2 Defining elder abuse
7. No standard definition of elder abuse applies
within the UK public sector. The term itself has been imported
from the USA. It has no legal status and would not be recognized
by many older people. Guidance issued by the Department in 2000
on the protection of vulnerable adults from abuse (No Secrets)
adopted a definition that included, but was not restricted
to, older people. Thus, a vulnerable person is one:
who is or may be in need of community care services
by reason of mental or other disability, age or illness; and who
is or may be unable to take care of him or herself, or unable
to protect him or herself against significant harm or exploitation.[4]
8. This definition has been criticised by some commentators
as appearing to exclude those individuals who do not require community
care services and who can care for themselves. It is based on
a health/social care model and assumes that the vulnerable person
must be in need of external support.[5]
Nevertheless, the definition is comprehensive, taking as its starting
point that "Abuse is a violation of an individual's human
and civil rights by another person or persons" and continuing:
Abuse may consist of a single or repeated acts. It
may be physical, verbal or psychological, it may be an act of
neglect or an omission to act, or it may occur when a vulnerable
person is persuaded to enter into a financial or sexual transaction
to which he or she has not consented, or cannot consent. Abuse
can occur in any relationship and may result in significant harm
to, or exploitation of, the person subjected to it.[6]
9. The guidance lists six main forms of abuse:
· Physical
abuse, including
hitting, slapping, pushing, kicking, misuse of medication, restraint,
or inappropriate sanctions;
· Sexual
abuse, including rape and sexual assault
or sexual acts to which the vulnerable adult has not consented,
could not consent to or was pressured into consenting;
· Psychological
abuse, including emotional abuse,
threats of harm or abandonment, deprivation of contact, humiliation,
blaming, controlling, intimidation, coercion, harassment, verbal
abuse, isolation or withdrawal from services or supportive networks;
· Financial
or material abuse, including theft,
fraud, exploitation, pressure in connection with wills, property
or inheritance or financial transactions, or the misuse or misappropriation
of property, possessions or benefits;
· Neglect
and acts of omission, including ignoring
medical or physical care needs, failure to provide access to appropriate
health, social care or educational services, the withholding of
the necessities of life, such as medication, adequate nutrition
and heating; and
· Discriminatory
abuse, including racist, sexist, that
based on a person's disability, and other forms of harassment,
slurs or similar treatment.[7]
10. As the guidance points out, "any or all
of these types of abuse may be perpetrated as the result of deliberate
intent, negligence or ignorance." Clearly, the term encompasses
an extensive continuum, extending as far as criminal activities.
This was also illustrated in the submission from the Nursing and
Midwifery Council, which reviewed conduct committee hearings that
have involved abuse ranging from not respecting dignity, to actual
"physical abuse" and "inappropriate personal relationships."[8]
11. Several memoranda suggested that we should address
abuse of all vulnerable adults, rather than focusing solely on
older people. It was pointed out to us that, within the context
of No Secrets and the protection of vulnerable adults,
"elder abuse doesn't exist as a concept", and "people
are not abused because they are 'elders' but because they are
unable to effectively protect themselves."[9]
However, we were concerned that the particular issues relating
to the abuse of older people might have been overshadowed if we
had looked at the wider group of vulnerable adults.
12. We found wide support from many of our witnesses
for the definition of abuse and guidance set out in No Secrets.
That this has been adopted by 82% of local multi-agency codes
of practice for the protection of vulnerable adults indicates
its acceptability.[10]
13. Given the wide range of personal circumstances
of older people, their relationships and the settings in which
they live or visit, there is no single definition of elder abuse
which would satisfy every test. Nevertheless, we consider that
the reference to the violation of an individual's human and civil
rights by another person or persons provides a useful foundation.
The proposed Commission on Equality and Human Rights, which is
due to come into being in 2006, could be an important step in
offering further protection to older people whose human rights
are infringed by abuse. The Commission will take on the responsibilities
that are currently split between three commissions (the Commission
for Racial Equality, the Equal Opportunities Commission, and the
Disability Rights Commission), and will assume additional responsibilities
in respect of age, sexual orientation and religion/belief. However,
we are concerned that while the new Commission will generally
have both promotion and enforcement powers, in respect of human
rights it will have only promotion, but not enforcement, powers.
We would be very disappointed if this were the case, and we urge
the Government to enable the Commission on Equality and Human
Rights to promote and enforce both equality and human rights on
an equal basis. We believe that the credibility of the new Commission
will be seriously damaged if it is unable to respond in this way,
and if it is seen to treat the issue of human rights as a lower
priority.
14. We recommend that the No Secrets definition
of elder abuse should be expanded to include those individuals
who do not require community care services, for example older
people living in their own homes without the support of health
and social care services, and those who can take care of themselves.
We recommend that all government departments and statutory agencies,
independent bodies, charities and organisations working within
the area of care for older people apply this definition of elder
abuse to promote consistency and conformity throughout government
and the health and social care sector.
4 Department of Health, No Secrets, 2002, para
2.3 Back
5
Ev 7 Back
6
No Secrets, paras 2.5- 2.6 Back
7
No Secrets, p 9 Back
8
Ev 161 Back
9
Ev 163 Back
10
Centre for Policy on Ageing, No Secrets-Findings from an analysis
of local codes of practice, June 2002. Back
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