The 6 most common types of elder abuse in home care

Senior lady crying

A study by KPMG of 151 home care providers found that in the six months from 1 November 2020 to 30 April 2021, 161 ‘serious incidents’ occurred.

The most common serious incident was stealing and coercion, which accounted for 69 incidents or 43%.

The second most common serious incident was neglect, with 50 cases, accounting for 31% of incidents.

The remaining 42 reports were of unreasonable use of force (14 reports, 9% of incidents), psychological or emotional abuse (10 reports, 6%), unexpected death (nine reports, 6%) and unlawful or inappropriate sexual contact (eight reports, or 5%).

By comparison, in the first six weeks of the Serious Incident Report Scheme (SIRS) for residential aged care (ending 12 May 2021), the Aged Care Quality and Safety Commission received 4,496 notifications of serious incidents, including 778 cases of unreasonable use of force, 448 instances of neglect, 192 cases of unexpected death, and nearly 150 cases of inappropriate sexual conduct.

The Serious Incident Response Scheme for residential aged care began collecting reports from 1 April 2021, but no such scheme exists for home care.

However, the government allocated $14 million for the expansion of SIRS into home care in the 2021-2022 federal budget. KPMG was commissioned to study the prevalence of serious incidents in the home care setting and to develop options for expanding the SIRS into home care.

The purpose of the KPMG study was to understand the volume and nature of serious incidents that occur in home care settings. The consultants outlined a range of options for a home care SIRS, including simply applying the residential aged care SIRS to home care or requiring only Priority 1 incidents to be reported for home care.

Though the KPMG survey data is informative, only 7% of Australia’s 2,078 home care providers took part in the survey.

It’s currently estimated that between 2% and 14% of older Australians experience elder abuse across the population.

About 900,000 Australians currently receive aged care services in their home, and this number is set to rise as people prefer to age in place.

The Royal Commission into Aged Care Quality and Safety recommended the government ensure the serious incident reporting scheme “addresses all serious incidents, including in home care”.

What do you think about these statistics regarding elder abuse in home care settings? Share your thoughts below. 

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  1. Just because 78% of Home care recipients reported no abuse only means it wasn’t reported. The real risk is that services in the home are unsupervised.
    Even with SIRS being expanded in home care who is going to report abuse incidents? The carer?
    What is in place to protect the vulnerable at home that do make a complaint? Nothing!
    They are vulnerable and afraid to speak up!

    1. I agree with your comments and note that in a recent Law Reform Commission review of older person abuse and neglect in Manitoba Canada found family as abusers and neglect as well as Home Care service employees so there needs to be clear laws and punishments for anyone abusing or neglecting older adults in any situation. This first needs to come from a human rights perspective so that societies no longer regard older people as lesser thanks and see them as devalued people isolated from their community and people.
      It is from the ageism that persists worldwide that change needs to happen to destroy that long lasting “ism”.

  2. Regarding the ‘reported’ cases in home care, we may find that the real rate of abuse is higher as there would be a lower rate of reporting in home care.
    SIRS focuses on abuse by staff ie: financial abuse by staff. Yet abuse occurs in the home by other contacts of the consumer, so the RAC SIRS criteria should be altered for home care.

    1. Very good point. It should be mandatory reporting same as childcare and teachers. There are many levels of abuse family can inflict on our elderly whether in their care or not. Emotional abuse is a big one. Sometimes it is wrapped in resentment and a lack of downtime or in home respite available to carers. Burn out is huge as is ptsd.

  3. Raw data tells of a potential problem but it doesn’t provide enough detail to make a sound interpretation. Of the 4,000 odd cases that were reported how many were proved to be supported after investigation? What inferences are being made without supportive facts? For example I can’t believe that physical/chemical restraint is not used during home care…I know of families where this is the case…for similar reasons to its use in care…to manage risk of harm to the person or others. In nursing homes these drugs are monitored and reduced/withdrawn when no longer required…is this also the case for person’s in home care?
    There are literally thousands of examples of kindness and compassion in occurring in Nursing Homes every day …but people are quick to make judgements based on data without interpretation and my fear is that continually reporting only part of the information available is like throwing the baby out with the bathwater!

    1. I would disagree that facilities who engage in chemical and physical restrains are more likely to continue the use of these because they have few staff to provide any type of interaction or distraction and the environment is far less tolerant of those who do not fit the norm snd therefore one of the most common reasons for the use of chemical restraints is to prevent the person from bothering others all the while ignoring the Black Box warnings not to use any of these drugs on elderly people in particular those with dementia of any of the 120 + different types, without the proper diagnosis of approved diseases of which these drugs may help but also carry with their use serious and often permanent side effects.
      In the UK in about 2008 when chemical drugging was rampant there, the government gave the MDs who were prescribing inappropriate drugs to LYC residents 10 years (way to lenient a timeframe) to stop prescribing them. In 2018 when the MDs did not stop prescribing them the government said fine we will arrest you for prescribing these drugs and put you in jail.
      There is no excuse fir the inappropriate drugging of older people who are specifically identified as those who should not receive these drugs.
      There are better ways to accommodate those with dementia and that includes housing in small “real” home environments and engaging them in rote activities that they know and feel able to do.
      What the MDs did in the UK in response to the hammer coming down on them was to stop prescribing the antipsychotics and switched to antidepressants because they were not considered so obvious but carry the same warnings as the antipsychotics did. Fewer families would object to making older people in LTC institutional facilities feel less depressed.

    1. The Manitoba Law Reform Commission report was released earlier this month and you are right this happens regularly in Canada and is not limited to Home Care staff either but by family members in particular make relations.
      It was disturbing to me to read the various Acts that are meant to protect the vulnerable from abuse and neglect and the wide variation between provinces some more encompassing than others but each province needed a protective Act .
      If ageism could be eradicated I think that would put a stop to some of the abuse snd neglect and society would regain their sense of just how valued older people and would embrace them once again as members of our societies.

  4. I feel 2-14% is underestimated. There is a lot of financial abuse by family members that clients don’t want reported through fear.
    Neglect is an issue, not knowing what happens as carers aren’t present 24/7. clients mention things, not eating properly, being cold etc but again they don’t want to cause issues and make things worse. It will be interesting to see who these issues fit in the reporting.

  5. It would be interesting to know if the incidents were by home care workers or by family members/carers.

  6. Whilst the data is informative, the question that is not answered is who are the perpetrators?
    Is it the staff of providers or is it the family of care recipients?

  7. As a home care provider – I have found that most cases of elder abuse is via families of our elderly. Mostly due to ignorance. e.g we have one client that has significant mental disabilities and mobility issues. Her main carer is her sister. Her sister consistently locks the client in her room, so as she can get some peace and quiet. The sister does not believe she is doing anything wrong. The client has been hospitalised recently due to hypothermia as the sister will not run the electricity too long due to the costs. The client now has 2 hour welfare checks daily. The sister still does not believe she has done anything wrong. Its a constant battle with families to re educate them on elderly abuse.

  8. I am surprised in a way that there was a suggestion that perhaps only the most serious abuses or neglects be reported and I would have expected that all abuses and neglects be reported as the environment of private individual homes would be easier targets for abuse and neglect as other studies/reports demonstrate that most often it is family members who abuse and neglect their own relatives snd then comes Home Care services as well.
    Regulating Home Care employees so that there is a standard set snd their employment record follows their employment would be another way to ward off or prevent abuses and neglects from the start.

  9. In recounting my experience, I am sorry to say that, in my opinion, none of the so called bodies that our Govt. hails as being strong advocates against elderly abuse are, in fact, fit for purpose.

    For the last week I have been trying to establish what has happened to my sister since she was discharged from Woy Woy Hospital. When I tried to call her I found that her phone had been disconnected.

    Last week I asked the Police to do a safety check at my sister’s address in the Central Coast, which they did, only to come back and speak very rudely to me and address me as if I were an axe murderer, yet I was the one that raised the alarm. The police constable refused to tell me anything about my sister or her wellbeing, only to say that she was fine.

    The police constable did not physically see my sister, he did not speak to her (which he admitted) and just accepted the black novel that the “defacto” and “carer” living in my sister’s premises bombarded the officer with about my character, despite not bothering to establish that the “defacto” and the carer are persons whom I have never met.

    My sister had only recently moved from Sydney. She had purchased a large and expensive 4 bedroom home which is unencumbered and has a very large amount of liquid cash in her bank account. To my knowledge, my sister at age 75 did not have a “defacto, nor did she had one for 45 years.

    When she came out of hospital, my sister’s phone was disconnected and this was a red flag to me. My sister would rather give you her physical limbs rather than relinquish her mobile phone. It is my opinion that my sister was being isolated and that her assets were and are being misappropriated.

    If the “defacto” and the carer ( I understand from the police officer there were two people in the home) were legitimate persons, there is no reason for either of them to prevent me from knowing my sister’s location, or disconnecting her phone and violating my character to the police. This is classic predatory behaviour of a perpetrator of elder abuse, acting for the purpose of financial gain.

    Despite still smarting from the police constable’s disgraceful and aggressive manner, I decided today to try and call the Aged Crime Prevention Officers and relate my concerns. The police officer said he would do a welfare check and get back to me, which he did.

    The Code of Practice for the NSW Police Force Response to Domestic and Family violence sates that “it is important that the police speak to the older person without the abuser present, often the abuser will say things like “they have dementia or alzheimers’ as a ploy to stop the police from talking to the victim directly”.

    The police officer DID NOT do this. When I questioned him about this he said he did not have to. He told me that the “defacto” and carer were living in the home, that my sister was placed in a nursing home (the name of which he would not divulge) and was told by them that she was being well looked after. That was all the police officer was prepared to tell me or take the matter any further.

    What hope does an elderly vulnerable person have against a predator? What help does a family member have against a wily predator? The answer to both questions is NONE. Aged Care, as I have said many times, is BIG BUSINESS. Service providers, nursing homes, guardianship tribunals etc. ALL have wonderful business models, a stock in trade that keeps on giving, no matter what happens – the dollars keep rolling in as long as the vulnerable elderly and disabled are there for the taking.

    The vulnerable of our society have no effective protections against financial exploitation, physical abuse or medical abuse despite all the hubris and PR window dressing bandied about by the government. Aged Care systems work for the benefit of those providers working within that area and past and current legislation provides no effective supports (if any) in a very lax system with allows no tangible recourse to justice for families or their loved ones – practice and theory make very poor bed mates.

    So many times the old chestnut of “privacy laws” is bandied about so that any hope of finding where a family member has been “dumped” prevents any chance of finding where they are or how they are faring. Without a pocket full of cash to hire investigators and engage legal representation, justice for society’s most vulnerable remains helpless and the industry and perpetrators rely on that. This lack of genuine support is a shameful blight on any civilized society.

    History has repeatedly shown that no Royal Commission or Inquiry is ever going to change the status quo for society’s most vulnerable that unless and until our government acts in an honest and honourable way by cutting out the hyperbole and ACTUALLY implement a system which puts an end to the corruption, cruelty, predatory behaviour and abuses that the elderly and disabled persons are forced to endure.

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