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Reporting abuse of a vulnerable adult

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What is abuse of vulnerable adults?

Unlike child abuse, where there is a presumptive right for the child to be protected and receive appropriate nurturing and care, adults are free to make poor, even self-destructive choices, if they so choose.  Where there is an established incapacity or loss of capacity to make such independent choices, the situation becomes much more complex. 

Except in extraordinary circumstances, you should discuss your concerns with the vulnerable adult and ensure they are in control of reporting their abuse. If the vulnerable adult states they do not want you to report suspected abuse, you must discuss the situation with your supervisor and carefully consider your ethical obligations.

There are two principal sources of understanding abuse of vulnerable adults, abuse of people with disability, and elder abuse.

Elder abuse is any act that causes harm to an older person and is carried out by someone they know and trust, such as a family member or friend. The abuse may be physical, social, financial, psychological or sexual and can include mistreatment and neglect.

Elder abuse is one of the worst manifestations of ageism and inequality in our society, and most commonly occurs within the family. Elder abuse is believed to be greatly under-reported and the World Health Organisation (WHO) estimates it affects 1% to 10% of older people worldwide.

In 2002, WHO defined elder abuse as:

… a single, or repeated act, or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse. It can also be the result of intentional or unintentional neglect.

A commonly applied definition locally is that adopted in 1999 by the Australian Network for the Prevention of Elder Abuse, which states elder abuse is “any act occurring within a relationship where there is an implication of trust, which results in harm to an older person.  Abuse may be physical, sexual, financial, psychological, social and/or neglect.”

Elder abuse is any act that causes harm to an older person and is carried out by someone they know and trust, such as a family member or friend. The abuse may be physical, social, financial, psychological or sexual and can include mistreatment and neglect.

Elder abuse is one of the worst manifestations of ageism and inequality in our society, and most commonly occurs within the family. Elder abuse is believed to be greatly under-reported and the World Health Organisation (WHO) estimates it affects 1% to 10% of older people worldwide.

In 2002, WHO defined elder abuse as:

… a single, or repeated act, or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse. It can also be the result of intentional or unintentional neglect.

A commonly applied definition locally is that adopted in 1999 by the Australian Network for the Prevention of Elder Abuse, which states elder abuse is “any act occurring within a relationship where there is an implication of trust, which results in harm to an older person.  Abuse may be physical, sexual, financial, psychological, social and/or neglect.”

The National Disability Service and the National Disability Abuse and Neglect Hotline defines abuse of people with a disability as having occurred when someone’s human rights are violated by the actions of another person, and should be considered in terms of:

Exploitation:
Taking advantage of a person or situation in a way to get benefit

Neglect:
Failure by the person’s responsible caregiver to provide necessary care, aid or guidance 

Violence:
Threatening or using physical force that results in injury, psychological harm or death

Impact:
The physical and emotional effect of an action on a person.

Abuse and neglect can happen:

Deliberately:
Someone wants to harm or take advantage of a person

Accidentally:
People do not realise their actions are abuse or the impact their actions have on people they are supporting

Systemically:
Staff not trained or supervised properly or adequately supported to do their job, or not enough funding to meet needs.

Definitions of specific categories of abuse of vulnerable adults

The following section provides detailed information on the definitions of the five common classifications of abuse of the vulnerable. Detailed information is available as dropdown boxes under each of the sub-headings.

Sexual assault of a vulnerable adult is any sexual activity with the person if they:

  • lack the capacity to give or withhold consent
  • are threatened, coerced or forced to engage in sexual behaviour.

Sexual assault includes:

  • non-consensual sexual contact
  • exploitative behaviour
  • rape and indecent assault
  • sexual harassment or sexual interference in any form.

This type of abuse may be instigated by any person, against any other person of any age and of either gender.

Examples of sexual assault include:

  • anal or vaginal intercourse without consent
  • fingers or objects inserted into vagina or anus without consent
  • cunnilingus or fellatio without consent
  • masturbation of another person without consent
  • non-consensual touching of breasts or genitals
  • indecent exposure
  • masturbation by a person in the presence of the victim
  • voyeurism
  • displaying pornographic photography or literature.

Sexual misconduct

Sexual misconduct includes lower-level sexual harassment such as lewd or suggestive comments, teasing or insults with sexual connotations, but which does not necessarily equate to a criminal offence. Sexual misconduct may be categorised as:

  1. crossing professional boundaries, which includes sexually explicit comments and other overtly sexual behaviour
  2. grooming behaviour.

Crossing professional boundaries can reasonably be construed as involving an inappropriate and overly personal or intimate:

  • relationship with
  • conduct towards
  • focus on

the vulnerable adult.

Persistent low-level breaches of professional conduct in this area, or a single serious “crossing of the boundaries” may constitute sexual misconduct, particularly if the vulnerable adult’s caregiver either knew, or ought to have known, their behaviour was unwanted.

Behaviour should only be seen as “grooming” where there is evidence of a pattern of conduct by the vulnerable adult’s caregiver promoting sexual activity between them and for which there is no other reasonable explanation. The types of behaviours that may lead to such a conclusion include, but are not limited to, the following.

  1. Persuading the vulnerable adult they have a “special” relationship, for example by:
  • spending inappropriate “special time” with them
  • inappropriately giving gifts
  • inappropriately showing special favours
  • asking for the relationship to be kept “to themselves”.
  1. Testing boundaries, for example, by:
  • undressing in front of the vulnerable adult
  • encouraging inappropriate physical contact, even where it is not overtly sexual
  • talking about sex
  • “accidental” intimate touching.

It is inappropriate to extend a relationship outside of work entangling the vulnerable adult into the caregiver’s private life.

Physical assault is non-accidental injury or physical harm to a person by any other person. It includes but is not limited to inflicting pain or any unpleasant sensation, causing harm or injuries by excessive discipline, beating or shaking, bruising, electric shock, lacerations or welts, burns, fractures or dislocation, female genital mutilation and attempted suffocation or strangulation.  This type of abuse can be perpetrated by people known to the vulnerable adult, or by strangers.

Examples of physical abuse include:

  • hitting, smacking, biting, kicking, pulling limbs, hair or ears
  • bending back fingers, bending an arm up behind the back
  • dragging, carrying or pushing people who do not want to be moved unless involuntary relocation is part of a behaviour management plan
  • roughly handling a person while providing supports such as personal care or transfers
  • threatening violence
  • bathing in water too hot or too cold.

Unauthorised physical restraint (restrictive practices)

 Restraining or isolating an adult for reasons other than medical necessity or the absence of a less-restrictive alternative to prevent self-harm. Restrictive practices include using chemical, physical, mechanical, psycho-social and seclusion mechanisms, or the denial of basic human rights or choices such as freedom of religion, association or movement; or access to property or resources.

Forms of restraint:

Physical: prolonged application on any part of a person’s body to restrict their free movement.

Chemical: inappropriate use of medication to control a person’s behaviour.

Mechanical: inappropriate use of a device to restrict the free movement of a person.

Psycho-social: the use of verbal communications and/or threats of social or material punishment that elicit fear and restrain a person’s behaviour.

Seclusion: confinement in a room or area from which an exit is prevented, or where a person believes they cannot or should not leave a room without permission.

Use of restraints are not considered abuse if they are applied under a properly established behaviour management regime, with adequate approvals and oversight.

Neglect is a failure to provide the basic physical and emotional necessities of life. It can be wilful denial of medication, dental or medical care, therapeutic devices or other physical assistance to a person who requires it because of age, health or disability.  

Neglect can also be a failure to provide adequate shelter, clothing, food, protection and supervision, or to place people at undue risk through unsafe environments or practices and thereby exposing that person to risk of physical, mental or emotional harm. Neglect includes the failure to nurture or provide stimulation needed for the social, intellectual and emotional growth or wellbeing of a vulnerable adult.

Neglect may occur when the primary caregiver of a vulnerable adult does not provide the essential elements for life described above, or when any person or organisation responsible for providing care or services to a vulnerable adult fails to meet this obligation.

Neglect can be a single significant incident where a caregiver fails to fulfil a duty, but is usually the cumulative effect of an ongoing pattern of repeated failures by a caregiver to meet the vulnerable adult’s physical or psychological needs.

Examples of neglect include:

  • refusing to provide a vulnerable adult with food because they have not done what was asked of them
  • hurrying or rushing assistance with eating or drinking to fit in with staff timetables rather than vulnerable adult’s needs
  • withdrawing or denying of privileges, planned outings or personal items that are not designated and planned behaviour management strategies
  • depriving the vulnerable adult of their right to express their cultural identity, their sexuality or other desires
  • failing to ensure adequate food, healthcare support, clothing, medical aid or culturally relevant contexts and supports
  • denying use of a device for communication or for expression of needs.

NSW Family and Community Services 2016 Abuse and Neglect Policy for people with a disability identified three types of neglect.

Physical neglect
Failure to provide adequate food, shelter, clothing, protection, supervision, medical and/or dental care, or to place persons at undue risk through unsafe environments or practices. Examples of physical neglect include:

  • not supporting the person to maintain hygiene
  • not providing adequate medical or dental care
  • not maintaining their house
  • failing to report hazards
  • not completing annual comprehensive health, risk and swallowing assessments.

Emotional neglect
The failure to support and encourage, protect and provide stimulation needed for the social, intellectual and emotional growth or wellbeing of an adult or child. Examples of emotional neglect include:

  • ignoring a person
  • forced isolation
  • depriving a person of their right to express their cultural identity, their sexuality or other desires
  • not using a communication device to enable expression of needs or other communication.

Passive neglect:
Failure to provide, or the withholding of, the necessities of life including food, clothing and shelter or medical care. Examples of passive neglect include:

  • denial of dental or medical care, therapeutic devices or other physical assistance
  • failure to provide proper food, fresh fruit and vegetables.

There are particular classes of neglect that can be committed by a paid caregiver/worker against a vulnerable adult.

Supervisory neglect:
An intentional or reckless failure to adequately supervise or support a vulnerable adult that results in the death of, or significant harm to, that person; or involves a gross breach of professional standards and has the potential to result in the death of, or significant harm to, the vulnerable adult.

Failure to protect from abuse:
Involves an obviously unreasonable failure to respond to information that strongly indicates actual or potential serious abuse of a vulnerable adult.

Psychological or emotional abuse includes:

  • verbal assaults
  • threats of maltreatment
  • harassment
  • humiliation or intimidation
  • failure to interact with a person or to acknowledge that person’s existence.

Psychological abuse may also include denying cultural or religious needs and preferences.  Although any person may initiate psychological abuse towards a vulnerable adult, it is likely to come from people on whom the person relies or associates with regularly. The sources could be primary caregivers, family, friends or other service providers.

Examples of psychological or emotional abuse include:

  • humiliating a vulnerable adult for losing control of their bladder or bowel, or about other private matters
  • treating a vulnerable adult in ways that deny the person their dignity
  • denying the right of the vulnerable adult to make their own decisions (where capable)
  • preventing a vulnerable adult from expressing themselves out of fear of retaliation
  • discouraging personalisation of rooms or clothing
  • limiting social freedom available to a vulnerable adult
  • denying cultural needs, such as serving pork to a vulnerable adult of the Jewish or Muslim religions
  • shouting orders to a vulnerable adult
  • treating a vulnerable adult like a child
  • using humiliating names when speaking to a vulnerable adult
  • removing aids or equipment, for example, wheelchairs or communication devices.

Exposure to domestic violence:
Domestic violence is a range of abusive behaviours perpetrated in the victim’s home by someone well known to them. 

While the potential harm for a vulnerable adult being exposed to persistent domestic violence is less than that for a child (whose normative neurological development is put at risk) the vulnerable adult’s psychological wellbeing can be severely compromised by having to live in an environment of overwhelming threat and intimidation.

A vulnerable adult who is the target for/subject of domestic violence is likely a victim of a criminal offence.

Financial abuse is the improper use of another person’s assets or the use or withholding of another person’s resources. Possible sources of financial abuse are carers, families or guardians who act formally or informally as financial managers and have access to or responsibility for the vulnerable adult’s finances and property.

Examples of financial abuse include:

  • denying a person access to or control over their money when they have a demonstrated capacity to manage their own finances
  • denying a person access to information about their personal finances
  • taking a person’s money or other property without their consent (a likely criminal offence)
  • forcing changes to wills or other legal documents
  • having cheques or credit-card payments forged, or using a person’s personal banking cards without their authorisation
  • using a person’s belongings
  • improper use of another person’s assets or the use or withholding of another person’s resources.

The NSW Family and Community Services 2016 Abuse and Neglect Policy for people with a disability identifies systemic abuse as a form of harm committed against vulnerable adults and defines it as the failure to recognise, provide or attempt to provide adequate or appropriate services, including services that are appropriate to the person’s age, gender, culture, needs or preferences.

Examples of systemic abuse include:

  • service providers arriving late or leaving early (without agreement)
  • relevant policies and procedures note being implemented
  • people denied the option to make decisions affecting their lives
  • unacceptable staff attitudes becoming normalised
  • lack of policy awareness and inadequate staff training and education
  • service or social isolation
  • not identifying and reporting abuse and neglect
  • creating dependence on one carer or service for all support
  • denying access to a telephone, internet or significant others or a way to independently leave the house
  • failure to provide adequate or appropriate services.

Legal or civil abuse:
A particular subset of systemic abuse that involves the denial of access to justice or legal systems that is available to other citizens.  Civil abuse includes:

  • denial of access to protection
  • no legal support or representation with known reports of abuse.

Information required to report abuse

Reporting suspected abuse of vulnerable adults can be the first step in a process. Protective authorities require information. However, if you do not possess all the following information, you should still report your concerns.

In its most simple form, the information required to make a report is:

Who did what to whom, when and where?

Useful information about the vulnerable adult includes:

  • name or alias or other means of identifying them
  • age and date of birth (or approximation)
  • home and/or mobile phone number
  • their “person responsible” or their appointed guardian
  • language, religion and other cultural factors
  • residential address or whereabouts
  • other residents of the house — private home or residential service
  • nature/type, severity, impact on functioning and other key details of disability/medical condition
  • services involved
  • other potential protective factors, if known.

The information about the alleged abuser includes:

  • name or alias or other means of identifying them
  • relationship to the vulnerable adult — spouse, relative, neighbour, NDIS/care worker, other service provider.

The NSW Ageing and Disability Commission

The focus of the NSW Ageing and Disability Commissioner is to:

  • provide support to those at need
  • raise community awareness to reduce and prevent abuse, neglect and exploitation toward older people and adults with disability
  • investigate concerns and allegations of abuse, neglect and exploitation
  • report and advise government on related systemic issues.

The Commissioner will step in where no other complaint or investigative body can in NSW, by looking in to and investigating cases of abuse, neglect and exploitation of older people and adults with disability.

The Commissioner’s role does not investigate the conduct of paid service providers for older people or adults with disability. Instead, the focus is on the conduct of the persons family and other informal supports, or members known to them from the community.

The Commissioner has the power to request further information from a person or body or apply for and execute search warrants to collect evidence as part of an investigation. These powers will only be used if absolutely necessary.

Contact the NSW Ageing and Disability Commission:

For detailed information on the Ageing and Disability Commission and access to online resources:
https://www.ageingdisabilitycommission.nsw.gov.au/
P:    02 4904 7500
E:    Commissioner@adc.nsw.gov.au

Contact the Ageing and Disability Abuse Helpline:
To report allegations of abuse or neglect of frail aged or adults with disabilities:
P:    1800 628 225 (9am-5pm Mon-Fri)
E:    nswadc@adc.nsw.gov.au

Where to report abuse and neglect

This section will be of assistance if you are unable or unwilling to contact the NSW Ageing and Disability Commission or you believe it is more appropriate to make direct contact with the particular responsible authority.

Emergency:
If the vulnerable adult is seriously injured or in need of urgent medical help, if they or you are being threatened, or if you just witnessed a serious accident or crime; stay calm and ring 000.

Criminal offence:
If you believe a criminal offence has been committed against a vulnerable adult, but it does not warrant a 000 call, you should contact the local Police station. You can locate the local Police station online:
www.police.nsw.gov.au/about_us/regions_commands_districts/police_station_search

You may contact the Police Assistance Line:

P:   131 444 (available 24 hours, 7 days a week)

Victim of domestic violence:
If the vulnerable adult is a victim of domestic or family violence, you should ring the National Sexual Assault, Domestic and Family Violence Counselling Service for advice, support and referrals.
P:   1800 737 732 available 24 hours, 7 days a week

Reporting alleged abuse by an NDIS worker:
If the vulnerable adult is being abused by a person employed by a NDIS service or by a peer in a NDIS service, contact the NDIS Quality and Safeguards Commission:
www.ndiscommission.gov.au

P:   1800 035 544 (9am-5pm Mon-Fri)

Online complaint:
www.forms.business.gov.au/smartforms/servlet/SmartForm.html?formCode=PRD00-OCF

Reporting alleged abuse or neglect of as vulnerable adult:

If you believe a vulnerable adult has been the subject of abusive or neglectful conduct involving a diocesan worker or person acting in the name of the Diocese or the abuse occurring in a diocesan setting, you must report it to the Office of Safeguarding:

P:  02 4979 1390 available during office hours Monday to Friday

E:   childprotection@mn.catholic.org.au

For more information on the reporting time frames imposed on Diocesan workers, please refer to the web page on Diocesan workers’ obligations to report abuse, specifically the section titled Reporting Timeframes: