Preventing the Financial Abuse of Older People by their Family Members

1. Preventing the Financial Abuse of Older People by their Family Members Adjunct Associate Professor Dale Bagshaw, Dr Sarah Wendt, Dr Valerie Adams, School of Psychology, Social Work & Social Policy University of South Australia Dr Lana Zannettino School of Nursing and Midwifery, Flinders University (c) Associate Prof Dale Bagshaw, UniSA

2. UniSA Research 2007 • Associate Professor Dale Bagshaw • Dr Sarah Wendt • Dr Lana Zannettino In 2007: we conducted research for and wrote the South Australian State plan for the Office for the Ageing Our Actions for the Prevention of Abuse of Older South Australians (c) Associate Prof Dale Bagshaw, UniSA

3. Related Publication • Bagshaw, D., Wendt, S & Zannettino, L. Preventing the Abuse of Older People by their Family Members. Stakeholder Paper 7, Australian Domestic and Family Violence Clearing House, September 2009. http://www.adfvc.unsw.edu.au (c) Associate Prof Dale Bagshaw, UniSA

4. Our current research: ARC-Linkage Grant • Associate Professor Dale Bagshaw (UniSA) • Dr Sarah Wendt (UniSA) • Dr Lana Zannettino (Flinders University) • Dr Valerie Adams (UniSA Research Associate) in partnership with • SA Dept for Families & Communities (Disability, Ageing and Carers Branch), • Relationships Australia SA, • Office of the Public Advocate, • Guardianship Board, • Alzheimer’s Australia SA and • supported by the Aged Rights Advocacy Service. (c) Associate Prof Dale Bagshaw, UniSA

5. The focus of our research • Preventing the Financial Abuse of Older People by a Family member: Designing and Evaluating Older Person-Centred Models of Family Mediation (c) Associate Prof Dale Bagshaw, UniSA

6. The importance of language We use the phrase ‘abuse of older people’ not ‘elder abuse’ out of respect for our Indigenous Elders. (c) Associate Prof Dale Bagshaw, UniSA

7. What age determines when one is ‘old’? • Varies from 45-65 depending on the researcher, organisation or service • ABS – starts at 45 which reflects the lower life expectancy of Indigenous adults. • Commonwealth Age pension – 65+ for males, 60-65 for females, depending on when they were born • Our research – 65+ (c) Associate Prof Dale Bagshaw, UniSA

8. Understanding and preventing abuse of older people by their family members is a priority social justice issue because of the increase in intra-familial care as a consequence of • government ‘ageing-in-place’ policies, • the rapidly ageing population, • limited resources for extra-familial care-work, • international agreements about human rights, • in addition to the ‘complex and diverse nature of elder abuse’ (Livermore, Bunt & Biscan, 2001: 41) (c) Associate Prof Dale Bagshaw, UniSA

9. Definitions and types of abuse The most commonly used definition of abuse of older people in Australia is: • Any act occurring within a relationship where there is an implication of trust, which results in harm to the older person. Abuse can include physical, sexual, financial, psychological, social and/or neglect. (c) Associate Prof Dale Bagshaw, UniSA

10. Responses to the definition from SA service providers in our prior research • The vast majority of respondents to our SA survey of service providers supported the need for a broader understanding of abuse to include abuse occurring in relationships where there is an imbalance of power and control (80%), which is central to definitions of domestic or family violence. (c) Associate Prof Dale Bagshaw, UniSA

11. Other additions to the definition from SA service providers in our prior research • abuse of older people can be gendered (86%) • abuse of an older person’s rights (86%) • cultural abuse (86%) • spiritual abuse (85%) • abuse of an older person’s pets (85%). • abuse can also involve an act or a failure to act, as in cases of neglect (73%). (c) Associate Prof Dale Bagshaw, UniSA

12. Abuse is more than physical • It is likely that many members of the community may not have heard the term ‘elder abuse’ and/or may only believe that behaviour is abusive if it is physical. • The older person may be subjected to several different kinds of abuse at the same time to a lesser or stronger degree. • Non-physical forms of abuse may be subtle and hard to detect. (c) Associate Prof Dale Bagshaw, UniSA

13. ‘Mistreatment’ sometimes used • Mistreatment can involve an act of commission (abuse) or omission (neglect) which can be intentional, wilful, deliberate or malicious, or unintentional, benign, passive or recklessness. (c) Associate Prof Dale Bagshaw, UniSA

14. Explanations for perpetrator behaviour • Perpetrator behaviour can be labelled as abusive, neglectful or exploitative, depending on its frequency, duration, intensity, severity, consequences and the cultural context. (c) Associate Prof Dale Bagshaw, UniSA

15. Types of abuse • physical abuse can include being hit, sexually assaulted, burned or physically restrained • psychological abuse can include humiliation, insults, fear, threats or being treated like a child. (c) Associate Prof Dale Bagshaw, UniSA

16. Neglect • Neglect can include passive neglect, which refers to older people being left alone, isolated, or forgotten and active neglect, which is the withholding of items that are necessary for daily living, such as food and medicine (c) Associate Prof Dale Bagshaw, UniSA

17. Types of abuse • Medical abuse can include the inappropriate use of constraints and withholding or careless administration of drugs • Social and environmental abuse can include a failure to provide human services and involuntary social isolation (c) Associate Prof Dale Bagshaw, UniSA

18. Financial abuse making improper use of an older person’s property or money without his or her knowledge or permission such as • forgery • stealing • forced changes to a will • transferring money or property to another person • withholding funds from the older person and the • failure to repay loans. (c) Associate Prof Dale Bagshaw, UniSA

19. Financial abuse • It can also include the misappropriation of enduring powers when a trusted person (usually a family member) is legally appointed with enduring powers to manage the financial affairs of the older person whose frailty is increasing and can no longer manage their own affairs. • With the ageing population and the increasing complexity associated with financial management, this type of abuse is likely to increase. (c) Associate Prof Dale Bagshaw, UniSA

20. Our findings from prior research The abuse of older people • is an under-researched and hidden problem • occurs across the spectrum of our society • is often unrecognised, unreported, and hard to detect. There is currently no central register for the collection of statistics when abuse is uncovered or reported. (c) Associate Prof Dale Bagshaw, UniSA

21. Prevalence • Australian and overseas studies have estimated that between 3 and 5% of older people aged 65 years and over and living at home suffer from various forms of abuse or neglect (Kurrle 2004, p.809). • These figures vary with the methods and definitions used. • Most of the abused older people are women (Rabiner, O’Keefe & Brown, 2004). (c) Associate Prof Dale Bagshaw, UniSA

22. Prevalence in Australia • Australian Institute of Criminology found that ‘4.6% of older people are victims of physical, sexual or financial abuse, perpetrated by family members and those in a duty of care relationship’ (Kinnear & Graycar 1999, p.1). (c) Associate Prof Dale Bagshaw, UniSA

23. Abuse of older people with dementia • Strong link between abuse of older people and dementia. • Increasing number of people diagnosed with dementia specifically in the older age groups who will not be able to manage their financial affairs. • Predictions that the number of Australians who will develop dementia in 2050 will be approximately 2.8% of the projected population; currently it is 1%. [1] [1] Access Economics Pty Ltd, for Alzheimer’s’ Australia. Dementia Estimates and Projections: Australian States and Territories. February 2005 (c) Associate Prof Dale Bagshaw, UniSA

24. Financial abuse • The Office of Seniors Victoria (2005) has stated that financial abuse is emerging as a significant form of abuse, and highlighted the need for financial literacy training, support from the financial services industry, education and specialised legal services. (c) Associate Prof Dale Bagshaw, UniSA

25. Prevalence and types of abuse • Other researchers have found that psychological and financial abuse—non-physical forms of abuse—are the most likely forms of abuse to be reported by people 65 and over (Schofield et al 2002: 25; Chen et al 2007). (c) Associate Prof Dale Bagshaw, UniSA

26. Financial abuse of older people by relatives • Many researchers have also concluded that the people most likely to commit financial abuse are the older person’s adult daughter or son (Brill, 1999; Cripps, 2001; Boldy, Webb, Horner, Davey, & Kingley, 2002; Faye & Sellick, 2003). • The Office for the Public Advocate in Western Australia found that, during 1995-1998, 10% of applications alleged financial abuse and relatives were most often the alleged perpetrators. (c) Associate Prof Dale Bagshaw, UniSA

27. Financial abuse from relatives • The majority of abusers of older people (80-90%) in Australia are close family members (Kurrle 2004, p.809). • Kinstle, Hodell and Golding (2008) point out that adult children or other family members are most likely to provide the assistance required by the disabled or dependent elderly person. (c) Associate Prof Dale Bagshaw, UniSA

28. Although the vast majority of families provide their ageing parents or relatives with a safe haven, it is also true that family members perpetrate the majority of reported incidents of abuse of older people (Johnson 1997; Cripps 2001; Boldyet al. 2002; Cavanagh 2003). (c) Associate Prof Dale Bagshaw, UniSA

29. Gender and abuse • The Aged Rights Advocacy Service in South Australia found financial abuse in one third of 100 cases over a period of 2 years, the majority of which involved women as victims aged over 75 years (James & Graycar, 2000; Cripps, 2001). • Other studies have found that abuse of older people within the family is still largely the abuse of older women by older and younger men, and that older women are particularly at risk of financial abuse, physical abuse, and sexual abuse (e.g. see Penhale1999; Boldyet al. 2002; Faye & Selleck 2003; Nerenberg2008). (c) Associate Prof Dale Bagshaw, UniSA

30. Gender and abuse • However, the gendered nature of the abuse of older people is still relatively invisible in Australia in spite of evidence from the Australian Bureau of Statistics (2006) that one in four women who have experienced an incident of physical violence is aged 45 years and older, a finding supported by other Australian research (e.g. Morgan Disney & Associates 2000). (c) Associate Prof Dale Bagshaw, UniSA

31. 1st UK National Prevalence Study 2009: Elder Mistreatment (abuse & neglect) Researchers conducted a face-to-face survey with 2,111 older people 66 and older who were living at home or in the community and found that • women (90%) were significantly more likely to have experienced mistreatment than men during the previous year, • there were gender differences according to the type of abuse and perpetrator characteristics (Biggs et al, 2009). (c) Associate Prof Dale Bagshaw, UniSA

32. UK Study: gender differences • Overall, 2.6% of the respondents reported that they had experienced mistreatment during the time period, the most common being neglect (1.1%), followed by financial abuse (0.7%). • Women were significantly more likely than men to have experienced neglect and physical, psychological and sexual forms of abuse, whereas the prevalence of financial abuse was similar for both sexes. (c) Associate Prof Dale Bagshaw, UniSA

33. UK study – age and gender effects • When age and gender effects were compared, the prevalence of neglect was highest among women 85 and older, however the interpersonalabuse of older women decreased with age. • Older people who were separated or divorced were more likely to be mistreated and people living alone were more likely than those living with others to have experienced financial abuse. • The prevalence of mistreatment also increased with declining health status. (c) Associate Prof Dale Bagshaw, UniSA

34. UK study: perpetrator characteristics • 51% of mistreatment in the past year was carried out by a partner or a spouse, 49% by another family member, 13% by a care worker, and 5% by a close friend. • the main perpetrators of financial abuse were other family members (54%) and care workers (31%) and only 13% were partners. (c) Associate Prof Dale Bagshaw, UniSA

35. UK study: perpetrator characteristics • Men were predominantly the perpetrators of interpersonal abuse (80%), but the gender split for financial abuse was more equal for men and women (56% men, 44% women). • Overall 53% of perpetrators were living in the respondent’s household at the time of the abuse (ibid: 7-11). (c) Associate Prof Dale Bagshaw, UniSA

36. DV and older women • The domestic violence sector has tended to focus on younger women and their dependent children and until recently has not paid as much attention to older women experiencing ongoing domestic violence. • Some researchers have recognised that abuse of older people is highly likely to be ‘spouse abuse grown old’ (e.g. Nerenberg2008; Leisey, Kupstas & Cooper, 2009; Brandl, 2000). (c) Associate Prof Dale Bagshaw, UniSA

37. Older women’s experiences may be different to those of older men • They tend to live longer than men and • are more likely to be financially abused after their partner dies (Brozowski & Hall 2004) • They are more likely to be abused by a broader range of family members than men (Livermore, Bunt & Biscan 2001). • They are less likely to have access to superannuation and, therefore, more likely to rely on the Aged Pension (Association of Superannuation Funds of Australia 2011). (c) Associate Prof Dale Bagshaw, UniSA

38. Financial abuse of older Aboriginal Australians • Financial abuse has also been found to be the most common form of abuse experienced by older Australian Aboriginal people (Office for the Public Advocate, 2005). (c) Associate Prof Dale Bagshaw, UniSA

39. Culturally and linguistically diverse older people are at risk of abuse because of • poor English skills • social isolation • dependency on family members • cross-generational factors which result in differing expectations of care and support • fear of being shamed by and excluded from their communities Office of the Public Advocate in Western Australia (2006) (c) Associate Prof Dale Bagshaw, UniSA

40. New and emerging populations Older people in new and emerging population groups in Australia face additional challenges in re-settlement e.g. • family unemployment, • poverty, • the changed roles and rights of older people (particularly older women), • lack of family support and intervention, • social isolation, and inter-generational conflicts (Bonar & Roberts 2006). (c) Associate Prof Dale Bagshaw, UniSA

41. Our current research findings Aim of the first stage of our research • To critically analyse the current national and international research and identify models of intervention designed to prevent the abuse • To identify and analyse individual, structural & ecological factors which place people at risk of financial abuse • To identify the existing strengths & gaps in national legislation, organisational policies & service provision currently responding to older people experiencing financial abuse from a family member (c) Associate Prof Dale Bagshaw, UniSA

42. Methods used to gather datato inform the development of models of mediation • Extensive review of the literature • Ethics approval from UniSA’s Human Research Ethics Committee • Online national survey of CEOsof organisations servicing older people and of family mediation agencies, using SurveyMonkey(the link to the survey emailed to CEOs and adverts placed in relevant publications) – quantitative & qualitative data collected • 2-day phone-in with older people and their relatives • National on-line survey of older people and their relatives (asked CEOs and service providers to distribute the link and placed adverts in publications and the Australian). (c) Associate Prof Dale Bagshaw, UniSA

43. Total number of survey responses • CEOs 228 responses • Service providers 214 responses • Relatives 69 responses • Older people 45 responses TOTAL: 556 responses (c) Associate Prof Dale Bagshaw, UniSA

44. Causal and risk factors • CEOs and service providers were asked to check the factors which contributed to the financial abuse of older people (multiple responses were possible) and to add other factors if they wished. (c) Associate Prof Dale Bagshaw, UniSA

45. (c) Associate Prof Dale Bagshaw, UniSA

46. (c) Associate Prof Dale Bagshaw, UniSA

47. Causes and risk factors – CEOs & service providers (c) Associate Prof Dale Bagshaw, UniSA

48. Preventative strategies • Respondents were asked to rank 12 strategies that may enhance the prevention of financial abuse of older people by a family member in order of importance • Responses were received from 132 CEOs & 123 service providers = total 255 responses. (c) Associate Prof Dale Bagshaw, UniSA

49. (c) Associate Prof Dale Bagshaw, UniSA

50. Reasons for concern • Older people and their family members were asked how concerned they were about the management of the older person’s property, finances or other assets now, or as s/he gets older • Respondents who answered ‘Yes’ or ‘Maybe’ were asked to check a list of 13 concerns as a multiple response question • 31 participants responded. (c) Associate Prof Dale Bagshaw, UniSA