The 1991 United Nations Principles for Older People and the following principles have been designed to provide a philosophy to guide actions of people working with older people who are vulnerable to abuse. The principles recognise the rights of older people, taking into account that individuals are responsible for their own behaviour.
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 focused with a view to ensuring safety and ongoing protection from violence and abuse.
- Victims of violence, abuse, threats, intimidation and harassment should 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 should be respected.
Range of Interventions
There are a range of interventions and people have the right to know all the options that are available to them. These may include introducing support or counselling services, arranging respite care, separating the victim from the abusive situation, finding alternative accommodation or taking legal action.
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 Aged Care Assessment Service worker, social worker, GP, or a community community service provider 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 residential 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.
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. 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. Counsellors should have appropriate expertise.
Treatment of the perpetrator
It is important to acknowledge the needs of the perpetrator. 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.
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.
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. In situations of domestic violence, the police may need to be involved if a Protection Order is sought. Similarly, applications to the Queensland Civil and Administrative Tribunal can be made where victims are unable to make a decision for themselves.