By the end of this chapter, the learner should be able to:

Recognise signs of abuse or other indications that the human rights of a client are being breached
Report abuse or other breaches of human rights to appropriate person(s)
Intervene appropriately when abuse is identified.

Breaches of human rights

If you are witness to a violation of the human rights of an older person, it is your duty to report this to the appropriate person(s).

The appropriate person(s) may include:

Supervisor
Member of senior management
Colleagues
Carers
Health professionals
External agencies (complaints and advocacy services and professional registering authorities)
Law enforcement officer.

Elderly people may be abused in their own homes, in care facilities or in relatives' homes.

Defining elderly abuse

Elderly abuse is any instance where someone takes advantage of an elderly person. It can include:

Financial exploitation – this is the unauthorised use of an older person's money or their property by either a caregiver or an external party. The types of practices include:
- stealing money
- forging cheques/credit cards/accounts
- forging the older person's signature
- identity theft
- requesting them to pay money to claim a 'prize'
- charity scams
- investment fraud
Physical abuse – this is the deliberate use of force on an older person, causing them pain, injury or disability. It includes violent assaults, using drugs (inappropriately), restraining them or keeping them captive.
Emotional abuse – also known as psychological abuse, this involves treating elderly people in any way that causes them distress or emotional pain.
This can include :
- verbal abuse – threats, intimidation, yelling, humiliation, placing blame
- non-verbal abuse – ignoring, social isolation, terrorising behaviour
Sexual abuse – this includes contact with an older person without their consent; this can mean physical sex acts but also includes making them watch sex acts, pornography, or forcing them to undress.
Neglect/abandonment – this includes failure to fulfil carer duties and is responsible for over half of elderly abuse cases. It can be intentional or unintentional, based on ignorance or denial of the care requirements for the elderly person.
Healthcare fraud – this can be committed by care providers or medical personnel; it includes:
- charging for healthcare they don't provide
- overcharging for services
- taking 'kickbacks' (bonuses) for referring patients to providers of certain drugs
- over/under-medicating
- recommending incorrect/fraudulent remedies for medical conditions/illnesses
- Medicare fraud.

Signs of abuse

Symptoms can be difficult to recognise as they may mirror those of dementia or frailty. It can be easy for people to explain away the signs and many people may dismiss them as a minor issue. However, you should not believe a caregiver at face value and investigate if you are at all concerned. The following are things you should be on the lookout for.

General abuse :

Arguments (frequent) between elderly person and caregiver
Changes in personality of the elderly person
Odd/unusual/different behaviour.

Physical abuse :

Unexplained injuries
Broken bones/sprains/dislocations
Medication irregularities
Broken glasses
Signs of restraint
Caregiver refuses to let elder be seen alone.

Emotional abuse :

Experience of threatening, bullying or controlling behaviour from caregiver
Dementia-like behaviour from elder – rocking, mumbling, sucking thumb.

Sexual abuse :

Bruises around genitals
Unexplained genital infections or STDs
Unexplained vaginal/anal bleeding
Torn/stained clothing.

Neglect :

Weight loss, malnutrition, dehydration
Being left unclean
Untreated physical problems
Unsuitable clothing for the conditions
Unsanitary living conditions
Unsafe living conditions
Desertion in a public place.

Financial exploitation :

Unexplained withdrawals from elder's accounts
Sudden changes in financial situation
Missing items/cash from the elder's house
Suspicious will/policy/power of attorney changes
Addition of names of documents
Unpaid bills/lack of medical care (despite a healthy financial situation)
Financial activity taking place when the older person is incapacitated
Unnecessary services being provided.

Healthcare fraud :

Duplicate medical bills
Evidence of over/under-medication
Evidence of inadequate care pertaining to the amount paid
Problems in the care facility.

Acting on elder abuse

There are three things you must do to prevent elder abuse:

Listen to elders and caregivers
Intervene when you suspect abuse
Educate others on how to identify and report elder abuse.

As a caregiver, you can do the following if you are overwhelmed by the demands:

Request help from colleagues, friends and family (of the elder)
Maintain your own health
Practice stress reduction exercises
Seek counselling if you are depressed
Finds support groups (if necessary)
Seek help for any substance abuse
Contact elder abuse helplines.