Despite nine years of compulsory reporting, the sector is still in the dark about the prevalence of assaults in aged care and the outcomes of notifications to the police.
It happens every year, like clockwork. Government figures showing an annual spike in the number of alleged or suspected assaults reported in residential aged care make headlines in newspapers across the country.
While the number of reports represents only around 1 per cent of the total number of residents in aged care, the yearly figures warrant further analysis.
Last financial year, 2,625 reports of alleged or suspected physical and/or sexual assaults were recorded, and just over 13,900 reports have been made since the scheme was introduced in 2007.
But despite the annual release of statistics, and the ensuing media coverage of annual increases in reports, the government does not respond to the data or analyse what’s going on behind those surface figures.
Under the compulsory reporting regime, it is the responsibility of police to substantiate the reports, while the federal health department’s primary role is to ensure aged care providers comply with the legislation’s requirements to report a suspected incident within 24 hours.
What are we getting out of compulsory reporting?
Dr Catherine Barrett, the lead author of Norma’s project, a groundbreaking 2014 study into the sexual assault of older women in Australia, said it was not enough for the government to simply collect and publish the numbers of reportable assaults in aged care each year.
“In other areas of assault – if you look at violence against women, for example – what we are doing is an analysis by perpetrator, of the context, factors that make women vulnerable. All that kind of analysis, that evidence informs prevention strategies and that’s the bit that’s missing,” she told Australian Ageing Agenda.
Dr Barrett said while compulsory reporting was a controversial topic in Norma’s project and there was a wide range of views among participants about its effectiveness, there was much broader agreement that the data captured and reported needed to be more comprehensive and to inform prevention and intervention strategies.
“It’s not enough just to collect the numbers. We have to say what they mean and how they can be used to better understand what is happening so we can prevent assault.”
Better access to data and greater public discussion around the issue would also improve awareness of the prevalence of assault and challenge the misconception that the sexual assault of older women does not occur, Dr Barrett said.
Norma’s project identified a range of perpetrators of alleged assault against female residents including cases of family and intimate partner violence that continued in a residential aged setting, assaults that were perpetrated by staff, as well as opportunistic assaults by a visitor.
What figures do the department have?
When Australian Ageing Agenda asked the Department of Health to provide a breakdown of reportable assaults according to perpetrator type, a spokesperson said that providers were not required to supply this information so the department did not routinely record it.
But figures released under a Freedom of Information Act request in 2011, which were taken from a small number of individual cases, showed a majority of the reports involved a staff member as the alleged perpetrator.
Of the reportable assaults in 2010-11 that resulted in breach of a provider’s responsibilities (160 in total), 116 or 72 per cent involved a staff member as the alleged offender. Of the rest, 15 reports had an unknown offender, 13 were resident on resident, eight involved a relative, one involved a health professional and one reported a friend as the alleged offender.
The fact that no record of alleged perpetrators and the contexts of the alleged assaults are kept is a significant gap in our knowledge on elder abuse in a residential care context.
In its final report, Norma’s project concluded the question of whether compulsory reporting achieves a better outcome for older people remains vexed.
While respondents in the study agreed that the introduction of compulsory reporting had led to providers improving their internal policies and staff training, many highlighted frustrations with the regime that primarily monitored provider compliance with the legislation but had no capacity to investigate actual cases.
Staff share their experiences
Associate Professor Linda Starr from Flinders University has just completed the first Australian study examining the experiences of nurses and carers in identifying and reporting alleged assaults as required under the regime.
She said that staff interviewed for her PhD project felt the industry was not properly prepared for the introduction of the compulsory reporting regime in 2007 and the changes were brought in too quickly without a sufficient lead time.
Some staff also expressed frustration or burn out when reports made did not lead to any action being taken by police.
Dr Starr said the investigation and prosecution of alleged cases of physical or sexual assault was frequently hindered by a lack of evidence such as medical evidence of injury or witnesses, or because what is reported to police cannot be prosecuted as a crime.
It was necessary to review the purpose and expectations of reporting to police as part of the reporting regime and to consider the merits of a specialised policy unit to investigate allegations of elder abuse, similar to what is in place in the US, she said.
Call to expand reporting
A significant limitation of the current reporting regime is that information on the outcomes of reports are not available.
“Until we know the outcome of the reports in greater detail it is hard to respond and provide meaningful interventions and assistance,” said Carolanne Barkla, chief executive of Aged Rights Advocacy Service.
Ms Barkla said consideration should also be given to broadening the requirements for reporting to all areas of elder abuse including financial, social, psychological abuse and neglect, as well as removing the exception to report if the perpetrator has a cognitive impairment.
By doing so, the sector can obtain a more accurate picture of the scope of abuse and ensure that timely support is provided to all residents, she said.
Currently, there is no central record kept on the level of peer-to-peer violence within facilities and the contexts in which they occur.
Meanwhile, the Australian Law Reform Commission is examining the effectiveness of the reporting regime in aged care as part of its inquiry into elder abuse.
For a policy that hasn’t been reviewed since its introduction, it’s a long overdue look at this controversial regime.
The extended version of this report appears in the current issue of Australian Ageing Agenda magazine (July-August).
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