Most sexual harassment of older Australians occurs in nursing homes. And most often, such misconduct is perpetrated by other elderly residents.

In the third and final part of our series, (see parts one and two) we explore how the concerns of sexual abuse in nursing homes are motivating women, sexual-orientation minorities, and victims of childhood sexual abuse to drive change in the aged care sector.

“As a group, survivors of institutional care remain fairly isolated, but one thing that unites them is their fear of re-institutionalisation,” wrote Caroline Carroll, Chair of the Alliance for Forgotten Australians in a submission to the recent Productivity Commission Inquiry Caring for Older Australians. “Having been helpless and abused in institutions as children, many of them fear that their own growing helplessness as adults will necessitate institutional placements for them.”

The Alliance for Forgotten Australians is an advocacy body seeking outcomes for the roughly 500,000 Australians who went through the orphanage and foster care system last century as vulnerable children. “Large numbers of these children experienced serious and often criminal physical, sexual and emotional abuse, neglect and assault,” Ms Carroll explained.

For these Australians, most now aged between 50 and 65, the prospect of returning to group accommodation and living to a fixed daily regime is deeply disturbing. The prospect that they may once again be subject to inappropriate sexual behaviour is almost too much to contemplate. In a frank interview with the ABC late last year, one survivor, now a 63-year-old grandmother, bluntly stated that she would rather die than go into a nursing home.

This fear of aged care institutions is shared by many other Australians. Many women feel they will be vulnerable in nursing homes while gay, lesbian, and transgender Australians worry that they will face discrimination and a lack of understanding about their identities.

Groups such as the Alliance for Forgotten Australians and the National LGBT Health Alliance are lobbying the government to give survivors of institutional care, and sexual minority Australians more options when it comes to aged care. Both groups are seeking funding for independent home living, and for purpose-built and affordable residential models of care with appropriately trained support staff.

As the Alliance for Forgotten Australians explained in its submission to the Productivity Commission Inquiry, “Independent living (in a non-institutional setting) is a goal for Forgotten Australians” while the National LGBT Health Alliance’s submission recommended that, “Residential facilities be required to have clear policies about the inclusion of LGBTI people, anti-discrimination polices, and measures and policies to eradicate harassment.”

The issue of harassment and assault in the aged care sector was among those canvassed in the final report of the Royal Commission into Institutional Responses to Child Sexual Abuse handed in December 2017. Recommendation 9.7 of the report included aged care providers among those key services needing to work more collaboratively with sexual assault support services to meet the needs of victims and survivors of child sexual abuse and other marginalised Australians.

The pressure for non-institutionalised aged care is already yielding change. Nearly a third of the government’s $18.6 billion budget for aged care this financial year will fund schemes designed to enable elderly Australians to continue living in their own homes through provision of meal delivery services and personal care assistance.

Announcing extra high-need home care packages, meanwhile, the Minister for Aged Care recently declared that the government’s aged care reforms are focussed on “providing older Australians with choice and control of their care”.

Increasing awareness of inappropriate sexual behaviour by the cognitively impaired in Australia’s nursing homes is proving a key driver for alternatives to nursing home placement. Importantly, however, it is also leading to a better understanding of such behaviour and the managerial, therapeutic, and medicinal options for reducing and controlling it.

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