APPENDIX 21
Supplementary memorandum by Bridget Penhale
to the Health Select Committee Single Evidence Session
on Elder Abuse (EA28A)
SUMMARY
This memorandum will discuss responses to abuse
and neglect that have been developing in Europe. Not all European
countries will be covered, but those that the author has been
able to determine in recent weeks will be briefly covered. It
is anticipated that provision of information of this type for
the Committee will contribute to deliberations concerning appropriate
responses to the abuse and neglect of older people in the UK.
1. This evidence is presented by Bridget
Penhale, who is the current European Regional Representative and
Acting Secretary of the International Network for the Prevention
of Elder Abuse (INPEA) and a Senior Lecturer in Social Work at
the University of Hull. Further information concerning the respondent
was outlined in the previous, substantive submission. Responses
here will not cover all European countries, but will be restricted
to a number of key areas, which will be numbered, for the benefit
of the Committee. This evidence is submitted on an individual
basis and ideally, should be read in conjunction with the previous
submission provided by the respondent. Full contact information
is available at the end of the submission should the Committee
subsequently wish to direct any queries to the respondent.
2. How prevalent is elder abuse? As outlined
on the previous memorandum, the research evidence concerning elder
abuse is limited and partial. There is at present insufficient
evidence concerning the prevalence and incidence of abuse in the
UK and many European countries share this difficulty. In most
countries where work has been conducted to establish the prevalence
of elder abuse (for example, US, Canada, Australia, Finland),
a figure of 5% of the older population likely to be affected has
been obtained and it is accepted on a global basis that 4-5% of
the population of older people in any country are likely to be
affected. This may however relate to those individuals who either
experience abuse or are at risk of abuse. The figure may be an
under-estimate as a proportion of older people are "hard
to reach" as they may be housebound, isolated or have communication
difficulties so are often excluded from research samples.
3. Although the phenomena were initially
recognised by English doctors in the mid 1970s it was not until
the late 1980s that the issue has really been concentrated on
in the UK. The amount of research and material published about
the subject in the UK has been increasing fairly steadily since
the 1990s. However, in many ways, it is still quite early in the
stages of identification of the problem and the development of
responses to it. Whilst a number of Western European countries
such as Sweden, the Netherlands and France similarly recognised
the existence of abuse at about the same time as the UK, there
are others such as Spain, Italy and Belgium where the existence
of abuse has only been acknowledged in recent years. Others still
(Iceland, Czech Republic, Slovenia) are only now beginning to
consider issues relating to elder abuse. Of course there are yet
other countries (Denmark and some of the accession countries)
that do not appear to have recognised elder abuse up until this
time.
4. For the purposes of the current hearing,
it would appear useful to provide brief information concerning
a selection of European countries. In this way it should be possible
for members of the Committee to gauge where the UK is positioned
in relation to the development of responses to elder abuse and
abusive situations. My thanks are due to a number of contacts
that I have established in Europe, through INPEA, who have provided
information concerning the situation in their countries.
5. France has been concerned about
issues relating to elder abuse since the late 1980s. Small amounts
of research have been taking place in recent years. ALMA France
(ALlô MAltraitance) was created in 1994 by Professor Robert
Hugonot, a retired professor of geriatric medicine. ALMA France
has several objectives:
2.
Support and protect the isolated, excluded and vulnerable
elderly.
3.
Recruit and train help line listeners/counsellors
among the community and from the students and professionals of
its institutions.
4.
Evaluate and document the work in the form of statistics,
research, and publications.
5.
Inform the general and professional press, radio
and TV networks.
ALMA France is developing a national network
of ALMA help line centres, with the aim of having one in each
of the 98 French departments. So far, 40 ALMA help line centres
have been opened and each function according to its specific local
needs. The system is quite different to that which Action on Elder
Abuse has developed in the UK. ALMA's efficient method brought
the topic "elder abuse" into the open and to public
awareness. Now ALMA France receives substantial funding from the
French government. Limited amounts of research have been taking
place in recent years. In 2002 several official policy texts and
laws were passed to fight elder abuse. A "Comité deVigilance"
was created by the "Secrétariat d'Etat des Personnes
Agées" (State Secretariat for the Elderly) in December
2002. A free 08 number (national helpline number) is to be established
from summer 2004. ALMA France's overall goal is to find ways to
uncover the risk factors in institutions and in the home which
lead to elder abuse and to prevent it from happening
6. Germany has been developing responses
in recent years since the mid 1990s and has seen developments
in a number of different areas. There are no laws which specifically
and explicitly deal with the topic of elder abuse. However, there
have been recent changes (and improvements) in laws pertaining
to elder care and quality of care. (Pflegequalitätssicherungsesetz—Law
on Quality Assurance in Nursing Care; Heimbewohnerschutzgesetz—Law
for the Protection of Nursing Home Residents); eg: residents'
family members can now become members of residents' councils.
At the level of federal policy, elder abuse is not a dominant
topic. However, there are some activities which specifically address
the problem of elder abuse. The Federal Ministry for Family, Senior
Citizens, Women, and Youth (BMFSFJ) has funded a model project
on Violence against elderly people in domestic settings
(1998-2001); a study on Crime and violence in old peoples'
lives will start in 2004. There are a number of activities
aiming at improvements in elder care etc. The BMFSFJ and the Federal
Ministry for Health have started a "Round Table on Care"
where experts from different institutions and disciplines meet.
7. In the (northern) federal state of Schleswig-Holstein
a so-called "Pflegenottelefon" (nursing care emergency
line) has been successfully operating for a couple of years. One
of its outstanding features is interagency cooperation and referral
of clients to services, independent of the institutional affiliation
of the advisor. Now, a process of handing down services from the
central institution in Kiel (the capital of Schleswig-Holstein)
to eight newly founded local services is under way. In a couple
of larger cities, especially in the south of Germany (eg Munich,
Stuttgart, Nuremberg) there are so called "complaint offices
for problems in elder care", which are funded by local authorities.
These complaint offices seem to work quite efficiently, although
they depend upon nursing homes' cooperation and do not have the
authority to impose any sanctions.
8. There are a number of NGO-helplines,
most of them at a local level. Probably the helpline run by "Handeln
statt Misshandeln" (virtually untranslatable; the literal
meaning would be "action [Handeln] instead of maltreatment
[Misshandeln]" in Bonn is the most important one.
These local helplines have formed a kind of national network.
Most elder abuse helplines focus explicitly or factually on problems
with elder care, mainly in residential settings. Other contexts,
in which elderly people are victimized, remain rather out of sight
(eg domestic violence in old age).
9. Domestic violence activities in Germany
mostly have young and middle-aged women as target groups. The
need to explicitly and actively "widen the circle" for
older victims of domestic violence has not yet been fully recognised.
Especially during the last few months there seems to be a slight
shift away from the very strong focus on elder care towards linking
the topic of elder abuse with broader concepts and activities
in the fields of crime prevention and violence prevention. The
Prevention Council of the federal state of North Rhine-Westphalia
has taken up the issue, so has the German Forum on Crime Prevention
(DFK). There is a long tradition of police crime prevention targeted
at the elderly. Traditionally, these programmes covered offences
like burglary, fraud, and robbery of handbags. Increasingly, the
police are "discovering" other areas of elder abuse
and neglect. There are still only a couple of German studies on
elder abuse, most of them either from the field of caring science
or from criminology—each with their own topical focus, terminology,
methodology and theoretical background. Starting in 2004, a new
study on elder victimization (Crime and violence in old people
lives) will be conducted by the Criminological Research Institute
of Lower Saxony (KFN).
10. In Sweden there was early research
work concerning elder abuse and caregiving in the late 1980s and
90s. There is a research group based a the University of Kalmar
(School of Nursing) but little appears to have so far developed
in relation to responses at a national level.
11. The situation in Finland appears
to be somewhat similar. There is a small amount of elder abuse
research currently taking place; earlier research took place in
the late 1980s and 1990s and included a prevalence study based
in the University of Oulu. There are currently two doctoral theses
in process at that university. One is on elder abuse and the other
is on physically forced actions (restraint) in elder care institutions.
Both theses are in their initial stages. There is one small project
which has recently been established in Finland thorough the auspices
of the Finnish Association for Shelters for Elders (although there
are no shelters yet established). The Prevention of Senior Abuse
project will run from 2003-05. The aims are to create different
action models for identifying, responding and preventing abuse.
One of the most important aims is to raise awareness (public and
professional) concerning abuse; training for health and social
care professionals, volunteers and students will be developed
and provided during the project.
12. Norway has been concerned about
the issue of elder abuse since the mid-late 1980s. Early research
work in Oslo led to the development of pilot projects to test
out interventions and responses to elder abuse. These were based
on an Action-research methodology, which meant that the projects
could change and develop as necessary. At the end of the 1990s,
it was determined that the model of intervention teams of specialist
social workers, which had developed through the pilot projects
would be established throughout Oslo and then progressively but
incrementally throughout the country. This is now in process.
The Ministries of Justice, Health and Social Affairs and Children
and Families provided funding in the mid 1990s to establish the
Norwegian Resource Centre for Information and Studies on Violence,
based in Oslo. This centre was unique in that it considered child
abuse (and protection), sexual violence and violence towards young
women and elder abuse and protection. The model has been successful
and as from January 2004, it will be combined with three other
institutions within Oslo University to form the National Centre
for Knowledge about Violence and Stress. The results of the intervention
projects on elder abuse will continue to feed into the work of
the centre.
13. In Italy, there are as yet, no
national projects concerned with elder abuse. There are, however,
some local regionally based initiatives, which have been developing
since the late 1990s. These include helpline and educational programmes
for professionals in Milan and Udine, based on the French ALMA
model and helplines in Rome and Turin. In the autumn of 2002,
there was the first national conference on elder abuse, held in
Treviso and work is continuing in the Veneto region to try to
obtain funding for some research and to establish a telephone
helpline. AUSER (the national NGO linked to older people) has
been involved in this initiative.
14. Despite a number of attempts throughout
the 1990s by gerontologists to raise awareness and concern about
elder abuse, Spain has effectively only begun serious work in
this area in the last five years. Small research projects, including
the development of an assessment tool by a group in Palma, which
is ongoing, are to be supplemented by a national survey of elder
abuse. Work is also taking place through the Spanish Association
of Gerontology together with the Institute for Migration and Social
Services on the development of a screening tool, guidance for
professionals and a comparative analysis of European legal provisions
on elder abuse. In September 2003, the Queen Sofia Centre for
Studies on Violence, Valencia based its annual international conference
on elder abuse. This attracted national media attention and was
highlighted by Queen Sofia, who opened the proceedings as an issue
of increasing global concern and one that Spain needed to concentrate
on in future. Further developments in Spain are considered likely
to be forthcoming in future
15. Gerontologists in Austria have
been concerned about the issue of elder abuse since the mid 1990s
and some developments have occurred but these have been rather
limited. During 2003, several elder abuse and neglect cases in
Vienna's largest nursing home (2000 residents) came to light through
the legal custodian (guardian) of one of the residents. The cases
included neglect and verbal abuse, but no deaths. As a result
of this, the role of a special ombudsman has been established
in Vienna, this person will be able to visit institutional care
settings for older people throughout the city without any advance
notice. It is hoped that further developments will continue following
this.
16. Israel has an established history
of research and work in this area, dating back to the late 1980s.
Work has taken place in a number of different areas since that
time. In some of the larger municipalities special units to deal
with elder abuse have been establishes and the Ministry of Welfare,
together with ESHEL (the Association of Planning and Development
of Services for the Aged in Israel now run annual training courses
for welfare officers. A large-scale national survey on elder abuse
is in process, co-ordinated by the University of Haifa. This will
include a qualitative study of families involved in abuse. Work
also continues on violence between couples/partners in later life
and developing the training of professionals.
17. In Belgium, there has been consistent
work since the 1990s, comprising both research and service development.
A branch of the French organisation ALMA has been developed (ALMA
Walllonie-Bruxelles) and a number of helplines developed over
the past five years. A number of conferences and symposia have
been held to assist in the training of professionals, students
and volunteers and in 2003 a training programme for frontline
doctors was established. Also in 2003, a pilot project, Libr'age
was established by three different organisations (CAPAM, URGEDES
and E.M.P.AGE) to provide a specialist service in each province.
This will consist of a telephone helpline, training programmes
for professionals and also campaigns concerning prevention of
elder abuse. Despite the lack of any specific legislation in relation
to elder abuse, certain laws are useful at times. These include
laws in relation to well-being and also relating to competence
and mental health. Attention is also paid to institutional settings
through regulation, complaints procedures and organisations to
assist elders in choosing a residential home and also linking
with residents.
18. In Ireland there have been a
number of developments since the late 1980s. This has included
short articles in professional journals, some media attentions
including reporting of fatal cases and also some enabling legislation
(Enduring Power of Attorney Act, 1996; Domestic Violence Act,
1996; 1990 Health (Nursing Homes) Act). In 1996 the Minister for
Health requested the National Council on Ageing and Older People
(Ministerial advisory body) to provide a report on elder abuse.
This report was produced in 1998 and included a literature review,
survey of professionals and service providers, review of policy
and legal framework and recommendations for a way forward. The
major recommendation was for the setting up of a Working Party
on Elder Abuse at the Department of Health.
19. A Working Group on elder abuse was established
by the Department of Health in 1999 and this reported in 2002.
Recommendations included: establishment of a national implementation
group at the Dept of Health to oversee the implementation of the
recommendations of the Working Group; formulation of national
policy on elder abuse; development by each health board of a strategy
to implement policy; setting up of a steering group in each health
board with a dedicated officer responsible for policy development
and implementation; recruitment of a Senior Case Worker in each
community care area to respond to all referrals; law reform, the
establishment of a National Centre for research and training on
elder abuse and a campaign in relation to financial abuse and
a public awareness programme. So far the main development has
been the establishment of the national implementation group at
the Department of Health and Children in December 2003 (one year
after publication of the report). One Health Board has developed
a draft policy on adult abuse and another has appointed a person
to develop policy in relation to this area. However, this report
was launched at a time of serious cutbacks in the health service
including a ban on recruitment and therefore little has happened
to date.
20. A number of other countries, such as
Greece, Poland, the Netherlands and Portugal
were involved in initiatives during the 1990s but no recent news
has been forthcoming about subsequent developments. Other countries
such as the Czech Republic, Slovenia and Iceland have
recently been involved in developing work in this area, particularly
in relation to awareness raising and professional responses. For
example, the first national conference on elder abuse was held
in Iceland in November 2003, whilst the production of guidance
for professionals is underway in Slovenia.
21. As is apparent from the information
provided above, different levels of development occur throughout
countries in Europe and there are undoubtedly some countries,
which have yet to begin to tackle the issue of elder abuse and
neglect. Whilst a number of committed individuals and organisations
in the UK have been working in this area to develop knowledge,
information and assistance concerning abuse and neglect since
the late 1980s, there is no room for complacency Effective guidance
at strategic and national levels is yet to be fully seen. Previous
recommendations made in my earlier written submission to the Select
Committee still stand. Much remains to be achieved for and on
behalf of elders who experience or at risk of experiencing abuse,
no matter where it occurs. It is to be hoped that the Select Committee
Hearing will provide much needed attention in this direction and
assist in raising both awareness of and the profile of elder abuse
and neglect in the UK.
January 2004
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