Nov 11, 2021

Preventing sexual assault in aged care: Why an immediate overhaul of training and reporting is needed

Sexual assault in aged care

Upwards of 50 sexual assaults are projected to take place each week. 

Of concern, this reality in the Australian aged care landscape is not reflected in the Royal Commission into Aged Care Quality and Safety’s 148 recommendations. Not one of these recommendations directly tackles the prevention of sexual violence. 

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. 

When questioned, employees said many of their aged care places of work did not have clear or established processes to mitigate or respond to incidents. 

It is an established, unquestionable human right to live life, regardless of age and gender, free of sexual violence. 

Avoiding addressing the situation of sexual violence in aged care homes highlights a glaring apathy surrounding older survivors and reinforces the very present struggle for older people to achieve and benefit from this right. 

Reactionary instead of preventative

The national focus in preventative measures in sexual violence within the aged care sector is found within the mandatory reporting criteria as established by the Aged Care Quality and Safety Commission

However, the way this is done is problematic. Rules dictate that personnel must gauge “incident seriousness” and “victim impact”, an arguably subjective task, far from a scientific base and a move that removes the agency from the older person – seemingly at odds with the recommendations of the royal commission. 

This approach additionally places a heavy psychological, legal, health and social burden of complexities onto care staff. 

Significant questioning in response to the new rules from the aged care sector has seen the regulator release the unlawful sexual contact decision support tool this month. 

Incidents are broken down in “Priority 1” or “Priority 2” in consequence to how staff, not the survivor, judge the gravity of the incident. 

Problematically, if a resident is seen not to need medical or psychological care as assessed by the person utilising the tool, criminal incidents of sexual violence could fall under “Priority 2” and not need to be reported for 30 days. 

The consequences of this are significantly alarming, as others could be in danger and the ramification to both residents and co-workers is immense. 

In response to concerns surrounding this current model of reporting, the regulator returned that there is an onus on aged care providers to communicate “serious” acts with police and the regulator immediately. 

The Aged Care Quality and Safety Commission stated the concern was covered by the question: “Are there reasonable grounds to report the incident to the police?”

Yet when data on reporting is investigated, the numbers of reporting are shockingly low. 

KPMH conducted a report into the pervasiveness of abuse between aged care residents. It was discovered that staff recorded no (58.1%) or minor (35%) physical or psychological harm resulting to survivors who had been sexually assaulted or raped. 

Examining the data further, the report highlighted that a mere three of the 1,259 incidents determined to be “Priority 1” or “very serious” were disclosed to the police. 

Although prior to the decision tool being rolled out, this disparity showcases the dangers of too heavy a burden on solo staff members that haven’t benefited or been guided by thorough, excellent and cohesive training. 

Forensic excellence expected of aged care personnel 

At the crux of why the current approach and tool cannot hold to the standard of care and prevention needed, and deserved, for aged care residents is that the tool is flawed. The tool demands exacting, arduous and complex capabilities of aged care employees. 

In order to report to police, an aged care staff member must have reasonable grounds to do so. 

These grounds are a complex web of forensic concepts and understandings. 

An act of sexual violence in the aged care sector may have an assailant and survivor both with a cognitive impairment

Aged care staff then have the onus to navigate the situation, the aftermath and prove an incident of sexual violence has transpired. 

Adding another layer of complexity, the incident could include a fellow colleague, whereby a staff member must navigate a complex situation, bystander stress, and the possibility of coming forward about a colleague or even a boss. 

Placing the onus on aged care personnel to carry the burden to judge and navigate situations that require policing expertise is not only unfair but perilous. 

Staff shortages, accuracy and differing accounts

There is a further flaw to the method of placing sexual incident reporting solely on staff. Staff cannot be everywhere at once. 

There have been numerous studies that have shown aged care staff to be stretched to breaking point. From understaffing to employee burnout, there are multiple factors which prevent staff from being optimally present physically and mentally. 

Jose came in one day to find his wife being sexually assaulted by another resident. 

“I saw my wife on the bed with a man. He was fondling her breasts, and he had his other hand inside her thighs. I just froze for a second and then I just screamed at her, ‘Get out of there!’ And my wife came out to me and she said, ‘That’s my husband.’”

A report filed later by the aged care facility called the incident “cuddling” and also stated that Jose’s wife was not distressed by the incident. Jose was shocked and disappointed with the report. 

This incident displays the multiple complexities at hand. Staff members did not see the incident in question yet were called on to assess and report the incident. 

A family member who did witness the incident significantly differs in the detailing of the incident. 

Jose also believes that it was due to staff shortages and underfunding that led his wife to be in such a vulnerable position. 

Additionally, both assailant and survivor had dementia, adding to the difficulty in beginning to comprehend and assess distress and impact. 

Dr Barett, Director of the Older People and Sexual Rights Institute, expressed concern about the current ability of staff to accurately assess the severity and impact on a survivor under current conditions. 

“We need to educate service providers about what sexual assault is and isn’t. Appropriately categorising an incident is essential to an appropriate response, whether that’s support for family, support for the woman and response to the alleged perpetrator.”

The survivor’s daughter Jennifer couldn’t understand how the home had concluded her mother wasn’t distressed. In the days following, Jennifer spoke of seeing her mother become more agitated, and at one point was found naked and moving her faeces on a wall. 

Jennifer understood that both parties had dementia, however, she explained her frustration stemmed from the need for the incident to be recorded properly and that her mother, while living with dementia, still deserved to have consent – and how could she consent?

The current approach to sexual violence reporting and management, and the level of training provided, cannot acurately and competently manage situations such as Jose and Jennifer’s loved one. 

Hope lies in specific and direct training

Monash Univeristy’s Health, Law and Ageing Reserach Unit has created an e-training intervention to advance sexual violence incident detection, processing and prevention. 

The training seeks to enable partnerships between expert dementia and sexual violence support services. 

The way to bring about important change for protection and ultimately full prevention is equipping personnel with the skills they need. 

The e-training intervention highlights core definitions, characters, detection markers, processing and methods to assist resident survivors, coupled with tools to guide employees on how to navigate the needs of residents and mitigate incidents. 

For those that have undertaken the training, they have spoken of increased awareness, heighted understanding on their current processes and progress in the management of sexual violence in their workplace. Most praised the training as relevant, practical and useful.

Many parts in the ongoing pursuit of the solution

There are many further steps to go in determining the knowledge growth needs of this population and situation. 

The training provided by Monash University is a step in the right direction. It contributes a base curriculum that can be emulated in development by national and international actors in pursuing further training methods and approaches. 

Reform is being called on by many; they highlight other factors that need to be examined, from the judicial to the social. 

Next steps are for government bodies, corporate executives and boards, and insurers to be brought into the discussion and to lean in with resources and development. 

Systemic culture needs to be powerfully influenced so as to eradicate sexual violence. It is to create an atmosphere not just where sexual violence is acutely detected and survivors honoured with justice and process, but where the violence itself cannot begin to draw oxygen. 

It is integral as a nation that the prevention of sexual violence be seen as crucial and possible. 

Gone must be the days of reactionary methods, and pithy processes, tied to placing the onus on employees to judge the damage of sexual violence. The development of substantiated solutions, to protect residents from incidents ever taking place, must be the true goal.

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. There are always unanswered questions.

    In the example above both residents had dementia and it can be assumed that this instance was consentual…what is the expectation of punishment or consequence?
    Are we going to have high care dementia people charged,put through the courts and jailed?
    Residents have the right to participate in what might appear to be inappropriate activity and even sex!
    In the example above…who is the aggrieved party? The husband!

    While it takes a bit of getting your head around these residents don’t have inhabititions they once had and have they done anything wrong?

    Carers and facilities can’t be held responsible for consentual activity, they ensure that residents don’t take advantage of each other in any manner but for two people to sneak off to a quiet spot and a quickie is probably something their families need to accept.

    Example of how things could be treated. A male resident is walking around holding hands with a female resident, enjoying each other’s company. The wife comes in and smiles and sits down with them both and understands the situation….or goes stark raving mad causing unnecessary distress and accusation that neither residents understand?

    It’s not black and white.

    Besides that…many reports of abuse in Home care scenarios but how many go unreported? Who does the reporting? A one on one scenario with no witnesses? Would a frail old man or woman be able to make a complaint, would they be intimidated or scared of complaining? That’s the area that needs examination!

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