Protecting Clients From Violence, Abuse, Neglect, Exploitation and Discrimination
Any client receiving care - regardless of age, gender or disability - should be able to access support without experiencing (or fearing) violence, abuse, neglect, exploitation or discrimination.
Abusive behaviour of any kind towards clients (from staff, residents or others) is a violation of basic human rights and unacceptable in any setting (Better Health Channel 2016).
A client’s right to access support without suffering abuse is set out under the National Disability Insurance Scheme (NDIS) Practice Standard 1: ‘Violence, Abuse, Neglect, Exploitation and Discrimination’ and the Aged Care Quality Standard 8: ‘Organisational Governance’ for disability and aged care services respectively.
The following article provides an outline of different forms of abusive behaviour so that you can recognise the signs and take action.
Definitions Violence (Physical Abuse)
Violence is defined as the use of physical force with the intention to hurt, damage or kill somebody else (Better Health Channel 2016). This might include:
- Striking (with or without a weapon);
- Pinching; and
Almost one in two (47%) of adults with a disability have experienced violence after the age of 15, which is 11% more than people without a disability (AIHW 2019).
Women with disabilities are especially likely to experience violence (Better Health Channel 2016).
Abuse is a violation of rights that involves the exploitation of power. There are several types of abuse that may be experienced by clients:
(RACGP 2014; NSW Ombudsman 2017)
Statistics regarding the prevalence of abuse against older Australians is limited, however, it is estimated that between 2-14% of the older adult population has suffered abuse (AIFS 2016).Neglect
Neglect is the failure to fulfil the client’s basic physical or psychological needs (RACGP 2014). It includes:
(Better Health Channel 2016)Exploitation (Financial Abuse)
Exploitation is the intentional misuse of a client’s money or assets for personal gain (RACGP 2014). It includes:
(RACGP 2014; CDC 2019)
- Sexual abuse refers to any sexual activity that takes place without the client’s consent. It does not necessarily involve penetration or physical contact and may take the form of indecent exposure or other sexually inappropriate actions that are not consented to.
- For clients who are minors, sexual abuse also includes enticing the client into performing sexual activities, watching/viewing sexual activities or engaging in sexual behaviour, regardless of whether the client is aware of what is happening.
- Emotional abuse is behaviour that scares or terrorises the client, potentially causing them to lose confidence, self-esteem or self-determination. It includes:
- Verbal abuse (subtle or overt);
- Extreme jealousy;
- Suicide threats; or
- Stalking and harassment (in-person or through technology).
- Social abuse is the intentional isolation of the client from their family, friends and other contacts.
- Systems abuse is the mistreatment of clients related to how the service is run (e.g. Clients being made to eat meals at a certain time to fit in with staff changeover).
- Physical neglect;
- Failure to provide the client with adequate food, shelter, clothing or protection; or
- Allowing the client to be placed at risk through unsafe environments or practices.
- Passive neglect (withholding or failing to provide the client with life necessities).
- Wilful deprivation (intentionally denying the client assistance, putting them at risk of physical, mental or emotional harm).
- Social neglect (limiting the client’s social, intellectual and emotional growth or wellbeing).
- Restricting the client’s access to (or information about) their money;
- Fraudulently using the client’s money;
- Stealing from the client;
- Forcing the client to surrender their money or assets through coercion or deception;
- Forgery; or
- Taking, misusing or concealing the client’s funds, property or assets.
Discrimination is the mistreatment or bullying of a client based on their personal characteristics (or presumed characteristics). These characteristics can include (but are not limited to) gender, age, sexual orientation, disability, employment, race or religious belief (Victorian Equal Opportunity & Human Rights Commission n.d.).Policies, Legislation and Services for Preventing Abuse
Your organisation must have clear policies and procedures established to protect clients from abusive behaviour. It is also important to maintain a workplace culture that promotes positive values, experience and attitudes and is transparent about its processes (NDS 2017).
Disability Services Queensland (pp. 18-21) outlines key features of abuse prevention that should inform policies and procedures.
It is also essential for your organisation to have a code of practice stating expectations and values (DSQ 2008).
In addition to individual organisations’ policies and procedures, there is federal and state legislation designed to protect the rights of clients. These include, but are not limited to:
The Disability Act 2006, which outlines the rights of people with disabilities. It contains provisions regarding disability services, including a mandatory explanation of rights to the client when they begin to use a service. The Discrimination and the Victorian Equal Opportunity Act 2010, which enforces discrimination as a legal offence in Victoria. The Charter of Human Rights and Responsibilities Act 2006, which outlines the human rights, freedoms and responsibilities of people in Victoria. The Aged Care Act 1997, which has compulsory reporting provisions for aged care residents (in certain circumstances).Mandatory Reporting
Mandatory reporting is a legally-enforced requirement for designated service providers (‘mandatory reporters’) to report the suspected abuse or neglect of children (and in some incidences of assault, aged care residents) to government authorities (NSW Government 2017; Seniors Rights Victoria 2018).
Some healthcare professionals including registered medical practitioners, registered nurses and midwives are mandatory reporters who are obligated to report abuse (NSW Government 2017)
Clients who suffer from abusive behaviour in healthcare may not seek help due to fear, guilt, shame, lack of capacity or lack of knowledge about resources (Better Health Channel 2018).
Therefore, it is important to be able to recognise the signs of abuse in case it is not being disclosed by the client. Signs may include, but are not limited to:
Malnutrition or dehydration; Poor personal hygiene or dirty clothes; Untreated medical issues; Fearful, anxious or withdrawn behaviour; Unexplained and frequent injuries; Unexplained cuts or bruises on the genitals or anus; Unexplained sexually transmitted infections; and Sudden and unexpected changes in financial status.
(Seniors Rights Victoria n.d.)
Mandatory reporting exists for a number of offenses and it is not only part of your duty of care as a healthcare professional to report these, but also your legal responsibility. In other cases, you must gain the client's (or their substitute decision maker's) consent before reporting abuse to a third party (NSW DoH 2020).
If a client chooses not to report abuse, you should respect their wishes but provide them with resources and helplines in case they change their mind (NSW DoH 2020).
You should also be mindful of the client’s decision-making capacity. Always adhere to the capacity assessment principles (NSW DoH 2020)
All clients have the right to receive care without abuse or fear of abuse. Abuse is never acceptable in the workplace. Ensure you can recognise the signs of abuse and always take action if you suspect a client is being harmed.Useful Organisations
- Aged Care Quality and Safety Commission
- My Aged Care
- National Disability Abuse and Neglect Hotline
- National Disability Insurance Scheme
- National Disability Services
- Older Persons Advocacy Network
Aged Care Quality and Safety Commission, Guide for Aged Care Staff – Compulsory Reporting, https://www.agedcarequality.gov.au/providers/guide-aged-care-staff-compulsory-reporting/compulsor y-reporting-approved-providers-residential-aged-care-services/guide-aged-ca re-staff-compulsory-reporting Aged Care Quality and Safety Commission, Standard 8. Organisational Governance, https://www.agedcarequality.gov.au/providers/standards/standard-8 JobAccess, Reporting Abuse or Neglect of Someone With a Disability, https://www.jobaccess.gov.au/people-with-disability/do-you-need-report-abuse-or-neglect-people-with-disability National Disability Insurance Scheme, NDIS Practice Standards, https://www.ndiscommission.gov.au/sites/default/files/documents/2019-12/ndis-practice-standards-and-q uality-indicators.pdf New South Wales Department of Health, Identifying and Responding to Abuse of Older People, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2020_001.pdf New South Wales Ombudsman, Early Response to Abuse and Neglect in Disability Services, https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0009/39492/A-quick-guide-Early-response-to-abuse-an d-neglect-in-disability-services.pdf Elder Abuse Course, https://www.ausmed.com.au/cpd/courses/elder-abuse-module
Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator ProfileReferences Q3. True or false? Some clients who are suffering from abusive behaviour in healthcare may not seek help. Q2. Jeff is a nurse at an aged care facility. His favourite client to visit is Mary, who he has a good rapport with. However, whenever Jeff sees Mary interacting with another nurse, he gets very upset and berates Mary for ‘betraying’ him. What kind of abuse is this? Multiple Choice Questions Q1. What percentage of adults with a disability have experienced violence after the age of 15?
- Aged Care Quality and Safety Commission 2020, Standard 8. Organisational Governance, Aged Care Quality and Safety Commission, viewed 7 May 2020, https://www.agedcarequality.gov.au/providers/standards/standard-8
- Australian Institute of Family Studies 2016, Elder Abuse, Australian Institute of Family Studies, viewed 7 May 2020, https://aifs.gov.au/publications/elder-abuse
- Australian Institute of Health and Welfare 2019, People with Disability in Australia, Australian Institute of Health and Welfare, viewed 7 May 2020, https://www.aihw.gov.au/reports/dis/73-1/people-with-disability-in-australia/justice-and-sa fety/violence-against-people-with-disability
- Better Health Channel 2018, Elder Abuse, Better Health Channel, viewed 7 May 2020, https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/elder-abuse
- Better Health Channel 2016, People With a Disability who Experience Violence, Abuse or Neglect, Better Health Channel, viewed 7 May 2020, https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/people-with-a-disability-who-exp erience-violence-abuse-or-neglect?viewAsPdf=true
- Centres for Disease Control and Prevention 2019, Elder Abuse: Definitions, Centres for Disease Control and Prevention, viewed 7 May 2020, https://www.cdc.gov/violenceprevention/elderabuse/definitions.html
- National Disability Insurance Scheme 2020, NDIS Practice Standards, National Disability Insurance Scheme, viewed 2020, https://www.ndiscommission.gov.au/sites/default/files/documents/2019-12/ndis-practice-standards-and-quality-indicators.pdf
- National Disability Services 2017, Preventing Abuse, National Disability Services, viewed 7 May 2020, https://www.nds.org.au/zero-tolerance-framework/preventing-abuse
- New South Wales Government 2017, Who are Mandatory Reporters?, New South Wales Government, viewed 7 May 2020, https://www.facs.nsw.gov.au/families/Protecting-kids/mandatory-reporters/about
- New South Wales Department of Health 2020, Identifying and Responding to Abuse of Older People, New South Wales Department of Health, viewed 7 May 2020, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2020_001.pdf
- New South Wales Ombudsman 2017, Early Response to Abuse and Neglect in Disability Services, New South Wales Ombudsman, viewed 7 May 2020, https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0009/39492/A-quick-guide-Early-response -to-abuse-and-neglect-in-disability-services.pdf
- Royal Australian College of General Practitioners 2014, Abuse and Violence: Working With our Patients in General Practice (4th edition), Royal Australian College of General Practitioners, viewed 7 May 2020, https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Whitebook/Abuse-and-violence-w orking-with-our-patients-in-general-practice.pdf
- Seniors Rights Victoria, Should Victoria Have Mandatory Reporting of Elder Abuse?, Seniors Rights Victoria, viewed 7 May 2020, https://seniorsrights.org.au/wp-content/uploads/2018/05/Mandatory-Reporting-Web.pdf
- Seniors Rights Victoria n.d., Supporting Someone who has Experienced Abuse, Seniors Rights Victoria, viewed 7 May 2020, https://toolkit.seniorsrights.org.au/toolkit/supporting-someone-who-has-experienced-abuse/#item-4
- Victorian Equal Opportunity & Human Rights Commission n.d., Types of Discrimination, Victorian Equal Opportunity & Human Rights Commission, viewed 7 May 2020, https://www.humanrightscommission.vic.gov.au/discrimination/discrimination/types-of-discr imination
- Social abuse
- Emotional abuse
- Sexual abuse
- Systems abuse