Máire Hoctor (Tipperary North, Fianna Fail)

I thank the Cathaoirleach and the Senators for giving me the opportunity to make a statement on the subject of elder abuse. It is important to highlight this issue at every opportunity and that is the reason I appreciate this opportunity.

Elder abuse in any form is unacceptable and I reiterate the Government's full and continuing commitment to tackling this issue. Elder abuse is a societal as distinct from a health problem. Significant progress has been made in recent years and we want to ensure that continues and any gaps are addressed in full. We also want to ensure older people who feel they are the subject of abuse in any shape or form have the confidence to report their anxieties to a social worker, a public health nurse, a member of the Garda Síochána or any professional or care worker, whichever they are most comfortable with. These are key objectives.

Elder abuse is a complex issue and difficult to define precisely. It may involve financial abuse, physical abuse, psychological abuse, sexual abuse or it may arise owing to inadequacy of care. The current policy on elder abuse is outlined in the 2002 report of the working group on elder abuse, Protecting our Future. It defines elder abuse 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 or violates their human and civil rights". That report recommended that a "clear policy on elder abuse is formulated and implemented at all levels of governance within the health, social and protection services in Ireland", and I will show how we have made substantial progress, especially in so far as the health services are concerned.

We do not know the prevalence of elder abuse in Ireland. We can assume that the instance is not unlike that in other developed countries where studies have shown that approximately 3% to 5% of older people living in the community may suffer abuse at any one time. In Ireland this could mean that between 14,000 and 23,000 people living in the community may be suffering from abuse, neglect or maltreatment. No figures are available on the incidence of abuse in institutions but, unfortunately, we know that it happens.

The Health Service Executive report on Elder Abuse Service Development 2008 shows that there were 1,840 referrals to the service in 2008, an increase from the 2007 figure of 927. The 2008 statistics do not make for easy reading. The majority, 67%, of alleged abuse victims are women. The reported rate of alleged abuse increases in the over 80s age group. Psychological abuse is the most common form reported at 25%, followed by neglect — 20%, financial — 16%, and physical abuse — 14%. Self neglect referrals are at 18%. Public health nurses are the main source of referral, with hospital, HSE staff and family being the other major sources. The majority, 82%, of referrals relate to individuals who live at home.

Nationally, 83% of cases report just one person causing concern, with a further 14% allegedly perpetrated by two people. The predominant alleged persons causing concern are those that have the closest relationship to the person, that is, son or daughter — 43%, partner, husband or spouse — 17%, and other relative — 12%. Nationally, in 53% of cases the alleged person causing concern is living with the older person. These findings are in keeping with the experience elsewhere, as is the finding that in a significant number of cases the persons causing concern are likely to have mental health, substance abuse or behavioural problems. Mediation and counselling are the most common supports provided, followed by referrals to other services.

As I said, the data have just been released and will require further study. Self neglect was not included in the definition of elder abuse by the working group. Internationally, practice and policies vary. However, it is now included in the data and the HSE has developed guidance on how to respond to such instances.

Current policy on elder abuse evolved from the National Council on Ageing and Older People, NCAOP, report, Abuse, Neglect and Mistreatment of Older People, which was published in 1998. The Government acknowledged the importance of the issue and established a working group on elder abuse in 1999. Following a comprehensive work programme the group published its report, Protecting Our Future, in 2002. That report provided the foundation for the development of policy and procedures to respond to actual or alleged cases of elder abuse.

In 2003 the elder abuse national implementation group, the EANIG, was established to oversee the implementation of the recommendations of the report. The EANIG includes representatives of the HSE, the Health Information and Quality Authority, the Garda Síochána, the NCAOP, the Law Society of Ireland, the Irish Association of Older People and the Department of Health and Children, and is chaired by Professor Desmond O'Neill, consultant geriatrician.

In the period 2003 to 2005, the Government allocated additional funding of €2.45 million to implement the findings of Protecting Our Future. In 2006, an additional €2 million was provided over a two-year period to complete the funding requirements set out in the report. These included the development of a national research centre. Last year, an additional €300,000 was allocated for the development of a public awareness campaign to which I will refer later.

Significant progress has been made in developing a comprehensive response to deal with elder abuse. I commend in particular the Health Service Executive which has made significant progress in developing the appropriate structures and mechanisms necessary for tackling and preventing elder abuse in a consistent manner throughout the country, namely, a HSE steering committee to oversee and ensure a nationally consistent approach in the provision of elder abuse services by the HSE in relation to its detection, reporting and response; four regional steering committees, which are an essential link in good inter-agency working practices and the development of practice specific networks; four sub-groups to examine the areas of training and development, communication, media-public awareness and policy and procedure; a national policy for HSE staff responding to allegations of elder abuse and associated implementation plan; the establishment of a national research centre for the protection of older people at University College Dublin; 27 of 32 senior case workers and three of four dedicated elder abuse officers in place; the development of a training programme for staff in public and private care settings; a public awareness campaign aimed at informing key audiences about the risks and realities of elder abuse; and annual reporting, that is, the Elder Abuse Service Developments 2008 report.

On the national centre for the protection of older people, building up knowledge for policy and practice is essential for the development of a sound service. Based on a recommendation in Protecting our Future, the HSE ran a competition to establish a national centre for the protection of older people. The contract was awarded to University College Dublin for an initial period of three years.

The principal function of the centre is to create a knowledge base of Irish and international research on the occurrence, prevalence, detection and response to abuse of older people. The principal function of the centre is to create a knowledge base of Irish and international research on the occurrence, prevalence, detection and response to abuse of older people. The objective of the centre is to place elder abuse in the wider social context as opposed to within the context of the HSE only. Financial abuse, ageism and discrimination are key issues which cannot be resolved solely within the HSE and the opportunity to inform policy across a wide range of departments and agencies will be strengthened by a centre that has an inter-agency mandate. The centre will be developed to integrate elder abuse issues from the arenas of health, social welfare, justice, finance and legal authorities. Therefore, while the HSE acts as the lead agent on the development of the national centre for the protection of older people, it will have links with other relevant sectors to influence policy in these areas.

Many older people may be reluctant to report abuse, particularly because elder abuse, by definition, occurs within a relationship in which there is an expectation of trust. If an older person is being abused by a close family member, the older person may not wish to upset that relationship. Similarly, if the abuse is perpetrated by a carer, the older person may be reluctant to report it. Sometimes the abused or the abuser may not recognise the actions as abuse. This may be particularly true in cases of financial or psychological abuse which can be more insidious and less easily recognised than other forms of abuse.

To address these issues the HSE ran an awareness campaign which began at the end of 2008. The campaign was aimed at informing key audiences, such as people over 50 years, carers, health workers and other stakeholders, about the risks and realities of elder abuse, and to create awareness of the elder protection services provided by the HSE and other agencies. The campaign highlighted the need to protect older people from abuse in all its forms and particularly aimed to educate key audiences on how to recognise abuse, make everyone aware of their responsibility to act and report, publicise the support services available and highlight, in particular, the issue of financial abuse.

The potential abuse of our older people, including financial abuse, is of concern to us all and is an area that I intend to vigorously pursue until the best possible measures are in place to protect our vulnerable older people.

The main goal of any response to elder abuse is prevention. There are two types of prevention, primary prevention, stopping elder abuse from happening in the first place, and secondary prevention, when it does happen, taking steps to ensure that it does not happen again.

The initiatives described earlier outline measures taken by the HSE that have been found to be effective in tackling elder abuse. I have focused on the HSE because of the key importance of the service, but some types of abuse, for example financial abuse, require action from other agencies and will be a priority focus from now on. In addition, negative attitudes towards, and perceptions of, ageing and older people can lead to intolerance and acceptance of abuse. We have to be ever mindful to eliminate ageism and ageist attitudes. These are not the only factors contributing to elder abuse but can give rise to a culture or an environment in which elder abuse can develop, leading to age discrimination and devaluing and disempowering older people.

Cosc, the National Office for the Prevention of Domestic, Sexual and Gender-based Violence, is a dedicated Government office with the key responsibility to ensure the delivery of a well co-ordinated "whole of Government" response to domestic, sexual and gender-based violence against women and men, including older people. In 2009, Cosc launched a public awareness campaign, Your Silence Feeds the Violence, on billboards, national and local radio and on-line. The campaign was designed to encourage Irish society to realise that only by taking an active role can we stop domestic violence from destroying thousands of lives. As the solutions needed to tackle various types of abuse differ, my office and Cosc work closely together to create, where possible, synergy to achieve maximum impact and awareness.

Late last year I asked the NCAOP to undertake a formal independent review of the implementation of the recommendations outlined in Protecting our Future. I was particularly anxious that any gaps in the present policy would be identified and that research would be carried out on areas not covered in the original report, such as financial abuse, institutional abuse, self-neglect and gaps for vulnerable adults. The terms of reference frankly acknowledge that insufficient progress has been made in areas other than the health services and significant issues, such as financial abuse, are not being addressed in a coherent or comprehensive way.

A key element of the review is that gaps in the present framework are addressed. The review is being guided by a steering group which has representatives from the NCAOP, the Department of Health and Children, the Irish Association of Older People, the HSE and HIQA. It includes a consultation process with all the main stakeholders at national and regional levels. I hope to have the completed review in May and I expect it will include recommendations on the structures, arrangements and mechanisms needed to inform future policy and actions.

Our first choice is for older people to remain living at home for as long as possible with the support of their families and community support services where necessary. When this is no longer possible, it is important that older people have access to the best possible residential care available. It is Government policy to develop and improve health services in all regions of the country and to ensure quality and patient safety.

We all need to ensure the protection of residents, to safeguard and promote their health, welfare and quality of life and to ensure that there is a focus on the well-being, dignity and autonomy of older people. Older people deserve the highest quality of care that we can provide in both public and private settings and these standards apply to all designated centres for older people.

The new national quality standards for residential care settings for older people in Ireland provide for 32 standards under seven groupings. Standard No. 8 sets out the criteria necessary to protect residents from all forms of abuse. These include the development of a policy on the prevention, detection, and response to abuse within the residential care setting. Persons in charge must take steps to ensure residents are safe from all forms of abuse including neglect and acts of omission. Procedures on whistle-blowing and protected disclosure are required under the Health Act 2007. All staff should receive induction and ongoing training in recognising, prevention and responding to elder abuse.

The standards are an objective and transparent way for care providers to implement and for inspectors to enforce standards to the benefit of nursing home residents. I am confident that they will play a pivotal role in driving improvements in the quality and safety of residential care for older people in the years ahead.

There are 23,000 people in long-term nursing home care in Ireland. It is important that everyone gets the best service and opportunities regardless of where they reside, be it public or private. The Health Act 2007 extends the registration and inspection to all nursing homes. From 1 July 2009, future inspections will be carried out by the chief inspector of social services, part of the Health Information and Quality Authority.

The establishment of the office for older people underlines the Government's commitment to older people. For that reason, I am pleased that one of the key functions of my office is to develop a strategy for positive ageing. My goal is to develop a meaningful and innovative strategy that will result in real improvements in the lives of older people.

The programme for Government stipulated that the strategy will involve, for example, the development of operational plans by Departments, clearly setting out objectives relating to older people, and joined up thinking on initiatives serving this community. Other areas for consideration include ongoing mechanisms to monitor progress and identify challenges. The cross-departmental group to develop the new strategy is in place. I also have responsibilities in the Departments of Social and Family Affairs and the Environment, Heritage and Local Government. I am also a member of the Cabinet committee on social inclusion, which ensures that there is an integrated coherent approach to issues relating to older people across Government level. This approach is key to delivering the Government's vision of improved integration of services, and thereby further supporting older people into the future.

My office will also continue to develop health policy and will oversee and monitor the delivery of health and personal social services for older people and the running of the long-stay charges scheme. It is, in short, the focal point for the development of a more comprehensive policy on older people. The resources of my office, which is currently staffed by officials from the Department of Health and Children, will be strengthened by the addition of staff of the National Council on Ageing and Older People.

Last week I introduced the Health (Miscellaneous Provisions) Bill 2009 in the Dáil. The Bill gives effect to the Government's decision to rationalise a number of health agencies and integrate some into the Department of Health and Children. One of these, the National Council on Ageing and Older People, is directly within my area of responsibility. The council enjoyed great respect and has made a significant contribution to policy development in regard to older people. The formulation of policy, however, is usually best located in Departments, and bringing the council's body of work into the Department will assist that role. Council staff have built up a range of expertise and experience on older people's issues that they can bring to the work of the office for older people. I have full confidence that the council will bring refreshing and rejuvenating insights into the Department and I am delighted they can join the office and assist in the development of the national positive ageing strategy and the work of the office into the future.

I reiterate the Government's commitment to improving protection services for this vulnerable section of our society. We have made great strides recently in developing appropriate services and raising awareness of elder abuse. However, we cannot become complacent. We must continue to carry out further research and develop appropriate mechanisms, to work in collaboration with other agencies and to keep a critical eye on all developments. Senators will agree any form of elder abuse is unacceptable and I urge all to open their eyes to elder abuse. If a person is in contact with an older person and has concerns, he or she should seek advice and not assume someone else will take action.