I came prepared for a stoush but, ironically, the fifth National Elder Abuse Conference was very, very polite.
As a newbie carer, I was uneasily curious about the topic. Until I, like everyone else, saw the shocking CCTV footage from the Oakden nursing home in South Australia, elder abuse had not registered on my personal radar of human barbarity. But now that my 90-year-old mother is living with me and I have power of attorney over her affairs – just in case, as she shows no signs of cognitive decline, in fact quite the contrary – I have a deeper awareness of what can go wrong and how quickly a carer’s behaviour can escalate from a testy remark made in irritation to something more harmful and sinister.
For the first time in my life, I see how it could happen all too easily. I understand what might lead a mother trapped at home with a crying baby to shake it. What might push someone to the limits of exasperation and cause them to act in a way that would later make them burn with shame.
Too often these days, an undertow of anger churns and roils beneath my civil surface. Never patient, I recognise that I am not temperamentally suited to the care of a vulnerable older person. But like so many others, I have no choice.
Imagine someone in robust health but with diminished mobility and hearing, a sometimes capricious and petulant personality, a tendency to moodiness and depression, who frequently lashes out in judgement with a tongue dipped in vinegar. Who refuses to contemplate moving to a retirement village because it’s too costly and unappealing; who, through a desire for control, refuses to relax her vice-like grip on the purse strings that could, if loosened, make everyday life easier for her family, buying them much-needed respite and more space to escape each other in cramped living conditions. They wonder how long they can endure their uneasy cohabitation and 24- hour on-call duties. Resentment builds like a storm front.
This, I now know, is the prelude to a syndrome called inheritance impatience – a variation on the contemporary malaise of entitlement. It is the primary cause of the most common type of elder abuse. The chief executive of the Australian Banking Association, Anna Bligh, speaking about measures the sector is taking to help prevent financial misdemeanours by family and other carers of the elderly, described this type of greed as “disgusting”. The word made me squirm in recognition, as if I had glimpsed my own features made ugly in a distorting mirror, warped by expectation, as a reward for duty and sacrifice.
Families go to war over this stuff, as the unvarnished testimony of rural carer Maria Berry proved. Isolation is often a precursor to the grim cascade of further abuse, and becomes especially toxic when combined with sibling rivalry and addiction. In Berry’s case, greed and drugs tore her family apart, destroying two Wodonga farming generations irrevocably. Today, despite a reluctance to be in the public spotlight, she is a dignified advocate for the rights and protection her parents never lived to enjoy. Her down-to-earth cred and sense of purpose reminded me of Rosie Batty.
Finding myself an unwilling and not particularly able carer, I waded into the Sydney conference with mixed emotions, horrified that elder abuse is, despite poor data, reportedly on the rise and likely to increase as a universal social problem, given that we are all living longer, both as parents and as children, which extends the time when we all have to rub along together. At present it is estimated that up to 10 per cent of older Australians are victims of some form of abuse.
But I was also queasily sympathetic to carers like myself, of which there are apparently more than 2.7 million, unpaid and without professional training for the role, who, with access and opportunity, are the most likely perpetrators.
To think of myself as a potential perpetrator was unfamiliar and deeply uncomfortable. I drew comfort from Ara Cresswell, chief executive of Carers Australia, who acknowledged what many do not: that elder abuse is a two-way street, and that carers too can be subjected to rudeness, ingratitude, resentment and subtle forms of punishment. Their role is often a thankless one resulting in long-term mental health problems including a form of post-traumatic stress disorder that is largely undiagnosed.
I anticipated antagonism because the conference organisers, Seniors Rights Service, a New South Wales-and Victoria-based legal and advocacy centre protecting the rights of older people, experienced blowback on several fronts. First, about the program: too heavy on academics and policymakers, too light on lived experience; second, about the registration fee of more than $800, which precluded many from being able to attend at the schmick Sydney hotel location. Sure enough, as soon as I picked up my lanyard, I saw that the crowd of 500 delegates was well heeled and smartly suited.
Standing at a buffet station, feebly attempting to network with a woman in-between mouthfuls of beef stroganoff, I complimented her on an eye-catching bracelet. She was a legal rep for the banking sector and happily showed me how the bangle was in fact a rose gold version of the more common neoprene health monitor, which tracks the wearer’s heart rate and number of steps. “It’s from Iris Apfel’s WiseWear range,” she told me helpfully. Later I checked its price online: $US400. That is who was there. Yes, the people who can afford such things are probably influencers and well intentioned and competent change makers. But the frontline troops of aged care were sorely under-represented (although organisers did offer last-minute discounted attendance and allowed one older woman who bowled up to the venue to attend free).
A third cause of potential conference friction was the participation of the NSW Trustee and Guardian. A sponsor of the event, it drew fierce online ire from dissatisfied clients who questioned its powers of investigation and perceived lack of accountability. Certainly, a common cause of frustration across the two-day talkfest was the need for a nationally consistent guardianship framework, illustrated by Malcolm Schyvens, deputy president of the guardianship division of the NSW Civil and Administrative Tribunal, who confirmed that it is not unusual for a family member to kidnap a parent or grandparent and whisk them across a border so they can escape a particular jurisdiction.
There were also repeated calls for a national register of powers of attorney, to make it easier to monitor whether these are up-to-date or have been revoked. Surprisingly, no one mentioned blockchain as a possible tool for keeping track of such important documents. Similarly, if anyone talked about robots as alternative carers who could perform tasks and provide companionship without causing harm, as they do in Japan, I missed it. Innovation was not part of the conversation.
I did not have the stomach for the session on the sexual abuse of older women. Later, I heard that case workers talked about wives with or without dementia who were raped not only by their husbands, but subsequently by their sons.
Aged care service providers united in their rejection of granny cams as a monitoring tool, playing the privacy card. “Would you want the camera on while your parent’s incontinence pad is being changed?” one asked disingenuously. There must be a solution that is not so starkly binary. It would help if we did not precariously invest our sense of dignity so heavily in the functional capacity of our physical selves – more specifically, our plumbing. When it fails, we are left with nothing but shame.
Troubled by the images these bodily dilemmas present, I chose the softer option of international speaker Dr Elsie Yan from Hong Kong, who shared her research into elder abuse and cultural sensitivities in Asia and China in particular. Her findings show that traditional filial piety is on the decline, while the enduring importance of not losing face prevents many from reporting elder abuse. Faith in reincarnation complicates matters: it means victims are willing to give away their material possessions in the hope this will ensure a better life the next time around. They will also often endure physical and psychological torment in the same belief.
For the rest of us, with only one chance at life, better safeguards, legislation and support are urgently needed. As usual, when it comes to progressive social policy, Victoria came out ahead for enlightened attitudes and strategies in the police force. Increasingly, it seems the most desirable state in which to live and die. Although there was also surprisingly good news from NSW Aboriginal health-care worker Fay Daniels, who reported on how a group of local elders in the Liverpool and Fairfield area have developed increased awareness of the importance of wills, powers of attorney and abuse risk factors thanks to public information sessions.
Reform in domestic violence legislation was cited time and time again as an example of what is possible. The #MeToo campaign was also quoted as an illustration of how stigma and silence help to conceal the worst crimes towards our most vulnerable citizens.
We all need to be protected and educated to avoid our baser impulses and our darkest selves. We have done it for our children; surely now we can do it for our parents. I’m not an advocate of anger as an agent of change, but sometimes a bit of heat does not go astray. When it comes to elder abuse, perhaps we need to stop being polite in public conversation about its rude reality.
This article was first published in the print edition of The Saturday Paper on Mar 10, 2018 as "Elder abuse". Subscribe here.