Category: health

Law Council calls for more action on elder abuse

The Law Council of Australia has continued to call for measures that will better protect older Australians.

“Elder abuse is insidious and more prevalent than I think any of us would like to believe,” Law Council of Australia President, Mr Tass Liveris said.

“Incidents of abuse may be physical, social, financial, psychological or sexual and can include mistreatment and neglect.

“What makes it most devastating is that the perpetrator is often someone the older person trusts and relies on, such as a family member, friend or carer.

“We must stamp out elder abuse and protect vulnerable members of our community.”

The Law Council is calling for:
• Appropriate, sustained and increased funding for specialist legal assistance and aged care advocacy services, government agencies, and relevant State and Territory tribunals that work towards reducing elder abuse.
• Implementation of outstanding priorities identified in the Australian Law Reform Commission and Royal Commission into Aged Care Quality and Safety (Royal Commission) reports and the National Plan to Respond to the Abuse of Older Persons 2019-2023, including:
• developing a new Aged Care Act which is consistent with the recommendations of the Royal Commission report by 1 July 2023; and
• ensuring that those in residential aged care facilities have legal redress to protect them from abuse, whether perpetrated by care providers (including in the use of restrictive practices) or fellow residents.

At the end of last year, the Law Council of Australia welcomed the decision by Commonwealth, State and Territory Attorneys-General to prioritise enduring power of attorney (EPOA) law reform to reduce the risk of older Australians being subject to financial abuse and looks forward to this work coming to fruition.

EPOA arrangements are intended to ensure a person’s interests are protected when they lose capacity to make decisions for themselves. However, in the absence of adequate legal safeguards, financial elder abuse by appointed decision-makers may be facilitated by such arrangements.

Law Council of Australia, 15/06/2022, https://www.lawcouncil.asn.au/media/media-releases/australia-must-address-elder-abuse

Incapacity: Choose Who Makes Decisions for You

By Russell Kennedy – Clare Hesbrook and Ilana Kacev

Estate Planning isn’t just about your Will, equally important are the documents in which you choose and who makes decisions for you if you lose capacity during your lifetime.

Choose Who Decides If you want to choose who makes decisions for you regarding your finances, property, lifestyle and medical treatment, it is essential that you have in place:
• An Enduring Power of Attorney and an Appointment of Medical Treatment Decision Maker (if you live in Victoria); or
• An Enduring Power of Attorney and an Appointment of Enduring Guardian (if you live in New South Wales).

Losing capacity
Currently it is estimated that almost half a million Australians are living with Dementia and these numbers are expected to continue to rise. Aside from Dementia, there are many other reasons why you may lose capacity to make decisions for yourself.

Public Trustee & Guardian appointments
On 14 March 2022, Four Corners aired an episode investigating the difficulties encountered by those who did not have these documents in place, at a time when they were deemed to have lost capacity. The Public Trustee & Guardian were appointed to take control of their finances and make decisions about their lifestyle, including where they lived.
The Four Corners episode highlights the importance of proactive estate planning and especially, making arrangements in the event of your future incapacity.

What it means when you have a Power of Attorney and Appointment of Enduring Guardian/Medical Treatment Decision Maker in place:
1. You decide who makes decisions about your money and lifestyle. You can choose the people who care about you and respect your values.
2. You decide how your chosen attorneys and guardians act and when their powers come into effect. You can provide directions about how they should act in end of life care decisions for example.
3. You preserve your wealth. A public trustee and guardian takes payment for their services from your assets. When you choose your own attorney and guardian (unless you choose to appoint a professional attorney) you do not generally pay for acting.

Taking positive action to put your estate planning affairs in order means that you get to decide who makes decisions over your life, rather than having it decided for you.

FIRST NATIONAL STUDY FINDS MORE ELDER ABUSE

In the year prior to the first national survey conducted into elder abuse, one in six older Australians reported they had experienced abuse most often committed by family members.

The National Elder Abuse Prevalence Study (NEAPS) survey, carried out between February and May 2020, showed that the most common subtype was psychological abuse (12%), followed by neglect (3%), financial abuse (2%), physical abuse (2%) and sexual abuse (1%). Some of the 7,000 participants aged over 65 years reported several types of abuse occurring, usually psychological abuse and neglect.

Types of elder abuse

Nearly one in five elder abuse perpetrators are children (18%), or their partners or grandchildren and about one in 10 elder abuse perpetrators are intimate partners. Children (most often, sons) are most likely to perpetrate financial abuse as well as friends and service providers.

Children are also the largest group of perpetrators of psychological and physical abuse while friends, acquaintances and spouses were most likely to perpetrate sexual abuse.
Children and intimate partners are both significant perpetrator groups (24-25% for each) of neglect. Professional carers (14%) and service providers (13%) are bigger perpetrator groups for neglect than for other abuse subtypes.

Psychological abuse is not always recognized by either victims or perpetrators. It includes insulting, belittling or threatening behaviour towards a person. Family and friends are the best protection for a person experiencing abuse rather than the person who is unlikely to directly confront the perpetrator.

Factors that increase risk of abuse

While women were slightly more likely to be the subject of abuse than men, other factors increased the risk of experiencing abuse, namely, being poorer, being single, separated or divorced and living in rented housing or owning a house with a debt against it. Having poor physical or psychological health also increased the risk of experiencing abuse.

The study did not include people living in aged care or suffering cognitive decline which could increase the identified prevalence of elder abuse in the community.
The federal government has announced additional funding to build on the National Plan to Respond to the Abuse of Older People. This announcement follows on from recommendations made by the Aged Care Quality and Safety Commission to increase funding to home care packages and create new training places for aged care staff.

AIFS, National Elder Abuse Prevalence Study, https://aifs.gov.au/publications/national-elder-abuse-prevalence-study

Be part of this research project

By simply spending 30 minutes of your time answering these questions about yourself, you can make a contribution to research about ageing and Australian women.

What is AgeHAPPY?

The Healthy Ageing Project Population Youth-senior (AgeHAPPY) is an online heath survey for Australians. The Healthy Ageing Project (HAP) mission is to improve the understanding of health across a lifespan to promote healthy ageing and prevent disease.

This round of the survey commenced in 2020. It started with a pilot study called HAP. Data on self-reported health, lifestyle, mood, and vascular risk factors is being collected from male and female participants aged 18 years and over. AgeHAPPY is a continuation of the Women’s Healthy Ageing Project (WHAP).

WHAP commenced in 1990 as a study examining the health of Australian women from midlife (then aged 45-55 years) before the menopausal transition and into ageing. The study has almost 30 years of data on mood, dietary intake, risky behaviours, physical activity and social connectedness among other factors. WHAP continues to follow up these women, who are now all aged over 70 years. The children of the original participants have now joined the study as of 2021 commencing the WHAP generations study.

AgeHAPPY is a study into the lifelong effects of lifestyle and habits on health and the progression of ageing. Everyone over 18 years of age can participate in the online health questionnaire. This research ultimately contributes to promoting healthy ageing in Australia and to improve the wellbeing of all Australians.

Chronic disease is the largest cause of death and disability in Australian society and throughout the western world. The information collected will enable greater understanding of the impact of social and behavioural factors on health and influence policies toward better prevention and early detection of health issues, including Parkinson’s and Alzheimer’s disease.

Most studies on “ageing” are usually limited to the elderly. HAP defines ageing as a phenomenon that occurs continuously throughout all stages of life – and presents its health challenges at all ages. Many studies show that indicators for chronic disease occur years before onset.

Through this online health survey, HAP can collect valuable demographic, clinical, behavioural and lifestyle data which allows them to analyse the impact of factors on health and ageing at every age.

Get involved in the AgeHAPPY study

The first section of the study is an online questionnaire covering areas such as demographic information, general health history, family health history, mood, quality of life, physical activity, sleep, diet, alcohol intake, smoking, physical function, social relationships, and negative life events.

The second section is a cognitive component which tests thinking skills, a bit like a brain game. A participant will be invited to complete the online cognitive testing from the Healthy Brain Initiative – Brain Health Registry (HBI-BHR). The Brain Health Registry is a web-based study that enables researchers to efficiently identify, assess and monitor the brain changes associated with the progression of neurodegenerative diseases and brain ageing more efficiently.

In 12 months’ time, HAP will contact you to complete a follow-up online questionnaire.

To participate, please follow the link:
https://medicine.unimelb.edu.au/research-groups/medicine-and-radiology-research/royal-melbourne-hospital/healthy-ageing-program/healthy-ageing-project

Australia’s health by socio-economic status

However you describe it, being poor, disadvantaged, or living in a low socioeconomic area is more likely to make you more susceptible to preventable chronic diseases such as heart disease, arthritis and diabetes.

Australia’s Health Tracker by Socioeconomic Status 2021 reports on the health status of Australians based on their socioeconomic standard which the study has found has a major impact on people’s health. Families and individuals with limited resources not only have more chronic disease, they are at greater risk of dying prematurely as a result of chronic health conditions. People living with mental ill-health are less likely to participate in employment, which in itself, is associated with an improvement in general mental health levels.

The ten million people living in the 40% of communities with lower and lowest socioeconomic status have much higher rates of preventable cardiovascular diseases, cancer, diabetes or chronic respiratory diseases than others in the population. These communities also have the highest rates of suicide throughout the nation.

Risk factors that are likely to contribute to this higher rate of illness and premature death include:
• Physical inactivity
• Lifetime alcohol consumption
• Daily tobacco use
• Unemployment as a result of mental health issues.

These health disparities within the Australian population are persistent despite considerable policy reform and efforts to improve services in recent decades. The targets for a healthier Australia were developed by the Australian Health Policy Collaboration, a national network of leading health experts and organisations. The Collaboration has worked with the support of the Mitchell Institute, Victoria University since 2014 to influence public and policy awareness and action to reduce high rates of preventable chronic disease in the Australian population.

The report sets health targets for medical conditions such as:
• Obesity – Obesity is a risk factor for cardiovascular disease, high blood pressure, type 2 diabetes, asthma, back pain and some cancers.
• High cholesterol – High levels of low-density lipoprotein cholesterol are a risk factor for heart disease. National data from 2011-12 is the most recent available data and indicated that close to one-third of all socioeconomic groups were estimated to have high cholesterol levels.
• High blood pressure – Rates of reported high blood pressure are relatively consistent across socioeconomic groups. High blood pressure is often caused by poor diet, physical inactivity, obesity and excessive alcohol consumption. It is a risk factor for chronic conditions including stroke, heart diseases, and chronic kidney disease
• Diabetes – Hospitalisations and deaths related to diabetes are, respectively, 2 and 2.3 times as high in the lowest socioeconomic communities compared to the highest.

Australia’s Health Tracker by Socioeconomic Status 2021 report, The Mitchell Institute at Victoria University. Australia’s Health Tracker by Socioeconomic Status 2021 report

COVID-19 impacts during 2020

Grandparents reported feeling disconnected and isolated from their children and grandchildren during the COVID restrictions imposed during 2020.

In two surveys conducted by the Australian Institute of Family Studies during each half of 2020, three out of 10 grandparents said that prior to the COVID-19 outbreak, they provided childcare to their grandchildren at least weekly. Of those grandparents, 14% of respondents with grandchildren aged under 13 years provided child care daily or several times a week, another 16% provided child care about once a week and around half provided care at least once per month.

Grandparent care and care for grandparents were most impacted during the pandemic, with respondents reporting that for many families, grandparents did not provide the usual care to their grandchildren for some months during the pandemic. Care for grandchildren ceased because of restrictions imposed on visiting family members or because parents increased their work from home.

Many grandparents reported feeling disconnected from their family and missing out on family traditions during the lockdown period. While some grandparents were able to access technological solutions to connect with family, others found the technology frustrating.

There were 7,306 respondents in the first survey of whom 6,435 completed all survey questions. In the second survey, 4,866 participants responded, of which 3,627 completed all survey questions. Over 80% were female respondents, tertiary-educated, ranging in age from over 18 years to 60+ years who lived either in a capital city, a major regional city or regional area.

Impacts on caring for others

In addition to generalised fears as to how the virus might affect the physical and mental health of family members, the pandemic forced changes to the availability of in-home support services. Caring hours for family members increased significantly over the year for 70% of respondents, nearly half of the respondents saying they spent over 30 hours per week in relation to child care and home schooling, while about 20% of respondents reported spending over 60 hours per week on caring activities which included caring for a parent or a partner.

Respondents also referred to giving assistance to non-household members which could include friends or work colleagues. This could include giving emotional assistance, or providing help with shopping, transport, house or garden maintenance and sometimes financial help.

Community volunteering was also impacted by the pandemic during 2020 in that in many volunteer-reliant charities, older volunteers were restricted in the types of volunteer work they could do and, at the same time, demand for services from charities increased due to the impact of COVID on employment and income.

Community volunteers were more likely to be older people. Survey results showed that over a quarter (27%) of respondents or their partners had engaged in some form of voluntary work in the past year, including half of those aged 70-79, 36% of those living alone, and 40% of those living in remote areas.

Of those who volunteered at some time during 2020, almost two in three (62%) continued to volunteer throughout the year, 20% volunteered before COVID but had yet to return to volunteering, 6% started volunteering after COVID, 4% stopped volunteering during COVID but have returned to volunteering, and 4% volunteered only during COVID. (The remaining 5% is other combinations.)

Report no. 1: Connection to family, friends and community, Families in Australia Survey, May 2021, https://aifs.gov.au/publications/connection-family-friends-community

Serious Incident Response Scheme begins in aged care facilities

With the release of the final report of the Royal Commission Into Aged Care, one of its most frightening details is that in 2019-20, over 851 alleged sexual assaults were reported in aged care facilities. However, as resident-on-resident assaults for the most part go unreported, the real figure is likely “as high as 2,520, or almost 50 per week”.

Despite such high statistics, the report’s 148 recommendations make no specific recommendations as to how that issue that predominantly affects older women should be managed.

The issue is expected to be managed by an enhanced reporting system known as the Serious Incident Response Scheme (SIRS) that begins on 1 April.

The scheme requires aged care providers to identify, record, manage, resolve and report all serious incidents that occur, or are alleged or suspected to have occurred.

Aged care providers also need to have in place an effective incident management system to manage all incidents, respond to incidents, and take steps to minimise the risk of preventable incidents reoccurring. The incident management system covers a broader range of non-reportable incidents and includes incidents that involve staff or visitors.

Under the existing system, aged care providers do not have to report incidents that involve a perpetrator who has a cognitive impairment and the operators have got strategies in place because it is felt that an impaired person cannot be successfully prosecuted.

“In some cases, family members encourage their loved ones to move into residential care because they felt that it would be safer for them”, the report notes. “But, on the contrary, people living in residential aged care likely face a much higher risk of assault than people living in the community.”

Under SIRS, there is a wider range of serious incidents that are reportable than those reported under current compulsory reporting requirements. Importantly, providers will have to report incidents of abuse and aggression between consumers, including where the resident who commits the incident has a cognitive or mental impairment.

Under the SIRS protocol, aged care must report all ‘Priority 1’ incidents within 24 hours to the Aged Care Quality and Safety Commission. ‘Priority 1’ incidents include those that cause or could reasonably have caused physical or psychological injury or illness requiring some form of medical or psychological treatment. Instances of unexplained absence from care and any unexpected death of a consumer are always to be regarded as Priority 1 reportable incidents.
From 1 October 2021, all ‘Priority 2’ incidents, that is reportable incidents that do not meet the criteria for ‘Priority 1’, must also be reported within 30 days.

In addition, the SIRS requires every residential aged care service to have in place an effective incident management system – a set of protocols, processes, and standard operating procedures that staff are trained to use.

For further information, refer to the Aged Care Quality and Safety Commission website, https://www.agedcarequality.gov.au/sirs

Author talk at Dennis Johnson Library Stanhope Gardens

Come along to join in the retirement conversation on

Join Alice and have a retirement conversation.
Saturday, 24 October 2020 at 1:30 pm – 3:00 pm.
At the Dennis Johnson Library, Cnr Stanhope Parkway & Sentry Drive, Stanhope Gardens, NSW 2768

Women experience retirement differently to men. Women generally live longer, have less money and volunteer more than their male counterparts. A practicing lawyer for over 30 years, Alice Mantel encourages making better decisions, giving advice on topics such as:

Inspiring women to make the most of their retirement opportunities, Every Woman’s Guide to Retirement encourages an active, connected lifestyle, staying healthy, lifelong learning, de-cluttering, and even online dating to make the most of this time.

Community attitudes to aged care explored

Following In-depth interviews and focus groups, the Royal Commission into Aged Care Quality and Safety has released a report, They look after you, you look after them: Community attitudes to ageing and aged care .

The researchers interviewed a range of focus groups to identify current community attitudes to ageing; community understanding of the aged care system and how individuals were planning for their own older age. Interviews were conducted with both younger and older people, diverse economic groups, Indigenous and culturally diverse groups and younger people with disabilities who already resided in aged care facilities.

Written before the pandemic, the report explores how people view entering an aged care facility, what their expectations were and most relevantly, what were the experiences of actual residents.

Post-Covid, the relatively negative comments of most interviewees about their fear of entering the aged care system, seems justified in light of the relatively high number of deaths in care facilities which appear to reflect the inadequate training and equipment available to care for older people.

The report found that as people became older, they were better informed about the complexities of the aged care system but they remained concerned about the cost and quality of care provided. There was a widespread, strong preference across the different age groups and communities to remain living independently as they age and making use of support to do so.

Most interviewees were critical of aged care facilities and saw them as being run as businesses that prioritised profit over high quality care. The prevalence of religiously affiliated organisations running facilities was seen as effectively limiting their choices, as they did not want to spend their older years living in an institution run by a religious body.

Most people described aged care facilities negatively, saying they were depressing, bleak places that felt clinical and sometimes were overcrowded. Moving to aged care was seen as ‘the beginning of the end’ that precipitated a rapid decline in one’s life expectancy and quality of life.

Specific negative factors mentioned included a lack of meaningful mental stimulation, social isolation and loneliness, poor quality personal care, insufficient staffing levels and staff training, and poor quality nutrition. These factors were interrelated with overstretched staff rushing residents through meals and personal care.

While some interviewees mentioned pleasant high end facilities, others mentioned budget facilities that provided a small per resident food budget, or residents being heavily sedated to reduce staff workload. The effect of having to provide a bond to ensure a place in a facility and the ongoing cost was of great concern to most as was the inadequate regulatory system.

Younger people with physical or mental disabilities living in aged care facilities were particularly critical of the care they received, mentioning issues of cleanliness, personal hygiene, stimulation and respect for residents and appropriate social engagement.

This qualitative research included 274 people from the general community and targeted diversity groups. It was conducted primarily to understand the perspectives of these diversity groups and to complement a national survey for the Royal Commission that has been charged with considering the design of Australia’s future aged care system.