We don't often think of older women being victims of sexual assault, but such assaults
occur in many settings and circumstances, including in nursing homes. Our research, published this week in the journal
Legal Medicine,
analysed 28 forensic medical examinations of female nursing home
residents who had allegedly been victims of sexual assault in Victoria
over a 15-year period.
The cases were
examined by Clinical Forensic Medicine – a division of the Victorian
Institute of Forensic Medicine – between January 1, 2000 and December
31, 2015.
The majority of the alleged victims had some form of cognitive or
physical impairment. All 14 perpetrators who were reported were male,
half of whom were staff and half other residents. The majority of case
reports didn't indicate whether the alleged victim had received
treatment for the
assault.
The most frequent alleged sexual contact was vaginal contact or
penetration. Injuries weren't reported for every case. Where present,
they consisted of bruising, skin tears, redness and swelling.
The physical examination was often limited because of the cognitive
status (in 38%) of the individuals, physical issues (in 31%), lack of
cooperation (23%), and poor examination conditions (23%). Data on
alleged victims' behaviour was commonly missing.
These information gaps highlight the difficulty of examination which
is essential to a detailed investigation. A better understanding of the
context and setting of the assault, which is usually available when
younger women are victims, is essential to inform prevention efforts.
Eliminating
sexual assault in nursing homes is a major challenge which starts with acknowledging it exists and recognising the scale of this abuse.
Much higher than we think
Sexual assault is
considered the most hidden, as well as least acknowledged and reported, form of elder abuse. This
makes it difficult to accurately estimate its prevalence.
Prior to 2007, it was estimated there were around 20,000 unreported
cases of elder abuse, neglect and exploitation in Victoria. Between
2009-10 and 2014-2015 the
published number
of sexual assaults among older people rose from around 280 to 430
reports nationally (information about each jurisdiction was not
available).
In 2015–2016 The Australian Department of Health
was notified of 396 reports of alleged or suspected unlawful sexual contact of residents in nursing homes in Australia.
Based on these statistics, we expected Victoria would have 80-120
sexual assaults of residents reported in nursing homes per year
(equating to approximately 1,200 assaults during the study period). The
28 cases reported to the forensic investigation team over a 15 year
period suggests under-recognition and under-reporting.
Nursing
home residents are
particularly vulnerable to sexual assault due to their dependency on caregivers, health problems, and the co-housing of residents, sometimes with
potentially dangerous older individuals with sexual assault backgrounds.
Negative stereotypes such as that older people aren't sexual beings, their greater
dependency on others, potential
divided loyalty to
staff members or residents
are unique barriers to reporting, detecting, and preventing sexual
assault in nursing homes. Despite severe health consequences, efforts to
prevent and address elder abuse
remain inadequate.
In the majority of cases we examined, signs of general or genital
injury were not found. Further, post-assault victim responses, such as
agitation, distress and confusion may mirror symptoms of cognitive
impairment. This can create difficulties for nursing home staff in
distinguishing between the usual behaviour or a response to trauma, such
as sexual assault.
Also, nursing home victims of sexual assault tend to be
ignored by staff
who often don't believe the accusations. Although we could not
determine who or what prompted reporting, what is known is that sexual
assaults are
unlikely to have a witness, though witnesses appear to be crucial to ensure successful prosecution.
Sexual assault, in any setting or age group, is one of the most
difficult crimes to prosecute due to the required elements of intent and
lack of consent. But this is made all the more complicated when it
comes to nursing home residents.
Awareness is crucial
Staff must be aware of the existence of sexual assault in nursing
homes. It is their duty as care providers to report alleged or suspected
sexual assault in a timely manner. More education, training and
research is needed to address the knowledge gaps around incidence,
levels of reporting, nature of investigations, responses required to
better assist the victim, and the interventions needed to prevent sexual
assault.
Without a clear understanding of the alleged victim and incident
characteristics, we will struggle to combat sexual assaults in nursing
homes. There is an urgent need to better use the existing data held by
the the Department of Health to understand the full extent of sexual
assault in nursing homes. The Royal Commission is an opportunity to
consider the development of tailored policies, staff training and
legislation.
Full Article & Source:
It's hard to think about, but frail older women in nursing homes get sexually abused too