Tripping over family purse strings

Nurses working with older people in the community are well placed to prevent or intervene in cases of financial elder abuse, writes Lana Zannettino.

The most prevalent form of abuse to be reported by people aged 65 years and over is financial abuse. While there is no national prevalence data for elder abuse in Australia it is estimated that 0.5 to 5 per cent of older Australians have experienced financial abuse.

Over the past three years I have been a researcher on an Australian Research Council Linkage project, which involves researchers from the University of South Australia and Flinders University in partnership with a number of government and non-government organisations.

The project seeks to design and evaluate interventions to prevent and mitigate the financial abuse of older people by their family members.

The research has so far involved a national online survey of CEOs and service providers as well as a South Australian phone-in and national online survey of older people and family members concerned about financial elder abuse. Currently, the researchers are involved in working with services in the community to evaluate a model of family mediation in preventing and mitigating the abuse.

The World Health Organisation defines financial elder abuse as “The illegal or improper exploitation or use of funds or other resources of the older person”. But the abuse usually occurs within a relationship of trust, such as between a parent and child, and this makes defining and addressing the problem difficult.

Relationships of trust are important as older people become more reliant on family members. The majority of financial abusers of older people are close family members, usually the older person’s adult son or daughter. Our ageing population, the increasing complexity associated with financial management, and the greater numbers of older people being cared for in the community, means that this type of abuse is likely to increase.

Financial abuse is not usually considered in nurses’ clinical work with older people. This is largely due to the invisibility of the problem. It is much more difficult to detect than physical abuse or neglect and older people are much less likely to report this form of abuse because it often involves family members or people close to the older person.

In some cases, older people may not even be aware that they are a victim. As most nurses at one time or another will be involved in providing care to an older person, it is imperative that they have the capacity to identify the common risk factors, as well as an understanding of the ways that they and other professionals can effectively intervene.

What nurses need to know

Our research has identified factors that make older people more vulnerable to financial abuse. An older person may be vulnerable if they:

• lack cognitive and physical capacity
• lack social support and are isolated
• have recently lost a partner or spouse
• are dependent on other people to manage their finances
• have a history of domestic and family violence
• have family members who think they are entitled to the older person’s assets as part of their inheritance
• have family members seeking compensation for what they perceive was an abusive or deprived childhood
• have family members or carers who have a drug, alcohol or gambling problem, or a mental illness
• have family members or carers who are struggling financially
• have family members or carers who have ageist attitudes.

It is important for nurses to know that more than one form of abuse can co-exist, which means that financial abuse may be accompanied by physical, emotional or some other form of abuse.

It is also important for nurses to recognise how routine interactions of trust and care can easily slide into abuse. For example, a family member who is helping an older person with their finances may themselves be under considerable financial stress and may steal from the older person with the intention of paying them back.

This is quite a different scenario from a family member forcing an older person to change their legal will so that the abuser becomes the primary beneficiary. It is important, therefore, to acknowledge the complexity of financial abuse, particularly in terms of whether or not the abuse is intentional or unintentional.

What nurses can do

The high value placed on older people’s ability to be self-determining and the reluctance to view them as a vulnerable group who are frail and needy has led Australian governments and community groups to oppose the development of mandatory reporting and or other protective legislation to address elder abuse. Our research has indicated that the absence of mandatory reporting provisions or other protective legislation often makes it difficult and sometimes impossible for nurses and other professionals to take action to prevent or mitigate financial abuse by family members, particularly where older people will not or cannot give their consent to receive these services.

On the other hand, research has also indicated that such legislation may exacerbate older people’s vulnerability by limiting their capacity to determine when, how and what kind of intervention occurs.

Prevention and early intervention are important strategies because they can address conflict, misunderstandings and poor communication between family members before they give rise to the distress and financial abuse. Where conflict and abuse already exists, prevention and early intervention strategies can help older people to understand the dynamics and meaning of the abuse as well as where and how to seek help.

Nurses are in an ideal position to start prevention and early intervention strategies because they often develop trusting relationships with the older person and the people closest to them. Nurses can encourage older people to disclose financial abuse to a trusted person, they can validate the person’s experiences of abuse and support them emotionally and psychologically. They can connect older people to services that can assist them to make plans and develop safeguards to protect their finances and assets.

Where the abuse is intentional and particularly severe and where the older person is afraid of the abuser and or afraid of the consequences of any actions the nurse might take on their behalf, the nurse must respect the wishes of the older person not to act, even when the nurse believes that not acting will make the situation worse.

This is difficult terrain for nurses to navigate. But, whatever is decided, the nurse must ensure that the older person’s safety is paramount at all times and that every action taken on behalf of the older person respects and values their dignity and humanity.

Dr Lana Zannettino is a senior lecturer with the School of Nursing and Midwifery at Flinders University. She will present at a public forum on elder abuse hosted by the university on April 11.

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