Australian Frontline Service Response to Elder Abuse During COVID-19: Learnings,Successes,and Preparedness for Disaster

Abstract

This study examines how service providers in Victoria, Australia, undertook early intervention and response to elder abuse during the COVID-19 pandemic in 2020–2021. This study comprised two phases: (a) interviews with 29 staff members from 23 frontline service organizations about their experience responding to the needs of vulnerable older people during COVID-19; followed by (b) a co-design workshop with 15 service providers to discuss and endorse recommendations to improve sector preparedness for early intervention and responses to elder abuse during disasters. Participants reported that the severity and frequency of elder abuse increased during the pandemic, and that remoteness of services undermined comprehensive risk assessments, especially for older people who were not proficient in English and/or current digital platforms. Service providers endorsed a range of recommendations to improve sector preparedness for responses to elder abuse during disasters, primarily to upskill providers and improve the service system and direct support for individuals.

Keywords

COVID-19 elder abuse frontline services

What this paper adds to existing literature

• Descriptions of adaption and innovation by providers aimed at maintaining services and facilitating older people’s resilience and recovery during the COVID-19 pandemic.

• Analysis of the strengths and weaknesses of remote servicing during the COVID-19 pandemic.

Applications of study findings to gerontological practice, policy and/or research

• Documentation of the successes, learnings and recommendations of service providers provides insight into what practices should be retained and scaled up, and what practices should be discontinued or changed as part of the prevention and response to elder abuse during disasters.

Introduction

Elder abuse is defined by the World Health Organization as “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (World Health Organization WHO). Elder abuse can be physical, psychological, sexual, financial, and also includes neglect of an older person (Lachs & Karl, 2015). The global prevalence of elder abuse has been estimated at 15.7% in community settings (Yon et al., 2017) and 64.2% within institutional settings (Yon et al., 2019). Older adults in the community report psychological and financial abuse more than other forms of elder abuse, while in institutional settings older adults and their proxies report psychological and physical abuse most, closely followed by financial abuse (World Health Organization WHO). In countries such as the United States and China, research has revealed that rates of elder abuse increased during the COVID-19 pandemic (Chang & Levy, 2021; Du & Chen, 2021; Han & Mosqueda, 2020).

COVID-19 and its physical distancing requirements increased the risk of elder abuse, particularly as older people faced greater social isolation and decreased access to healthcare services (Makaroun et al., 2020, 2021; Steinman et al., 2020; The second shadow pandemic: Elder abuse, 2021). Increased caregiver stress is also a known risk factor for elder abuse, and carers grappled with increased financial hardship during the pandemic (due to job losses), withdrawal of home support services, home-schooling, as well as their own anxieties relating to the pandemic (Giebel et al., 2020; Han & Mosqueda, 2020; Makaroun et al., 2020). Amid a wider context of fear of the disease itself, ageism—a driver of elder abuse (Phelan, 2008)—was also amplified during the pandemic. Public and political discourse often ranked the worth of older adult’s lives as lesser relative to the economy and justified older adults being denied live-saving medical care due to their age (Ayalon et al., 2020). Across the globe, residents were underserved, abandoned, and/or locked in their rooms for months, contributing to the disproportionate death rate in aged care facilities (Anand et al., 2021; Ayalon et al., 2020; Rada, 2020).

Three years on since the beginning of the COVID-19 pandemic, there is a paucity of published research exploring facilitators and barriers to service provision for older adults during times of stay-at-home or physical distancing orders, though some exploration has emerged from the United States (Elman et al., 2020, 2023; Liu et al., 2021; Makaroun et al., 2020; Steinman et al., 2020), Ireland (Brennan et al., 2020), Hong Kong (Chan et al., 2022), and Portugal (von Humboldt et al., 2022). Available research indicates that a variety of strategies were adopted to increase safety while continuing services, such as the use of Personal Protective Equipment (PPE) (Elman et al., 2020). Service providers also engaged in more proactive outreach than previously, for example, calling clients to “check in” and offer assistance (Brennan et al., 2020; Elman et al., 2020; Liu et al., 2021). Some service providers also implemented new phone services including hotlines/helplines and telephone peer support groups (Elman et al., 2020). In Ireland, social workers also implemented outdoor appointments with older people (Brennan et al., 2020).

While frontline services transitioned to or incorporated use of videoconferencing and telephone appointments as an alternative to face-to-face interaction during the COVID-19 pandemic, not all older adults offered these services had the resources or technological proficiency to engage (Chan et al., 2022; Elman et al., 2020; Makaroun et al., 2020; von Humboldt et al., 2022). Further, video or telephone services may not have been suitable for older people with hearing difficulties and forms of cognitive impairment (Elman et al., 2020; Steinman et al., 2020). Where carers and family members of older people were relied on to facilitate use of remote technologies, older people may have also been denied the privacy needed to disclose abuse to service providers (Elman et al., 2020). Significantly, Elman et al.’s (2023) study found that service providers in New York City did not feel that remote interaction was adequate for assessing abuse or wellbeing due to these challenges, as well as lesser ability to build rapport via telephone or videoconferencing.

While the available evidence suggests that elder abuse rises during times of disaster (Gutman & Yon, 2014; Rosenthal et al., 2021), disasters such as the COVID-19 pandemic also prompt adaptations, innovations, and workarounds by service providers and it is important to capture these experiences as part of disaster preparedness into the future. Too often the research focus is on the post-disaster context of recovery and response. Relatively little exists in the way of mitigating abuse and planning for the conditions that best facilitate older people’s resilience and recovery during long-term disasters such as COVID-19 (Kwan & Walsh, 2017).

Addressing this gap, the aim of this study is to document the successes and learnings of service providers and offer insights into what practices should be retained and scaled up, and what practices should be discontinued or changed as part of the prevention and response to elder abuse during disasters. Our insights are derived from providers’ experiences in Melbourne and the state of Victoria, Australia. Over 2020–2021, Melbourne had six lockdowns spanning 262 days, earning it the appellation of “the world’s most locked down city” (“Melbourne Reopens”, 2021). Our two key research questions are: How have Victorian service providers undertaken early intervention and response to elder abuse during COVID-19? What recommendations can be made to improve sector preparedness for early intervention and response to elder abuse during disasters?

Methods

Context

This study was conducted in the state of Victoria, Australia’s second most populated state (ABS, 2022). The prevalence of elder abuse in Australia is estimated to be 14.8% for community dwelling people aged 65 and older (Qu et al., 2021). During the COVID-19 pandemic, the message impressed upon the community by Australian federal and state governments was to socially distance and minimize physical contact with members of other households to avoid unnecessary deaths and overwhelm the public health system (Tan et al., 2020). Overall, Victoria faced higher case numbers than most Australian states and was subject to particularly stringent public health orders to contain the spread of the virus (AIHW, 2021; Tan et al., 2020). There were only four legally permissible reasons to leave home during lockdowns in Victoria: exercise (no more than 2 hours per day and at the peak, no more than 1 hour per day with one other household member), household shopping within a 5 km radius of home, to receive or provide care (including to be tested or vaccinated), and to attend work or school if it was not possible to do so from home (Andrews, 2020). Residents of Melbourne were locked down for a total of 262 days over the course of six periods in 2020–2021, arguably placing it among the longest locked down cities in the world during the COVID-19 pandemic (Pockett, 2021).

As in other parts of the world, older people in Victoria were disproportionately impacted by COVID-19, due in part to increased risk for COVID-related severe disease, hospitalization, and death with advancing age (AIHW, 2021; Holt et al., 2020; Johnson 2022). Failures in policy and management also meant that older Australians in aged care were not adequately protected, with the virus spreading to several Victorian aged care facilities (Buhler et al., 2021). As argued by Buhler et al. (2021), the aged care sector in Australia was already in a state of crisis and facing significant problems with respect to older people’s safety and wellbeing when COVID-19 began circulating in the community. Older people in Australia, including those living in the community, were among the most isolated during the pandemic, with research finding that older people struggled to stay connected with others due to lesser use of video calling and other forms of virtual contact (Carroll et al., 2020).

Data for this study were collected prior to the third wave of COVID-19 driven by the Delta variant, which brought Victoria into full lockdown once more. At the time of interviewing, the state had been in lockdown for 154 days (Dunstan, 2021).

Procedure

Ethical approval was granted for this project by the HREC delegated committee of Austin Health (Reference Number: HREC/71798/Austin-2021). Following ethical approval, participants were invited via email to take part in an interview and one of three subsequent workshops.

After giving written informed consent, interviews were conducted via videoconferencing from May to July 2021 by a male researcher, Peter Feldman (MAsEv), with extensive experience in qualitative research in the health and community services sectors. Twenty-nine staff members from 23 frontline service agencies took part in interviews (see Table 1 for agencies or services that participated).

Table 1.

Agencies and Services of Study Participants.

	Agency or service	Service type
1	Human rights organisation	Advocacy, counseling, and advisory services
2	Financial counselling service
3	Counselling and mediation service
4	Senior government official
5	Senior government official
6	Legal service
7	Advocacy organisation
8	Peak body
9	Housing service
10	Legal service
11	Advocacy and support service
12	Legal service
13	State government agency
14	Health service	Health and community care services
15	Aged care service
16	Health service
17	Health service
18	Health service
19	Local council
20	Health service
21	State police	Emergency and crisis response services
22	State ambulance service
23	Non-emergency patient transport services

All services that participated were involved with elder abuse prevention, identification, and response as part or all of their work. Interview participants were asked about elder abuse presentations and the situations of older adults since the onset of COVID-19, older adult’s engagement with services, and changes in services (see Supplementary materials). Interviewees were not provided with a copy of the discussion guide prior to interview. Each interview lasted 30–60 minutes, was conducted in English, and audio recorded.

All interview participants were invited to take part in a follow-up workshop held in August 2021 to finalize recommendations for improving sector preparedness for early intervention and response to elder abuse during disasters. Fourteen (48.3%) of the original 29 interviewees attended the workshop, plus an additional agency representative who was unable to take part in the interview phase of the project. Prior to the workshops, the research team sent participants draft recommendations that were developed from analysis of interview data. Workshops were facilitated by Bianca Brijnath, Briony Dow, and the interviewer Peter Feldman. Bianca Brijnath (PhD) and Briony Dow (PhD) are researchers with extensive experience in elder abuse research, including qualitative studies. The World Café method was used to conduct the workshop so that participants could work separately in specialist sub-groups and also together as part of an interconnected conversation (Löhr et al., 2020). The method was adapted to be COVID-safe as an online event, using the breakout rooms feature of a video-conferencing platform for sub-group work.

Workshop participants were allocated to one of three groups according to their service type: Emergency and Crisis Response Services; Health and Community Care Services; Advocacy, Counselling and Advisory Services. During workshops, participants discussed recommendations specific to their service groups as well as broader recommendations for all agencies that provided services to older adults and their carers. The Emergency and Crisis Response Services group held a follow-up meeting facilitated by the study team, to continue their discussions on response to elder abuse and finalize their recommendations.

Sample and Recruitment

The sample was drawn from existing state-wide elder abuse roundtable groups and prior research contacts. All participants were invited to take part in the research via email. Elder abuse frontline providers were defined as: (a) leaders, managers, and frontline staff working in health, housing, aged care, family violence, police, and legal services specific to elder abuse; (b) Victorian government agencies, regulators, and spokespeople working in elder abuse and/or family violence; (c) organizations and services that work across the spectrum of elder abuse including prevention, early intervention, and response. Persons who were employees or representatives of frontline providers defined above during the COVID-19 pandemic were eligible for inclusion in this study.

A key network from which participants were sourced was the Victorian Ministerial Advisory Group for Safeguarding Older People. This group comprised representatives from state government departments and agencies, as well as frontline services. One of the project’s research team, Bianca Brijnath, is a member of this Advisory Group, and was therefore able to communicate with members about the research project. Additional participants were drawn from the health and community care networks of the research team and then by referral and word-of-mouth. The sample was purposive in so far as participants were recruited who would best answer the study’s research questions.

Advocacy, counseling and advisory services were largely involved in addressing elder abuse through their work in responding to cases raised by members of the public, by victims directly, or by hospitals and other community agencies. Responses included providing services to victims such as financial counseling, psychological counseling, legal assistance, case management, and various types of advice; and by referring victims to other organizations to provide these and further responses. Advocacy services in particular were also involved with prevention activities, such as consolidating research and data to inform policy development, and undertaking awareness raising activities such as providing community education around elder abuse. Health and community care services largely addressed elder abuse by identifying cases, and following-up with comprehensive assessment and referrals to specialist services. Crisis and emergency response services, such as police and ambulance services, were well positioned to detect physical injury or signs of neglect that may be a result of elder abuse.

Analysis and Data Verification

Interview recordings were transcribed and loaded into NVivo for coding by Peter Feldman. Thematic analysis closely followed the topics addressed in the interview schedule, while allowing for new themes to arise from the data (Braun & Clarke, 2012). New themes that arose independently from the data largely revolved around agency support for staff wellbeing (a topic that was largely outside the commissioned scope of this project), and unanticipated benefits from COVID-safe practices.

A summary of research findings and interviewees’ recommendations was developed by Peter Feldman, cross-checked by Bianca Brijnath, and then presented to interview participants for review prior to the co-design workshops. In this way—input from multiple researchers, verifying findings with participants, triangulating with the literature, setting the study in its context—the study’s reliability and validity were confirmed (Noble & Smith, 2015). In the next section we collectively report on the major themes of interview findings and related recommendations.

Results

During the COVID-19 pandemic, most advocacy, counseling and advisory services, and non-emergency health and community care services worked remotely with their clients. While operating remotely helped bridge some service gaps and, in some cases, delivered productivity gains and other benefits, providers found that remote servicing was not sufficient to adequately assess clients’ risk of abuse. These experiences and challenges are illuminated below in conjunction with participants’ recommendations to improve sector preparedness for responding to elder abuse during disasters.

Figure 1 provides a conceptual-level mapping of factors identified by service providers that were perceived to elevate risk of elder abuse during the COVID-19 pandemic and lockdown conditions. Risk elevation was driven from one side by the modification, restriction and closure of services and ageist discourse around COVID, and on the client side by the situations, actions and beliefs of older people, their carers and families. The domains of risk are in the center. It should be noted that the interconnections between drivers and risks are far more complex than represented in this diagram, wherein the interconnections have been streamlined for conceptual clarity. For example, almost all arrows from the left and right columns should point towards elevated carer burden and stress.

Figure 1.

Mapping of factors perceived to elevate risk of elder abuse.

Elder Abuse at Home and in Institutions

Interviewees noted that the cumulative effect of older people’s increased social isolation was to reduce opportunities to detect abuse. Emergency responders that maintained face to face services with older people, such as police, hospitals, and crisis assistance providers, reported an increase in elder abuse complaints, emergency department presentations and requests for service. Cases were thought to involve greater complexity than previously because of a reduced frequency with which clients were accessing services, if at all, resulting in a greater degree of unmet health and support needs and therefore also a greater degree of caregiver burden.

There’s a lot of carer stress, carer burn out issues, so a lot more, I’m hearing a lot more about older people coming into hospital with significant neglect or care issues (…) so the very real sense is that family members have struggled through COVID (…) either because the service providers have done that [reduced services], or more commonly as I said it’s because family have not had services coming in. (Participant #9, health and community care services).

Periodic shortages in the supermarkets of essential hygiene items, driven by lockdown-induced hoarding and supply chain issues also increased stress on caregivers during the pandemic:

When the toilet paper issue came up, the lack of toilet paper, you know we managed to source I don't know how many boxes and we delivered them, the toilet paper, for cost price (…) we supplied masks for a fair while there to clients as well, clients were having issues regarding getting hand sanitiser, so once again we purchased in bulk. (Participant #10, health and community care services).

Participants endorsed a recommendation to ensure carers have supplies of goods subject to panic-buying in the event of future disasters. Service providers also felt that given the relationship between high carer burden and elder abuse and neglect, it is imperative to alleviate carer burden and stress during disasters. As such, providers endorsed recommendations to align the service system to reduce carer stress where possible, such as by improving referral pathways and access to information and services for carers. Further, recommendations were endorsed to support public awareness campaigns providing information about the health needs of carers and positive messaging around carer stress, as well as ongoing public education about elder abuse and the rights of older people.

Elder abuse in institutional care was also believed to have increased during the pandemic, especially around physical abuse and restricting older people’s movements. One hospital-based interviewee said:

We had a couple of people admitted from residential aged care facilities with really concerning injuries that aren’t what would be classically considered care-based or training-based injuries. And, for me, it’s a no brainer that this is not a typical sort of injury, this is something that needs to be escalated. (Participant #5, health and community care services).

Two participants also reported a novel form of elder abuse wherein retirement community managers acted illegally by preventing residents from leaving and family carers from entering:

We had [residents of] two retirement villages, both in Victoria, called us saying ‘Yes, the owner has put security at the gate, they’re not letting us see our family members, they’re not allowing us to go to our community’. The owner wasn’t allowing them to go to their own doctors for a flu shot (…) the police were helping us to explain to the owner and he’s like ‘Oh no, I’m just protecting people’, and it’s like ‘No, actually, you’re violating their human rights’, and he didn’t get it, really. (Participant #6, advocacy, counselling and advisory services).

Participants recommended that elder abuse in institutional settings be included within the state government framework of elder abuse, which currently views elder abuse as a form of family violence and thus confined to community settings. Participants also recommended that residents in aged care facilities should be “given a voice,” for example, by creation of support groups to identify common issues. In the event of future disaster, “safe visiting” should be implemented as soon as possible in residential aged care. A suggested example of safe visiting is adoption of/mirroring of hospital visitation policies, such as full vaccination status of visitors and one family member per day.

Who Could Adapt to Pandemic Conditions?

Apart from emergency, hospital, and home care services, most service providers took the approach of avoiding all physical proximity with clients and with each other early in the pandemic. Instead, they relied on videoconferencing or telephone contact as the first or only option of contact. While some providers already had work-from-home arrangements in place prior to COVID-19, others needed to boost their Information Technology (IT) capabilities and reconfigure their phone systems to transition to work-from-home. Nearly all interviewees reported that their agencies adapted successfully if not immediately, however scarcity of funds was a barrier for some smaller agencies. Participants endorsed a recommendation to improve funding for IT resourcing to agencies that were unable to transition to full remote servicing during the pandemic to be better prepared for disaster.

Additionally, participants endorsed a recommendation to increase support for older adults to improve their IT literacy, with some participants suggesting this may be achieved by improving access to hardware and instructional information, and making essential systems such as welfare support more easily accessible. Interviewees broadly observed that older adults tend to be disadvantaged by a lack of IT equipment, training, skills, as well as sensory or cognitive deficits. Nevertheless, several participants commented on how well many older adults responded to an opportunity to learn and use new technologies, including tablets and laptop computers:

The majority really surprised everybody, and actually we’ve talked with other service providers about this, about how there’s perhaps this perception that older people in the community are not so tech savvy, but actually yeah, a lot of older adults really embraced it and were quite happy. (Participant #24, advocacy, counselling, and advisory services).

By contrast, police and other emergency and crisis services were unable to transition to work-from-home arrangements. COVID-safe practices reduced the daily number of call-outs that each paramedic could attend, as vehicles had to be thoroughly cleaned after transporting each patient. Multiple layers of PPE were also thought to have a depersonalizing impact on service, as well as delays:

It must be very dehumanising for patients, because it’s that fabulous white suit thing that covers you from head to toe, with this much of your face showing, with blue bootee things that cover your shoes, multiple sets of gloves, and then your goggles, your mask and (…) those shield things on top of that as well. So, you don’t look like a person, you can’t use non-verbal communication skills to your advantage, and I’m sure that that negatively impacts on the patient experience hugely. But, you know, there was no choice, and I think the community in general are understanding of that. There’s also a tremendous delay, by the time you get out of the ambulance, you then have to put all your gear on and so the patient is waiting for upwards of five minutes for you to get yourself sorted. (Participant #22, emergency and crisis response services).

In order to better serve older people generally and in times of disaster, providers endorsed a recommendation to fully train ambulance paramedics in recognizing and responding to elder abuse. Providers from emergency services also endorsed a recommendation supporting systemic change in order to better respond to elder abuse, including the provision of clearer guidelines and procedures for responding to elder abuse.

In anticipation of elevated risk of family violence, the police focused on monitoring high-risk perpetrators and compliance with intervention orders. Some of these practices continued thereafter, within the evolving model of policing practice. Additionally, the police commenced trialling a financial elder abuse response in 2020 in five of the 21 police divisions in Victoria, involving specialist investigation units working directly with financial, legal, and advocacy agencies.

Benefits of Remote Servicing

Many agencies experienced higher efficiencies when they moved to online environments, and for some there were substantial productivity gains:

The biggest advancement through COVID is simply, has honestly been the use of Teams. (…) It’s led to me probably having 4 or 5 [more] meetings a week than I would previously. It’s given us greater access, particularly when people were working remotely, and partner agencies working remotely. (Participant #23, emergency and crisis response services).

Services with legal functions commented that remote attendance at court hearings saved a lot of time and stress for attendees, who would normally attend court for many hours despite only being required to contribute for a very short period of time. Remote attendance was also thought to provide greater protection for abuse victims:

Sometimes the virtual hearings have been a blessing because it kind of reduced the need for, or reduced the possibility of confrontation of interested parties, who may, you know, pose a risk or hesitation. Anyway, you’re avoiding a whole lot of stress because people are meeting virtually. (Participant #13, Advocacy, counselling and advisory services).

The shift away from face-to-face services also created an impetus to diversify and intensify alternative means of engaging with older adults and their carers—for example, by facilitating pen-pal programs, online chat groups, and community radio announcements. One elder care agency servicing ethnically diverse communities initiated telephone chat groups to replace their face-to-face groups. In doing so, they managed to reach new client groups, engaging older adults who had never participated before:

We started these groups, and we had an amazing response, like, we had 40 elderly people a week. (…) We’re discovering people in their 90s who live alone, and they may have a disability or something, and I think it’s very unlikely that they would leave and go one hour away somewhere to hear a talk or be part of a group (…) We found out that there is this extra vulnerable group that perhaps we have been too busy working previously before COVID to actually do something like that. (Participant #3, advocacy, counselling and advisory services).

Inadequacies of Remote Servicing

Loss of face-to-face client consultations and home visits were the most frequently mentioned and most significant challenges reported by participants. Providers’ capacity to gather accurate and complete information about a client’s abilities, living conditions, family dynamics, and risk of abuse was negatively impacted by shifting to phone or telehealth appointments:

We want to be able to see, hear, smell, observe the relationship between people, all those sorts of things that give us clues as to what’s happening (…) it’s very difficult to build rapport and trust under the circumstances of picking up the phone. I guess you pick up on all those non-verbal cues when you’ve got somebody face-to-face with you. So, it allows you to maybe ask more things in-depth. (Participant #5, health and community care services).

In some settings family members and friends were relied on to provide and/or assist with the technology used in remote assessments; however, interviewees recognized that this approach came with the risk of a perpetrator controlling the exchange of information. This risk was elevated in linguistically diverse client populations since there were not enough interpreters available for telehealth assessments to meet the demand. As a result, there were situations where clients relied on family members who may be perpetrators for help with translation as well as help managing the technology:

We see it [abuse] in terms of neglect, intentional neglect, unintentional neglect. We see it in terms of blocking access to services, … in terms of adult children moving back into the property with the elderly parents. We see it in terms of misinterpretation, when a patient is a language other than English (sic) so controlling that flow of information by [insisting] on being the interpreter and then misinterpreting what’s said. (Participant #18, health and community care services).

When situations were perceived as high risk, providers gave clients “safe words” to use in future consultations if they needed urgent assistance or removal from a perpetrator.

Elder abuse advocacy workers also noted that during the pandemic, the adult children of clients may have been consulted more than the older adults themselves:

I found aged care case managers, because they weren’t home visiting, tended to be talking to the adult children more than the older person, which doesn’t give you an honest reflection of what’s going on. (Participant #20, advocacy, counselling, and advisory services).

Interviewees said that over time their organizations found it necessary to revise their initial COVID-safe policies to respond to clients who were at unacceptable levels of risk. In some instances, these revisions involved reinterpretation of current guidance; for example, Aged Care Assessment Services (ACAS) were instructed by the federal government to conduct all assessments by telehealth. However, noting that face-to-face visits were not explicitly banned, some services triaged their community-based clients and offered COVID-safe one-on-one face-to-face appointments where there were communication issues or safety concerns. Clients would be triaged either over the phone or in person outside of their homes:

One of the things that we did with ACAS was, we did extensive screening, like either phone screening or standing on the front lawn in full PPE screening (…) In the first few weeks, we all probably did revert to Telehealth and then very quickly recognised that there were things that we were missing when it came to older people and the complexity of those situations. (Participant #5, health and community care services).

Service providers endorsed a recommendation, in the event of future disaster, to triage new clients to assess their level of risk and vulnerability and prioritize resource allocation accordingly. Considering the inadequacy of remote services for assessing client needs and risk, providers also endorsed a recommendation supporting greater exemptions to provide face-to-face services in cases where remote alternatives were not adequate or feasible. Further, to mitigate the potential for increased isolation of older adults during disaster, participants endorsed recommendations to open up community halls to facilitate socially distanced group activities, and to provide safe and accessible community spaces for clients and people at risk to go to. Participants also recommended that service providers should pro-actively review clients who have suspended home support services such as cleaning or shopping and conduct regular check-ins with those clients.

Discussion

The study findings illuminate the challenges faced by frontline service providers in preventing and responding to elder abuse during COVID-19 as well as their solutions to these issues (see Table 2). Such insights add to the sparse literature around managing elder abuse during disasters and are important for future planning, particularly in situations where there are prolonged restrictions to everyday activities and considerable periods of social isolation.

Table 2.

Key Research Findings and Recommendations.

Key findings and recommendations	Examples include
Adaptions and innovations that improved practice	• Proactive monitoring
	• Triaging and prioritising clients for face-to-face services
	• Provision of IT hardware and assistance for clients
	• Enhanced community outreach strategies
	• Virtual legal processes
Unintended consequences and challenges of COVID-safe adaptions	• Impaired assessment capacity and fewer opportunities to detect elder abuse or risk of abuse when using remote technologies
	• Isolation of older people from health and care services, community activities and reliable information
	• Delayed assessment or treatment
	• Increased carer stress due to withdrawal of services
	• Abuse of aged care residents’ rights by restricting the movements of residents beyond health regulations
Recommendations to improve early intervention and response to elder abuse during disasters	• Enable ‘safe visiting’ to residential aged care
	• Stronger support for IT literacy for older people
	• Ensure carers have supplies of goods subject to panic-buying
	• Ongoing community education on elder abuse and the rights of older people
	• Provide safe and accessible community spaces for client and people at risk to go
Recommendations to improve the service system	• More exemptions for agencies to provide face-to-face services
	• Clear referral pathways
	• Full training for paramedics in recognising and responding to elder abuse
	• Services should conduct pro-active review of their client base to identify those most at risk and conduct regular check-ins with them
	• Triage new clients to prioritize resource allocation

First, in line with global findings (Gutman & Yon, 2014; Rosenthal et al., 2021), our participants reported increases in elder abuse during the pandemic. Physical abuse and neglect were perceived by participants to be occurring with greater severity and frequency, linked to social isolation, decreased access to healthcare, increased reliance on technology, and increased carer stress (Giebel et al., 2020; Makaroun et al., 2020, 2021; Ory & Smith, 2020; Steinman et al., 2020; The second shadow pandemic: Elder abuse, 2021). Importantly, abuse increased in both familial and institutional settings. Abuse in the latter setting prompted such concern that the Australian Royal Commission into Aged Care Quality and Safety, ongoing at the time, accelerated its COVID-19 recommendations into ameliorating the suffering of residents in aged care (The Royal Commission into Aged Care Quality and Safety, 2022). The Commission’s second recommendation was the restoration of physical connection between older people and their families and friends; the first was that government act and be accountable to parliament for implementing these recommendations.

Crucially, the vulnerability of older adults increased if they lacked access to technology, had low technological competence, or their use of technology was mediated by other family members (Elman et al., 2020; Hall Dykgraaf et al., 2022; Makaroun et al., 2020, 2021). These extrinsic factors ultimately dictated the effectiveness of remote servicing rather than the internal capacity of agencies themselves (though smaller ones did initially struggle). Services could only reach new, “extra vulnerable” clients, who might otherwise not engage in-person, because these older people had the digital capability and infrastructure to engage with them. This finding was also made in the US regarding engagement with hard-to-reach groups in remote areas (Halphen et al., 2021). Going forward, mixed servicing, i.e., remote and in-person, are dual track strategies needed to reach and sustain engagement with vulnerable older people.

Third, remote servicing did lead to higher throughput, particularly in relation to consultations with colleagues and dealing with external agencies. It also delivered benefits by mitigating in-person confrontations between older people and their perpetrators in adversarial settings such as the courts, which participants said reduced older people’s feelings of distress. However, the benefits of remote servicing were asymmetric and not all providers, such as those in frontline health and emergency services (e.g., hospital staff, paramedics, and police), could undertake their work remotely. In conjunction with the withdrawal of other non-essential services, this left a gap in the timely recognition and response to abuse, as emergency services were often the only ones in situ with older people. However, not all of these professionals (e.g., paramedics) were trained in identifying signs of elder abuse and making appropriate referrals. In the future, it is important that all frontline emergency services be trained to recognise and respond to elder abuse.

Finally, risk assessments for clients could not be effectively undertaken remotely, as services struggled to identify clients’ non-verbal cues and determine whether an older person was communicating in the presence of a potential perpetrator. In the case of clients with low English proficiency, services may have relied unknowingly on perpetrators for translation. These shortcomings highlight the tangibility of assessments and how risk is assessed and managed through talk, touch, smell, and intuition. As such, greater exemptions to provide face-to-face services are vital during disasters to better protect and assist older adults, including those at risk of or experiencing elder abuse.

Limitations

The research did not engage with older adults at risk of/who had experienced abuse to investigate the impact of the pandemic on their lives. However, this was outside the scope of the project’s funded objectives. Nevertheless, further research that privileges older adults’ voices is needed. As Cornell et al. (2012, p. 50) argue about disaster, “The opinions and thoughts of older people … have rarely been canvassed. It has been more the case of doing things to and for older people rather than asking older people what they want.” Another limitation of our data is that establishing the frequency and severity of elder abuse was not a study objective. Rather, such information emerged when interviewees were asked whether and how elder abuse presentations or calls to their service had changed over the course of the pandemic. Few participating agencies had completed analysis of service data for the relevant period at the time of interview. Thus, the information reported here relating to changes in frequency and severity of elder abuse presentations is based mostly on service providers’ perceptions as frontline workers.

Conclusion

COVID-19 will not be the last of the pandemics. As the frequency of natural disasters increase into the future alongside population ageing, disaster preparedness planning must encompass the needs and vulnerabilities of older people. By reporting frankly on the challenges and steps taken by diverse providers, we outline strategies that governments, services, and older people themselves may consider to mitigate these risks and better safeguard older people during disaster.

Supplemental Material

Supplemental Material - Australian Frontline Service Response to Elder Abuse During COVID-19: Learnings, Successes, and Preparedness for Disaster

Supplemental Material for Australian Frontline Service Response to Elder Abuse During COVID-19: Learnings, Successes, and Preparedness for Disaster by Bianca Brijnath, Peter Feldman, Briony Dow, and Rachel Muoio in Journal of Applied Gerontology

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article from the Department of Health and Human Services (DHHS), State Government of Victoria, Australia. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Ethical Statement

ORCID iD

Bianca Brijnath

Supplemental Material

Supplemental material for this article is available online.

References

Anand

J. C.

Donnelly

Milne

Nelson-Becker

Vingare

E.L.

Deusdad

Cellini

Kinni

R. L.

Pregno

(2022). The COVID-19 pandemic and care homes for older people in Europe: Deaths, damage and violations of human rights. European Journal of Social Work, 25(5), 804–815. https://doi.org/10.1080/13691457.2021.1954886

Andrews

(2020). Statement from the Premier. Melbourne: Premier of Victoria, State Government of Victoria. https://www.premier.vic.gov.au/atement-premier

Australian Institute of Health and Welfare (AIHW) (2021). The first year of COVID-19 in Australia: Direct and indirect health effects. AIHW. Cat no. PHE 287. https://doi.org/10.25816/phdn-x648

Australian Bureau of Statistics (ABS) . (2022). National, state and territory population. Canberra: ABS. https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/mar-2022

Ayalon

Chasteen

Diehl

Levy

Neupert

S. D.

Rothermund

Tesch-Römer

Wahl

H. W.

(2020). Aging in times of the COVID-19 pandemic: Avoiding ageism and fostering intergenerational solidarity. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 76(2), 49–52. https://doi.org/10.1093/geronb/gbaa051

Braun

Clarke

(2012). Thematic analysis. In Hooper

(Ed.), APA Handbook of research methods in Psychology: Vol. 2 Research Designs (pp. 57–71). The American Psychological Association. https://doi.org/10.1037/13620-004

Brennan

Reilly

Cuskelly

Donnelly

(2020). Social work, mental health, older people and COVID-19. International Psychogeriatrics, 32(10), 1205–1209. https://doi.org/10.1017/S1041610220000873

Buhler

Wali

Ball

Gurung

Schismenos

(2021). The aged care crisis in Australia’s COVID-19 success story: A commentary. Humboldt Journal of Social Relations, 1(43), 51–59. https://doi.org/10.55671/0160-4341.1150

Carroll

Hand

Budinski

Baxter

(2020). Older people struggling to stay connected during COVID-19. Australian Institute of Family Studies. Retrieved from: https://aifs.gov.au/sites/default/files/media_release-aifs_life_during_covid19-staying_connected_0.pdf

10.

Chan

C. K.

Tang

M. Y.

Lee

M. L.

(2022). Delivering social services during the COVID-19 pandemic: The case of older people centers in Hong Kong. Journal of Social Service Research, 48(1), 1–11. https://doi.org/10.1080/01488376.2021.1956670

11.

Chang

E. S.

Levy

B. R.

(2021). High prevalence of elder abuse during the COVID-19 pandemic: Risk and resilience factors. American Journal of Geriatric Psychiatry, 29(11), 1152–1159. https://doi.org/10.1016/j.jagp.2021.01.007

12.

Cornell

V. J.

Cusack

Arbon

(2012). Older people and disaster preparedness: A literature review. Australian Journal of Emergency Management, 27(3), 49–53. https://search.informit.org/doi/10.3316/ielapa.735861542668183

13.

Chen

(2021). Prevalence of elder abuse and victim-related risk factors during the COVID-19 pandemic in China. BMC Public Health, 21(1), 1096–1110. https://doi.org/10.1186/s12889-021-11175-z

14.

Dunstan

(2021). Melbourne marks 200 days of COVID-19 lockdowns since the pandemic began. ABC News. https://www.abc.net.au/news/2021-08-19/melbourne-200-days-of-covid-lockdowns-victoria/100386078

15.

Elman

Breckman

Clark

Gottesman

Rachmuth

Reiff

Callahan

Russell

Curtis

Solomon

Lok

Sirey

J. A.

Lachs

M. S.

Czaja

Pillemer

Rosen

(2020). Effects of the COVID-19 outbreak on elder mistreatment and response in New York City: Initial lessons. Journal of Applied Gerontology, 39(7), 690–699. https://doi.org/10.1177/0733464820924853

16.

Elman

Gottesman

Makaroun

L. K.

Chang

E. S.

Baek

Clark

Rosen

(2023). Adult protective services perspectives on responding to elder abuse and serving clients during the COVID-19 pandemic. Journal of Applied Gerontology, 42(7), 1551–1564. https://doi.org/10.1177/07334648231166276

17.

Giebel

Hanna

Cannon

Eley

Tetlow

Gaughan

Komuravelli

Shenton

Rogers

Butchard

Callaghan

Limbert

Rajagopal

Ward

Shaw

Whittington

Hughes

Gabbay

(2020). Decision-making for receiving paid home care for dementia in the time of COVID-19: A qualitative study. BMC Geriatrics, 20(1), 333–338. https://doi.org/10.1186/s12877-020-01719-0

18.

Gutman

G. M.

Yon

(2014). Elder abuse and neglect in disasters: Types, prevalence and research gaps. International Journal of Disaster Risk Reduction, 10, 38–47. https://doi.org/10.1016/j.ijdrr.2014.06.002

19.

Hall Dykgraaf

Desborough

Sturgiss

Parkinson

Dut

G. M.

Kidd

(2022). Older people, the digital divide and use of telehealth during the COVID-19 pandemic. Australian Journal of General Practice, 51(9), 721–724. https://doi.org/10.31128/AJGP-03-22-6358

20.

Halphen

Solis

Burnett

(2021). A statewide elder mistreatment virtual assessment program: Legal, ethical and practical issues. Journal of the American Geriatrics Society, 69(10), 2759–2765. https://doi.org/10.1111/jgs.17424

21.

Han

S. D.

Mosqueda

(2020). Elder abuse in the COVID-19 Era. Journal of the American Geriatrics Society, 68(7), 1386–1387. https://doi.org/10.1111/jgs.16496

22.

Holt

N. R.

Neumann

J. T.

McNeil

J. J.

Cheng

A. C.

Unit

H. E.

Prahran

(2020). Implications of COVID-19 for an ageing population. The Medical Journal of Australia, 213(8), 342–344.e1. https://doi.org/10.5694/mja2.50785

23.

Johnson

(2022). Life is returning to normal, but many older Australians still harbour ‘perfectly reasonable’ fears about COVID. ABC News. https://www.abc.net.au/news/2022-02-25/covid-normal-older-australians-fearful-catching-virus/100855136

24.

Kwan

Walsh

C. A.

(2017). Seniors' disaster resilience: A scoping review of the literature. International Journal of Disaster Risk Reduction, 25(2), 259–273. https://doi.org/10.1016/j.ijdrr.2017.09.010

25.

Lachs

M. S.

Pillemer

(2015). Elder abuse. New England Journal of Medicine, 373(20), 1947–1956. https://doi.org/10.1056/NEJMra1404688

26.

Liu

P. J.

Wang

Schwab-Reese

L. M.

Stratton

S. K.

(2021). Elder mistreatment victims during the COVID-19 pandemic: Administrative data from San Francisco adult protective services. Journal of Family Violence, 37(7), 1027–1040. https://doi.org/10.1007/s10896-021-00305-1

27.

Löhr

Weinhardt

Sieber

(2020). The “world café” as a participatory method for collecting qualitative data. International Journal of Qualitative Methods, 19(9), 160940692091697. https://doi.org/10.1177/1609406920916976

28.

Makaroun

L. K.

Bachrach

R. L.

Rosland

A.-M.

(2020). Elder abuse in the time of COVID-19—increased risks for older adults and their caregivers. American Journal of Geriatric Psychiatry, 28(8), 876–880. https://doi.org/10.1016/j.jagp.2020.05.017

29.

Makaroun

L. K.

Beach

Rosen

Rosland

A.-M.

(2021). Changes in elder abuse risk factors reported by caregivers of older adults during the COVID-19 pandemic. Journal of the American Geriatrics Society, 69(3), 602–603. https://doi.org/10.1111/jgs.17009

30.

Melbourne reopens as world’s most locked down city eases limits . (2021, Oct 22). Melbourne reopens as world’s most locked down city eases limits. Al Jazeera. https://www.aljazeera.com/news/2021/10/22/update-2-melbourne-reopens-as-worlds-most-locked-down-city-eases-pandemic-restrictions

31.

Noble

Smith

(2015). Issues of validity and reliability in qualitative research. Evidence-Based Nursing, 18(2), 34–35. https://doi.org/10.1136/eb-2015-102054

32.

Ory

M. G.

Smith

M. L.

(2020). Social isolation: The COVID-19 pandemic’s hidden health risk for older adults, and how to manage it. The Conversation. https://theconversation.com/social-isolation-the-covid-19-pandemics-hidden-health-risk-for-older-adults-and-how-to-manage-it-141277

33.

Phelan

(2008). Elder abuse, ageism, human rights and citizenship: Implications for nursing discourse. Nursing Inquiry, 15(4), 320–329. https://doi.org/10.1111/j.1440-1800.2008.00423.x

34.

Pockett

(2021). COVID in Victoria: 262 days in lockdown, 3 stunning successes and 4 avoidable failures. The Conversation. https://theconversation.com/covid-in-victoria-262-days-in-lockdown-3-stunning-successes-and-4-avoidable-failures-172408

35.

Kaspiew

Carson

Roopani

De Maio

Harvey

Horsfall

(2021). National elder abuse prevalence study: Final report. (Research Report). Australian Institute of Family Studies. https://aifs.gov.au/research/research-reports/national-elder-abuse-prevalence-study-final-report

36.

Rada

A. G.

(2020). COVID-19: The precarious position of Spain’s nursing homes. BMJ, 369, m1554. https://doi.org/10.1136/bmj.m1554

37.

Rosenthal

Stover

Haar

R. J.

(2021). Health and social impacts of California wildfires and the deficiencies in current recovery resources: An exploratory qualitative study of systems-level issues. PLoS One, 16(3), e0248617. https://doi.org/10.1371/journal.pone.0248617

38.

Steinman

M. A.

Perry

Perissinotto

C. M.

(2020). Meeting the care needs of older adults isolated at home during the COVID-19 pandemic. JAMA Internal Medicine, 180(6), 819–820. https://doi.org/10.1001/jamainternmed.2020.1661

39.

Tan

E. J.

Meyer

Neill

Phillipou

Toh

W. L.

Van Rheenen

T. E.

Rossell

S. L.

(2020). Considerations for assessing the impact of the COVID-19 pandemic on mental health in Australia. Australian and New Zealand Journal of Psychiatry, 54(11), 1067–1071. https://doi.org/10.1177/0004867420947815

40.

The Royal Commission into Aged Care Quality and Safety . (2022). Aged care and COVID-19: A special report. Canberra: Commonwealth Government of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf

41.

The second shadow pandemic: Elder abuse. (2021). The Lancet Healthy Longevity, 2(6), e301. https://doi.org/10.1016/S2666-7568(21)00122-7

42.

von Humboldt

Low

Leal

(2022). Health service accessibility, mental health, and changes in behavior during the COVID-19 pandemic: A qualitative study of older adults. International Journal of Environmental Research and Public Health, 19(7), 4277. https://doi.org/10.3390/ijerph19074277

43.

World Health Organization (WHO) . (13 June 2022). Key facts: Abuse of older people. Geneva: WHO. https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people

44.

Yon

Mikton

C. R.

Gassoumis

Z. D.

Wilber

K. H.

(2017). Elder abuse prevalence in community settings: A systematic review and meta-analysis. Lancet Global Health, 5(2), e147–e156. https://doi.org/10.1016/S2214-109X(17)30006-2

45.

Yon

Ramiro-Gonzalez

Mikton

C. R.

Huber

Sethi

(2019). The prevalence of elder abuse in institutional settings: A systematic review and meta-analysis. European Journal of Public Health, 29(1), 58–67. https://doi.org/10.1093/eurpub/cky093

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