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A human rights approach to care?

By Professor Bianca Brijnath

Is a human rights approach the right way to tackle elder abuse in multicultural communities?

As a result of COVID-19 and the associated restrictions, health services in Victoria have reported increased incidents of elder abuse over the past two years. Efforts to respond to this crisis have been made through a human rights approach to care, to empower older people in vulnerable situations to access essential services. However, we are seeing that this approach is often unsuccessful with regard to elder abuse in culturally diverse families. This is because factors of increased dependencies on extended families, cultural expectations of care, lack of access to culturally safe services, and poverty, all have implications on stressed family networks and carers who are struggling to access many services. Therefore, we need to consider the cultural and social setting in which abuse occurs, as explained in the following quote from a hospital provider:

‘Particularly with Vietnamese cultural groups … elders, the children and generations living together in one household providing care and respect for their elder, you know is a breeding ground for carer stress, and these elders have grown up in a time where receiving care from their children is expected, … so the thought of aged care or accepting more services into a home … it’s kind of seen as this big, “Oh no! We would be complete failures if we had to even think of aged care or services (…)”

And so a lot has fallen onto families, especially if they’re working from home, and needing to juggle caregiving of children and other dependents as well… it’s been compounded with all of that, external stresses from finances, jobs, caring from home, services cancelling, and deteriorating health.’

So what is an appropriate response?

First, we need to move away from ‘privileging’ individual rights at the expense of the wider structure of the vulnerable older person. Rights and abuse do not occur in a vacuum; rather, human rights violations and abuse occurs at a micro level between perpetrators and older people and their extended families, shaped by broader cultural structures and networks.

Second, health providers and professionals must resist the urge to ‘save’ older people by referring them to residential aged care. As we have learned, through the Royal Commission into Aged Care Quality and Safety, elder abuse occurs at extraordinarily high percentages (30.8%) within residential aged care. There are grave concerns that older people in this environment struggle to have their fundamental human rights met, including basics such as a right to everyday care (e.g. help to shower, eat, toilet, be mobile) and the right to healthcare (e.g. being able to access a GP, dentist, mental health/other allied health services). It has become clear that care staff are rarely able to spend enough time attending to individual older persons’ needs. So, the ramifications of taking a person from their home, and familiar social and cultural environment and relocating them into an unfamiliar setting is problematic and risks exacerbating their distress and trauma. Such a shift should be one of the last options, not an immediate response.

Instead, the evidence points to the need for a multidisciplinary response. Counselling of older people and their families in tandem with education and training of healthcare providers, enables better knowledge of and referral to family mediation, often a preferred source of assistance for older people. Fundamentally we must understand the relationship dynamics between the perpetrator and the older person because very often in the context of elder abuse within families, the older person does not want the relationship to end, they want the abuse to stop.

In terms of an alternative ecological framework for culturally diverse communities, we need to understand the need to safeguard a strong sense of community, spirituality and resilience, respect for older people, loyalty to family, and the value of motherhood. These are all concepts and ideas that have been found to strengthen protective factors against abuse and help to restore relationships and stop abuse. Some of these factors might be incongruent with Western ideas; for example, the value of motherhood might be seen to perpetrate gender stereotypes about the role of women as nurturers and carers. Nevertheless, this is what the evidence is indicating and it is an important starting point for us to engage with people in a meaningful way to broker relationships that stop abuse.

There is no one-size fits all in the approach to improving the quality of care for older people. Discussion and choice is important and everyone has a right to exercise those freedoms. There is opportunity for all of us, both older people as well as their family carers and the broader care system, to reflect, to experiment, to hope in order to create a better world. Perpetrations of elder abuse are often lifted out and taken in isolation but they are part of a larger life story that have an antecedent and an afterlife, which we need to consider and act in ways that create a space for restoration and rehabilitation of relationships.

Ultimately we must respect the choices of older people and families. Thus, rather than an individualistic human rights approach, a diverse community perspective is needed. Emphasis should be placed on the quality of caring relationships in which the older person is involved; between themselves and professionals, and with family, friends, and social networks. It must be a relationship in which they have an active say. Only then will we develop a framework to tackle elder abuse in multicultural families.

Professor Brijnath is the Director of Social Gerontology, National Ageing Research Institute (NARI) and an Adjunct Professor, School of Social Sciences, University of Western Australia