Elder abuse can occur – tackling threats and violence in aged care

LAST month Have a Go News was approached by Bryan Nesbitt, whose partner (Wyn) had allegedly been beaten up in aged care. This is his story:

“It all started about 12 months ago, Wyn had been diagnosed with Alzheimer’s disease five years earlier and I was looking after her fulltime. Everything was as good as possible. I dressed and showered her – no trouble.

“I got her to attend a community centre three times a week. Everything was going good until the woman who ran the centre told me that if I did not get a home care package I wouldn’t be able to bring Wyn to the centre.

“Soon after Wyn began fighting with the carer. I called the doctor who told me to call an ambulance, which I did.  She was taken to Joondalup Health Campus for assessment but when she got there she was a different person she was laughing and joking and they discharged her as ok.”

Bryan later agreed to place Wyn in respite for a short period.

“I wasn’t very happy about the room as it was shared and the other woman, who kept taking Wyn’s clothes and things, so I moved her to another aged care facility on the advice of a nurse.

“When the respite was over I got two offers for permanent accommodation in Kinross and also Hamersley. Both were single rooms with ensuite. I chose Kinross because it was nearer and on the advice of the nurse.

“I wish to god I had ignored her and gone to Hamersley and all this heartache would not have happened.

“Wyn was only there a week when she was attacked by a male resident and knocked down because she walked into his room.

“They all do that,” the acting manager told me. “We can’t guarantee it wouldn’t happen again.

“Later when taking Wyn out I noticed bruising on her arms and back and she always smelt as though she hadn’t been washed.”

Eventually Bryan was able to move Wyn to another dementia care facility after considerable delays, due to legal problems. He is understandably furious at the poor care Wyn received.

Have a Go News asked a number of questions to Associate Professor Colm Cunningham, Director of the Dementia Centre.

HAGN: How prevalent is verbal and physical aggression in dementia residential facilities?

“Behaviour which may be challenging, including verbal and physical aggression, is relatively common to encounter in the care of people living with dementia. Dementia Support Australia (DSA) is a national service which administers the Dementia Behaviour Management Advisory Service (DBMAS) and Severe Behaviour Response Team (SBRT). These programs provide expertise and advice to aged care services and respond to incidents involving changed behaviour. DSA has so far been asked to assist more than half of the aged care homes throughout Australia. “

HAGN: Are there identifiable causes of aggression that could be addressed?

“Pain, especially when it is poorly managed, is one of the main triggers for behaviour that may be challenging. For example, joint pain is a common complaint among older people, especially in the morning. But a person living with dementia who lacks the verbal skills to articulate what’s wrong may resort to pushing a staff member who is attempting to help them move. This behaviour is not so much about the dementia as it is about pain management.

“A lack of treatment for undetected infections can lead to delirium, which is another common trigger for behaviour that may be challenging. Staff members need to be familiar with those under their care in order to detect any unexpected changes in mood or behaviour.

“Environmental factors are also common causes – poor lighting, excessive noise and information overload can all exasperate or trigger a person living with dementia. Managing these triggers comes down to understanding the social history of each resident. A noise that may be innocuous for most, such as a nurse’s call alarm, could be mistaken for a siren by a retired police officer. Understanding each resident’s history is the first step in tailoring their environment and managing their behaviour,” he said.

HAGN: What can and should staff and management do about challenging behaviour?

“It is important to make sure all staff are supported and trained to understand dementia and the people they are caring for. Dementia Training Australia (DTA) is a national consortium that provides excellent dementia-specific training to care providers, health care professionals, undergraduates, and a range of professionals and community service providers

“Ultimately, staff need to be led by management that embodies a culture of understanding and problem-solving. The fact is some strategies may only work for a while, and those that do work will need reviewing and tweaking through constant communication. Carers can only improve if they are empowered to understand their residents and come up with fresh strategies, rather than simply complete set tasks,” said Professor Cunningham.

HAGN: What external resources are available to help?

“Dementia Training Australia (DTA) and Dementia Support Australia (DSA) are two significant, government-funded programs that are available to assist staff and management. DTA provides much-needed training to anybody working with people living with dementia, while the DSA is available to respond to specific incidents at residential care facilities to provide expert analysis, insight and advice.

There is also a wealth of resources online that can be accessed by any member of the public. HammondCare Media has many resources specifically designed for dementia and aged care, including the latest release Toilet talk: Accessible design for people with dementia, which is available as a free download online (www.dementiacentre.com/resources/61-toi let-talk-accessible-design-for-people-with-dementia).

Family of those who are exhibiting changed behaviour may also wish to consider a specialist dementia care unit (SDCU). These homes are specifically designed to accommodate people with severe behavioural and psychological symptoms through measures including environment design and higher levels of specialised care.

HAGN: What can the patient’s family do if they think their member is being bullied by fellow residents?

“The first step to resolving any perceived issue within an aged care home should be to speak to the staff. This may require family members to sit down and meet with the manager and key workers in order to determine exactly what has happened, and what can be done to resolve any issues. Any suspected incidents or issues should be raised promptly in order to help care workers determine what happened, why it happened, and how to prevent it in future,” said Professor Cunningham

HAGN: If they get no satisfactory response from the management what is their next step?

“If a family is not satisfied with the outcome from discussion with senior management then they should use the organisation’s own complaints process. If they are still not happy with the outcome, the matter should be elevated to the Australian government’s Aged Care Complaints Commissioner (see next page).

Jason Burton, Alzheimer’s WA head of dementia practice and innovation said there are no statistics on violence and aggression in dementia care.

“Aggression is not common in dementia cases but it does occur. Aggressive behaviour is not caused by dementia but is an expression of distress on the part of the person living with dementia.

“What’s going on for the person, their response to something, or a stimulus that they can’t deal with results in stress and frustration. A person living with dementia can’t deal normally with their emotions.

“Carers and family should look for the root cause of abnormal behaviour, these can be loss of identity, everything done for you, boredom, lack of purpose in life…

“Stress builds up and the person responds either overtly shouting or becomes withdrawn.

“Two ways to tackle this behaviour are music – chosen for the person’s own taste and life stories – the family can also contribute by telling carers of their likes and dislike.” he said.

Deidre Timms, CEO of Advocare said there is mandatory reporting of abuse in aged care facilities to the Aged Care Complaints Commissioner.

“If a friend or family member suspects a person living with dementia is being abused the first action is to take up the problem with the care facility.

“If you fail to get a satisfactory response, contact the Aged Care Complaints Commissioner.

“If you feel you need help ring us at Advocare and we will do our best to provide advocacy and support,” she said.

Aged Care Complaints Commissioner Rae Lamb says violence and threatening behaviour is unacceptable and if people are concerned that this is occurring, they should raise their concerns immediately with the service.

“If they need help with this, they may find it helpful to seek the support of a free aged care advocate. The Older Persons Advocacy Network offers free advocacy, information and education services and are contactable by calling 1800 700 600.

“If people cannot do this or are unhappy with the response from the service they should come to us.

“We can check to see that the service is doing the right things to ensure residents are safe and are being properly cared for,” he said.

The Commissioner accepts confidential and anonymous complaints.

Useful phone numbers

Alzheimer’s Australia Helpline 1300 667 788.

Advocare Elder Abuse Help line on 1300 724 679.

Aged Care complaints commissioner www.agedcarecomplaints.gov.au 1800 550 552

Dementia Australia provides webchat www.dementia.org.au/helpline/webchat and for telephone help ring 1800 100 500.

Older Persons Advocacy Network 1800 700 600.