.
- Research must be undertaken to develop best practice approaches to the identification and prevention of abuse, particularly in relation to LGBTQI, CaLD, Aboriginal and Torres Strait Islander peoples and other marginalised communities. This must be initiated as a matter of urgency and national benchmarks set.
- Domestic violence, including against older people and those living with disabilities, must be included within a Commonwealth adult abuse strategy.
The full report is available for download by clicking here.
