Elder Abuse in Institutions 2014

1. GERON 2014 Elder Abuse in Institutions By Sailesh Mishra Founder President ,Silver Inning Foundation Founder Secretary, ARDSI Greater Mumbai Chapter 6th and 7th Sep 2014 Kolkata Copy Right: Silver Innings

2. Copy Right: Silver Innings

4. "Trees grow stronger over the years, rivers wider. Likewise, with age, human beings gain immeasurable depth and breadth of experience and wisdom. That is why older persons should be not only respected and revered; they should be utilized as the rich resource to society that they are”: United Nations Ex. Secretary-General Kofi Annan Love ,Care and Respect will give them Dignity and better Life Copy Right: Silver Innings

5. Elders in India • Due to better medical facility, good lifestyle longevity increase •• In 2008 India population of Elderly was around 8% of total population 86 Million • In 2014 Elder Population approx 104 million , 174 million projected in by 2026 , 356 Million in 2050 • Average age in 1951 – 42 yrs, Average age in 2008 - 68.6 yrs • It will be75 years in 2045-2050. • According to UN India will be soon Ageing nation, India has 2nd largest number of Senior Citizens • Around 70% Elderly are in Rural area • Many Elderly are illiterate and rely mostly on Family members • 90% of Indians Retires without Pension • Feminization of Ageing • Increase of 80 + very old population • Increase in Incidence oCf oDpye Rmighte: Snilvteira In n&ing As lzheimer’s 3%

6. Longevity y According to UNICEF Life expectancy in India : ¾ In 1951 42 yrs ¾¾ In 1970 49 yrs ¾ In 1990 58 yrs ¾ In 2005 64 yrs ¾ In 2008 68.6 yrs ( Female : 70yrs) y There is 60% increase in 60 yrs of lifespan ¾ 3 TYPES OF SENIOR CITIZENS: Drastic change in 3 segment :Young Old (60- 69 yrs ), Old Old ( 70 – 79yrs ) Very Old ( 80+ yrs) Copy Right: Silver Innings

7. India Pyramid 2000 Copy Right: Silver Innings

8. India Pyramid 2050 Copy Right: Silver Innings

9. Old Age in India • In India, old age was never a problem. Elder abuse was considered as a western problem and old age home was an alien concept. •• Earlier, the elderly persons of a family were respected a lot and they continued to live with respect till their death. But now the times have changed. The elderly are treated as burden , often neglected / ignored Copy Right: Silver Innings

10. Elder Abuse • Elder abuse as a social problem remains hidden. • Least researched topic with very little intervention. • According to pan-Indian surveys, 40% of elderly subject to some form of abuse • Elderly are equally responsible • Few Intervention by Government and Society , hardly any Law • More abuse done by Family and Relative • Old Age Homes and Institutions Copy Right: Silver Innings

11. What is Elder Abuse • Single repeated act • Where there is Lack of appropriate action • Where there is Expectation of trust • It leads to Harming development of his/her personality Copy Right: Silver Innings

12. Types of Abuse in Institution • Physical abuse • Emotional abuse or neglect • Financial abuse • Sexual abuse • Violation of rights • Systemic abuse: In institutional settings, some forms of abuse are not always obvious. Subtle emotional harms may occur such as treating older people like children (infantilization) and disregarding their wishes. In some institutional settings, systemic neglect may occur where there is not sufficient number of staff. "It's just the way things are here" .This is an aspect of an unsupportive environment. Copy Right: Silver Innings

13. Other types of abuse/neglect • Abuse by over-medication or under medication • Abuse by inappropriate use of physical or chemical (medication) restraints – diapers , Tied down , Sedative • Thefts of residents' personal property because of lack of security • Some forms of institutional abuse violate people's rights to accept or decline treatment •• Food –– Quality/Quantity/Time • End of Life • Lack of Basic Facility - Cleanliness, Bathing, Recreation, Grievances cell , Communication Copy Right: Silver Innings

14. Common Abuse in Institutions • More of physical abuse: Slapping or hitting •• Excessive use of restraints – more like hostel – not like home •• Pushing, grabbing, shoving or pinching of residents. •• Psychological abuse : included yelling at the resident in anger, insulting or swearing at the resident, and isolating the resident inappropriately. • Neglect situations Copy Right: Silver Innings

15. Case Study1 • Son working in MNC could not handle his restless AD father , admitted his Dad in Nursing/Care Home . • Could not visit frequently ,visited after 15 days & was Surprised to find father Passive & dull . Took him home & found Bruise mark on hand & legs – liked Tied down , found him drugged , got huge bill with 15 unnecessary medicines , no Activity Copy Right: Silver Innings

16. Case Study 2 • Daughter in law could not manage the Stress of handling Cheerful & overactive Dementia Pa in Law, admitted him in Well known Dementia Care facility away from city with lots of hope • Visited after couple of months , found him Weak & Tired with bundle of Unwashed Clothes , Soiled Bed sheets & unchanged Diapers , Smelly Room ……………. Copy Right: Silver Innings

17. Case Study 3 • A NRI son admits his AD mother to Elder Home • After few months Visited mother, founds Staff untrained, inefficient medical support , No Spiritual facility, No Counselor, No Psychologist , Average Food quality– his complaint was ignored • Unfortunately Mother passed away after 2 years and Son still running Pillar to post to Get the Refund Deposit and Justice for Excess Billing Copy Right: Silver Innings

18. Sli Til Slippery Tiles , Unfriendly Staff , Scared Elderly , Lonely Elderly Non Elderly Friendly Infrastructure, Untrained & Inadequate Staff Management : Top to Bottom Approach Copy Right: Silver Innings

19. Why Abuse or Neglect Happens • Isolation/ Hidden: Many care facilities are separate from the community. Other than family members who may visits, few outsiders may have contact with seniors who are living in care facilities. That may make it easier for abuse or neglect to remain hidden or go undetected. • Mismatch of Skills: Seniors in care today are much more physically frail and much more likely to be cognitively impaired. Staff members giving care today need considerable skills in assisting seniors who are physically or cognitively impaired. Without these staff skills, the risk of abuse or neglect of the residents in care can increase. • Ageism and Ablebodied-ism: Sometimes a society places considerable value on being young and active. When people grow older or develop conditions that impair their abilities, they may become devalued. Their preferences and wishes are given less weight than other (usually younger) people's needs or interests. • Systemic Problems: "It's just the way things are here" , This is an aspect of an unsupportive environment. Copy Right: Silver Innings

20. Why • Personality traits of staff, volunteers, administration or other persons in the environment may lead to abuse or neglect. Like any other setting, some people working or volunteering in a nursing home, personal care home, assisted living or other institutional setting may not have the personality best suited for helping frail older adults. • The facility's culture and organization. An abuse-free environment starts from the top. The development and maintenance of a respectful environment that recognizes the inherent dignity and worthy of each individual requires organizational work and attention. • Inadequate staffingCopy Right: Silver Innings

21. Why • Staff minimization and rationalization of abuse: Some people may have a tolerance for certain kinds of disrespect, or verbal aggression towards residents or the staff because of the institutional culture, or lack of training. • Financial constraints within the facility which may contribute to poor quality care. • Poor enforcement of nursing home standards or inadequate standards. • Difficulty recruiting and retaining qualified and well trained staff. This may be related to wages or working conditions. • Work related stress and professional burnout. Copy Right: Silver Innings

22. Rights of the Residents • Independence : Elders should have access to adequate food, water, shelter, clothing and health care • Care : Elders should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives. • Dignity: Elders should be able to live in dignity and security and be free of exploitation and physical or mental abuse. • Meet with Advocate as often as necessary • Meet privately with friends and family • Choose recreational activities and have access to an organized spiritual and religious care program. • Rights to make their own health care and personal care decisions, • Freedom from discrimCionpya Rtigioht:n Si lver Innings

23. How to avoid/STOP Abuse • Training and Education • Good Selection of Facility • Read the agreement properly and see under the line – fine print •• Refund policy • Facility they provide – Food, Recreation, Water , Shelter • Ask for receipt • See the organisation/Trustee • Do they follow minimum standard • Do they have Medical, social, Psychological , proper security • facility - mostly its only FOUR walls • Emphasizing that health care professionals are not to respond to aggression with aggression. • Educating the staff on how to deal with conflict with the patients. • Promoting support groups and counseling for staff members. • Listening to employees about concerns they have in regards to work overload, or other problems which are occurring which head staff may be unaware of. Copy Right: Silver Innings

24. Laws for Elderly in India • Section 125 of the Cr PC:A magistrate can order the child to maintain his old parents. •• Hindu Adoptions and Maintenance Act (HAMA) :an aged a parents can demand maintenance from same way a wife can demand from her husband • Domestic Violence Act (DVA): Lodge complaint with local Police • Maintenance of Welfare of Parents and Senior Citizens Act 2007 (MWPSCA) : Not yet implemented . Tribunal , No Advocate needed,90 days ,3rd Party can do it, Max Rs 10,000/- p.m..Penality Rs.5000/- - 3 months jail Copy Right: Silver Innings

25. What can be done • Set Minimum Standard • License • Monitoring and Evaluation • Awareness campaign • Legislation / ACT’s •• Grievances cell like Tribunals/Consumer Court • Report abuse • Visit them, don't leave them alone • Intergeneration programmes • Participation and responsibility of Civil Society Copy Right: Silver Innings

27. Rights of Residents at A1 Snehanjali • Right to voluntary participation : Each resident’s participation shall be voluntary and they shall be provided information to make an informed choice of participating and accepting services. • Right to practice own religion : Every resident is free to practice his/her own religion, without disturbing other residents • Right to medical care : Every resident has the right to have private communications and consultations with physicians of their choice and of A1 Snehanjali / Silver Innings, as per terms and condition of A1 Snehanjali • Right to present grievances by residents and family : Every resident, plus family will have the right to express grievances if any to the centre manager for redress Copy Right: Silver Innings

28. Rights of Residents at A1 Snehanjali • Right to confidentiality in treatment : Every resident has the right to confidentiality, privacy and treatment. • Right to receive needs based services : If required, every resident has the right to need based assessment when required. Additional costs would be provided by the family / guardian / self. • Right to dignity : Every resident has the right to live respectively and enjoy a dignified life. • Right to have family visit : Every resident shall have the right to receive visits from family members and other adults as per the terms and conditions of A1 Snehanjali. • Responsibility to respect personal rights and privacy : Every resident shall follow all the rules of the home and will respect the rights and property of other residents. Copy Right: Silver Innings

47. Putting old parents in old age homes should be considered as a secondary / last option by the children and not as the only option for taking better care of their parents. The People who do not have enough economic resources to fulfill all the necessities of their old parents and if they find that they can be given better care in old age homes then they can go for such options. Copy Right: Silver Innings

48. Someday this could happen to you one can be victim • By learning to recognize signs of abuse and reporting suspected cases, you can make a difference in the lives of elderly and dependent. • Parents are a treasure that children should guard zealously. Putting them into old age homes must never be the first but always the last option. Treat your parents as assets not liability. Let them feel wanted and not a burden.. Copy Right: Silver Innings

49. Let us all Protect Senior Citizens rights which will help them to lead dignified, secure lives, as equal members of society. Exercising these rights will enable Elders to be treated with respect on an equal basis with younger people. Love ,Care and Respect will give them Dignity and better Life Copy Right: Silver Innings

51. We are Human Being too…. Copy Right: Silver Innings

52. “My World… Your World… Our World – Free of Elder Abuse”” Its Silver Inning Foundation Presentation www.silverinnings.com Email: silverinnings@gmail.com Tel: 9029000091 Copy Right: Silver Innings

53. References • Reference: Charter of Rights for People with Dementia and their Carers in Scotland : http://social.un.org/ageing-working-group/ documents/Alzheimer%20Scotland%202.pdf • WHO : Dementia Fact Sheet : http://www.who.int/mediacentre/factsheets/fs362/en/ • A1 Snehanjali, Silver Innings Assisted Living Elder Care Home • SPAIN : “The Act for the Promotion of Personal Autonomy and Care for Dependent Persons” configures a new citizenship right. A right for the elderly or disabled people that need help in carrying out the basic activities of daily living •• RIGHTS OF RESIDENTS IN ASSISTED LIVING RESIDENCES , NYC , Susan Somers Copy Right: Silver Innings

54. Thanks Copy Right: Silver Innings

Elder Abuse in Institutions 2014

Elder Abuse in Institutions 2014

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