Identifying and responding to the abuse of older people

Identifying and responding to
the abuse of older people:
the –step approach
Prepared by:
NSW Elder Abuse Helpline & Resource Unit (EAHRU)
2016
NSW Elder Abuse Toolkit
5
Disclaimer
This toolkit is provided for your information only. This toolkit is not intended to be
comprehensive, and it does not constitute and must not be relied on as legal advice.
No responsibility is taken for any loss suﬀered as a result of the information given herein.
The case scenarios used in this toolkit are fctitious and developed for training purposes only.
The 5-step approach should only be used if this is within your professional capability and
job role.
Copyright
© EAHRU (2016). The publication, ‘NSW Elder Abuse Toolkit – Identifying and Responding
to the Abuse of Older People: the 5–step Approach’ is copyright. No part of this publication
may be altered in any way.
3
Contents
INTRODUCTION 5
THE 5–STEP APPROACH TO IDENTIFYING AND RESPONDING TO THE ABUSE OF
OLDER PEOPLE 7
SECTION 1: THE TOOLS 9
STEP 1: IDENTIFY ABUSE (suspected, witnessed or disclosed) 9
Key messages 9
Step 1: Tools 9
Tool 1.1 Financial abuse: behaviours and signs 1 1
Tool 1.2: Psychological abuse: behaviours and signs 12
Tool 1.3: Neglect: behaviours and signs 13
Tool 1.4: Physical abuse: behaviours and signs 14
Tool 1.5: Sexual abuse: behaviours and signs 15
Tool 1.6: Abuse types – behaviours and signs 16
Tool 1.7: Risk factors for abuse 18
Tool 1.8: Elder abuse risk factor assessment checklist 19
Tool 1.9: Eﬀective questioning: tips and suggestions 20
Tool 1.10: Red ﬂags 23
Tool 1.11: Elder Abuse Suspicion Index (EASI) 24
Tool 1.12: The Modifed Caregiver Strain Index (MCSI) 25
Tool 1.13: Domestic Violence Safety Assessment Tool (DVSAT) 27
STEP 2: ASSESS IMMEDIATE SAFETY 29
Key messages 29
Step 2: Tools 29
Tool 2.1: Responding to risks 31
Tool 2.2: What to do in an emergency: Q & A 32
Tool 2.3: Worker safety tips for home visits 33
Tool 2.4: Police reports 34
STEP 3: PROVIDE SUPPORT 35
Key messages 35
Step 3: Tools 35
Tool 3.1: Recommendations for communicating with older adults 36
Tool 3.2: Checklist – triggers that might indicate a need for a capacity
assessment 37
Tool 3.3: Communication tips – talking to a person with dementia 38
Tool 3.4: Responding with compassion – talking to a person who has been
sexually assaulted 39
Tool 3.5: Communication with older people from a CaLD background 40
Tool 3.6: Communicating eﬀectively with Aboriginal and Torres Strait
Islander people 42
STEP 4: INFORM MANAGER & DOCUMENT 47
Key messages 47
Step 4: Tools 47
Tool 4.1: The general principles of documentation 49
Tool 4.2: Sample report form 50
Tool 4.3: Barriers to reporting 51
STEP 5: RESPOND & REFER 53
Key messages 53
Step 5: Tools 54
Tool 5.1: Flow chart: responding to the abuse of older people 55
Tool 5.2: Key fnancial support agencies 56
Tool 5.3: Key health agencies 57
Tool 5.4: Key social and welfare agencies 59
Tool 5.5: Key legal and justice agencies 60
Tool 5.6: Diﬀerence between Power of Attorney and Enduring Guardianship:
it’s important you know the diﬀerence 62
Tool 5.7: Revoking a Power of Attorney 63
Tool 5.8: Assessing needs of an older person 64
Tool 5.9: Example of a safety plan for a person experiencing abuse 65
Tool 5.10: Policy checklist 66
Case studies 7 1
SECTION 2: SUPPORTING INFORMATION 75
What is elder abuse? 75
Glossary 75
Principles that guide the way we work with older people 76
Ageism and discrimination 76
Charter of Victims’ Rights 77
Capacity and consent 77
Carers 78
Confdentiality 79
Dementia 79
Working with people from culturally and linguistically diverse backgrounds 79
Working with Aboriginal and Torres Strait Islander people 81
Working with Lesbian, Gay, Bisexual, Transgender and Intersex older people 82
Domestic and family violence 84
Enduring Guardianship 85
Powers of Attorney and Enduring Powers of Attorney 85
United Nations Principles for Older Persons 86
APPENDICES 87
Appendix 1: Legislation and guidelines 87
Appendix 2: Bibliography 88
5
Welcome to the toolkit, ‘Identifying and Responding to the Abuse of Older People:
the 5–step Approach’.
The 5–step approach to identify and respond to abuse of an older person provides
a framework for agencies that have staﬀ, including volunteers, in positions where the
abuse of an older person may be suspected, witnessed, or disclosed. This approach
is aligned to the NSW Interagency Policy. Each section of the toolkit will focus and
expand on these steps.
While there is no mandatory reporting of abuse of older people living in the community, it is expected that agencies will have policies and procedures in place that
guide an appropriate response. There are some circumstances where agencies are
required to report abuse to the NSW Police.
Where the abuse of the older person is reported to have occurred in a Commonwealth-funded Residential Aged Care setting, mandatory reporting applies and
agencies should report to the Australian Government Department of Health on
1800 081 549.
The NSW Elder Abuse Helpline & Resource Unit (EAHRU)
The release of the NSW Ageing Strategy 2012 provided an impetus for establishing a
state-wide specialist helpline and resource unit, which commenced in February 2013.
The EAHRU is a key body that supports the implementation of the NSW Interagency
Policy.
The Helpline provides a free, confdential telephone service for anyone with a concern about an older person who lives in the community and believes the older person is being abused or is at risk of abuse.
The Helpline is available Monday to Friday, 8.30 am to 5 pm. Call 1800 628 221. Anyone can make the call.
Introduction
“We all have the right to live free from abuse
of any kind. Our age or circumstances should
have no bearing or eﬀect on this basic right.”
Age UK Fact Sheet, Safeguarding older people from
abuse, Fact Sheet 78, December 2015
7
The 5–step approach to identifying and
responding to the abuse of older people
STEP 1: IDENTIFY ABUSE (suspected, witnessed or disclosed)
• Ask questions and gather further information.
STEP 2: ASSESS IMMEDIATE SAFETY
• Determine the level and urgency of safety concerns for the older person and others.
• In the event of an emergency, contact emergency services.
• Consent of the older person is not necessary in emergency situations.
• Protect evidence.
• Follow your workplace policy and procedures for internal reporting.
• If not an emergency, continue to step 3.
STEP 3: PROVIDE SUPPORT
• Listen to the older person.
• Acknowledge what they tell you.
• Validate their experience.
• Check for capacity indicators.
STEP 4: INFORM MANAGER & DOCUMENT
• Report suspected, witnessed or disclosed abuse to your manager or supervisor.
• Document the abuse and action/s taken, following your own workplace policy and protocols.
• Document if the older person has capacity and refuses intervention.
STEP 5: RESPOND & REFER
• Ask the older person what they want to do about their situation. If the older person lacks
capacity, include the substitute decision–maker (if this person is not the abuser) in the
conversation.
• Discuss referral options.
• Seek consent from the older person or, when lacking capacity, the appropriate substitute
decision–maker to make a referral.
• Make appropriate referrals.
• Leave information (if safe to do so) if the older person refuses assistance, and keep the
lines of communication open.
• Consider implementing any local or regional protocols, interagency protocols and service
coordination plans.
• Ensure procedures are in place for coordination and/or monitoring, and follow–up as
required.

9
Section 1: The Tools
1
STEP 1: IDENTIFY ABUSE (suspected, witnessed or disclosed)
• Ask questions and gather further information.
Key messages
Identifying that an older person is, or may be experiencing abuse is the frst step in
preventing abuse reoccurring. The relationship between staﬀ and the older person
means staﬀ are often best placed to recognise changes that may suggest a client is
being abused. Staﬀ should remain observant and aware to the indicators of abuse,
especially where there is no disclosure or witnessing of the abuse.
In NSW, fve forms of abuse of older people are recognised:
• Financial abuse.
• Psychological abuse (including social isolation).
• Neglect – intentional or unintentional. (This does not include self-neglect or
self-harm).
• Physical abuse.
• Sexual abuse.
It is important to recognise that diﬀerent forms of abuse may co-exist. For example,
psychological abuse often underpins several other types of abuse, e.g. coercing a
person to sign a document or threatening them to hand over money is both fnancial
and psychological abuse.
Discussing what was observed with a manager can help determine the health and
safety of an older person.
The presence of one or more indicators of abuse does not necessarily mean abuse
has occurred. Indicators of abuse are not always obvious and can vary.
Step 1: Tools
Tool 1.1: Financial abuse: behaviours and signs.
Tool 1.2: Psychological abuse: behaviours and signs.
Tool 1.3: Neglect: behaviours and signs.
Tool 1.4: Physical abuse: behaviours and signs.
Tool 1.5: Sexual abuse: behaviours and signs.
Tool 1.6: Abuse types – behaviours and signs.
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
10
Tool 1.7: Risk factors for abuse.
Tool 1.8: Elder abuse risk factor assessment checklist.
The risk assessment checklist can be used when abuse is suspected. The checklist
proposes a number of questions about the older person’s circumstances.
Tool 1.9: Eﬀective questioning: tips and suggestions.
Provides examples of open and direct questions with some additional tips and
suggestions.
Tool 1.10: Red ﬂags.
This tool illustrates a range of behaviours from both the older person and the abuser
that may indicate abuse is occurring.
Tool 1.11: Elder Abuse Suspicion Index (EASI).
The EASI is a validated tool developed to raise a doctor’s awareness about elder abuse.
Tool 1.12: Modifed Caregiver Strain Index (MCSI).
The MCSI is a tool that can be used to quickly screen for caregiver strain. It is a tool
that measures strain related to care provision. There is at least one item for each of
the following major domains: fnancial, physical, psychological, social and personal.
The higher the score on the MCSI, the greater the need for more in-depth assessment to facilitate appropriate intervention.1
Tool 1.13: The Domestic Violence Safety Assessment Tool (DVSAT).
“The DVSAT has been developed to help service providers consistently and accurately
identify the level of threat to domestic violence victims. Consistent identifcation of
threat through use of a common tool by service providers across NSW promotes a
shared understanding of domestic violence, its indicators, dynamics and consequences.
Eﬀective identifcation of threat allows service providers to oﬀer victims appropriate
tailored support; prioritise victims at greater risk of harm; and take action to prevent
violence from escalating.”2
1 Try this: Best practices in nursing care to older adults, Issue 14 revised 2013. The Modifed
Caregiver Strain Index (MCSI).
2 rlc.org.au, Using DV Safety Assessment Tool in client interviews.
”Any form of abuse is unacceptable,
no matter what justifcation or
reason may be given for it, and it
is very important that older people
are aware of this and that they
know that support is available.”
Age UK Fact Sheet (2015)
‘Safeguarding older people from abuse’,
December 2015
10
11
Anna’s story
Anna is an 82–year–old woman who has a chronic illness and poor mobility. Her son, Tom
moved in to be Anna’s carer after his marriage broke down.
Tom does the shopping using Anna’s ATM card and never shows her the receipts when she asks.
There are unpaid bills piled on the table and Anna tells you that she cannot aﬀord community
services any more.
Behaviours – Tom never shows Anna the ATM receipts.
Signs – Unpaid bills on the table and Anna wants to cancel community services.
Step 1 Tools: Identify Abuse
Tool 1.1 Financial abuse: behaviours and signs
Financial abuse is the illegal or improper use of an older person’s assets.3 Assets
can include property and fnances.
Behaviours:
• Threatening, coercing or inﬂuencing a person to change their Will or sign documents relating to their assets.
• Taking control of a person’s fnances against their wishes and denying access to
their own money.
• Abusing Powers of Attorney by taking money or property.
• Stealing goods, e.g. jewellery, credit cards, cash, food or other possessions.
• Stealing money such as pension–skimming and selling belongings without the
person’s permission.
• Recent addition of a signature on a bank account.
Signs:
• Unexplained disappearance of belongings.
• Unauthorised use of banking and fnancial documents.
• Inability to pay bills.
• Signifcant bank withdrawals.
• Changes to Wills.
• Inability of a person to access bank accounts or statements.
• Stockpiling of unpaid bills.
• Insufcient food in the fridge.
• Disparity between living conditions and money.
• No money to pay for essentials for the home including food, clothing or utilities.
• Cancelling or refusing community services.
3 Family & Community Services, NSW Interagency Policy.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 1.2: Psychological abuse: behaviours and signs
Psychological abuse is the inﬂiction of mental stress, fear or feelings of shame and
powerlessness. It may be verbal or non-verbal, and is usually a pattern of behaviour
repeated over time and intended to control the person. Psychological abuse includes
social isolation.4
Behaviours
• Pressuring, bullying, intimidating and harassing a person.
• Verbal abuse, including name-calling.
• Frightening and/or threatening to harm someone, or break belongings.
• Threats to harm someone’s pet.
• Threats of placing a person into an aged-care facility.
• Treating an older person as if they are a child.
• Engaging in emotional blackmail.
• Preventing contact with family and friends.
• Denying access to services, religious (spiritual) and/or cultural events.
• Misusing the function of Enduring Guardianship.
• Screening telephone calls, listening in to calls or disconnecting the telephone
without the person’s consent, or withholding mail.
• Taking control of the person’s home without their consent.
• Moving a person far away from family or friends or otherwise socially
isolating a person.
• Withholding aﬀection.
Signs
• Feelings of helplessness, shame and powerlessness.
• Changes in levels of self-esteem.
• Sadness or grief at the loss of important relationships.
• Depression, withdrawal or listlessness due to a lack of social interaction.
• Worry or anxiety after a visit by a specifc person.
• Confusion, agitation and social withdrawal.
• Unexplained paranoia or excessive fear and anxiety.
• Disrupted appetite or sleep patterns.
• Unusual passivity or anger.
4 Family & Community Services, NSW Interagency Policy.
Maria’s story
Maria is an 80–year–old woman with limited English. She has a recent diagnosis of depression. Maria
lives with her husband, Vincent and daughter, Theresa who moved in 4 months ago. Theresa notices
that her father is very controlling, puts her mother down; he also refuses to take Maria to church,
despite her asking repeatedly.
Theresa has concerns about her mother’s safety and thinks she is becoming quite withdrawn.
There is a history of domestic and family violence.
Behaviours – Vincent is verbally abusive, and is socially isolating Maria.
Signs – Maria is becoming withdrawn.
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Tool 1.3: Neglect: behaviours and signs
Neglect is a term used to describe the failure of a carer or responsible person to
provide the necessities of life to an older person. Some examples are adequate food,
shelter, clothing, medical or dental care and neglecting to meet a person’s emotional
needs.5
Behaviours
• Failure to provide adequate: food; shelter; clean clothing; heating/cooling;
medicines; medical or dental care.
• Under- or over-medicating.
• Refusal to permit others to provide assessments or appropriate care.
• Preventing the person from accessing services and/or equipment and support.
• Exposure to danger or lack of supervision.
• An overly attentive carer in the company of others; the “hovering carer”.
• Misusing the role of Guardian.
Signs
• Inadequate clothing; complaints by the person of being too cold or too hot.
• Poor personal hygiene; unkempt appearance.
• Lack of medical or dental care.
• Injuries that have not been properly cared for.
• Absence of required assistive technologies.
• Exposure to unsafe, unhealthy or unsanitary conditions.
• Unexplained weight loss; dehydration; and malnutrition.
• Poor skin integrity, e.g. pressure sores.
Self-neglect is not considered a form of elder abuse, although it can be a sign of abuse
if, for example, the person is feeling hopeless or depressed from an abusive situation.
Self-neglect may include living in unsafe or unhygienic conditions, refusing to seek or
comply with treatment for injury or illness or failing to eat or drink adequately.
Joe’s story
Joe is a 79–year–old gentleman; he has a diagnosis of dementia and other chronic illnesses. He
lives in social housing with his son, Ben who is his carer and Power of Attorney.
Ben has cancelled Joe’s aged-care services. Joe’s clothes are soiled and dirty and he appears
to have lost weight.
Behaviours – Joe’s son has cancelled aged-care services.
Signs – Joe has lost weight and has soiled, dirty clothes.
5 Family & Community Services, NSW Interagency Policy.
Step 1 Tools: Identify Abuse
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 1.4: Physical abuse: behaviours and signs
Physical abuse involves the inﬂiction of physical pain or injury, or physical
coercion.6
Behaviours
• Pushing, shoving or rough–handling.
• Kicking, hitting, punching, slapping, biting, or burning.
• Restraining: physically or medically.
• Locking the person in a room or home.
• Intentional injury with a weapon or object.
• Overuse or misuse of medications.
Signs
• Internal or external injuries (sprains; dislocations and fractures; pressure
sores; unexplained bruises or marks on the body; pain on touching or injuries at diﬀerent stages of healing).
• Broken or healing bones.
• Lacerations to mouth, lips, gums, eyes or ears.
• Missing teeth and eye injuries.
• Evidence of hitting, punching, shaking or pulling (e.g. bruises, lacerations,
choke marks, hair loss or welts).
• Burns (e.g. rope, cigarettes, matches, iron, or hot water).
• Discrepancies between an injury and the explanation of how it happened.
George’s story
George is a 78–year–old gentleman. While undergoing rehabilitation for a knee replacement, he has resided with his son, Ken and Ken’s family.
George has bruising on his arms and says that Ken gets angry and has grabbed him but
doesn’t mean anything by it.
Behaviours – George disclosed that Ken gets angry and has grabbed him.
Signs – Evidence of bruising on George’s arms.
6 Family & Community Services, NSW Interagency Policy.
15
Tool 1.5: Sexual abuse: behaviours and signs
Sexual abuse is a term used to describe a range of sexual acts where the victim’s consent has not been obtained or where consent has been obtained through coercion.7
Behaviours
• Sexual assault: touching or penetration of the vagina or anus.
• Indecent assault: any unwanted sexualised behaviour such as grabbing someone’s
breast or penis; exposing genitals.
• Aggravated sexual assault: indicates use of a weapon, force or threat.
• Non-consensual sexual contact and other sexual behaviours.
• Cleaning or treating the older person’s genital area roughly or inappropriately.
• Unwanted exposure to pornography.
• Enforced nudity of an older person.
• Sexual harassment: any unwanted or unwelcome sexual behaviours.
• Any behaviour that makes an older person feel uncomfortable about their body
or gender.
Signs
• Unexplained STD or incontinence (bladder or bowel).
• Injury and trauma (scratches, bruises etc.) to face, neck, chest, abdomen, thighs
or buttocks.
• Trauma including bleeding around the genitals, chest, rectum or mouth.
• Torn or bloody underclothing or bedding.
• Human bite marks.
• Difculty walking, sitting or pain when toileting.
• Anxiety around the perpetrator and other psychological symptoms.
• Fear of being touched.
Tess’s story
Tess is an 83–year–old woman. She lives in a granny ﬂat adjoining her daughter, Jackie and
son-in-law, John’s property.
Unbeknownst to Jackie, John has been making unwelcome visits to Tess. John exposes himself
and talks about what he would like to do with Tess in a sexually explicit way.
Tess wants to move away but worries if she tells her daughter, it will ruin their relationship.
Behaviours – John is exposing himself and using sexually explicit language.
Signs – Tess is worried and wants the behaviours to stop.
7 Family & Community Services, NSW Interagency Policy.
Step 1 Tools: Identify Abuse
16
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People

Financial	Psychological	Neglect	Physical	Sexual
Behaviours: Threatening, coercing re: assets or Wills; Taking control of the older person’s fnances against their wishes and denying access to their own money; Abusing Powers of Attor ney; Stealing goods, e.g. jew ellery, credit cards, cash, food, and other possess ions; Unauthorised use of banking and fnancial documents; and The recent addition of a signature on a bank account.	Behaviours: Pressuring, intimidating or bullying; Name–calling, and verbal abuse; Treating an older person like a child; Threatening to harm the person, other people or their pets. Engaging in emotional blackmail such as threat ening to withdraw access to grandchildren, family, friends, services, or placement in an aged– care facility. Preventing contact with family and friends, or denying access to the phone or computer; Withholding mail; Preventing an older person from engaging in religious or cultural prac tices; and Moving an older person far away from family or friends.	Behaviours: Failure to provide basic needs, e.g. food, ade quate or clean clothing, heating, medicines; Under- or over medication; Exposure to danger or lack of supervision, such as leaving the older per son in an unsafe place or in isolation; An overly attentive carer in the company of others; and Refusal to permit others to provide appropriate care.	Behaviours: Pushing, shoving, or rough-handling; Kicking, hitting, punch ing, slapping, biting, and/ or burning; Restraining: physical or medical; Locking the person in a room or home or tying a person to a chair or bed; Intentional injury with a weapon or object; and Overuse or misuse of medications.	Behaviours: Non-consensual sexual contact, language or ex ploitative behaviour; Rape and sexual assault; Cleaning or treating the person’s genital area roughly or inappropri ately; Unwanted exposure to pornography; Enforced nudity of a person; and Any behaviour that makes an older per son feel uncomfortable about their body or gender.

Tool 1.6: Abuse types – behaviours and signs
17

Financial	Psychological	Neglect	Physical	Sexual
Signs: Unexplained disappear ance of belongings; Inability to pay bills; Signifcant bank with drawals and/or changes to Will. Inability of an older person to access bank accounts or statements. Stockpiling of unpaid bills. Disparity between living conditions and money; and No money to pay for essentials for the home including food, clothing, and utilities.	Signs: Resignation, shame; Depression, tearfulness; Confusion, agitation, and social isolation; Feelings of helplessness; Unexplained paranoia or excessive fear; Disrupted appetite or sleep patterns; Unusual passivity or anger; Sadness or grief at the loss of interactions with others; Social withdrawal; Changes in levels of self-esteem; and Worry or anxiety after a visit by specifc person/ people.	Signs: Inadequate clothing; complaints of being too cold or too hot; Poor personal hygiene; unkempt ap pearance; Lack of medical or dental care, or injuries that have not been properly cared for; Absence of required aids; Exposure to unsafe, unhealthy, and/or unsani tary conditions; and Unexplained weight loss, dehydration, poor skin integrity, malnutrition.	Signs: Internal or external inju ries (sprains, dislocations and fractures, pressure sores, unexplained bruis es or marks on diﬀerent areas of the body, pain on touching); Broken or healing bones; Lacerations to mouth, lips, gums, eyes or ears; missing teeth and/or eye injuries; Evidence of hitting, punching, shaking, pull ing, e.g. bruises, lacera tions, choke marks, hair loss or welts; and Burns, e.g. rope, ciga rettes, matches, iron, and/or hot water.	Signs: Unexplained STD or incontinence (bladder or bowel). Injury and trauma, e.g. scratches, bruises etc. to face, neck, chest, abdo men, thighs or buttocks. Trauma including bleed ing around the genitals, chest, rectum or mouth. Torn or bloody under clothing or bedding. Human bite marks; and Anxiety around the perpetrator.

Step 1 Tools: Identify Abuse
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 1.7: Risk factors for abuse
Understanding the factors that contribute to abuse of older people supports agencies in identifying, responding and preventing abuse. Research refers to compounding factors such as the personality and individual circumstances of the abuser, family
dynamic, medical, social, environmental and situational factors as well as understanding domestic violence theories, gender, ageism and social rights perspectives
and the views of older people themselves.8
Risk factors can be present for both the older person at risk of abuse and the abuser.
These factors are articulated in the NSW Interagency Policy as:
Risk factors for the older person:
• Social isolation is a key risk factor for the abuse of older people as older people
experiencing abuse often lack social connection from neighbours, family and/
or community and defne abuse in “societal terms including social exclusion, the
belittling of their views and contribution, and violation of their rights”.9
• Confused about their property, belongings and/or surroundings.
• Vulnerable to other persons taking advantage of them because of deteriorating
health, cognitive decline, dementia and capacity issues.
• Physically or verbally violent/aggressive because of progressively worsening
conditions such as dementia.
• A history of family dysfunction, domestic and family violence and abuse.
• Insecure accommodation.
• Substance abuse and gambling.
• Financial difculties.
• Personality and/or behaviour changes due to illness and/or other progressively
worsening condition/s.
• Relative powerlessness because of diminished ability to advocate eﬀectively for
themselves or to modify their environment.
• Women who have experienced (often unreported) domestic violence for many years.
• Limited English.
• Cultural issues and dependency, e.g. for all fnancial and communication matters.
Some of the risk factors for people that abuse older people are:
• Domestic and family violence involving violent, abusive or intimidating behaviour
carried out by a partner, carer or family member to control, dominate or instil fear.
• Carers and family members play a crucial role in caring for older people and while
not all perpetrators of abuse are carers, carers may become abusive in certain
situations.
• Cultural/settlement issues (multiple carers, over-dependency, lack of understanding of resources, services and systems, refugee background, isolation from
cultural activities or interaction).
• Other variables such as mental health, a history of drug and alcohol abuse, gambling
or other behaviours.
8 Bagshaw, D., Wendt, S., Zannettino, L., Preventing the abuse of older people by their family
members, Australian Domestic and Family Violence Clearing House, Stakeholder paper 7, 2009.
9 Family & Community Services, NSW Interagency Policy.
19
Tool 1.8: Elder abuse risk factor assessment checklist
This risk factor assessment checklistcan indicate known risk factors for abuse.10
Notes:
• Answers to the questions may result in disclosure of abuse or information that
requires additional intervention initiated by your agency and/or NSW Police.
• The level of risk increases with each YES answer.
10 Modifed from Eastern Community Legal Centre, Elder abuse toolkit, 2012.

The client	Yes	No	Comment
Does the person live alone or appear to be socially isolated?
Does the person have insecure or inadequate housing arrangements?
Is the person in poor health, frail, or have ongoing health issues?
Does the person lack mental competency or show signs of dementia?
Is there a lack of services involved in the client’s care?
Is the client’s personal hygiene or home cleanliness poor?
Does the person appear to have fnancial difculties (lack of food; unpaid bills)?
Does the person have addiction or gambling issues?
Does the person have drug or alcohol misuse issues?
Are there signs of family dysfunction or dysfunctional relationships?
Is there a history of domestic and family violence from a partner or carer?
Is the person reluctant to talk about their carer/s?
Does the person appear to be psychologically or physically dependent on their carer?
Does the person appear to be overly anxious about their safety, or is depressed or fearful?
Does the person show signs of abuse?
Has the person said anything that makes you suspect abuse may be occurring?

Step 1 Tools: Identify Abuse
20
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 1.9: Eﬀective questioning: tips and suggestions
This tool explores a range of eﬀective questions that demonstrate support to an
older person where abuse is suspected or indicators are present. Open questions
cannot easily be given a ‘yes’ or ‘no’ answer and are non-judgemental. Questions
about family relationships and caring roles may bring up family or other tensions
and abuse. A way to start can be to ask about how things are at home and how they
spend their days.
Key considerations
• Might the presence of others eﬀect disclosure? Privacy is important; talk to the
person alone.
• Does the person have sensory defcits? Ensure glasses and hearing aids are used
and eliminate background noises. Ensure the area is well lit. Arrange seating faceto-face, use familiar words and repeat questions.
• Are reactions slowed? Allow extra time for responding and pace questions.
• Are questions culturally sensitive? Where English is a second language, oﬀer the
use of professional interpreters. Ensure that you speak clearly and avoid jargon.
• Is it feasible to talk to the person in their own home? Most older people feel safer
in familiar surroundings, and the living situation can also be observed.111
11 ‘Elder Abuse & Neglect’, Family violence intervention guidelines, New Zealand
Ministry of Health, 2007.
21
Eﬀective questions

Open questions: use to initiate
conversations

Direct questions: use when abuse is
strongly suspected

• How are things going at home?
• How do you spend your days?
• How do you feel about the amount
of help you receive at home?
• How do you feel your carer/family is
managing?
• How are you managing fnancially?
• How do you feel when carer/family
member does/says (name behaviour
noticed)?
• Lots of women put up with abuse
and it can be hard to talk about.
Does this sound like your situation?
• What is happening now/how can I
support you?
• I noticed a bruise on your arm today.
How did this happen?
• You seem a little upset – what’s
happening for you?
• How are you managing at home?
(Or how is your carer managing?)
• What would you like to do about
your situation?
• You seem anxious about your
fnances. What would it be like if I
arranged someone to assist you with
your banking etc.?

• Are you feeling safe?
• Are you afraid of anyone at home?
• Has anyone close to you tried to hurt
or harm you recently?
• Are you often sad or lonely?
• Are you helping to support someone?
• Has anyone touched you without
consent?
• Has anyone shouted at you or threat
ened you?
• Has anyone taken anything that was
yours without your consent?
• Have you signed any documents that
you didn’t understand?
• Has anyone failed to help you when
you needed help?
• Is there someone you can talk to
about your situation?
• Would you like me to talk to some
one who can help or advise you?
• Would you like to have a visit from
one of our social staﬀ?
• Has anyone tried to hurt you recently?
• Do you know about a free telephone
service called the NSW Elder Abuse
Helpline – would you like the number?

Step 1 Tools: Identify Abuse
22
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Less appropriate questions
Do you feel as though you can’t trust anyone in your family?
This is a leading question that is not very clear and is based on an assumption. A better
question may be to ask who in their family the older person can confde in.
Why don’t you tell your son not to talk to you that way?
“Why” questions should be avoided. This question is confronting and judgemental.
For many reasons, the older person may fnd it difcult to confront her son. They
may feel fearful, disempowered or protective. A better question may be to acknowledge that you noticed their son talking to them in an abusive
manner and ask how they feel about the situation, if they need support or what
they may want to do about their situation. Empowering the older person and
reminding them what their rights are is important.
Why haven’t you got any food in the fridge?
This question could be changed to a statement followed by an open question: “I noticed
you don’t have any food in your fridge. What happened?”
Where has your antique clock gone – it was there last week?
This question could be reworded to include a less confrontational approach. “I noticed
that your antique clock has gone. What happened?”
You shouldn’t put up with this – why don’t you do something about it?
Make a statement based on observation. Let the older person know that there is
support available to stop and prevent the abuse in a non-judgemental, nonconfrontational way.
Are you feeling afraid at home?
This questions could be reworded to a statement based on observations rather than
conclusions: “You seem fearful today” or “Are you feeling safe?”.

23
Tool 1.10: Red ﬂags
There are a number of behavioural indicators of abuse that may suggest a person
is being abused without indicating how the abuse is occurring. This list has been
adapted from Brandl (2004).12
Note: The presence of one or more indicators of abuse does not necessarily mean
abuse has occurred. Indicators of abuse are not always obvious and can vary.
12 Brandl, B. Assessing for abuse in later life, NCALL Coordinator, National Clearinghouse
on Abuse in Later Life (NCALL), a project of the Wisconsin Coalition Against Domestic
Violence, 2004.

An older person may:	A potential abuser may:
Have injuries that don’t match explanations given.	Minimise or deny the abuse has occurred.
Have repeated injuries or bruises and call them “accidental injuries”.	Blame the older person for being clumsy or difcult.
Appear withdrawn, sullen or non-communica tive.	Be overly charming and/or helpful to the worker OR abusive when questioned.
Express or hint at being afraid.	Act lovingly towards the older person in the presence of others.
Consider or attempt suicide, abuse drugs and/or alcohol, and exhibit signs of depression.	Coerce or make threats such as self-harm or to withdraw aﬀection, access to grandchildren, place in aged care or hurt the family pet.
Present as “difcult”, not wishing to answer questions.	Want to be present for all interviews.
Have vague, chronic, non-specifc complaints.	Answer for the older person.
Frequently missed appointments with professionals or is unable to follow through on a treatment plan.	Portray the older person as incompetent, unhealthy or suﬀering a mental health problem or dementia.
Delay or not seek medical help.	Agrees to a treatment plan but doesn’t fol low through and is reluctant to explain why.
Exhibit evidence of stress or trauma such as chronic pain or illness.	Threatens to deny access to medicines or services or withholds information. Prohibits older person from seeking help.
Not seem to know their rights or be aware of their medical plans.	Prohibits the older person from purchasing items they want or need.
Be unsure or worried about their money; cancel services; lack necessary items in the house; or suddenly be unable to buy food or other items.	Turn family members against the older per son.
Complain about their situation or appear unhappy.	Expresses interest or a right to the older person’s money and assets such as living in the house, not wishing to accept services or have the older person moved to residential care.
Talk about family arguments or dysfunction or not see family.	Talks about how good the older person has it and how ungrateful they are.
Withdraw from social networks or decline to attend social occasions.	Turns family members against older person. Refuses to support social interaction.

Step 1 Tools: Identify Abuse
24
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 1.11: Elder Abuse Suspicion Index (EASI)
The EASI was developed to raise a doctor’s awareness about elder abuse to a level
at which it might be reasonable to propose a referral for further evaluation by social
services or adult protective services (such as the NSW Civil & Administrative Tribunal
or NSW Police). While all six questions should be asked, a response of “yes” on one
or more of questions 2-6 may establish concern. The EASI was validated for use by
family practitioners of cognitively intact seniors in ambulatory settings.131
13 The Royal Australian College of General Practitioners, Abuse and violence: working with
our patients in general practice, 3rd edition, 2008.

The Elder Abuse Suspicion Index
EASI Questions Q.1 – Q.5 asked of patient; Q.6 answered by doctor Within the last 12 months:
Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?	YES	NO	Did not answer
Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids or medical care, or from being with people you wanted to be with?	YES	NO	Did not answer
Have you been upset because someone talked to you in a way that made you feel shamed or threatened?	YES	NO	Did not answer
Has anyone tried to force you to sign papers or to use your money against your will?	YES	NO	Did not answer
Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically?	YES	NO	Did not answer
Doctor: Elder abuse may be associated with fndings such as: poor eye contact, withdrawn nature, malnour ishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months?	YES	NO	Not sure

For an online version of the EASI or additional resources about abuse and violence,
review the following website: www.racgp.org.au/your-practice/guidelines/whitebook/tools-and-resources
© The Elder Abuse Suspicion Index (EASI) was granted copyright by the Canadian Intellectual
Property Ofce (Industry Canada) February 21, 2006. (Registration # 1036459). Available at
http://nicenet.ca/tools-easi-elder-abuse-suspicion-index
Reproduced with permission.
25
Tool 1.12: The Modifed Caregiver Strain Index (MCSI)
Directions: Here is a list of things that other caregivers have found to be difcult.
Please put a checkmark in the columns that apply to you. We have included some
examples that are common caregiver experiences to help you think about each item.
Your situation may be slightly diﬀerent, but the item could still apply.14
Yes, on a regular basis = 2 Yes, sometimes = 1 No = 0
14 Thornton, M., & Travis, S. S., Analysis of the reliability of the Modifed Caregiver Strain Index,
The Journal of Gerontology, Series B, Psychological. Sciences and Social Sciences, 58(2), p.S129.
My sleep is disturbed
(For example: the person I care for is in and out of bed or wanders around at night)
Caregiving is inconvenient
(For example: helping takes so much time or it’s a long drive over to help)
Caregiving is a physical strain
(For example: lifting in or out of a chair; eﬀort or concentration is required)
Caregiving is confning
(For example: helping restricts free time or I cannot go visiting)
There have been family adjustments
(For example: helping has disrupted my routine; there is no privacy)
There have been changes in personal plans
(For example: I had to turn down a job; I could not go on vacation)
There have been other demands on my time
(For example: other family members need me)
There have been emotional adjustments
(For example: severe arguments about caregiving)
Some behaviour is upsetting
(For example: incontinence; the person cared for has trouble remembering things;
or the person I care for accuses people of taking things)
It is upsetting to fnd the person I care for has changed so much from his/her
former self
(For example: he/she is a diﬀerent person than he/she used to be)
There have been work adjustments
(For example: I have to take time oﬀ for caregiving duties)
Caregiving is a fnancial strain
I feel completely overwhelmed
(For example: I worry about the person I care for; I have concerns about how I will
manage)
Total Score: Sum responses for “Yes, on a regular basis” (2 pts. each)
and “Yes, sometimes” (1 pt. each).
Step 1 Tools: Identify Abuse
26
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
A range of other tools are available by reviewing the following websites:
NSW Government: South Western Sydney Local Health District Carer program
swslhd.nsw.gov.au/carers/assessment.html
Alzheimer’s Association: caregiver stress check if caring for someone with
dementia
alz.org/care/alzheimers-dementia-stress-check.asp
27
Tool 1.13: Domestic Violence Safety Assessment Tool (DVSAT)
The NSW Government: Domestic Violence Safety Assessment Tool (DVSAT) and Guide
The DVSAT has been developed to help agencies/service providers consistently and
accurately identify the level of threat to domestic violence victims. The DVSAT has
two components:
Part A: Risk identifcation checklist; and
Part B: Professional judgement.
Police should refer to their internal DVSAT procedures and guidelines.
The DVSAT Guide (15 pages) and the DVSAT tool (six pages) can be found via the
links following:
domesticviolence.nsw.gov.au/__data/assets/fle/0003/301179/DVSAT_guide.pdf
domesticviolence.nsw.gov.au/__data/assets/fle/0020/301178/DVSAT.pdf
Step 1 Tools: Identify Abuse

29
STEP 2: ASSESS IMMEDIATE SAFETY
• Determine the level and urgency of safety concerns for the older person and
others.
• In the event of an emergency, contact emergency services.
• Consent of the older person is not necessary in emergency situations.
• Protect evidence.
• Follow your workplace policy and procedures for internal reporting.
• If not an emergency, continue to step 3.
Key messages
Do not engage the alleged abuser:
• If the older person or worker is in immediate danger and/or at risk of serious
harm, contact emergency services immediately.
Protect evidence:
• Evidence can include, but is not limited to, items such as clothing, documents,
and possessions. It would mean to not touch anything or clean the older person
or their clothing and dwelling which prevents evidence from being destroyed,
lost or altered for the police and other emergency services.
Step 2: Tools
Tool 2.1: Responding to risks.
This tool provides a prompt about types of agencies that could be accessed depending
on risk factors presented by an older person that may make them vulnerable to abuse.
Tool 2.2 What to do in an emergency: Q & A.
Tool 2.3: Worker safety tips for home visits.
This tool highlights some important tips to ensure worker health and safety.
Tool: 2.4: Police reports.
There are some forms of abuse that are crimes and this tool provides examples with
reference to the NSW Interagency Policy and the Crimes Act, providing a guide in
reporting to NSW Police.
2
Step 2 Tools: Assess Immediate Safety
“The promise of complete confdentiality cannot be given
to any person who raises a concern about the abuse of an
older person. This includes the older person themselves, a
relative, a fellow worker or a member of the public. When
information about abuse is provided to Police and other key
NSW Government agencies, these agencies will act, even if
consent has not been given, when:
• The vulnerable older person is believed to lack capacity
to make an informed choice,
• A criminal investigation by the Police may be required,
• There is a wider public interest.”
Family & Community Services, NSW Interagency Policy
31
Tool 2.1: Responding to risks
Where risks are identifed, a response plan could be developed, using knowledge of
local resources and needs. This table provides an example.

Risk factors for older person	Examples of referrals
Mobility and other health problems	Modifcations and equipment
General Practitioner
Aged Care Assessment Team
Community transport
Social isolation	Day programs and respite
Community visitors
Social support services
Community transport
Not eating; fearful	General Practitioner and medical assessments
Meals on Wheels
Help with shopping; cooking
Respite
Social support
History of domestic violence; conﬂictual family relationships	Domestic and family violence services and resources
NSW Police: Domestic Violence Liaison Ofcer
Sexual assault services
Mediation services
Family referral services and counselling
Psychological needs	General Practitioner
Counselling and/or mediation
Respite
Specialist Mental Health Services for Older People (SMHSOP)
Worried about money	Centrelink Centrepay scheme
Bank safeguards
Planning Ahead Tools – NSW Trustee & Guardian
Legal advice
Carer stress identifed	Carer/caregiver stress assessment
Carers NSW
Carer respite
Dementia, cognitive impairment and/or psychological problems	Specialists such as Geriatricians; SMHSOP
Aged Care Assessment Team
Alzheimer’s Association
Brain Injury Association
Stroke Recovery
Disability	Disability advocacy organisations
Disability information and referral services
Mental health services

Step 2 Tools: Assess Immediate Safety
32
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 2.2: What to do in an emergency: Q & A
1. What should I do in an emergency?
Call 000 without delay.
You should then work in accordance with your own agencies policies and procedures.
Depending on the situation and your role, you may also need to:
• Contact other emergency services and arrange medical treatment or other
emergency services.
• Arrange emergency accommodation.
• Determine capacity of an older person and make an urgent Guardianship application.
• Other support sensitive to culture, sexual identity and religious beliefs.
2. What if I am unsure about whether it is an emergency?
An emergency is when there is an immediate threat or risk of physical harm or serious
damage to property. Workers should review their own policies about emergency
situations.
• The threat or risk may be suspected or actual. If you are unsure, it is safest to
treat it as an emergency.
3. What can the police do?
The NSW Police respond to emergencies and have powers under NSW Crimes acts.
Some forms of elder abuse are crimes.
Police can:
• Conduct a welfare check
• Investigate a report that is made which may lead to criminal charges
• Under some circumstances, gain access and entry to premises
• Apply on the person’s behalf for an Apprehended Domestic or Personal Violence
Order which can include an Exclusion Order
• Ring an ambulance or mental health team and make referrals
4. What if the older person does not want help?
Older people should be involved in making decisions about their life as much as
possible, including in an emergency. However, if a worker decides a person is in imminent danger, they must act, even if this goes against the person’s wishes. This relates
to ‘duty of care’ to avoid further harm.
33
Tool 2.3: Worker safety tips for home visits15
General advice
If a worker is in immediate danger and/or at risk of serious harm, contact emergency
services immediately.
Pay attention to intuitive feelings.
Be alert to your surroundings.
Do not confront the abuser.
Carry only enough money to get you through the day.
Maintain your car; ensure you have enough petrol.
Carry a mobile phone.
Obtain history of the person you are visiting (i.e., drug and/or alcohol abuse, history of
violence, non-compliance with medication, and/or known family dysfunction, etc.).
Appearance is everything
Dress practically and wear comfortable walking shoes.
Avoid wearing expensive jewellery or accessories.
Keep your purse or wallet out of sight, and keep car keys handy at all times.
Protect your health
Learn about any situations that might jeopardise your health.
Carry sanitary wipes or anti-bacterial lotion.
Know where you are going
Plan your route.
Go with assistance if a risk is known.
Notify colleagues about feldwork (updating rosters and any changes in itinerary).
Have your supervisor or co-worker make a safety-check phone call every 10-15
minutes.
Before you get out of the car
If you don’t feel safe, don’t get out of the car. Leave.
Park in a visible area close to the person’s residence.
Ensure your car cannot be blocked when leaving.
Getting to the door
Don’t enter the home if an animal threatens your safety (ask the person to secure
the animal).
After knocking, stand away from the door and to one side, if possible.
Entering the person’s home
Ensure the person who answers the door walks ahead of you when entering the
residence.
Once in the home, note the entry and exit points, making sure they are accessible.
Consider seating orientation for your meeting/interview.
Sit near an exit. Do not allow anyone between you and the door.
15 http://www.cdss.ca.gov/agedblinddisabled/res/SWTA/IHSS101_PartII.pdf
Step 2 Tools: Assess Immediate Safety
34
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 2.4: Police reports
Regardless of the victim’s views, agencies must ensure staﬀ report to NSW Police
any instances where:
• The abusive situation results in serious injury inﬂicted on the older person.
• The perpetrator has access to a gun and is threatening to cause physical injury to
any person.
• The perpetrator is using or carrying a weapon (including guns, knives or any
other weapon capable of injuring a person) in a manner likely to cause physical
injury to any person or likely to cause a reasonable person to fear for their safety.
• An immediate serious risk to individual/s or public safety exists.
• Staﬀ are threatened.16
If in doubt, staﬀ can also ring NSW Police for advice or speak to specialist ofcers
such as the:
• Domestic Violence Liaison Ofcer
• Crime Prevention Ofcer
• Investigations Manager
• Aboriginal Liaison Ofcer
In some cases, information can be passed over on the basis of anonymity to ensure
a vulnerable person receives assistance.
16 Family & Community Services, NSW Interagency Policy.
• Multicultural Liaison Ofcer
• Vulnerable Communities Liaison Ofcer
• LGBTI Liaison Ofcer
35
STEP 3: PROVIDE SUPPORT
• Listen to the older person.
• Acknowledge what they tell you.
• Validate their experience.
• Check for capacity indicators.
Key messages
Supporting the person is an important step requiring communication skills that
conveys to them that they are being heard and believed.
Step 3: Tools
Tool 3.1: Recommendations for communicating with older adults.
Tool 3.2: Checklist – triggers that might indicate a need for a capacity assessment.
This tool is from the NSW Government ‘Capacity Toolkit’ and provides a series of
triggers that may indicate that an older person’s capacity should be assessed.
Tool 3.3: Communication tips – talking to a person with dementia.
Tool 3.4: Responding with compassion – talking to a person who has been sexually
assaulted.
Tool 3.5: Communicating with older people from a CaLD background.
Tool 3.6 Communicating eﬀectively with Aboriginal and Torres Strait Islander people.

3
“The NSW Government promotes the general
principle that older people have the right to:
• Be treated with dignity and respect
• Make their own decisions and choices
• Live in a safe environment
• Access the protections available to other adults
• in the community.”
Family & Community Services, NSW Interagency Policy 35
Step 3 Tools: Provide Support
36
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 3.1: Recommendations for communicating with older
adults17
17 http://aging.arizona.edu/sites/aging/fles/activity_1_reading_1.pdf
General tips for improving interactions with older adults
1. Recognise the tendency to stereotype older
adults, then conduct your own assessment.
2. Avoid speech that might be seen as patronising
to an older person (“elderspeak”).
General tips for improving face-to-face communication with older adults
3. Monitor and control your non-verbal behaviour.
4. Minimise background noise.
5. Face older adults when you speak with them,
with your lips at the same level as theirs.
6. Pay close attention to sentence structure
when conveying critical information.
7. Use visual aids such as pictures and diagrams
to help clarify and reinforce comprehension of
key points.
8. Ask open-ended questions and genuinely listen.
Tips for optimising interactions between health care professionals and older patients
9. Express understanding and compassion to help
older patients manage fear and uncertainty related to the ageing process and chronic diseases.
10. Ask questions about an older adult’s living
situation and social contacts.
11. Include older adults in the conversation even
if their companion is in the room.
12. Customise care by seeking information about
older adults’ cultural beliefs and values pertaining to illness and death.
13. Engage in shared decision–making.
14. Strike an appropriate balance between respecting patients’ autonomy and stimulating
their active participation in health care.
15. Avoid ageist assumptions when providing
information and recommendations about
preventive care.
16. Providing information to patients is important,
but how you give information to patients may
be even more important.
17. Use direct, concrete, actionable language
when talking to older adults.
18. Verify listener comprehension during a conversation.
19. Set specifc goals for listener comprehension.
20. Incorporate both technical knowledge and
emotional appeal when discussing treatment
regimens with older patients.
21. To provide quality health care, focus on enhancing patient satisfaction.
22. Use humour and a direct communication style
with caution when interacting with non-Western older patients.
23. Help Internet-savvy older adults with chronic diseases fnd reputable sources of online
support.
24. If computers are used during face-to-face
visits with older adults, consider switching to
models that facilitate collaborative use.
37
Tool 3.2: Checklist – triggers that might indicate a need for a
capacity assessment
The Capacity Toolkit states: “It is not always obvious when a person can’t make a
specifc decision. However, particular circumstances, events or behaviours might
lead you to question a person’s capacity at a point in time. These are called triggers.”18
The following list of triggers may indicate that a capacity assessment should be
conducted.

Trigger	Yes?
Repeatedly making decisions that put the person at signifcant risk of harm or mistreatment.
Making a decision that is obviously out of character and that may cause harm or mistreatment.
Often being confused about things that were easily understood in the past.
Often being confused about times or places.
Having noticeable problems with memory, especially recent events, and which have an eﬀect on the person’s ability to carry out everyday tasks.
Dramatically losing language and social skills. For example, having difculty fnding a word, not making sense when speaking, not understanding others when they speak, having wandering thought patterns, interrupting or ignoring a person when they are speaking, or failing to respond to communication.
Having difculty expressing emotions appropriately, such as inappropriate anger, sexual expression, humour or tears without actual sadness.
Displaying sudden changes in personality. For example, excessive irritability, anx iety, mood swings, aggression, overreaction, impulsiveness, depression, paranoia or the onset of repetitive behaviours.
Declining reading or writing skills.
Having difculty judging distance or direction, for example when driving a car.
Not looking after him/her self or their home the way they usually do and this be ing bad for their health or putting them at signifcant risk. For example, neglect ing signifcant personal concerns such as health, hygiene, personal appearance, housing needs or nutritional needs.
Not paying bills or attending to other fnancial matters, such as running their business, repaying loans or other debts.
Making unnecessary and excessive purchases or giving their money away, and this being out of character.
Noticeably being taken advantage of by others, such as being persuaded into giving away large assets that they still require such as a house, car or savings, or signing contracts that disadvantage them.
Having been diagnosed with a condition that may aﬀect their capacity.
Having lacked capacity to make decisions in the past.

18 NSW Government, and Attorney General’s Department, Capacity toolkit.
Step 3 Tools: Provide Support
38
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 3.3: Communication tips – talking to a person with
dementia19

Do	Don’t
Talk to the person in a tone of voice that con veys respect and dignity	Talk to the person in ‘baby talk’ or as if you are talking to a child
Keep your explanations short. Use clear and ﬂexible language	Use complicated words or phrases and long sentences
Maintain eye contact by positioning yourself at the person’s eye level	Glare at, or eyeball, the person you are talking to
Look directly at the person and ensure you have their attention before you speak. Always begin by identifying yourself and explain what it is you propose to do	Begin a task without explaining who you are or what you are about to do. Talk to the person without eye contact, such as while rummaging in a drawer to select clothing
Use visual cues whenever possible	Try to compete with a distracting environ ment
Be realistic in expectations	Provoke a catastrophic reaction through un realistic expectations or by asking the person to do more than one task at a time
Observe and attempt to interpret the per son’s non-verbal communication	Disregard your own non-verbal communica tion
Paraphrase and use a calm, reassuring tone of voice	Disregard talk that may seem to be rambling
Speak slowly and say individual words clearly. Use strategies to reduce the eﬀect of hearing impairment	Do not shout or talk too fast
Encourage talk about things they are familiar with	Interrupt unless it cannot be helped
Use touch, if appropriate	Attempt to touch or invade their personal space if they are showing signs of fear or aggression

19 http://www.dementiamanagementstrategy.com/Pages/ABC_of_Behaviour_Management/
Communication_tips.aspx
39
Tool 3.4: Responding with compassion – talking to a person
who has been sexually assaulted20
Three key things to say

Say…	This is heard as…
I am sorry for what has happened.	I believe you.
What happened is a crime.	This is not your fault.
I will do what I can to help.	You are not alone.

Initial response

Do	Do not
Listen to the story.	Tell them what to do or try to take over.
Let them express how they feel.	Ask them the ‘why’ questions, why they were there, went there, why they trusted him. Why questions are blame questions.
Let them cry.	Get angry on their behalf. They have enough to deal with without worrying about you.
Encourage them.	Assume you know how they feel. Everyone experiences sexual assault diﬀerently
Not worry if parts of the story don’t add up.
Tell them you are sorry for what happened.
Explain what you can do.

20 Responding with compassion when someone says ‘I have been sexually assaulted’, Fact
sheet, Rape and Domestic Violence Services Australia.
Step 3 Tools: Provide Support
40
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 3.5: Communication with older people from a CaLD
background
The following checklist highlights good cross-cultural communication practice for
working with people from CaLD backgrounds:
• Keep in mind that limited profciency in English:

– –	Does not reﬂect an individual’s level of intellectual functioning; and Has no bearing on one’s ability to communicate in one’s language of origin, nor in one’s literacy in their own language of origin.
•	Make the environment conducive to communication. Avoid places with too much background noise, distractions, and where interruptions are likely. Have consideration for the individuality of the person.

• • Give the speaker plenty of time in which to communicate. Having to hurry creates tension, which aﬀects the way people speak.
• Listen.
• Use only qualifed language interpreters when communicating with clients and
their carers who lack adequate English communication skills. This is especially
important in situations wherein the information discussed is critical to the wellbeing of the person.
• All information relating to key service delivery contexts (e.g., care plan and
service agreement) should be provided to the client and their advocate in their
own language.
• Speak clearly but do not raise your voice. Speaking loudly will not necessarily
ensure that you will be understood.
• Speak slowly throughout the conversation and repeat when you have not been
understood or ask the person to tell you what has been said to confrm that
they understand.
• Adapt the pace of the conversation to ft the person’s ability to comprehend.
• Use words your listener is likely to know. Avoid jargon and popular idioms or slang.
• Use the active rather than passive voice, e.g., “We will give you breakfast at 7
o’clock”, not “Breakfast will be given to you at 7 o’clock”.
• Give instructions in clear, logical sentences and present one topic at a time.
• Gauge how much people are likely to remember.
• Body language can provide important clues for increased understanding for the
carer and the client. Use empathy. Use touch – if appropriate and acceptable –
and validate the person’s thoughts and feelings.
• If required, learn and use key words in the person’s own language to improve
communication during routine care and other simple service interventions.
• Accept that it may be necessary to use alternative forms of communication
for some families, (e.g., verbal, as word of mouth may be a preferred method of
receiving information).
41
• If required, use visual aids, gestures, and physical prompts.
• Do not speak Pidgin English. It is not easier to understand and can unintentionally
sound condescending.
• Avoid jokes, as these may not be understood by your listener. Irony, satire, and
sarcasm should be avoided for the same reasons.
• Do not exclude the client from discussion when relatives are present. It may be
easier to talk to relatives, but it is important that the individual is heard.211
21 Adapted from the Multicultural Communities Council of SA Inc and Multicultural Aged
Care Inc’s Working cross culturally guide. http://www.mac.org.au/docs/WCCGuide.pdf
Step 3 Tools: Provide Support
42
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 3.6: Communicating eﬀectively with Aboriginal and
Torres Strait Islander people
Demonstrating understanding
The negative impacts of racial and economic disadvantage and a series of past
government policies, including segregation, displacement and separation of families
has contributed to the mistrust held by Aboriginal and Torres Strait Islander people
towards government services and systems.
In today’s Western dominant society, Aboriginal and Torres Strait Islander people
continue to be a marginalised and socially disadvantaged minority group. Compared
to other Australians, Aboriginal and Torres Strait Islander people experience signifcantly varied outcomes related to health, education, employment and housing.
Discrimination, racism and lack of cultural understanding mean that Aboriginal and
Torres Strait Islander people still experience inequality and social injustice.
People’s cultural beliefs, values and world views inﬂuence thinking, behaviours and
interactions with others. It is important to reﬂect without judgement before, during
and after interacting with people whose beliefs, values, world views and experiences
are diﬀerent to your own.
Personal communication
Rapport
In many traditional cultures, a high sense of value is placed on building and maintaining relationships. Taking a ‘person before business’ approach will help form this
relationship and build rapport.
• Introduce yourself in a warm and friendly way.
• Ask where people are from, share stories about yourself or fnd other topics of
common interest.
Language
Many Aboriginal and Torres Strait Islander people do not speak English as their frst
language. Some also speak English in diﬀerent dialects such as Kriol, Aboriginal
English and Torres Strait Creole.
Some general tips to overcome language barriers may include:
• Avoid using complex words and jargon.
• Explain why you need to ask any questions.
• Always check you understood the meaning of words the person has used and
vice versa.
• Use diagrams, models, DVDs and images to explain concepts, instructions and
terms.
• Be cautious about using traditional languages or creole words unless you have
excellent understanding.
• If required, seek help from local Aboriginal and Torres Strait Islander staﬀ.
43
Step 3 Tools: Provide Support
Time
In Western culture, emphasis is placed on time to meet deadlines and schedules.
Time is percieved diﬀerently in Aboriginal and Torres Strait Islander cultures, as
more value is placed on family responsibilities and community relationships.
• Consider allocating ﬂexible consultation times.
• Take the time to explain and do not rush the person.
Non-verbal communication
Some non-verbal communication cues (hand gestures, facial expressions etc.) used
by Aboriginal and Torres Strait Islander people have diﬀerent meanings in the Western context. Be mindful that your own non-verbal communication will be observed
and interpreted. For example, feelings of annoyance may be reﬂected by your body
language and are likely to be noticed.
Personal space
Be conscious about the distance to which you are standing near a person. Standing
too close to a person that you are unfamiliar with, or of the opposite gender, can
make a person feel uncomfortable or threatened.
Touch
Always seek permission and explain to the person reasons why you need to touch
them. Establish rapport frst to make the person feel comfortable.
Silence
In Aboriginal and Torres Strait Islander cultures, extended periods of silence during
conversations are considered the ‘norm’ and are valued. Silent pauses are used to
listen, show respect or consensus. The positive use of silence should not be misinterpreted as lack of understanding, agreement or urgent concerns. Observe both
the silence and body language to gauge when it is appropriate to start speaking. Be
respectful and provide the person with adequate time. Seek clarifcation that what
was asked or discussed was understood.
Eye contact
For Aboriginal and Torres Strait Islander people, avoidance of eye contact is customarily a gesture of respect. In Western society averting gaze can be viewed as being
dishonest, rude or showing a lack of interest. Some (but not all) Aboriginal and Torres
Strait Islander people may therefore be uncomfortable with direct eye contact,
especially if unfamiliar. To make direct eye contact can be viewed as being rude,
disrespectful or even aggressive. To convey polite respect, the appropriate approach
would be to avert or lower your eyes in conversation.
• Observe the other person’s body language.
• Follow the other person’s lead and modify eye contact accordingly.
• Avoid cross-gender eye contact unless the person initiates it and is comfortable.
Titles
In Aboriginal and Torres Strait Islander cultures, the terms ‘Aunty’ or ‘Uncle’ are
44
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
used to show respect for someone older than you. This person does not have to be
a blood relative or necessarily an Elder.
• Only address people with these titles if approval is given and/or a positive
relationship exists.
Shame
‘Shame’ (deeply felt feelings of being ashamed or embarrassed) for Aboriginal and
Torres Strait Islander people may result from sharing private or personal information,
cultural beliefs and from breaches of confdentiality.
• Take a discrete approach and avoid discussions in open or public spaces.
• Build trust and rapport to help people feel safe and comfortable with you and in
their surroundings.
• Ensure confdentiality and consider Men’s and Women’s Business.
Listening
Explaining may take time because of narrative communication style or due to linguistic
diﬀerences. The person may be struggling to communicate what they are trying to
get across.
• Avoid selective hearing and ensure you are ‘actively’ listening.
• Paraphrase by summarising and repeating what the person said. This will help
with clarifcation and signal you have been listening.
• Show empathy, be attentive and avoid continually interrupting or speaking over
the person.
Questioning
In Aboriginal and Torres Strait Islander cultures, indirect questioning is the approach
most preferred. Direct questioning may lead to misunderstandings, discourage participation and make it difcult to obtain important information, particularly when a
person is communicating in non-Standard English.
• Use indirect, ‘round about’ approaches (e.g. frame a question as a statement
then allow time for the answer to be given).
• Clarify if the person understood the meanings of your words or questions and
that you understood their answers.
• Avoid compound questions (e.g. “how often do you visit your GP and what are
the reasons that you don’t?”).
• Use plain words (e.g. say ‘start’ rather than ‘commence’).
• Do not ask the person to continually repeat themselves.
• Avoid using hypothetical examples.
‘Yes’
Aboriginal and Torres Strait Islander people have a tendency to agree with the questions
even when they do not understand or agree, and may answer questions the way they
think others want. People may say “yes” to questions to end the conversation so they
can leave, to deal with other priorities, or because they simply feel uncomfortable.
45
Step 3 Tools: Provide Support
• Take the time to build rapport to make the person feel comfortable.
• Explain at the beginning how long the appointment will take and give the person
the opportunity to ask questions.
• If a person repeatedly says ‘yes’ immediately after a question, ask with respect what
they understood from the questions and/or to explain reasons for their decision.
Clear instructions
It is critical to provide clear and full explanations so that the person fully understands
your instructions. For example, to simply say “take until fnished” – this may be misunderstood as “take until you feel better” rather than “take until all the tablets are
fnished”.
Provide options and ownership
When people are given choices and ownership over managing their health, the likelihood of medical compliance is increased.
• Provide options for care; for example, explain how some medications can be taken
orally or by injection.
• Ensure that any options are practical and realistic.
• Do not make promises that you cannot deliver as this may create mistrust.
Making decisions
Due to family kinship structures and relationships, decision-making usually involves
input by other family members.
• Check with the person if their decisions requires consultation with family.
• Allow time for information to be clearly understood.
• Be respectful if you are asked to leave the room or the meeting for matters to
be discussed in private by the family.
Communication assistance and cultural support
Build relationships within the local community and learn suitable and generally accepted words. Your local Aboriginal and Torres Strait Islander staﬀ may be able to
assist with cultural knowledge and interpreting information. They may also advise
you of the best ways of distributing information through the community.22
22 Aboriginal and Torres Strait Islander cultural capability, https://www.health.qld.gov.au/atsi
health/documents/communicating.pdf

47
STEP 4: INFORM MANAGER & DOCUMENT
• Report suspected, witnessed, or disclosed abuse to your manager or supervisor.
• Document the abuse and action/s taken, following your own workplace policy
and protocols.
• Document if the older person has capacity and refuses intervention.
Key messages
Documentation is important in being able to explain more fully what was suspected,
witnessed, or disclosed, noting the time, date, facts and actions. A written record
supports any action that may be taken by the agency such as a service review, NSW
Police report or application to the NSW Civil & Administrative Tribunal. It also provides accountability and professionalism and supports handover procedures should
there be a change of agency and/or staﬀ turnover.
Agencies should provide policy or procedural guidance regarding client documentation,
and any other reporting requirements.
Record any concerns and actions taken and document current and past signs of abuse.
If an older person has capacity and refuses intervention, this should be documented.
It is important to report to a manager when abuse is suspected, witnessed, or disclosed. Documenting the abuse soon after the event improves accuracy and ensures
remedies are in place as soon as possible which impacts on the older person, and
potentially staﬀ safety, comfort and wellbeing.
Step 4: Tools
Tool 4.1: The general principles of documentation.
Tool 4.2: Sample report.
This tool provides key areas to address in recording and documenting an incident of
abuse. Agencies can review any existing policies about ‘client documentation’ or
‘critical incidents’ as guidance.
Tool 4.3: Barriers to reporting.
This tool provides a list of prompts for agencies as to common barriers staﬀ may face
in reporting abuse of an older person. The issues can be raised in a team meeting.
4
Step 4 Tools: Inform Manager & Document
“Where an agency has a key role in responding to abuse
of older people in NSW, it is responsible for recognising
abuse of older people within its specifc jurisdiction, for
developing agency-specifc policies and guidelines, and
for maintaining appropriate records. Workers are advised
to refer to their agency policies and guidelines governing
documentation and record keeping.”
Family & Community Services, NSW Interagency Policy
49
Step 4 Tools: Inform Manager & Document
Tool 4.1: The general principles of documentation23
• Make sure you check your organisation’s requirements regarding documentation.
• Be factual, concise and accurate.
• Be objective and non-judgemental.
• Make sure your writing is neat, clear and legible.
• Writing should be in black or blue ink.
• Use exact words when quoting – use quotation marks to show direct quotes.
• Never use correction ﬂuid – draw a single line through the error, initial and date
the change.
• Record the date and time, especially when relating incidents that have occurred
• Present information in a logical sequence.
• Use abbreviations approved in your organisation.
• Use correct spelling, punctuation and grammar.
• Edit your report before presenting it – get rid of errors.
• Always sign and date each entry.
23 slideshare.netmobileaiﬂdocumentation-the-basics
50
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 4.2: Sample report form
The following sample report form does not replace any agency’s own reporting processes
and provides guidance as to information that could be captured.
• Describe injuries (including the type, extent, age and location). If you suspect
violence is a cause, but your patient/client has not confrmed this, include your
comment as to whether the explanation accurately explains the injury.
• Record what the older person said (using quotation marks if appropriate).
• Record any relevant behaviour observed, being detailed and factual rather than
stating a general opinion, e.g. rather than “the patient/client was distressed”, write
“the older person cried throughout the appointment, shook visibly and had to stop
several times to collect herself before answering a question”.
Report date: 1 March 2016

Date of incident: 1 March 2016	Time of incident: 1:37 pm
Abuse was witnessed	Abuse was disclosed	Abuse is suspected

Who was present when the
abuse was disclosed or
witnessed?
Client – Joan Citizen
Client’s son – John Citizen

Record names of staﬀ present:
Mary Smith

What was witnessed, disclosed or observed:
I was attending Joan’s house today to help with domestic assistance tasks.
Joan was having a coﬀee in the lounge room whilst I was tidying in the same room.
When John walked past, Joan asked, “Can you take my mug to the kitchen?”.
John responded, “Take it yourself, you lazy bitch. You’re good for nothing these days.”
Joan was teary and stated that, “He talks to me like that all the time.”
Joan gave consent for me to contact her care advisor to follow-up.
– Care advisor notifed 1 March 2016, 2pm

Name and position of author: Mary Smith: care staﬀ
51
Step 4 Tools: Inform Manager & Document
Tool 4.3: Barriers to reporting
Reporting the abuse of older people supports the prevention of abuse reoccurring
by providing a pathway to support and safety. The points below list some of the key
barriers to reporting abuse from the perspective of the older person and staﬀ.
Understanding these reasons means that barriers can be addressed through
support, training and providing information.

What are some of the reasons older people may not report abuse?	What are some of the reasons staﬀ may not report abuse?
Dependence on the person who is abus ing them.	Staﬀ have diﬀerent experiences and expectations. The abuse may resemble something that has happened in the staﬀ member’s life and they have normalised the behaviour, not recognising it as abuse.
Family conﬂict and fear of losing impor tant relationships.	Staﬀ may be unsure of procedures and don’t know who to talk to or what to do.
A history of domestic and family vio lence, ongoing fear and difculty talking about it.	An older person may not want to report abuse.
Cognitive impairment.	Concerns about breaching client conf dentiality and privacy.
Isolation from others.	Lack of awareness about what abuse can look like – may be some cultural diﬀerences that inﬂuence how abuse is perceived.
Lack of knowledge of available support services.	Concerned that services may be cancelled.
Fear of retribution or punishment.	Unsure if it is abuse.
Fear of repercussions, e.g. being placed in residential aged care.
Denial or disbelief that it is happening to them.
Unaware of their rights.
“It’s private” – ashamed to tell others.
Previous inaction or action that did not work.
Limited English.
Lack of awareness about what abuse can look like – may be some cultural diﬀerences that inﬂuence how abuse is perceived.
No cultural supports or networks to turn to, particularly for Aboriginal and Torres Strait Islander Elders or people from culturally and linguistically diverse backgrounds.

53
STEP 5: RESPOND & REFER
• Ask the older person what they want to do about their situation. If the older
person lacks capacity, include the substitute decision-maker (if this person is
not the abuser) in the conversation.
• Discuss referral options.
• Seek consent from the older person or, when lacking capacity, the appropriate
substitute decision-maker to make a referral.
• Make appropriate referrals.
• Leave information (if safe to do so) if the older person refuses assistance, and
keep the lines of communication open.
• Consider implementing any local or regional protocols, interagency protocols
and service coordination plans.
• Ensure procedures are in place for coordination and/or monitoring, and
follow-up as required.
Key messages
The abuse of older people is multifactorial and needs a variety of intervention strategies.
Understanding the social context in which the abuse occurs helps identify the possible
referral pathways. Consider what happens when an older person’s world starts to
shrink and the older person’s only support is someone who is abusing them. Reintroducing supports to older people helps prevent abuse from reoccuring.
A societal approach:
Staying connected
Key agencies where referrals can be made can be grouped into categories as follows:
• Financial
• Health
• Social and welfare
• Legal and justice

5
Step 5 Tools: Respond & Refer
Older
Person
Alleged
Abuser
Support
Networks
Environments
54
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Step 5: Tools
Tool 5.1: Flow chart: responding to the abuse of older people.
Tool 5.2: Key fnancial support agencies.
Tool 5.3: Key health support agencies.
Tool 5.4: Key social and welfare support agencies.
Tool 5.5: Key legal and justice support agencies.
For a comprehensive list of referral agencies, go to: http://elderabusehelpline.com.au/
for-professionals/websites
Tool 5.6: Diﬀerence between Powers of Attorney and Enduring Guardianship.
This table provides a snapshot of the diﬀerences between Powers of Attorney and
Enduring Guardianship as some instances of abuse of older people involve the misuse
of these powers.
Tool 5.7: Revoking a Power of Attorney.
Tool 5.8: Assessing needs of an older person.
Tool 5.9: Safety plan.
Tool 5.10: Policy checklist.
Case studies: Bill, Shirley and Olivia.
These case studies explore abuse situations and possible responses. They demonstrate
that more than one abuse type can coexist.
“All workers employed in NSW agencies,
whether government or non-government,
have a responsibility to respond to abuse
of older people in our community…agency
roles will vary according to the nature of
the abuse and the level of independence or
health status of the older person who has
experienced abuse…”
Family & Community Services, NSW Interagency Policy
54
55
Tool 5.1: Flow chart: responding to the abuse of older people
2 2 3 4 5
STEP 1
Identify abuse. Ask questions and gather information.
Yes.
STEP 2
Assess immediate safety. Is it an emergency?
No immediate risk
or unsure.
Advise/discuss with your
supervisor or manager.
Discussion suggests it is
not abuse.
STEP 4
Inform manager & document.
STEP 2 (cont.)
Contact emergency services and
protect evidence.
Discussion with the older
person suggests abuse or
possible abuse.
If advice is required, consult
the NSW Elder Abuse Helpline
for information, support and
referral options.
STEP 5
Respond & refer.
• Ask the older person what they want to do about their situation.
If the older person lacks capacity, include the substitute decisionmaker (if this person is not the abuser) in the conversation.
• Discuss referral options.
• Seek consent from the older person to make a referral.
• Make appropriate referrals.
• Leave information (if safe to do so) if the older person refuses
assistance, and keep the lines of communication open.
• Consider implementing any local or regional protocols, interagency protocols and service coordination plans.
• Ensure procedures are in place for coordination and/or
monitoring, and follow-up as required.
1
If advice is required,
consult the NSW Elder
Abuse Helpline for information, support and
referral options.
STEP 3
Provide support to the older person.
Step 5 Tools: Respond & Refer
56
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 5.2: Key fnancial support agencies
Possible referrals
Australian Bankers’ Association (ABA)
The ABA website has useful information for consumers about:
• Financial literacy programs
• Industry guidelines about protecting vulnerable clients
• Preventing fnancial abuse
The banking industry is concerned about fnancial abuse and crimes such as fraud.
Banks have industry standards in place and a bank manager can discuss a range of
options to prevent further abuse and safeguard an older person’s money. The
association’s website also has a range of fact sheets and other useful information for
consumers and can be contacted on (02) 8298 0417.
Centrelink
Centrelink can support older people at risk of fnancial abuse by organising separate
partner payments, arranging bill payments through Centrepay, carer’s payments and
loans. Centrelink can be contacted on 13 23 00.
Gambling help
A free and confdential Gambling Helpline is available. Anyone can call 24 hours a
day by phoning 1800 858 858 and this number will provide a gateway to other
support as well as telephone counselling and self-help information.
Financial Rights Legal Centre (incorporating the Credit and Debt Hotline)
The Financial Rights Legal Centre is a community legal centre specialising in fnancial
services, particularly individual cases and policy issues related to consumer credit,
banking and debt recovery. The centre has a particular focus on issues that aﬀect
low income and disadvantaged consumers. Also provided is fnancial counselling
information, advice and referral services to individual consumers in NSW on credit,
debt and banking issues. This service can be contacted on 1800 007 007.
NSW Trustee & Guardian
NSW Trustee & Guardian provides professional and independent trustee services
such as writing Wills, acting as Executor in deceased estates, administering trusts
and Powers of Attorney and delivering fnancial management services. The NSW
Trustee & Guardian can be contacted on 1300 364 103 and has a contact person if
someone needs to enquire about their role as a private Power of Attorney as well as
a range of publications and resources such as A Guide for Powers of Attorney.
Get it in Black & White
This website about Planning Ahead Tools lists a range of information for consumers
and service providers in plain English about future legal and fnancial decisions such
as: advanced care planning, Powers of Attorney, Guardianship, and Wills.
57
Tool 5.3: Key health agencies
Possible referrals
Aboriginal Medical Service (AMS)
A comprehensive list of Aboriginal Medical Services across NSW can be found on
the Better to Know website.
Counselling
Relationships Australia oﬀers counselling, family dispute resolution (mediation) and
a range of family and community support and education programs. This service can
be contacted on 1300 364 277.
Domestic violence and sexual assault
The website 1800Respect lists a range of services that deal with domestic violence
and sexual assault. 24/7 information can be provided by phoning 1800 737 732.
Disability advocacy
The Department of Social Services list advocacy services in NSW for people with a
disability.
General Practitioners
GPs play an important role in talking to older people about their concerns and by
making referrals. The Royal Australian College of General Practitioners have published an abuse and violence guide which includes the Elder Abuse Suspicion Index.
If a person cannot visit a GP, contact the GP Helpline on 1800 022 222.
Mental Health Information Service
The Mental Health Information Service provides information, support and referrals
regarding mental health issues via community mental health, crisis intervention,
treatment services and accommodation. This service can be contacted on 1300 794 991.
My Aged Care
My Aged Care is an Australian government gateway (website and contact centre) to
access information about aged care services in the home, residential care and respite.
Services in the home can contribute to older people being less vulnerable to abuse
as they can address one of the key risk factors: social isolation. My Aged Care is also
the site where people can obtain information about Aged Care Assessment Teams in
their area. For further information call 1800 200 422.
Ministry of Health
Local health districts provide a variety of services to older people, from emergency
services to transitional care and rehabilitation. Professionals can utilise local health
districts for a range of information from chronic disease, integrated care, safety and
multicultural health. More information can be found by accessing the website NSW
Health
Step 5 Tools: Respond & Refer
58
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
NSW Refugee Health Service
Aims to protect and promote the health of refugees and people of refugee-like
backgrounds living in NSW. This service can be contacted on (02) 8778 0770.
Specialist Mental Health Services for Older People (SMHSOP)
SMHSOP provides input to assessment and management of older people with severe,
complex behavioural disturbances, in partnership with a range of other aged-care
services. To access a SMHSOP service phone the Mental Health Line on 1800 011 511.
STARTTS
STARTTS provides culturally appropriate and cutting-edge psychological treatment
and support to help people heal the scars of torture and refugee trauma and rebuild their lives in Australia. This service can be contacted on (02) 9794 1900.
Support and counselling
A list of support and counselling numbers is available on the Support and Counselling
page of the Family & Community Services website.
Telecross
Telecross provides peace of mind to people who are isolated through a daily call to
check on their wellbeing and safety. This service can be contacted on 1800 812 028.
59
Tool 5.4: Key social and welfare agencies
Possible referrals
ACON (Aids Council of NSW)
ACON is a leading organisation for gay, lesbian, bisexual, transgender and intersex
people (LGBTI) and provides a range of health resources and services including
training to home and community care providers. Contact ACON (02) 9206 2000.
Alzheimer’s Australia
Alzheimer’s Australia/NSW can provide support to families caring for someone with
dementia as well as education and information. Call 1800 100 500.
Carers NSW
Carers NSW is an association for relatives and friends caring for people with a
disability, mental illness, drug and alcohol dependencies, illness or who are frail.
Carers NSW provides information, referrals, support, and counselling to carers and
can be contacted on (02) 9280 4744 or 1800 242 636.
Community Justice Centre (CJC)
The Community Justice Centre is a free government service to help people resolve
disputes through professional mediation. To discuss whether mediation is suitable
for a particular situation, call the CJC on 1800 990 777.
Squalor and Hoarding Helpline & Resource Unit
Catholic Community Services has a squalor and hoarding service that assists eligible
people who have hoarding tendencies and who may live in domestic squalor. For
further information and referrals call 1800 225 474.
Tenant Advice and Advocacy Services
Tenant Advice and Advocacy Services assist tenants of private rental housing, social
housing tenants, boarders and lodgers, and residential park residents. To fnd where
the closest service is, refer to their website.
Staying Home Leaving Violence
The Staying Home Leaving Violence program supports victims of domestic and
family violence through promoting housing stability and focusing on preventing
homelessness.
Step 5 Tools: Respond & Refer
60
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 5.5: Key legal and justice agencies
Possible referrals
Aboriginal Legal Service (ALS)
The Aboriginal Legal Service provides free and means-tested legal services to
Aboriginal and Torres Strait Islander people. The service represents people in a
range of legal matters. Contact ALS on 1800 765 767.
Key community legal centres
• The Seniors Rights Service oﬀers free independent legal advice about all areas
of law eﬀecting older people. The Seniors Rights Service can be contacted on
1800 424 079.
• The Domestic Violence Legal Advice Line for Women is a free, confdential legal
information, advice and referrals service for women in NSW with the focus on
domestic violence and Apprehended Domestic Violence Orders (ADVOs). The
advice line can be contacted on 1800 800 708.
• Women’s Legal Services of NSW is a community legal centre providing a range of
free legal services for women across NSW.
Legal Aid
Legal Aid has a series of fact sheets and resources available on their website providing useful strategies to prevent and manage abuse. They include:
• Your home and the age pension: what you need to know
• They want me to leave: staying in your home when your partner dies
• Helping your family fnancially: understand the risks
• Why make a Will?
• Who will decide for you if you can’t decide for yourself? Thinking about planning
ahead
The civil division of Legal Aid NSW have regular face-to-face advice clinics in Sydney
and regional areas throughout NSW. Legal Aid oﬀers legal advice on a wide range
of issues that might aﬀect older people and their carers including housing, nursing
homes, discrimination, Guardianship and fnancial management, grandparents and
family law, Centrelink matters and consumer law. Review the following link for ofce
locations and contact details legalaid.nsw.gov.au/contact-us/legal-aid-nsw-ofce
Law Access
Law Access provides free legal information on the phone and can refer to other legal
services, such as the nearest Legal Aid ofce or a Community Legal Centre. Law
access can be contacted on 1300 888 529.
NSW Civil & Administrative Tribunal
An application to the Guardianship Division of the NSW Civil & Administrative Tribunal can be made about an older person. Sometimes the outcome means that the
NSW Trustee & Guardian are legally appointed to protect and administer the fnancial
61
aﬀairs and property of people unable to make those decisions for themselves. The
Public Guardian can be appointed to make important health and lifestyle decisions
on behalf of an older person. The contact number is 1300 006 228.
NSW Police
The NSW Police website has a page related to elder abuse. Physical abuse of someone
is a crime of assault. A report to the NSW Police should be made. Some strategies
the police use to manage elder abuse are on policing domestic violence and other
crimes via Apprehended Violence Orders (AVO). Police can request an Exclusion
Order as part of an AVO.
NSW Trustee & Guardian
The NSW Trustee & Guardian (TaG) are an independent and impartial Executor, Administrator, Attorney and Trustee for the people of NSW. TaG provides direct fnancial management services and authorisation, and direction to private fnancial managers. TaG can be contacted on 1300 364 103.
For managed clients: 1300 320 320.
For general information on Guardianship or the Public Guardian, contact the
Information & Support Branch on (02) 8688 6070 (NSW STD callers 1800 451 510).
Public Guardian Support Unit
The Public Guardian Support Unit provides a free and confdential service to legally
appointed private Guardians. Guardians can contact this unit during business hours
on (02) 8688 6060 or (NSW STD callers 1800 451 510).
Step 5 Tools: Respond & Refer
62
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 5.6: Diﬀerence between Power of Attorney and Enduring
Guardianship: it’s important you know the diﬀerence
Many instances of fnancial and psychological abuse result from the misuse
of Powers of Attorney and confusion between the roles of an Attorney and an
Enduring Guardian.

Things to Consider	Power of Attorney	Enduring Power of Attorney	Enduring Guardian
Can only be appointed by the person whilst they have capacity.
Manages fnances and assets on behalf of old er person, according to older person’s wishes (e.g. paying bills).
Useful if older person is overseas or unwell and needs fnances managed by another person.
Can be in eﬀect whilst older person has capacity.
Is eﬀective when the older person loses capacity.
May decide where the older person lives.
May decide what health care the older person receives.
May decide what other kinds of personal services are received.
Can consent to medical or dental treatment being carried out.

* Note: other decisions can be made by Enduring Guardians, however they require a “special function” which must be clearly stated in the Guardianship documentation. These
special functions may include an“access function” which allows the Enduring Guardian to
restrict specifc persons, stated in the Guardianship documentation, from having access to
the older person. This is normally used when there is some discord in family or close relationships. However, without these special functions being specifcally listed in the Guardianship documentation, the Enduring Guardian does not have the right to restrict access
to the older person.
For more information about Powers of Attorney and Enduring Guardianships
please see:
http://www.tag.nsw.gov.au/powers-of-attorney-landing.html
http://www.publicguardian.justice.nsw.gov.au/agdbasev7wr/publicguardian/
documents/pdf/accesssummaryweb2014.pdf
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Tool 5.7: Revoking a Power of Attorney
Revoking a Power of Attorney
(PoA) can be easy. If you have a
Power of Attorney in place you
have the right to revoke that power
if you no longer want that person
managing your money or assets.
Who can revoke a Power of Attorney?
You can revoke (cancel) a PoA at any time
as long as you have the capacity to do so
(refer to fgure 1.1). Only you can revoke the
power given to your attorney.
How do you revoke a PoA?
You can revoke a PoA simply by writing to
your attorney, stating that you are revoking
the PoA. You should also notify, in writing,
organisations your attorney was dealing
with on your behalf, e.g. banks and Centrelink. Once you have revoked the PoA it is best
to destroy all copies of the original PoA
document.
There is no specifc form to fll out when
revoking a PoA although there is a sample revocation document on the Land and
Property website at http://www.lpi.nsw.gov.
au/__data/assets/pdf_fle/0005/25367/
Revocation_of_POA_Form_FINAL.pdf
A document revoking a PoA must state
the following:
• your name (the name of the attorney
is optional)
• the date the PoA was put in place
• the registered number of the Power of
Attorney (if registered in which case
the revocation must also be registered)
• the date of the revocation
• words indicating cancellation such as
“I hereby revoke” (Land & Property
information, 2015).
What happens if you lack capacity?
If you lack capacity (refer to fgure 1.1) you cannot revoke an Enduring PoA (EPoA). If the PoA
is not enduring then it ceases once you’ve lost
capacity (i.e your PoA can no longer assist with
your fnances or assets unless you made them
Enduring PoA when you had capacity). If you
lack capacity and family members or concerned
others feel that your money and assets are being misappropriated by your enduring attorney,
the NSW Civil & Administrative Tribunal (NCAT)
have a process in place to investigate these
matters once an application is lodged.
What can the NSW Civil & Administrative
Tribunal (NCAT) do?
If an application is made to the Tribunal and
they fnd that your money and assets have been
misappropriated, they may decide to allocate a
fnancial manager to manage your funds for you.
This may be the NSW Trustee & Guardian or an
appropriate family member or friend.
1.1 Capacity
Capacity refers to an adult’s ability to
make decisions for themselves (Justice
2015). When revoking a PoA you must
understand the nature and consequences
of the decision you’re making. Professionals
such as doctors can assist in determining
your level of capacity.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 5.8: Assessing needs of an older person
In developing a support plan, safety plan and making referrals, consider the
following factors:

Older person
Is your client at risk of harm?
• Refer to the risk factors listed in this
toolkit and what you know about the
older person.

Alleged abuser
What is the relationship between the older
person and the alleged abuser?
• What inﬂuence does the abuser have on
the older person: fnancial, psychological,
social, physical and sexual?
• Access the abuser has to the older person
such as whether they live in the same
house as the older person or carer.
• The risk factors for the alleged abuser,
e.g. carer stress factors, mental health etc.

Support networks
What support does the older person have?
• Family.
• Friends.
• Interests/hobbies.
• Church.
• Health and/or other social services.

Environments
What is the environment like for the
older person? Consider:
• Health factors such as mobility.
• Social isolation.
• History of domestic and family violence.
• Support networks.
• Values, experiences, decision-making.
• Belief systems and culture.
• Legal factors.

65
Tool 5.9: Example of a safety plan for a person experiencing
abuse
A safety plan plays an important role where the person is residing with the abuser
and ensures the older person is aware of emergency phone numbers, options for
referral and support. Forsdike, Tarzia, Hindmarsh and Hegarty (2015) cite several key
elements of safety planning24 :

Developing a list of emergency and other phone numbers and having access to these numbers, such as: • Emergency • Crime Stoppers • Local police stations • Lifeline • NSW Domestic Violence Line and advocacy which can also advise on refuges and court assistance • Legal services: women’s, Indigenous, older persons’ • Alcohol, Drug and Information Service • Mental Health Line • Link2Home NSW • ACHA program • Safe Place Program (LGBTI) • ACON Anti-violence Project • Housing NSW contact centre • Family & Community Services Helpline	Providing a safe place to store valuables and important documents, such as: • Medicare and Tax File numbers • Rent and utility receipts • Birth certifcate • ID and driver’s licence • Bank account and insurance policy numbers • Marriage licence • Wills and other documents such as Powers of Attorney or Enduring Guardianship • Valuables such as jewellery • Hidden bag with extra clothing
Removing weapons from the house and engaging NSW Police to help with this where necessary.	Identifying a safe place to go and how to get there.
Identifying family and friends that can provide support (and establishing a signal for help).	Ensuring availability of money and having an extra set of house and car keys.

24 Forsdike, K., Tarzia, L., Hindmarsh, E., Hegarty, K., Family violence across the life cycle,
reprinted from Australian Family Physician Vol.43, No 11, November 2015.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Tool 5.10: Policy checklist
This policy checklist is designed to:
• Ensure current workplace policy is aligned to the Preventing and responding to
abuse of older people: NSW Interagency Policy 2015.
• Assist in redrafting or writing a policy in relation to the abuse of older people.
• Note: if your agency does not have a policy, see elderabusehelpline.com.au for a
policy template.
Glossary
For the purposes of this checklist, the following terminology is used:
• ‘Agency’ is used throughout this document as a collective and generic term to
mean: any government, non-government, community service organisation or
service provider.
• ‘Managers’ include all senior staﬀ such as directors, supervisors, program managers and senior coordinators/care advisors.
• ‘Staﬀ’ includes: all staﬀ in the agency, for example frontline and direct care staﬀ
and volunteers.

Yes	No
Introduction – a clear introduction that identifes:
The policy owner.
How the policy will be implemented including staﬀ awareness and training.
Related policies and legislation.
A policy review date.
Purpose – a clear purpose is outlined that:
Guides staﬀ in providing a consistent response in addressing abuse of older people in the community.
Protects and supports staﬀ to encourage reporting.
Upholds the rights, dignity and respect of older people.
Values response mechanisms such as interagency and multidisciplinary approaches to manage suspected and actual cases of abuse of older people.
Makes reference to the Preventing and responding to abuse of older people: NSW Interagency Policy 2015.
Supports a collaborative eﬀort aimed at achieving a unifed approach to the abuse of older people within NSW.
Articulates a commitment to prevention and early intervention strategies such as forming regional partnerships and service systems. An example could be developing an interagency collaborative at the regional or sub–regional level and where referral protocols and pathways are developed.
Addresses systemic issues that are identifed locally or within a specifed region.
Defnition of abuse – an overall defnition of the abuse of older people is provided that:
References the World Health Organisation defnition as articulated in the NSW Interagency Policy.
Lists the forms of abuse including types and signs exemplifed in the NSW Inter agency Policy.

Yes	No
Scope – the parameters of the policy outlines:
Who the policy is for.
What the policy covers and does not cover (e.g. does not cover abuse of older people in a Commonwealth residential aged-care facility).
The role of the agency and their overall responsibility in managing the abuse of older people.
Procedures that will be developed to guide policy implementation.
The limitations to the policy based on the agency role.
Related policies or procedures within the agency and how staﬀ can access these.
Key principles of working with older people – key principles that align to:
• NSW Interagency Policy • United Nations Principles for Older Persons • NSW Charter of Victims’ Rights and NSW Code of Practice for the Char ter of Victims’ Rights • Home Care Standards
Consider the views of the older person even when they cannot make their own decisions.
State how older people will be supported and respected to make their own decisions, by oﬀering choices, including the decision not to act or refuse ser vices if they are competent to make that decision.
When responding, focus on the safety and ongoing protection of the older person who has been abused.
Identify the legal remedies and protections available for older people who are victims of crimes: violence, sexual assault, physical assault, domestic violence, abuse, threats, fraud, neglect, stalking, intimidation and harassment.
Take account of the diverse needs of the older person such as Aboriginality, culture, disability, religion, gender and sexuality.
Acknowledge that the needs of the older person at risk of abuse and the abuser should be kept separate at all times, especially if the abuser is the carer.
Articulate that confdentiality cannot be guaranteed where the safety of others is involved.
Support the reporting of the abuse of an older person without fear of retalia tion or retribution, and in a supportive environment.
Commitment – to deal eﬀectively with the abuse of an older person by:
Creating a climate of trust where staﬀ are encouraged and confdent about identifying and responding to abuse.
Protecting and supporting staﬀ from any adverse action when making a report.
Developing a process to deal with reports thoroughly and prevent abuse from reoccurring.
Provide training for staﬀ about identifying and responding to abuse.
Managing workplace issues that the allegations identify or may result from a report of abuse and/or address any other problems.
Working collaboratively within the agency and across agencies to achieve the best outcome for the older person and prevent abuse from reoccurring.
Reassessing/reviewing the policy periodically.
Identifying abuse – details the 5 forms of abuse outlining defnitions and indicators consistent with NSW Interagency Policy as:
Financial abuse defnition and signs.
Psychological abuse (including social isolation) defnition and signs.

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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People

Yes	No
Physical abuse defnition and signs.
Neglect defnition and signs.
Sexual abuse defnition and signs.
Risk factors – vulnerability or risk factors can be present for both the older person and the alleged abuser and outlines:
Local demographics where older people are at risk (e.g. high numbers of older people, social isolation due to living in rural and remote areas, lack of services or accommodation including respite.
Common risk factors consistent with the NSW Interagency Policy for older people such as: • Social isolation; confusion; deteriorating health; cognitive decline; dementia and capacity issues including behaviour changes such as violence and aggression; family history of abuse including domestic violence; family dysfunction; substance abuse and gambling; fnancial difculties; inability to advocate or modify environment; cultural factors and dependency.
Common risk factors consistent with the NSW Interagency Policy for abusers (carers and family members especially) such as: • Financial; emotional and physical situations; sleep deprivation; challeng ing behaviours of the older person; lack of support from family; communi ty and service system; cognitive decline; cultural issues; lack of skill in the caring role; family history of abuse including domestic violence.
Key considerations in responding to abuse of older people – providing an appropriate, adequate and timely response with a focus on the safety of the older person, the carer and staﬀ member by:
Outlining responsibilities of staﬀ in relation to their duty of care.
Developing local procedures and protocols that align to the NSW Interagency Policy.
Responding promptly.
Identifying what the older person wants in relation to care/case planning.
Establishing a frst point of contact within the agency.
Considering referral options even if they fall outside the responsibility of the agency.
Seeking opportunities to work collaboratively.
Consideration of a case-management approach.
Reporting and consulting a manager.
Documenting, recording and monitoring as appropriate.
Information sharing – protecting personal information provided to the agency by:
Explaining privacy, confdentiality and duty of care.
Listing exemptions in release of information in responding to the abuse of an older person by referencing and summarising the impact of appropriate legislation: NSW legislation • Crimes Act 1900 • Crimes (Domestic and Personal Violence) Act 2007 • Crimes (Domestic and Personal Violence) Amendment (Information Sharing) Act 2013 • Health Records and Information Privacy Act 2002 • Privacy and Personal Information Protection Act 1998

Yes	No
Federal legislation • Privacy Act 1988 • Privacy Amendment (Enhancing Privacy Protection) Act 2015
Emergency response – describes the types of situations and responses to an emergency:
Situations where an emergency service is contacted and where the police must be called regardless of the victims views, such as: • serious injury • access to a gun and threats to cause injury • using or carrying a weapon and likely to cause injury or instil fear • an immediate and serious threat to an individual or public safety exists • staﬀ are threatened
Protecting evidence for a Police investigation.
Seeking guidance from NSW Police or other emergency service.
Training and support to staﬀ.
Maintaining an up-to-date list of resources.
Mental capacity and consent – describes how capacity and consent relate to responding to the abuse of an older person in line with local guidelines and NSW Interagency Policy:
Defnition of capacity as it relates to an older person.
Assessment of capacity.
Considerations of capacity as it relates to informed consent.
Lack of capacity and other options such as Guardianship and Powers of Attorney.
Cultural considerations – reﬂect the role culture plays in understanding, identifying and responding to the abuse of older people where service delivery reﬂects:
Aboriginal and Torres Strait Islander older people.
When and what type of information can be shared, consistent with legislation stated.
Advice from the person’s local Aboriginal community.
Provision of options and service delivery that is ﬂexible and culturally responsive to build family and community resilience.
Support from Aboriginal-specifc organisations, depending on the person’s choice and circumstances.
That elder abuse is something that can happen to any older Aboriginal person, not just Elders.
The diﬀerence in life expectancy of Aboriginal people compared to non-Aboriginal people.
The role of kinship in Aboriginal communities.
Cultural and Linguistically Diverse (CaLD) older people.
Informed and sensitive support to older people in CaLD communities, acknowledging the role of family.
Culturally appropriate services used such as interpreter services, bilingual community or health workers, GP or specialist services.
De-identifed consultation with community development workers from the cultural background of the family concerned as well as within your agency.
Other considerations you may wish to include:
Lesbian, Gay, Bisexual, Transgender, Intersex older people.
Women experiencing domestic and family violence.

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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People

Yes	No
Staﬀ roles and responsibilities – identifes staﬀ roles with a purpose to:
Allocate key responsibilities in relation to the abuse of older people. Also refer to the NSW Interagency Policy.
Appendices – useful resources and references populated such as:
Useful contacts
Legislative and other references

71
Case studies
Meet Bill
Bill is 86 years old and a grandfather of two. When Bill’s wife passed away he became
forgetful, a little disorientated, confused and depressed. Bill didn’t really want to move
away from his friends but his daughter, Sally persuaded him to sell his house, transfer
the money into her and her husband’s account and move in with the family. Sally said
they could both beneft from this course of action. Bill sold his house and transferred
$250,000 in exchange for his care. There was no formal record of the arrangement.
Sally also held Enduring Power of Attorney for Bill. Everything was fne until Sally
used the money to take her family on holidays, leaving Bill home alone, unable to
buy his diabetes medication or go to the shops. Sally began verbally berating Bill
and refused to give him back the money when he asked for it, claiming it was a gift
and kicked Bill out of the house, leaving him homeless.
Bill’s story adapted from Senior Rights, Victoria and available from
http://www.sbs.com.au/news/article/2014/09/03/elder-abuse-victims-fear-family-backlash
Note: the answers listed here are a guide only. Other options or actions may be
appropriate.
Types of abuse: indicators
• Financial – Bill sold his house and Sally used all the money.
• Neglect – Bill was unable to buy his diabetes medication, go to the shops and
was left homeless.
• Psychological – Sally verbally berated Bill.
Social issues and responses
• Support Bill in fnding alternative accommodation such as accessing social housing and a community support worker. Also consider short-term respite until a
plan is in place.
• Ask Bill whether he wants to attend counselling and repair his relationship with
his daughter and consider referrals to the Community Justice Centre or Relationships Australia for mediation.
Health issues and responses
• Bill has depression/confusion and may need an assessment via the Aged Care
Assessment Team and/or Specialist Mental Health Services for Older People.
• Support Bill in accessing specialist medical help via referrals that can be made at
a visit to his GP.
• Diabetes management.
Legal/fnancial issues and responses
• Bill has the right to legal help to try to recover his money. Referrals for Bill to the
Seniors Rights Service or another community legal service could be made.
• Arrange for Bill to speak to a social worker and fnancial management service at
Centrelink.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
• Support Bill in revoking the Power of Attorney if he has the cognitive/mental
capacity to do so.
• An application to the NSW Civil & Administrative Tribunal (NCAT) may be necessary for a Public Guardian to be appointed and to review Sally’s Enduring Power
of Attorney.
Contact the NSW Elder Abuse Helpline & Resource Unit for further information and
support.
Meet Shirley
Shirley is 79 years old and lives in social housing. Shirley has mobility problems and
emphysema. Shirley relies on oxygen and finds cooking and household chores
difficult. Shirley’s son, Allan moved in when his marriage failed fve years ago. Allan
doesn’t work and is on a carer’s payment. Allan has a mental health problem (Bipolar I), is non-compliant with medication and has developed a gambling habit. Shirley
relies on Allan for most things. Allan has Power of Attorney and is signatory to her
account. Shirley has cancelled Meals on Wheels and help with her personal care because she cannot pay the accounts. Shirley doesn’t ask where the money has gone
because Allan gets angry.
Note: the answers listed here are a guide only. Other options or actions may be
appropriate.
Types of abuse: indicators
• Financial – Shirley doesn’t ask where the money has gone and is unable to pay for
necessary services.
• Psychological – Allan gets angry and Shirley is fearful.
Social issues and responses
• Consider a review meeting with Shirley to discuss her cancellation of services and concerns about abuse. Check if Shirley is comfortable with Allan living at
home. Discuss with Shirley the steps in the Legal Aid fact sheet: ‘Adult children
living at home: what to do if you want them to leave?’
• Explore what Shirley means by Allan getting angry. Provide information on safety
planning for Shirley.
• Explain Shirley’s right to ask Allan where her money has gone and determine
what she wants to do about her situation.
• Ask Shirley if she would like a volunteer to take her shopping and help her with
the banking.
• Would counselling for Allan be helpful?
Health issues and responses
• Support Shirley to see her GP. Explore options for some respite for Shirley outside of the home so she can be medically assessed.
• Consider Allan’s needs in relation to his mental health and make some suggestions.
Legal/fnancial issues and responses
73
• Suggest to Shirley that she cancel/revoke the Power of Attorney if she is being
fnancially abused. Shirley could seek support from a legal service.
• Suggest Shirley consider paying her bills using Centrelink’s Centrepay service.
• Suggest Shirley monitor her bank balance via bank statements. The bank manager
could be informed of potential fnancial abuse and put some safeguards in place
for Shirley.
• Consider your duty of care to report physical abuse if it has occurred to NSW
Police and/or explain to Shirley about gaining an Apprehended Domestic Violence Order for personal protection.
Contact the NSW Elder Abuse Helpline & Resource Unit for further information and
support.

Meet Olivia
Olivia is 86 years old and has dementia. Two years ago, Olivia moved in with her son,
Tommy, his wife, Sarah and their two children. Olivia speaks English well but it is her
second language and at times she reverts to Italian. Tommy has Enduring Guardianship and Enduring Power of Attorney. Sarah is in receipt of the carer’s payment
and in the past Tommy has been reluctant to accept aged-care community services
for his mother so support is minimal. Over time, Olivia, has told workers that Sarah
screams at her and Olivia keeps pointing to her head saying there is a lump. Olivia’s
clothes are dirty and Olivia appears to be losing weight. The house is very untidy
with bills piled on the table. Sarah tells workers she is coping well, although Olivia
had been admitted to hospital a couple of times for falls.
Note: the answers listed here are a guide only. Other options or actions may be
appropriate.
Types of abuse: indicators
• Psychological – Sarah screams at Olivia.
• Physical – Olivia indicates she has a lump on her head and has been admitted to
hospital for falls.
• Neglect – Olivia is losing weight, her clothes are dirty, bills are piled on the table
and Sarah’s past reluctance to accept services.
Social issues and responses
• Arrange a meeting with Olivia to ask her questions about her situation at home
and if she is comfortable with her living arrangements.
• Arrange a service review and involve Olivia’s family. Explain your concerns to
them about what can constitute abuse and discuss any additional support
services such as dementia care, day respite, and personal care.
• Inform Sarah and her family of support offered by Carers NSW as well as
financial support services.
Health issues and responses
• Review fles from aged-care service provider and the hospital to see if there have
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
been prior concerns about Olivia and speak to the hospital social worker, if appropriate.
• Arrange for Olivia’s GP to go through the Elder Abuse Suspicion Index questions.
Also arrange for a full physical assessment of Olivia, as well as a capacity
assessment.
• A referral for a new Aged Care Assessment may be needed as well as some
temporary respite outside of the home.
• After the assessments, discuss the future accommodation options for Olivia and
convene a case conference.
Legal/justice issues and responses
• If physical abuse is evident, report to NSW Police.
• An application to the NSW Civil & Administrative Tribunal (NCAT) may be
necessary to have Guardianship and Powers of Attorney reviewed.
Contact the NSW Elder Abuse Helpline & Resource Unit for further information and
support.
75
Section 2:
Supporting information
What is elder abuse?
The World Health Organisation’s (WHO) defnition of the abuse of older people:
“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”.25
Elder abuse can take various forms such as physical, psychological or emotional,
sexual and fnancial abuse. It can also be the result of intentional or unintentional
neglect. In this context, abuse is generally perpetrated by a relative of the older
person where the trust relationship involves dependency and proximity to the older
person such as an adult child or spouse.
Supporting and educating the older person, no matter what their choices are in
relation to their situation is paramount. Providing information about available
support and options can support the older person in their decision-making and in
making referrals.
Glossary
For the purposes of this toolkit the following terminology is used:
‘Older person’ is used to mean people over the age of 65 and Aboriginal and Torres
Strait Islander people over 50 years of age.
‘Agency’ is a collective and generic term to mean: any government, non-government, community service organisation or service provider.
‘Manager’ includes: all senior staﬀ such as directors, supervisors, program managers
and senior coordinators/care advisors.
‘Staﬀ’ includes: all staﬀ in the agency, for example frontline and direct care staﬀ,
professionals and volunteers.
‘CaLD’ will be used to mean culturally and linguistically diverse and is in common
usage as a broad descriptor for groups and individuals according to religion, race,
language and ethnicity, but excluding those whose ancestry is Anglo–Saxon,
Anglo-Celtic, Aboriginal or Torres Strait Islander (Community Relations Commission
for a Multicultural Society Terminology).
25 Family & Community Services, NSW Interagency Policy.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
KEY FACTORS IN RESPONDING TO THE ABUSE OF
OLDER PEOPLE
Principles that guide the way we work with older people
The following principles are an extract from the NSW Interagency Policy which
guides the way service providers work with older people who may be experiencing
abuse.26

•	Older people who are at risk or have experienced abuse are to be:
–	Provided with information about all relevant options available to them, including services trained to support and empower them and equipped to help them end abuse when it occurs. Encouraged and assisted to make decisions, including a decision not to act. Respected and given the choice to accept or refuse services if they are competent to make that decision.
– –

• Every eﬀort must be made to ensure the views of the older person are taken into
account even when they cannot make their own decisions.
• Responses to the abuse of older people will be in the interests of the older person
at risk or who has been abused and focused on ensuring safety and ongoing protection from violence and abuse.
• Many forms of abuse of older people are crimes. Legal remedies and protections
are available for older people who have experienced: violence, sexual assault,
physical assault, domestic violence, abuse, threats, fraud, neglect, stalking, intimidation and harassment.
• Responses to the abuse of older people will be consistent with the NSW Charter
of Victims’ Rights, which is accompanied by the NSW Code of Practice for the
Charter of Victims’ Rights.
• Responses to the abuse of older people will as far as possible take into account
of the needs of the older person in relation to Aboriginality, culture, disability,
language, religion, gender and sexuality.
• The needs of the older person at risk of abuse or who has been abused and the
abuser must be kept separate at all times. This is particularly important in situations where the abuser has been the victim’s carer or has complex needs.
• When the safety of others is involved, confdentiality cannot be oﬀered unconditionally. In situations where a report to NSW Police is required, the consent of the
person involved is not necessary.
• Any person should be able to report abuse of older people without fear of
retaliation or retribution and in a supportive environment.
Ageism and discrimination
Promoting the dignity and inherent value of older people is a crucial component of
elder abuse identifcation, intervention and prevention. Ageism is pervasive and often
facilities poor decision-making on behalf of the older person. Ageism excuses or
discredits abuse, often resulting in devastating outcomes for the older person.
26 Family & Community Services, NSW Interagency Policy.
77
Section 2: Supporting Information
As advocates for the rights of older people, avoid cliches and stereotypes which
perpetuate ageism and ageist attitudes. It’s not simply about accepting older people,
but embracing, valuing and involving older people in all generational levels of our
society.
For additional information about ageism and other forms of discrimination, review
the following websites and associated publications:
Australian Human Rights Commission
humanrights.gov.au/our-work/age-discrimination/about-age-discrimination
World Health Organisation Missing Voices (2002) report
who.int/ageing/publications/missing_voices/en/
NSW Ageing Strategy
ageing.nsw.gov.au
NSW Elder Abuse Helpline & Resource Unit (EAHRU)
elderabusehelpline.com.au
Charter of Victims’ Rights
A victim of crime has rights; these are called the Charter of Victims’ Rights. Under
the charter a victim is a person who suﬀers harm as a direct result of a criminal offence. The charter requires NSW Government agencies to ensure that a victim has
rights to:
• Respect and compassion.
• Information about and access to welfare,
health, counselling and legal services.
• Protection, privacy and safety.
• Information about investigation and
prosecution of the crime.
For additional information about the Charter of Victims’ Rights and accompanying
NSW Code of Practice for the Charter of Victims’ Rights, review the following website:
NSW Justice – Victims Services and Support page
victimsservices.justice.nsw.gov.au
Capacity and consent
One of the key considerations for agencies is determining if a person has mental/
cognitive capacity to make decisions. ‘Capacity’ refers to an adult’s ability to make a
decision for themselves about their daily life.27
According to the Capacity Toolkit and the NSW Interagency Policy:
“A person has capacity to make a decision or to give their consent if they can:
• Understand the nature and eﬀect of a particular act or decision;
• Weigh up the consequences of the act or decision; and
• Communicate their decision.”284
27 NSW Government, and Attorney General’s Department, Capacity toolkit.
28 Family & Community Services, NSW Interagency Policy.
• Help with preparing victim impact
statements.
• Make submissions about oﬀenders
in custody.
• Information about compensation.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
In NSW there is a legal presumption that all adults have decision-making capacity
and can give consent until proven otherwise.
Issues of consent and capacity should be assessed and decided in consultation with
professionals, such as a medical practitioner or specialist medical ofcer, Aged Care
Assessment Team or the Guardianship Tribunal.
Before taking any steps to have a substitute decision-maker appointed, agencies
need to be sure that a client does not have capacity.
For additional information, review the following websites and/or associated publications:
NSW Department of Justice Capacity Toolkit
justice.nsw.gov.au/diversityservices/Pages/divserv/ds_capacity_tool/ds_capacity_tool.aspx
Law Society of NSW – When a client’s capacity is in doubt – a practical guide for solicitors
lawsociety.com.au/cs/groups/public/documents/internetcontent/023880.pdf
Capacity Australia
capacityaustralia.org.au/wp-content/uploads/2013/10/NSW-Legal-kit-8pp-sept-
2013-version-.pdf
Carers
Carers play an important role in the lives of older people living in the community.
Whilst the caring role can be rewarding and fulflling, it can also be stressful.
Some stress factors include:
• Physical and emotional demands of caring.
• Lack of skill in the caring role and/or lack of knowledge regarding resources.
• Lack of choice about being a carer which may lead to feelings of resentment.
• Conﬂict and frustration under the pressures of illness and adversity, or where the
carer has a history of poor relations with the person they are caring for.
• Lack of support as a carer, feeling alone, isolated and fnding it difcult to access
services and supports.
• Social isolation because of the caring role, having to give up other employment
or fnding it difcult to visit friends and participate in activities.
• Cognitive decline of the carer.
• Other causal factors such as geographical isolation.29
“Cultural factors impact on caring. People from culturally and linguistically
diverse backgrounds may have diﬀerent expectations about how and who will
provide care.
“Caring is an important cultural value for Aboriginal people. Aboriginal concepts
of care are based on the notion of family obligations, so Aboriginal carers often
take on a large caring role. Poorer health and intergenerational disadvantage
have also led to a higher proportion of Aboriginal people relying on unpaid care.
Aboriginal carers are more likely to be caring for children who cannot live with
their parents, as well as family members who are ageing or have a disability,
29 Carers NSW, carersnsw.org.au
79
Section 2: Supporting Information
chronic condition or mental illness.”30
For additional information, review the following websites and associated publications:
Australian Government website – Carers page
australia.gov.au/information-and-services/benefts-and-payments/carers
Carers Australia
carersaustralia.com.au
Carers NSW
carersnsw.org.au
Confdentiality
Confidentiality refers to the relationship between staff/agencies and a client,
with an obligation not to disclose personal information unless consent of the person
concerned is given. However, there will be situations where confdentiality is lawfully
overridden. In these circumstances, workers should always consult their supervisors
who will act in accordance with their agency’s policies and guidelines.31
Dementia
People with dementia are at higher risk of elder abuse (Cooper et al, 2008) due to
their cognitive impairment, loss of capacity, communication challenges and increasing
dependence on their caregivers.32 33
Dementia can also make it harder to detect abuse as common reactions to abuse,
such as withdrawal from communication, can also be symptoms of dementia. The
person with dementia may also abuse the caregiver either due to lifelong habits or
impact of the disease.34 35
For additional information about dementia and support available, review the following
website or contact the Helpline:
Alzheimer’s Australia
https://fghtdementia.org.au/
National Dementia Helpline
Ph 1800 100 500 (9 am–5 pm, Monday to Friday)
Working with people from culturally and linguistically diverse backgrounds
“International research indicates that the traditional ethnic family is characterised by
extended family systems with an emphasis on interdependence of family members,
continuity between generations and familial duty. Older people in traditional
‘age-honouring’ cultures hold a position of prestige within the family, and obligation
to older members is emphasised. Ethnic families often prefer to care for older family
members at home (Ministry of Social Development, 2002). It is important to ac-
30 Family & Community Services, NSW Carers Strategy 2015 – 2019, NSW Government, p. 4.
31 Family & Community Services, NSW Interagency Policy, Section 5.
32 alzheimers.org.uk, Mistreatment and abuse of people with dementia.
33 alzheimer.ca, Elder abuse.
34 alzheimers.org.uk, Mistreatment and abuse of people with dementia.
35 alzheimer.ca, Elder abuse.
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NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
knowledge, however, that generalisations across cultures are risky and issues for
ethnic communities are complex.
“Increased numbers of nuclear ethnic families and higher participation by women in
the workforce can compromise traditional care-giving practices and may contribute
to intergenerational conﬂict. Inadequate resettlement processes can prevent participation within the individual’s own ethnic group and limit integration into the wider
community. Support networks can therefore be limited and the responsibilities of
carers can be greater.
“There can be cultural, structural and economic barriers to using mainstream services,
as well as language barriers, which can contribute to social isolations and inactivity.
Diﬀerences in beliefs about health and illness and stigma attached to the use of particular health and community services are additional factors for some ethnic groups.
“Research indicates that a range of ﬂexible, culturally appropriate services are
required to meet the needs of ethnic older people and their families. The use of
interpreting services, translated materials and multilingual staﬀ are features of
culturally appropriate services. Addressing structural and economic barriers to access
and raise cultural awareness of service providers will also be required (Ministry of Social
Development, 2002; Brownell, 1997; Kosberg and Garcia, 1995; Charlesworth, 1986).”36
The abuse of older people or terms such as ‘elder abuse’ may take on a diﬀerent
context or lack meaning by people from culturally and linguistically diverse backgrounds. The concept of individual rights is an Anglo-mainstream way of thinking,
where for many CaLD communities, collective decision-making in families is strong
and may also include family members living overseas. Cultural traditions regarding
family roles and responsibility may aﬀect the way abuse is perceived and or understood. The notion of individual rights may inhibit appropriate help for the older person as they fear actions that separates them from their family.
The settlement process brings further barriers for people from CaLD backgrounds
including low English language competencies, lack of knowledge of service systems
and how to access them, and greater dependency on younger family members that
have already integrated in to the Australian system and culture.37
Implications for practice
The following points can guide working with CaLD people where abuse may be present:
• Understand the diﬀerent cultural world views that can aﬀect the way the abuse
of older people is perceived.
• Awareness that there may be issues of shame.38
• Cultural expectations of family and collective decision-making.
• Economic and social dependency.
• Cultural and experiential issues that relate to older age and a loss of status, as
well as needing support in understanding the Australian legal system.
• Cognitive impairment results in less capacity to communicate in English.
36 ‘Elder Abuse & Neglect’ Family violence intervention guidelines, New Zealand Ministry of
Health.
37 Family & Community Services, Planning ahead in culturally and linguistically diverse
communities (CaLD).
38 Bagshaw, D., Wendt, S., Zannettino, L., Preventing the abuse of older people by their family
members, Australian Domestic and Family Violence Clearing House, 2009, Stakeholder
paper 7.
81
• Seek advice from bilingual people experienced with the particular cultural background of the family concerned.
• Provide a safe environment so trust can be developed.
• Respond sensitively where actions reﬂect the important role of family and that
separating older people from their family may be an inappropriate response.
• Provide appropriate support to older people from a CaLD background such as
professional interpreter services as the lack of English language skills and cultural inﬂuences can mean that an older person is more vulnerable to abuse where
it occurs, and that they are less likely to identify abuse or seek support. It is
advisable not to use family members to interpret.
• Problems for women and new arrivals can be compounded by social isolation.
• Carers from culturally and linguistically diverse (CaLD) backgrounds may not
identify as carers and therefore fail to recognise the services available to support
them. With limited profciency in English, for example, CaLD carers also face barriers in accessing services available to them and the person for whom they care.
• No culture is homogenous. Values, attitudes and practices to old age can be different from family to family and across and within cultures. Staﬀ should be aware
of their own values and belief system so they are not imposed on others.
• The concept of individual rights is an Anglo–mainstream way of thinking so consulting and engaging with members of the older person’s community is important.
• Diﬀerent cultural world views may aﬀect the way that abuse is perceived, and a lack
of understanding regarding the notion of ‘individual’ rights may inhibit appropriate
help for the older person as they fear action that separates them from their family.
• Cross-cultural training assists staﬀ to develop closer working relationships with
older people and builds cultural competency. This means older people are more
likely to disclose abuse as trust is built.
Multicultural NSW
multicultural.nsw.gov.au/about_us/
Telephone Interpreter Service (TIS: 131 450)
tisnational.gov.au/en/Interpreters
Ethnic Communities Council (02) 9319 0288
Ethnic Communities Council
Cross cultural and working with interpreter training
startts.org.au/resources/resources-for-free/
Brochures in other languages such as from NSW Legal Aid and NSW Trustee & Guardian.
Multicultural health services – local health district multicultural contacts
health.nsw.gov.au/multicultural/pages/default.aspx
Australian Human Rights Commission
humanrights.gov.au/
Working with Aboriginal and Torres Strait Islander people
Aboriginal and Torres Strait Islander people should be provided with culturally appropriate services and support by acknowledging the impact of change, dispossesSection 2: Supporting Information
82
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
sion of land and culture, stolen generation and the breakdown of traditional ways
of life in Aboriginal communities that contributes to the vulnerability of older Aboriginal people in the community.39
Implications for practice
The following points can guide agencies in working with Aboriginal people where
abuse may be present:
• Seek advice from Aboriginal people such as community leaders, exercising special sensitivity in relation to the abuse of older people in Aboriginal communities,
issues of economic and social marginalisation, and shame.
• Decision-making may be collective, within communities.
• Provide service delivery that is ﬂexible, provides choice and is culturally responsive to build family and community resilience.
• Recognise that service support should be provided from an Aboriginal-specifc worker
or organisation, depending on the person’s choice and circumstances such as an
Aboriginal Health Worker or Aboriginal Police Liaison Ofcer, where possible.
• Recognise that the term ‘Elder’ has diﬀerent meanings for diﬀerent Aboriginal
communities. In some, an ‘Elder’ can be any respected member of the community
regardless of age. It is important to recognise that Elder abuse is something that
can happen to any older Aboriginal person, not just Elders.
• Understand that the average life expectancy of Aboriginal people is 17 years
shorter than non-Aboriginal people and account for this diﬀerence in accessing
aged care support as well as the expected increase in the Aboriginal population.
• The important role of kinship in Aboriginal communities where members of the
community, including older members take on responsibility for multiple roles,
such as caring for children who have been removed from parents.
• Aboriginal people who live in rural and remote areas can be isolated by geography as
well as lack available services and therefore the risk factors for abuse are compounded.
Aboriginal people are more likely to have family living with them as carers.40
Aboriginal Medical Services
health.nsw.gov.au/aboriginal/Pages/contact.aspx
bettertoknow.org.au/AMS
Aboriginal specialist staﬀ in NSW Police, Family & Community Services, Aged Care,
Health NSW.
Aboriginal Housing Ofce aho.nsw.gov.au/
Aboriginal cultural awareness training and resources
community.nsw.gov.au/__data/assets/pdf_fle/0017/321308/working_with_aboriginal.pdf
heti.nsw.gov.au/courses/aboriginal-culture—respecting-the-diﬀerence/
Working with Lesbian, Gay, Bisexual, Transgender and Intersex older
people
Australia has an ageing population which means that there are increasing numbers
39 NSW Government, Health, Responding to family violence in Aboriginal communities, 2011-
2016. Aboriginal Family Health Strategy.
40 http://www.health.nsw.gov.au/aboriginal/Publications/pub-family.pdf
83
Section 2: Supporting Information
of older people who identify as lesbian, gay, bisexual, transgender or intersex (LGBTI).
Up to 11% of Australians may be of diverse sexual orientation, sex or gender. The
Australian Human Rights Commission states:
“Sexual orientation and sex and/or gender identity are integral to every person’s
dignity and humanity and must not be the basis for discrimination or abuse”.41
The Australian Human Rights Commission also states that the prevalence of violence,
harassment and bullying in the LGBTI community is proportionally higher than that
experienced in the general community citing a study where over 85% of the LGBTI
community in NSW had experienced homophobic abuse, harassment or violence
during their life. Workers must be particularly sensitive when working with older
people experiencing abuse who identify as LGBTI.
Implications for practice
• Negative attitudes and discrimination towards LGBTI people may make them
more vulnerable to abuse.
• Discrimination and invisibility are two key issues. It’s a mistake to see all LGBTI
people as being alike.
• Not everyone will be open about their orientation or identity, others may prefer
to keep this part of their lives private and this can often be due to experiences of
discrimination or stigma.
• Someone’s sexual orientation or gender identity may not always be clear, so
avoid making assumptions.
• Don’t assume all clients are heterosexual or that they identify as one of two genders.
• Working in ways that are inclusive of gender and sexual diversity can help to
ensure your LGBTI clients get the services they need.
• Discrimination against LGBTI people is unlawful under the NSW Anti-discrimination
Act (1977) with some exceptions and exemptions.
• Legislation exists across Australia recognising some (but not all) of the rights
and responsibilities of LGBTI people and same-sex couples in relation to tax, social
security and family.
• Government services, including health care and community services are required
to respect people’s basic rights and make sure that people are not treated unfairly.
• Access resources from ACON such as the community visitor scheme to support
socially isolated people, and safety planning and relationship planning to address
domestic violence.
ACON (AIDS Council of NSW) – Anti-violence Project
http://www.acon.org.au/lgbti-health/safety/
Australian Human Rights Commission
https://bullying.humanrights.gov.au/lesbian-gay-bisexual-trans-and-intersex-equality-1
LGBTI Health Alliance
lgbtihealth.org.au
Q & A for LGBTI – Top ten legal issues to consider for older lesbian, gay, bisexual, transgender and intersex people
seniorsrightsservice.org.au/wp-content/uploads/2014/08/qa-for-lgbti-booklet-.pdf
41 Australian Human Rights Commission, https://bullying.humanrights.gov.au/lesbian-gay-bi
sexual-trans-and-intersex-equality-1
84
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
We live here too: A guide to lesbian inclusive practice in aged care. Matrix Guild Vic.
matrixguildvic.org.au/docs/booklet_WeLiveHereToo.pdf
Domestic and family violence
The current defnition of domestic violence, under Section 5 of the Crimes (Domestic
and Personal Violence) Act 2007, includes relationships involving those dependent
on the ongoing paid or unpaid care of the other person, as well as family members,
partners, those living in the same household, and those in an intimate relationship.
The legal protections and services available to people who experience family
violence apply equally to older people.
“Elder abuse shares a number of characteristics with other forms of family violence
(Fanslow, 2005; Dunlop et al, 2000; Korbin et al, 1989). As with partner abuse
and child abuse, elder abuse is largely hidden, private and underreported (see
Fallon, 2006). Victims and families are often isolated, and in a weakened, powerless
and dependent position, and families often lack support. There is often a history of family conflict, alcohol and/or drug abuse, psychological problems, low
self-esteem and/or unemployment (Lachs and Pillemer, 2004; Gnaedinger, 1989).
“There are also a number of diﬀerences; gender diﬀerences, for example, are less
clear-cut than in cases of partner abuse. In elder abuse both men and women may
abuse or neglect (Thompson and Atkins, 1996). Similiarly, both older men and older
women are at risk of being abused, although older women are at greater risk according to most studies (Fallon, 2006).
“Issues of power and control can also be more complex. The older person may be
dependent on others, making them vulnerable to abuse. However, the abuser may also
be fnancially and emotionally dependent on the older person (Wolf, 2000; Anetzberger, 1987; Pillemer, 1986).
“In comparison with child abuse, older people are (generally) legally competent
adults, able to make their own decisions about where they live, with whom they live
and how they live. Older people may choose to remain in a living situation which is
not physically, psychologically or fnancially safe for them. Such a decision made by a
competent adult needs to be respected and options for improving safety within this
context need to be explored.
“Other issues may complicate the picture in situations of elder abuse. For example,
it may be a situation where there is pre-existing family conﬂict, or it may be partner
abuse occurring between older people. Sometimes an older person may be abusing
their partner and/or caregiver due to dementia or other conditions. There can also
be specifc elements that require specialist services, such as issues of consent and
assessment of mental capacity, occurrence of abuse with rest homes and institutions,
and/or responding to fnancial and material abuse.”42
NSW Government
dvnsw.org.au/
domesticviolence.nsw.gov.au/__data/assets/fle/0019/301177/DV-info-Sharing-Protocol.pdf
NSW Police
police.nsw.gov.au/community_issues/domestic__and__family_violence
42 ‘Elder Abuse & Neglect’ Family violence intervention guidelines, New Zealand Ministry of
Health 2007
85
Section 2: Supporting Information
Enduring Guardianship
An Enduring Guardian is a person chosen to make health and lifestyle decisions on
behalf of another person when they are no longer capable of making these decisions
themselves. The Enduring Guardian must be appointed whilst the person has capacity
and only takes eﬀect if the person loses capacity to make their own decisions.
The Enduring Guardian can only make decisions in health and lifestyle areas. A person
must choose the decision-making areas they give to their Enduring Guardian. These
decision-making areas are called functions.
The most common functions (decision-making areas) are already included on the
specifc form of appointment. These are:
• Accommodation – to decide where you live
• Healthcare – to decide what healthcare you receive
• Services – to decide what personal services you should have to support and
assist you.
Other functions
Some situations are more complicated and may need another function to give your
Enduring Guardian the authority to make other types of decisions if needed.43
While a person has mental/cognitive capacity they can cancel or change the Enduring
Guardianship arrangement. Where a person has no Enduring Guardian and has
impaired capacity, or where there is a dispute about the actions of the person who
has Enduring Guardianship, an application to the NSW Civil & Administrative Tribunal
(Guardianship Division) may be required.
NSW Justice, Public Guardian
publicguardian.lawlink.nsw.gov.au
NSW Trustee & Guardian
tag.nsw.gov.au/
NSW Government: legal resources for health professionals
healthlaw.planningaheadtools.com.au/
Powers of Attorney and Enduring Powers of Attorney
A Power of Attorney is a legal document which allows the person making the Power
of Attorney (the principal), to appoint another person (the attorney) to take care of
their fnancial aﬀairs should the need arise. A Power of Attorney can be general or
enduring.
“The term attorney in this sense does not necessarily mean a lawyer or solicitor. The
attorney may be a family member, close friend or trustee organisation such as the
NSW Trustee & Guardian.”44
A general Power of Attorney will terminate if the principal loses mental capacity
and is useful for short-term appointments, for example, if the principal is going
43 Enduring Guardianship in New South Wales: your way to plan ahead, Revised 2014.
44 NSW Trustee & Guardian, A guide for Powers of Attorney
86
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
overseas and needs someone to look after their financial affairs or sign documents in their absence.
An Enduring Power of Attorney will not cease to operate when the principal lacks
capacity. A person can cancel or change a Power of Attorney at any time while they
have mental capacity to do so.
“Making a Power of Attorney does not mean that you will lose control over your fnancial aﬀairs. As long as you retain mental capacity you still have capacity to deal with
your assets and money just as you did beforehand.”45
Where a person has no Enduring Power of Attorney or where there is a dispute about
the actions of the person holding the Power of Attorney, an application to the NSW
Civil & Administrative Tribunal (Guardianship Division) may be required.
NSW Trustee & Guardian
tag.nsw.gov.au/
NSW Government: legal resources for health professionals
healthlaw.planningaheadtools.com.au/
United Nations Principles for Older Persons
The United Nations General Assembly adopted eighteen Principles for Older Persons
on 16 December 1991 (Resolution No.46/91). Governments are encouraged to incorporate these principles into national programmes whenever possible. The principles
call for action in many areas. These principles recognise rights to independence,
participation, care, self-fulflment and dignity of older persons. These key principles
underpin a response to older people experiencing abuse.
United Nations Human Rights
ohchr.org/EN/ProfessionalInterest/Pages/OlderPersons.aspx
45 NSW Trustee & Guardian, A guide for Powers of Attorney.
87
Appendix 1: Legislation and guidelines
Australian
Aged Care Act 1997
Aged Care Amendment (Residential
Care) Act 2007
Age Discrimination Amendment Act
2004
Crimes Act 1914
Disability Discrimination Act 1992
Disability Services Act 1986
Home and Community Care Act 1985
National Consumer Credit Protection Act
2009
National Disability Insurance Scheme Act
2013
Privacy Act 1988
Work Health and Safety Act 2011
World Health Organisation Act 1947
NSW
Anti-discrimination Act 1977
Carers (Recognition) Act 2010
Children and Young Persons (Care and
Protection) Act 1987
Crimes Act 1900
Crimes (Domestic and Personal
Violence) Act 2007
Crimes (Forensic Procedures) Act 2000
Disability Inclusion Act 2015
Guardianship Act 1987
Health Care Complaints Act 1993
Health Records and Information Privacy
Act 2002
Housing Act 2001
Home Care Services Act 1988
Independent Commission Against
Corruption Act 1988
Law Enforcement (Powers and Responsibilities)
Act 2002
Mental Health Act 2007
Privacy and Personal Information
Protection Act 1998
Public Interest Disclosures Act 1994
Victims Rights and Support Act 2013
Work Health and Safety Act 2011
Policies, publications and guidelines
Capacity Toolkit, NSW Government,
Attorney General’s Department (2008)
NSW Code of Practice for the Charter of
Victims’ Rights, Attorney General and Justice
(2013)
Compulsory Reporting Guidelines for
Approved Providers of Residential Aged
Care (2008)
Ofce of the Australian Information Commissioner, Chapter C: Permitted General
Situations (2014)
Department of Health, Home Care
Standards (2012)
Preventing Financial Abuse of People with
Dementia (2015)
Domestic Violence Information Sharing
Protocol (2014)
Preventing and Responding to Abuse of
Older People: NSW Interagency Policy 2015
The Health Records and Information
Privacy Code of Practice (2005)
Privacy and People with Decision-making
Disabilities (Privacy NSW publication) (2004)
NSW Charter of Victims’ Rights (2013) United Nations Rights of the Disabled
Person (1975)
Appendices
88
NSW Elder Abuse Toolkit: Identifying and Responding to the Abuse of Older People
Appendix 2: Bibliography
Aged Rights Advocacy Service (ARAS): Prevention of Abuse of Older People Facilitators Guide, Service Providers Training Package.
Ageing, Disability and Home Care (2012), Abuse and Neglect Policy.
Alzheimer’s Association (2010), Preventing fnancial abuse of people with dementia.
Attorney General’s Department, NSW Government (2008), Capacity toolkit.
Bagshaw, D., Wendt, S., Zannettino, L. (2009), Preventing the abuse of older people
by their family members, Australian Domestic and Family Violence Clearing House,
Stakeholder paper 7.
Benevolent Society, Recognising, preventing and responding to abuse of older people
living in the community: A resource for community care workers, Research to Practice
Briefng 3.
Bethany, I., Vandsburger, E. (2011), Elder abuse and neglect: assessment tools,
interventions, and recommendations for eﬀective service provision, Educational
Gerontology, 37:7.
Blundell, B. and Clare, M. (2012), Elder abuse in culturally and linguistically diverse
communities: developing best practice. Centre for Vulnerable Children and Families,
University of Western Australia.
Brandl, B. (2004), Assessing for abuse in later life, NCALL Coordinator, National
Clearinghouse on Abuse in Later Life (NCALL), A Project of the Wisconsin Coalition
Against Domestic Violence.
Cohen, M. (2011), Screening tools for the identifcation of elder abuse, JCOM
Journal, Vol 18, No 6, June Edition.
Dow, B., Joosten, M. (2012), Understanding elder abuse: a social rights perspective.
International Psychogeriatrics, Cambridge University Press.
Elder Abuse Protocol (2013), Guidelines for action, Alliance for the Prevention of
Elder Abuse: Western Australia.
Eastern Community Legal Centre (2013), Elder abuse toolkit, for local governments
working with older people, produced by Eastern Community Legal Centre (2013).
Family & Community Services (2015), Preventing and responding to abuse of older
people, NSW interagency policy.
Family & Community Services (2008), Planning ahead in culturally and linguistically
diverse communities (CaLD), Ageing Disability and Home Care.
Forsdike, K., Tarzia, L., Hindmarsh, E., and Hegarty, K. (2015), Family violence across
the life cycle, reprinted from Australian Family Physician Vol.43, No 11, November
2015.
Glasgow, K., Fanslow, J.L. (2006), Family violence intervention guidelines: elder
abuse and neglect. Wellington: Ministry of Health.
89
Lachs, M. S., and Pillemer, K. (2004), Elder abuse, The Lancet, Volume 364, Issue
9441, 2 October 2004.
Phelan, A., and Treacy, M. (2011), A review of elder abuse screening tools for use in
the Irish context, National Centre for the Protection of Older People.
Selwood, A., Cooper, C., and Livingstone, G. (2007), What is elder abuse – who
decides? International Journal of Geriatric Psychiatry 22(10).
NSW Government, Health (2011), Responding to family violence in Aboriginal communities, 2011-2016. Aboriginal Family Health Strategy.
The Royal Australian College of General Practitioners (2008), Abuse and violence:
working with our patients in general practice, 3rd edition.
Thornton, M., and Travis, S. (2003), Analysis of the reliability of the Modifed Caregiver
Strain Index. The Journal of Gerontology, Series B, Psychological.
World Health Organisation (2002), Missing voices: views of older persons on elder
abuse.
Appendices

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