Speech for Minister Áine Brady TD for the opening of the Open Your Eyes conference on World Elder Abuse Awareness Day
Good morning everyone, and welcome to this important national conference on World Elder Abuse Awareness Day. I am delighted to be here today to launch “Open Your Eyes” – the Health Service Executive’s Elder Abuse Media and Public Awareness Campaign. I would like to thank the National Centre for the Protection of Older People, UCD for hosting this event. Today we have an invaluable opportunity to share experiences, generate awareness, and most importantly, further develop the discussion on approaches needed to tackle elder abuse.
Elder abuse is a complex issue and difficult to define precisely. It may involve financial abuse, physical abuse, psychological abuse, sexual abuse or it may arise due to inadequacy of care. Current policy on elder abuse is outlined in the 2002 Report of the Working Group on Elder Abuse Protecting our Future and the review of that Report in 2009. Protecting Our Future defines 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 or violates their human and civil rights.” That Report recommended that a “clear policy on elder abuse is formulated and implemented at all levels of governance within the health, social and protection services in Ireland”. I am very pleased that substantial progress has been made and continues to be made, especially in the health services, in implementing the recommendations of these reports.
Elder abuse in any form is totally unacceptable and I can reiterate my full commitment to tackling all forms of elder abuse. However elder abuse is a societal as distinct from a health problem and therefore requires us, as a civic society, to recognise elder abuse and to report it if we come across it. Significant progress has been made in the last few years in developing the structures needed to tackle this abuse. The indications are that these structures are working. It is imperative that this progress continues, that any gaps are identified and addressed in full and, that older people are emboldened to report their anxieties to a social worker, a public health nurse, a member of the Garda Siochána, or any professional or care worker. These are important key objectives.
Although we do not know the prevalence of elder abuse in Ireland, we can assume that the instance is not unlike that in other developed countries. Studies have shown that around 3 to 5 per cent of older people living in the community may suffer abuse at any one time. In Ireland, this could mean that between 14,000 and 23,000 people living in the community may be suffering from abuse, neglect or maltreatment. The National Research Centre for the Protection of Older People has commenced work on determining the prevalence of older abusing in Ireland and I look forward to reading the Centre’s research findings which are due later in the year. 2009 Referrals
You will have heard from Bridget earlier about the recent developments in the HSE’s collection and analysis of data relating to allegations of elder abuse. I won’t go into great detail but it is worth mentioning the increase in referrals from 1,840 cases in 2008 to 1,870 in 2009. Paradoxically, any increase in referrals is a good thing, as we know that under-reporting of elder abuse is a global issue, of concern to us all. Any increase in the number of referrals shows that the programmes, and structures in place for reporting the incidence of elder abuse, are working. In the main, the trends for the 2009 referrals repeat those for 2008, with one or two exceptions.
The statistics do not make for easy reading. The majority of alleged abuse victims are women 62%. Proportionally, the reported rate of alleged abuse increases in the over 80 years age group. It is a key concern that the predominant alleged persons causing anxiety are those that have the closest relationship to the person i.e. son/daughter (46%), partner/ husband/ spouse (18%), and other relative (20%). Nationally, in 53% of cases, the alleged person causing concern is living with the older person. The majority of referrals relate to individuals who live at home (83%).
Central to the elder abuse programme, is the identification of issues for the client, and the tailoring of interventions and supports to meet their needs. In 2009, 85% of clients referred were offered services. That year saw a more comprehensive range of supports on offer to clients which included day care, advocacy and conflict mediation.
These findings are in keeping with the experience elsewhere, as is the finding that, in a significant number of cases, the person causing concern is likely to have mental health, substance abuse or behavioural problems. Supports offered to persons causing concern include referral to mental health and addiction services. We are dealing with a complex set of problems here.
Review of Protecting our Future
As I mentioned earlier current policy on elder abuse is derived from the 2002 report Protecting Our Future and the Review of that Report in 2009. In commissioning the Review, we were particularly anxious that any gaps in policy be identified, and that research on areas not covered in the original report be carried out. These included financial abuse, institutional abuse and self-neglect. I was pleased that the Review Report found that “progress was most evident and pronounced in the health sector”. It did, however, acknowledge that significant issues, such as financial abuse, were not being addressed in a sufficiently coherent and comprehensive way. The Review continued to make recommendations around three main areas:-
- strengthening existing institutional arrangements,
- accelerating progress on existing recommendations in Protecting our Future, and
- addressing emerging areas of concern.
Performance and Activity Indicators were developed in 2009 which will assist in monitoring and planning for the service into the future. In addition, an Action Plan has been developed, in conjunction with the HSE, to implement the outstanding proposals in the Report.
National Centre for the Protection of Older People
The establishment of the National Centre on the Protection of Older People is of significant importance. The principal function of the Centre is to create a knowledge base of Irish and international research on the occurrence, prevalence, detection and response to abuse of older people. The objective of the Centre is to place elder abuse in the wider social context, which is essential for the development of a sound service. Financial abuse, ageism and discrimination are key issues which cannot be resolved solely within the HSE. Therefore the opportunity to inform policy across a wide range of departments and agencies will be strengthened by a Centre that has an inter-agency mandate.
The Centre has completed a number of reviews and studies, one of which considered the public’s perception of elder abuse. It is important to note that the review highlighted the need to increase the public’s knowledge about elder abuse, especially among older people themselves.
As we all know many older people may be reluctant to report abuse, particularly because elder abuse, by definition, occurs within a relationship in which there is an expectation of trust. If an older person is being abused by a close family member, the older person may not wish to upset that relationship. Similarly, if the abuse is perpetrated by a carer, the older person may be reluctant to report it. Sometimes neither the abused nor the abuser may recognise the actions as abuse. This may be particularly true in cases of financial or psychological abuse. Either of these forms of abuse can be more insidious, and less easily recognised, than any other type of abuse.
I would like to commend the HSE for a comprehensive public awareness campaign aimed at elder abuse in community settings, which also includes a focus on financial abuse. The majority of referrals originate in the community, and are reported through the Public Health Nurse. The training DVD, leaflets, and legacy card being launched here today will go a long way to addressing the gap in information that exists in community settings. Over 55,000 people – which includes many of you here today – are engaged in activities that brings them into contact with older people on a daily basis. People providing home help, meals-on-wheels services, home visitation groups, active retirement associations, and community groups etc., are in a unique position to identify signs of elder abuse. The challenge is to equip these individuals with the skills and knowledge to enable them to recognise, and respond appropriately to elder abuse. It is important that we continue to create awareness of the elder protection services provided by the HSE and other agencies.
The potential abuse of our older people – including financial abuse – is of concern to us all. The Department of Health and Children will continue to work closely with the HSE and other agencies until the best possible measures are in place to protect our vulnerable older people.
The main goal of any response to elder abuse is prevention. There are two types of prevention – primary prevention, i.e., stopping elder abuse from happening in the first place, and secondary prevention, i.e., when it does happen, taking steps to ensure that it does not happen again. The progress made by the health sector has been found to be effective in tackling elder abuse. Today I have focused mainly on the HSE because of the key importance of its Elder Abuse Service. But some types of abuse, for example financial abuse, require action from other agencies and will be a priority focus from now on. In addition, negative attitudes towards, and perceptions of, ageing and older people can lead to intolerance and acceptance of abuse. We have to be ever mindful to eliminate ageism and ageist attitudes. These are not the only factors contributing to elder abuse but can give rise to a culture or an environment in which elder abuse can develop, leading to age discrimination, and devaluing and disempowering older people. Strategy for Positive Ageing
We must plan ahead now to make Ireland an ‘age-friendly’ country in which every individual, regardless of their age, can access the kinds of services and supports that enable them to live healthy, fulfilling and independent lives in their own homes and communities for as long as possible.
As Minister for Older people one of my main priorities is to develop a National Positive Ageing Strategy which will set out a common framework for the development of operational plans by Government Departments. They will clearly set out their objectives relating to older people, as well as the development of ongoing mechanisms designed to monitor progress and identify challenges facing older people in the future.
I intend to have a very broad-ranging Positive Ageing Strategy, which will have a much wider focus than on health and personal social services. Of course, health and social services are vitally important, but it is my belief that all services and all sectors are relevant to older people and the Strategy that I am developing will reflect that broader focus in setting the direction for all future policies, programmes and services relating to older people. I do of course envisage that the Strategy will include a recommendation on the evaluation of the approaches and responses needed to prevent and tackle elder abuse.
Conclusion In conclusion I would like to re-iterate my Government’s commitment to improving protection services for this vulnerable section of our society. We have made great strides recently in developing appropriate services and raising awareness of elder abuse. However we cannot become complacent – we need to continue to raise awareness, carry out further research and develop appropriate mechanisms to work in collaboration with each other.