actions to counter elder abuse in france seventeen years of experience - moulias r, alma (allo...

ACTIONS TO COUNTER ELDER ABUSE IN FRANCE seventeen years of experience

- MOULIAS R , ALMA (allo mistreatment),

professor emeritus university Paris VI

- BUSBY F, ALMA (allo mistreatment)

www.alma-france.orgTEL. 04 76 84 20 40

To act is more useful than to become indignant

• At the last quart of the XXst century, spreading out of awareness on Elder Abuse.

• Obvious need to go further than describing facts• But how to break the taboo ?• How to know and to « treat » Elder Abuses ?• How to organize an efficient prevention ? • How to create skilled teams able to understand and to

resolve complex abuse situations ?• How to create knowledge in this « new » field ?


Birth of Allo maltraitance (ALMA)a helpline devoted to Elder Abuse

• 1994 : a geriatrician : Pr Hugonot, created the first local helplines in five french districts

• Helpline must be : - in the neibourghood of the victim

- competent in the field

- warranting confidentiality to callers and ethical rules for the victim

-respect autonomy of the victim (choices)• 2008 : national N°39 77 for calls for Elder Abuse,

analyse, counsel and follow up remains made by ALMA


Proximity helplines for listening and counsel : ALMA (allo maltraitance)

• 1 ) Voluntary basis

• 2 ) Competence : Specific education and training of the entire team, pluridisciplinatity, voluntary professionals

• 3 ) Independence of any power, absence of conflict of interests

• 4 ) Neutrality

• 5 ) Proximity (knowledge of local actors and networks)

• 6 ) Confidentiality warranted, and ethical rules of running

• 7 ) Preservation of autonomy of caller and victim.

• 8 ) Evaluation of outcomes


To prevent is better than to treat : education and training

• ALMA (associative): first : sensitizations targetted to nursing homes staffs, home care services,

today: + targetted also towards management, judiciary guardians, social workers, police, professional education (medicine, nurses, psychologists, barristers, etc)

• SF G Gerontology : Tools to avoid E A (Mobiqual)• STATE : - Medico -social Agency ANESM : Good

Practices recommendations

- Instructions to Regional Health Agencies

- Funding helplines: ALMA network and national N°3977


Birth of the concept of « good caring » (bientraitance)

• Perfection in technical help and care is not sufficient i long term care :

• Is the staff aware of needs, wishes, values of the person• Is the team trained to give priority to objectives of the

well-being and the dignity of the person?• to permit to live with well being and dignity in spite of a

« dependent « situation = aim of « well caring »• A very valorizing concept for teams of L T C


1995 2012

France counts 100 ‘départements’ALMA France covers 75% of the territory

ALMA centresDossiers monitored by ALMA


ALMA France goals

• Pledge for ABUSE PREVENTION MEANS

• Further expand network• Support and strengthen

ALMA centres• Develop studies and research• Extend partnerships (national

and international)

• Inform and train about abuse

TRAINING•ALMA volunteers•PROFESSIONALS : medical, social workers, managers, lawiers, psychologists, etc•Aged public and familial caregivers•Politicians, etc.


Management of each ALMA centre

LISTENERS COUNSELLORS

LOCAL ADVISORY COMMITEE (medical, social, judicial local

authorities)- contacted punctually by the

counsellors-Takes measures to «treat» the abuse

situations-informs ALMA about measures taken

-once a year, meet the ALMA team

ADMINISTRATORS-founding centres, searching for

financial support, technical facilitiesRecruiting volunteers, organizing

traning sessions for them-tightening bonds with advisory

committee, other centres and ALMA France

-Warranting ALMA ethical rules

Coordinator(part-time salary)


Profile of the volunteers (retired, active or students)

listeners• Mr. or Mrs EVERYBODY

ready to learn to listen!• Persons who were faced

with abuse• Professionals from various

backgrounds• Students• Always : specific selection,

education, and training: • must be skilled

counsellors• Social workers• Medical and health

professionals (GP, psychiatrists, geriatricians, nurses, managers)

• Justice staff• Psychologists• Social workers• etc.


Learn about abuse and risks

abuse

Repeatedly ?•Financial abuse•Psychological abuse•Physical, sexual abuse•Refreining of citizen rights•Medical abuse•Neglect•Undue influence

Risks ( for whom ?)

• At home and in the city• In institution• Health problems• Dependency on others• Financial difficulties• Lack of time of pro• Reduced, untrained team• Burn out• NH dysfunction, etc.


The HEART of an ALMA centre : listeners

Listeners (2)

-listen with a systemic approach :draw sociogram while listening

-search for information-take notes, fills in dossiers

-transmits to counsellors-take part in analysis

-respect ALMA ethical rulesGood practices for listening


? ? ?

::

G.P.

l

home helper

neighbour

? ‘AUTHOR’

For listeners and counsellors : sociograman unique ALMA tool

??CALLER

A sociogram is a graphic representation which serves to reveal, visualize the relationships between ‘victims and agressor’, within the family and their external environment such as health and social services, work, friends, neighbours, etc.


clarification of situations

CALLERSProfessionals

Family membersfriends, neighbours

‘Victims’ rarely

LISTENERS listen and search for information

Who is involved ? What is the health status of all persons involved ?

Where ? at home, in institution ? Who knows about the situation ?

What are the problems, the complaints ? Are they repeated ?

Since when ? Are there other witnesses ?

Do the victims get social or medical help ?

What are the caller’s questions ? What is expected from ALMA ?


COUNSELLORSALERT

COUNSEL - GUIDETIGHTEN BONDS

with medical, social and judicial servicesENCOURAGE mediation

CALLERSProfessionals

Family membersfriends, neighbours

‘victims’ rarely


The HEART of an ALMA centre : counsellors

Multi-disciplinary counsellors

inform, guide, counsel callersfollow through, monitor dossiers from first call to ‘solution’Encourage the callers and witnesses to take measures

support the professionals in coordinating helping measures

refer to the advisory committee when necessary

-- Only one aim : end of mistreatmentWith respect to strict ethical rules- Good practices for counselling


Is the complaint relevant ?

• 3 calls : this 70 year old man is mistreated, neglected, abandoned ! Do something !!

• ALMA calls the mayor of the town !

• This man is well known and HAPPY ! in HIS way !! ?Not according to the life values of the callers !!


ALMA ETHICAL RULES

18

DOUBLE LISTENING

MULTI-DISCIPLINARY ANALYSIS AND COUNSELLING

CONFIDENTIALITY, DISCRETION

NO JUDGEMENT, IMPARTIALITY

ACT WITH AGREEMENT OF CALLERS/VICTIMS

FOLLOW UP WITHIN THE LEGAL TEXTS (danger to victim ?)

RESPECT THE DIGNITY OF ALL PERSONS INVOLVED


OUTCOMES

• 62 ALMA Centres cover 75 % of the french territory• « Treat » and follow up 5.000 situations of mistreatment

each year (80 % in home and city, 20 % in NH).• Sensitize and train 15.000 to 20.000 professionals/ year• Start studies and publications in the different fields of

Elder Abuse (Neglect, Inappropriate care, Undue influence, Financial abuses, Neglect in terminal care, Reglementary abuses, Cohabitation, Good Practices in listening and counselling, Methodology for helplines for E A, Well -caring, etc)


Conclusion

• Associative helplines working in a national network gives an efficient way to « treat » E A situations and to strongly reduce abuse and neglect in Nursing Homes and Home Care services but also iin family and in the city

• Conditions of competence, proximity, independence and respect of ethical rules can be more warranted by associative organizations

• Voluntary work gives independence, large panels of competence and a low cost for this new type of helplines.


Conclusion (2)• Sensitization and training of all involved teams on

prevention and well-caring is the necessary other activity of such helplines and requires also Good practices and ethics of training.

• The field is not limited to medico social areas of care homes and home care

• Trainers must be trained expert professionals

• ALMA system can be adapted in any other country

Thank you for your attention and your questions

[email protected]

actions to counter elder abuse in france seventeen years of experience - moulias r, alma (allo...

Documents

alma allo mistreatment

alma network

alma france goalspledge

counter elder abuse

alma centresdevelop

elder abuse1994

elder abuses

abuse prevention meansfurther