Elephant in the room: How do we prevent sexual assaults in aged care facilities?

Elephant in the room: How do we prevent sexual assaults in aged care facilities?

When news first broke that up to 50 sexual assaults were occurring in residential aged care facilities every week, the only thing more shocking than the statistic, was the lack of response.

The final report of the Royal Commission into Aged Care Quality and Safety made 148 recommendations.

However, not one of these recommendations addressed the need to prevent sexual violence.

Experts believe that 50 sexual assaults per week may be a conservative estimate, but a lack of available data and convoluted reporting obligations have made it virtually impossible to understand just how prevalent these assaults are.

A 2019 report by KPMG that surveyed more than 170 aged care service providers found that staff who were surveyed felt as though 58.1% of incidents that are categorised as rape or sexual assault resulted in “no impact” on the victims’ wellbeing.

Women’s rights advocate and CEO of the Older Women’s Network NSW, Yumi Lee, believes that this assumption by staff highlights a lack of sexual assault education in the aged care sector.

“We know that sexual assault impacts everyone, whether you have cognitive impairment, or not, because it is such a primal fear when your personal safety is violated,” said Ms Lee.

Safeguarding aged care residents against sexual assault while honouring their rights to autonomy is a complex social, legal and health task. The weight of responsibility regarding this issue is currently being carried by aged care staff.

Unfair expectations

The current approach to preventing sexual violence in aged care focuses on mandatory reporting obligations set down by the Aged Care Quality and Safety Commission.

These rules require staff to define “victim impact” and “incident seriousness’ in accordance with guidelines laid out by the ‘Unlawful Sexual Contact Decision Support Tool.’

This tool requires staff to define incidents based upon severity as either ‘Priority 1’ or ‘Priority 2,’ according to how staff – not the victim – perceives the nature of the assault. This means that criminal acts of sexual violence could potentially be branded as ‘less urgent’ if the victim is not judged to require medical or psychological treatment by a staff member.

Lawyer and Lead Practitioner of elder abuse cases for ADA Law, Jason Abraham, believes that burdening staff with the responsibility of defining sexual acts is not the only issue that could impact incident reporting.

“When a sexual assault occurs, there’s a bit of a culture challenge because a staff member is admitting that something has happened to a resident while in their care. It raises a number of questions for staff like: How will I be viewed if this happened on my watch?”

Experts at the aged care royal commission conceded that many sexual assaults in aged care are likely going unreported. Asking staff to adjudicate what kind of behaviour constitutes a police report is an unfair and systematically flawed approach.

In aged care settings, incidents of sexual violence may involve both a survivor and a perpetrator with cognitive impairment. This adds to the already difficult task of “proving” an act of sexual violence has occurred.

A study conducted by Monash University discovered that 66% of aged care personnel had not been through training regarding the prevention of sexual violence in the past year.

Asking these same staff to assess incidents of sexual assault without any expertise is negligent and dangerous.

Capacity and consent

As Australia’s foremost campaigner for the rights of people with dementia, and somebody who is currently living with young onset dementia, Kate Swaffer has spent decades fighting to ensure that age and cognitive ability do not limit freedom of choice.

While resident safety is a priority, Ms Swaffer believes that having the right to engage in sexual activity should not be encroached upon by blanket bans and unnuanced legislation.

“Of course, someone who is in the very late stage of dementia who may be in a palliative state doesn’t have the capacity to give consent for sexual intimacy of any kind – partly because of the drugs they’re being given. End-of-life drugs are pretty powerful.

“But for others, it’d be like saying to me, you don’t have the right to have sex just because you have got young onset dementia. Nobody has that right,” she said.

Yumi Lee of the Older Women’s Network NSW revealed that some of her group’s members are so terrified by the prevalence of sexual abuse in aged care that they are advocating for the creation of new facilities that only consist of female staff and residents.

Ms Lee is also in favour of a cautious approach to consenting sexual activity when cognitive impairment is involved. 

“When a woman has cognitive impairment, it is really important to protect her. And I believe that she has to be protected from men who may have cognitive impairment and from having an intimate relationship with her if she’s unable to consent to it,” said Ms Lee.

According to Jason Abraham, finding the right balance between a rights-based approach and safeguarding against sexual abuse needs to begin with talking to the individual and focusing on their capabilities.

“We’ve got to look at [residents] as people and talk with them, to plan with them in regards to their own safety, and to really focus on their strengths rather than the diagnosis,” said Mr Abraham.

“We need solutions that anybody would have in that situation, rather than a solution just based on a dementia diagnosis.”

Education and a safe environment

As the Director of the Older People and Sexual Rights Institute, Dr Catherine Barrett has been a long-time advocate for increased sexual assault education and training in aged care.

Working closely with both Yumi Lee and Jason Abraham, Dr Barrett has created an informative online resource called ‘Ready to Listen’, that can assist providers and aged care staff in identifying and preventing sexual abuse in care facilities.

“It’s about developing resources and tackling some of those barriers, beliefs and perceptions, by educating staff in residential aged care, but also providing aged care residents with a voice.”

The Ready To Listen project has been funded by the Department of Health and is being delivered by the Older Person’s Advocacy Network, in partnership with Celebrate Ageing and the Older Women’s Network, New South Wales.

The platform boasts a wealth of best-practice information on how to assess and deal with incidents of sexual assault in aged care. It also contains valuable expert advice on how to ensure that aged care residents who are victims of sexual assault feel supported.

“We are talking about a generation of people who grew up when sex was a taboo topic,” said Ms Lee.

“These people have a different mindset compared to the young people of today and they have been conditioned not to speak out. And we need others to take this seriously. Fifty sexual assaults are happening every week, but there are no marches happening for these women.”

Jason Abrahams echoed Ms Lee’s sentiments and shared his belief that improved education and awareness of sexual assault in aged care is one of the first steps towards prevention.

“I think part of that change needs to come about by allowing people to tell their story in their time in a way that’s respectful, in an environment where they feel safe.

“I think that the other part would be to get students who are passionate about this into courses that tackle these sorts of issues. This way, that knowledge can be passed on to the next group coming through.”

Mr Abrahams added, “We need to empower staff through education and look to continually develop best practice methods. I think that the Ready to Listen project is a great initiative that is geared towards equipping people with those skills.”

Confidential information, counselling and support service

If you or someone you know is seeking support, contact 1800RESPECT, a 24-hour helpline, to support people impacted by sexual assault, domestic or family violence and abuse. Phone 1800 737 732.

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  1. People who have been sexually abused in their childhood and teens carry this trauma with them. Having a man wander into your room or getting an enema or being roughly handled can re-traumatise the person. I remember standing outside my mother’s door while the staff changed her pad and hearing her say “Please don’t hurt me”. It was as if my mother wasn’t human and did not matter. There is a random brutality about Aged Care. It is a kind of violence that I never really got used to. Education will help but what is really needed is more Nurses and a complete change in the culture of care.

  2. The only way you will stop sexual abuse in aged care is to segregate men from women. I have said this many times over my yrs of working in the sector. More males than women are a threat to us all in the sector. Nothing changes just because you have cognitive issues. It just seems too hard in the Aged Care sector, to find a healthy balance for residents and carers. Males are more prone to physical abuse of staff, other residents male and female and are usually alot harder to care for. More staff would definitely help as the more eyes you have the better safety for residents particularly women. But as long as nobody wants to make better safety progress in this matter nothing will change. Can you blame the staff if they complain and the RNs and CMs don’t see it as an issue but still put the blame on the AINs for not supervising properly? Staff can only do so much when there is not enough eyes on wards to supervise. You never see an RN sitting at a desk in our Dementia wards. They could do their work there on computers and supervise while the carers are caring but they like to sit together at the main nurse’s station.

  3. I am a bit shocked to hear this. Its just another disgusting horrible experience for the poor residents to suffer from.
    Aged care has been understaffed for years and its just got worse and worse as people are living longer with more co-morbidities etc etc.

    Who ever is responsible for pushing the changes through needs to be sacked. They are probably on a very large salary and obviously do not care about the poor residents and staff.
    Please start with staffing. Also a big pay rise for all Ains and lower paid workers.

  4. I’m sick to death of hearing about this. “Resources and training”, please!!
    The staff don’t have time for resources and training, a lot of staff have English as a second language. When Mum first went into care, they had an only female wing. Then they decided to integrate male and female. The demeanour of the female residents changed almost immediately. The men, unwittingly, took over the lounge area, they were loud and intimidating. The women hated it.
    Why is it so bloody hard to understand that women need protection. Separate the sleeping areas, don’t allow male carers to undertake personal care on females, it’s too confronting.

    1. I whole heartedly agree with you Bob. I will never understand why they need to have males sharing wards and often wandering into women’s rooms. There is no reason really why they cannot segregate the sexes. We only recently had a little 97 yr old lady pushed to the floor by a large aggressive male who’s dementia is so bad you cannot explain even the basics to him. He wanders the ward and other resident’s rooms when staff are so busy (only 2 for 13) He is incontinent of both urine and faeces and nobody can change him as the Australian Aged Care Authority has deemed all residents and dementia and disability residents as their own person and are to be treated with respect. So if they don’t want a continence change they don’t have one. Staff will attempt numerous times on every shift to assist these people with hygiene but we are under rules where we cannot be “man handling” or holding someone’s hand gently against their wishes even if their health from lack of washing is at risk. So there you are!! And our governments past and present still cannot stand up to this industry and believe the stories of the stresses and the responsibilities placed on low paid women in this industry. They push it further away from the important issues that need fixing in this country.

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