World Elder Abuse Awareness Day (15 June 2013)

Growing old is an inescapable fact of life.  Old age awaits us all, and when it arrives, surely we would expect to be treated with the same dignity and respect that we have experienced throughout the rest of our lives.  And yet, disgracefully, for many older people, this is not the case.

In a departure from my usual genre, I want to take this opportunity to draw some attention to a topic which will come to be important to us all.

Today is World Elder Abuse Awareness Day.  It was launched on 15 June 2006 by the International Network for the Prevention of Elder Abuse (INPEA) and the UN’s World Health Organization.  On 9 March 2012, UN General Assembly Resolution 66/127 established 15 June as a UN International Day.

Much work has been done to raise the protection of vulnerable older people up the political agenda, but there is still more to do.  No one questions the need to keep our children safe, but when it comes to adults, the issue becomes more complex.  It is assumed, for many, that because we have knowledge of our rights and are able to speak for ourselves, we do not require assistance in securing these rights.  However, as we grow older, we may find ourselves physically unable to do the things we once did for ourselves.  We may find that we deteriorate mentally, leaving us unable to advocate for ourselves and totally reliant on others.

Many elderly people are extremely vulnerable.  They may not have relatives; they may live alone and be unable to leave the house unaided.  They may feel ashamed to report abuse, fearing it will be an admission that they are vulnerable and are no longer as capable as they once were.  For many elderly people, this results in them being taken advantage of, neglected, treated with disrespect and indifference and left in conditions that would cause outrage were it to happen to a child.  We know this is happening and yet society turns the other way - our growing elderly population is an inconvenience to us.

Sixty percent of all adult safeguarding alerts raised in 2011-12 involved people over 65.  The majority of this abuse takes place in people’s own homes.  According to the charity Action on Elder Abuse:

-      8.6% of older people living in our communities are subject to elder abuse (in excess of 500,000 people)

-      60% of victims are over 80 years of age and more than 15% are over 90 years old.

-      Nearly a quarter (23%) live with their abusers (66% of abusers are relatives) and 19% of victims have dementia.

The truth is that the vast majority of abuse arises out of ignorance – an inability on the part of perpetrators to see that their actions are abusive.  Financial abuse of older people is commonplace, with relatives helping themselves their “inheritance” early or selling off belongings without permission.  Many elderly people who are reliant on others to provide their care are simply neglected, either wilfully or due to time pressures.  They are left in the same position for hours, sometimes in soiled continence pads, put to bed in the afternoon or left without access to food and drink, as evidenced by a Care Quality Commission (CQC) review of dignity and respect in care homes and an Equality and Human Rights Commission (EHRC) report, published in 2012.

Many older people, especially those with dementia, are not included in decisions about their own care.  Many, particularly those who cannot independently mobilise, are not provided with social stimulation.  No effort is made to support older people to take part in the activities they enjoyed when they were independent.  Often they spend the majority of their days sitting in lounges or in bed, not even offered the opportunity to access homes’ gardens.  It is a moral imperative that everyone should be able to enjoy the best quality of life possible until the end.  Too often providing anything beyond basic care is seen as simply not worth the effort.

Care provided by domiciliary care agencies in the home is frequently rushed, and is accordingly of poor quality, sometimes even unsafe.  In order to fit into schedules, customers are put to bed in the afternoon and are expected to stay there until the next morning.  Carers do not stay to ensure the clients are eating or drinking properly.  A CQC report into home care published in February 2013 found that the people they spoke to “felt that they lacked choice with regard to the number of new or unfamiliar care workers who arrived at their home.”  Imagine how you would feel your personal care was delivered by a succession of strangers?  This is the reality for many older people across the UK.

It cannot be denied that much of this has its roots in the current economic climate.  Staffing levels in many care homes and nursing homes are low, putting staff under pressure and leaving residents with their basic needs unmet.  Domiciliary care staff are paid minimum wage (sometimes less, as they are not paid for travel between calls) and are expected to deliver care in sometimes as a little as 15 minutes.  A United Kingdom Home Care Association (UKHCA) report, published in July 2012, found that “73% of homecare visits in England appear to be 30 minutes or shorter and a staggering 87% in Northern Ireland (42% in Wales and Scotland).

There is evidence of the use of visits which are 15 minutes or fewer in all administrations, and as high as 28% in Northern Ireland.” 

Providers report frustrations at how little local authorities are prepared to pay them to provide care, whilst the local authorities, in turn, protest that they are facing budget cuts and cannot afford to pay more.  This week the Care Minister Norman Lamb called home care providers to a summit, as he fears (quite rightly, as it turns out, given the revelations about the poor care delivered to an 83-year-old woman exposed by the BBC on Thursday) that the crisis in home care funding is “a scandal waiting to happen”.

The Care Bill

The Care Bill currently making its way through the House of Lords does much to ensure that current adult protection measures are made statutory, but it also has a number of shortfalls.  Of main concern is the fact that the Bill does not allocate adequate funding to cover the costs of the new statutory safeguarding work, nor does it touch upon provision of funding to prevent local authorities resorting to low cost care options.  The Bill also does not comprehensively protect vulnerable adults from abuse by people in positions of trust.  There need to be greater safeguards around social care staff accessing vulnerable people when the abuser is controlling access, with appropriate legal constraints to stop local authorities abusing this power.  The Bill does not provide guidance on exactly how Safeguarding Adults Boards should be funded once they are statutory, which could leave them underfunded and ineffective.

Action on Elder abuse would like to see a criminal charge of elder/adult abuse included in the Bill, which would “cover circumstances where an adult uses their relationship or position to cause or allow an older person or dependent adult to suffer unnecessary physical pain or mental suffering, or injures their health, or steals, defrauds or embezzles their money or property.”  MP Nick Smith is calling for an amendment to the Bill which will make corporate neglect an offence, in order that care home companies take responsibility for the poor standards in their homes.

The Care Bill will be going through the House of Commons later this year, so you can help by writing to your MP and highlighting some of the Bill’s weaknesses.  Please feel free to contact me for more information.  Action on Elder Abuse are also lobbying for many of these changes – visit their webpage for further details.

Raising Awareness

It is vital that a spotlight is shone on the widespread abuse of vulnerable elderly people in our society.  There are thousands of carers and relatives out there who provide excellent care, but there are too many who do not.  It is unacceptable.  Adult Safeguarding should be far higher on the government’s agenda.  It will be costly, but it should be, because this is an investment for all our futures.  We as individuals also have a responsibility for instigating a change in attitudes.  One of the first steps towards this is to spread awareness of what constitutes abuse, to make abusers to stop and think about the impact of their behaviour and to ensure that victims recognise it as abuse, and not just something to be suffered in silence.

What constitutes abuse?

Financial abuse: taking money or welfare benefits without your permission; belongings or property being withheld or stolen by another person.

Physical abuse: as well as intentional physical harm, this can include assisting you to move in a rough manner, forcible restraint, and even locking you in a room.

Emotional abuse: shouting, swearing, bullying, teasing or humiliating you or making threats.

Neglect: ignoring medical or physical care needs, whether maliciously or not.

Sexual: being made to do things of a sexual nature against your will.

Discrimination: comments or jokes about a person’s disability, age, race or sexual orientation.

Where to go for help or advice?

There are a number of places to go to get help and advice around adult safeguarding:

-      If someone has been seriously injured or is in immediate danger, you should call 999.  If you suspect a crime has been committed, it should be reported to the police.

-      Contact Adult Services, a department of your local council.  You can find out who your local authority is on the DirectGov website. Contact numbers can be found in the phone book.  Tell them you want to report an Adult Safeguarding issue.  They will be able to advise and support you.  Most councils will also have further information on adult safeguarding on their websites.

-      If the concerns are about a care home or domiciliary care service, you can contact the regulatory body to report any concerns:

o   If you live in England, this is the Care Quality Commission - 03000 616161

o   If you live in Scotland, this is the Scottish Care Commission - 0845 603 0890

o   If you live in Wales, this is the Care and Social Services Inspectorate for Wales - 01443 848450

o   If you live in Northern Ireland, this is the Northern Ireland Department of Health, Social Services and Public Safety - Social Services Inspectorate  - 0289 052 0500

-      These bodies also offer a service for raising about concerns about a care that you work for, which can be raised anonymously if you wish.  The CQC advise that before contacting them with a whistleblowing allegation, you consider:

- speaking to your line manager or a senior member of staff about your concerns.

- reading your employer's whistlebleblowing policy which will give you information on       what to do next.

-      Mencap also run a free confidential whistleblowing helpline for all care staff working in the UK – the number is: 08000 724725

-      From October 2010 the Local Government Ombudsman has been able to consider complaints from people who fund their own care through Direct Payments. It is a free service, but in most cases they will only consider a complaint once the care provider has been given a reasonable opportunity to deal with the situation. You can contact their advice team on 0300 061 0614

-      You can speak in confidence to your GP, practice nurse or dentist if you are being harmed.

-      The Citizens Advice Bureau is a good source of advice around financial matters, if you have any concerns in this area.  They can be contacted on 08444 111 444

-      Domestic abuse can occur at any age and is never acceptable.  If you are scared of someone you live with, you can call the National Domestic Abuse helpline on 0808 2000 247

-      Action on Elder Abuse has a free confidential helpline which provides information, advice and support to victims and others who are concerned about or have witnessed abuse. This helpline is available Monday to Friday, 9am to 5pm on: 080 8808 8141

-      Age UK also has an advice number you can call: 0800 169 6565

-      You can also call the Samaritans if you have any concerns you want to discuss on 08457 90 90 90

The conditions under which we allow our some of our elderly people to live are appalling.  We would not tolerate it for ourselves, so how can it be acceptable for those who have lost the ability to provide and speak for themselves?  Please take the time to share some of this information with the people you know.  If you have elderly friends, relatives or neighbours, you may want to consider printing out the numbers and details above to give to them.  We must do more to raise awareness of these issues, to keep them on the government’s agenda and end the abuse of our older generation to whom we owe so much.