As general manager of the HSE’s national safeguarding authority, Tim Hanly has come across shocking cases of elder abuse. His department has dealt with a woman in her 80s who was being intimidated by her grandson and others to hand over her pension to pay for drugs. They have seen pensions stolen from older people by their adult children.
Perhaps most distressing of all, Hanly recalls one case where an elderly woman was worried that if her son was prosecuted for stealing her pension, he would stop coming to visit her. She found herself faced with the possibility of losing her relationship with her son and losing the support she so badly needed.
These examples show just how complex elder abuse is. The stories Hanly tells are not unusual. In fact, elder abuse has become an even greater in recent years. Since 2008, incidences of elder abuse have gone up by 30 per cent, and half of cases are perpetrated by adult children on their elderly parents.
The reality of adults abusing their elderly parents is not easy to digest. What does this abuse look like and how does it happen in the first place?
As older people go into their 80s, and particularly if they have dementia, they're more likely to be at risk
“The biggest areas for older people are emotional or psychological abuse, and financial abuse,” says Hanly. “The National Centre for the Protection of Older People, based at UCD, has done research into financial abuse of older people . . . In particular, we find as older people go into their 80s, and particularly if they have dementia, they’re more likely to be at risk.
“There can be some quite abusive family dynamics going on where they’re being manipulated and controlled by family members. Psychological abuse goes hand in hand with [financial abuse].”
Psychological abuse of an older person can be even more insidious than financial abuse, and can manifest itself in many ways that are often difficult for the older person to articulate.
“Psychological abuse is different because it’s around people’s behaviours,” says Hanly. “It’s about being shouted at, it’s people being humiliated, called names. We’ve had older people being humiliated and called very abusive terms so that they become compliant.
“We’ve also come across cases where older people are overmedicated so that they’re very passive. Inappropriate administering of medication is a form of abuse.
“We’ve had situations where older people have been locked in their rooms. People are told, ‘You can’t go out’, or ‘You can’t visit another family member’. They’re not allowed to socialise, go to bingo, meet their friends. That kind of pattern of controlling behaviour is psychological.”
Investigate and mediate
Across Ireland, the HSE runs nine safeguarding services where suspected elder abuse can be reported. When an allegation of abuse is made, it is the job of the HSE to investigate it and to ensure that the older person is safe and protected.
“The important thing is that we work with the older person to hear their account of what has happened and to listen to their experience, because it’s important that there’s a positive outcome for them,” says Hanly.
“What we want to establish is, are there grounds for concern here? A complaint or an allegation might come in, and it’s important that we gather information and look into it. In serious cases, we might have to report it to the gardaí – if there has been a theft, for example. But we would be working with the older person to establish what they see as a good outcome for themselves. Sometimes we work with families to get people to change their behaviour towards the older person. Or our job could be to try to mediate, to get people to look at respecting the older person’s integrity.
An ageist society
Dr Marita O’Brien is the health policy officer with charity Age Action. Like Hanly, she works to protect older people from abuse.
“Most research would point to the fact that we live in an ageist society,” says Dr O’Brien. “Ageism really constructs the context for older people to be treated differently, and [they] are therefore seen as having different rights to the rest of society.”
O’Brien has been developing a programme for nursing homes and day-care centres to help them improve life for the older people they care for. The model is based on Prof Simon Biggs’s theory of generational intelligence.
We set society up in a way that facilitates a context where older people's rights and their opportunities to live a fulfilled life are constricted by the structure we put in place
“He came up with this idea that we’ve all been young, so we know what it’s like to be young, but we don’t really know what it’s like to be old,” says O’Brien. “We assume that older people share the same priorities as us. So, when we look at the world, we look at it from our eyes, but we don’t look at it from the eyes of an older person, and it’s harder to relate because we’ve never been old.
“Because of that we set society up in a way that facilitates a context where older people’s rights and their opportunities to live a fulfilled life are constricted by the structure we put in place. The idea is that if people can walk in an older person’s shoes and look at life from an older person’s perspective, they are more likely to be more empathetic to the older person and understand their needs and priorities, and what they want from life.”
‘Mum wouldn’t mind’
When we can’t see the world through an older person’s eyes, the result is that abuse can manifest itself in insidious ways. Often, the older person and the adult child may not even realise that what is happening in the home constitutes abuse.
“If the adult child is having financial difficulty, they might see it as, ‘Well, it’s mum’s money, I’m sure she wouldn’t mind’, and things can develop from there,” says O’Brien. “It can start off as very simple, and if you asked a lot of people, they probably wouldn’t consider that they were doing anything wrong.
“Sometimes you will ask an older person, ‘If your son doesn’t pay you back money, what do you think of that?’ and they might say ‘Oh, but they never pay me back, and when I give them the money I know they’re never going to pay me back’, but the next question is ‘Well, if you asked for the money and they still didn’t give it back, would that be wrong?’
“It’s very much based on relationships,” she continues. “Your son or your daughter is always your child, no matter what age they are, so it’s very complex. That’s why it’s probably so difficult for people to report it or get out of it. They probably can’t vocalise exactly what’s happening to them, but they know it’s not right and they’re anxious or worried or they’re not in a good place, but they don’t want to get their children into trouble.”
O’Brien says that it is essential that professionals respect the wishes of the older person when they come forward with a complaint of elder abuse.
“Unless there’s an immediate danger, you still have to be guided by the person as to what they want to happen. Most people want to keep their relationship with their children. You have to look at how you can maintain that relationship, especially when it comes to adult children. The other thing would be that older people who have a lot of needs and are being cared for by a relative or a child, they see reporting it as, ‘Well, if anything happens to my carer or I complain about it, I’ll have to go into a nursing home, and I don’t want to go into a nursing home’.”
Stay connected
Seán Moynihan, chief executive of Alone, a charity that works with older people, says that it is important that older people stay connected, as isolation is the breeding ground for abuse.
“We need older people to realise that as they get older, they need to stay connected and not become dependent in any way on one individual,” says Moynihan. “On the far side, what we need to do is make sure that families and friends are aware of the rights of older people, and to realise that at times we can be ageist. We need to keep pushing education, and we need a system that when people are brave enough to come forward, or when people are aware that basically they can actually unpick issues and support an older person, and replace support that the person was giving the older person, because often the fear for the older person is, ‘If I lose this support, if I lose this individual, what will I do then?’ And if there isn’t an answer to that, then people may end up having to stay or remain and put up with that situation, which shouldn’t happen.
“Once you become vulnerable, once you become dependent, unfortunately there is a percentage of people who will take advantage of that. What we need is regulation and oversight,” he says.
Widespread abuse
Patricia Rickard-Clarke is the independent chairwoman of the National Safeguard Committee, and like others working in the area, she is striving to make Ireland a safer place for the elderly. The NSC recently released results from a Red C research poll they commissioned into the abuse of vulnerable adults in Ireland.
The survey revealed that one in three people believe abuse of vulnerable adults is widespread. If abuse of vulnerable people is so widespread, how can it be prevented? According to Rickard-Clarke, there needs to be more of a joint approach in solving the problem.
Ageism is pervasive across all areas of society, and until it is stamped out, elder abuse will persist
“My experience is that there is a mentality where we don’t work intersectorally or interdepartmentally across these issues. It’s not just a HSE business; it’s across society and across every department and every agency, because it arises in difference circumstances. Particularly with financial abuse, that’s not the job of the HSE. The job of the HSE is to run a health service, not to deal with these other issues, although they do in the safeguarding office insofar as they can.”
For Rickard-Clarke, it is essential that public awareness of the challenges facing the elderly today in Ireland be increased.
“We are now starting on a public-awareness campaign, and we’ll use this baseline survey to mark that as we go along and see what needs to be done. That is why it is important to have intersectoral committees and a number of organisations all working and understanding with a common approach as to what the issues are that need to be addressed and how one addresses them.”
For those working in the area, the way forward is in raising the public profile of the rights of the elderly. Ageism is pervasive across all areas of society, and until it is stamped out, elder abuse will persist.
