Relationship Australia trialled its Elder Relationship Service in response to a significant problem arising from the ageing of Australia's population: conflict within families around ageing-related issues. Show Key messages
Family relationships in an ageing societyIn recent decades, demographic, health and social changes have resulted in the ageing of the Australian population and an increase in the complexity of family structures (Australian Bureau of Statistics [ABS] 2008, 2012). These changes have the potential to increase ageing-related family relationship issues. Ageing can contribute to poor family relationships in a number of ways. Older people with care requirements are predominantly looked after by their families. Longer life expectancies, coupled with extended ageing-related illness or disability, can significantly prolong the care phase. This, in turn, places significant mental, physical and financial burdens on older people, caregivers and extended family members (Millward, 1998; Silverstein & Giarrusso, 2010). It also places older people living in vulnerable situations at increased risk of violence and abuse. Where there are health issues and family care is no longer appropriate or available, or end-of-life decisions need to be made, relationships may become increasingly strained, particularly for families with complex structures, poor communication skills or histories of relationship dysfunction. Family disputes can affect interpersonal relationships far into the future, permeating burial arrangements, estate devolution and family interactions. These disputes affect the wellbeing of individuals, families and communities, and lead to increased costs to welfare and service systems. Australians are also increasingly seeking legal avenues to solve their grievances, which can be emotionally and financially costly for individuals, families and the government (Australian Law Reform Commission [ALRC], 2016; Bagshaw, Zannettino, Wendt, & Adams, 2012; Conway, 2016). The need for a new serviceThe current suite of family and relationship counselling and family law services has been successful in improving family relationships for a broad range of Australian families over the past decade; however, there is still a service gap in the suite of alternative dispute resolution services for older people and their families (Braun, 2013; Ellison, Schetzer, Mullins, Perry, & Wong, 2004). In response to this service gap, in 2016 Relationships Australia trialled a new service targeted at families with ageing-related relationship issues. The aims of the Elder Relationship Services Pilot Program were to:
The program provided a range of services and supports including counselling, capacity building, support, information, education and supported referral to police or other specialist legal services. Where appropriate, it supported family meetings, often co-facilitated by a counsellor and mediator. The program serviced 140 clients (Table 1). The age of clients ranged from 34 to 92 years. Just under two-thirds (65%) of clients were women (Figure 1). Half of the clients (48%) were older people, followed by adult daughters (30%) and adult sons (18%) (Table 2). Family meetings commonly involved one or more adult sibling and one or more parent.
Source: Relationships Australia administrative data, February 2017 Presenting issuesThe most common presenting issue (58%) was family relationship problems, which included conflict, violence and abuse, poor relationships, disrespectful behaviour, poor communication and estrangement. Family relationship problems were evident in relationships between parents and siblings, and/or between sibling groups. In 50% of cases, the presenting issue related to the future care or housing arrangements of a parent or parents. Where the care arrangement of parents was an issue, this was often compounded by family conflict, family violence, estrangement, and grief and loss. Figure 1: Elder Relationship Services Program, client age by gender, as percentage Source: Elder relationship service intake form Family violence was identified as a presenting issue for one-quarter (24%) of clients, including violence perpetrated by older people, adult children and between members of sibling groups. The most common types of family violence were financial abuse, emotional abuse and, in a small number of cases, physical abuse. Family violence presentations could be divided into two categories: historical family violence that continued to affect the family into old age, with features of gendered family violence and power and control issues; and violence that resulted from increased vulnerability of family members due to ageing, and primarily involved financial abuse. Mental health issues were identified as a presenting issue for 22% of clients, and grief and loss was identified as a presenting issue for 8% of clients.
Source: Elder relationship service intake form Complex casesAs stated earlier, 58% of cases involved conflict, violence and abuse, poor relationships, disrespectful behaviour, poor communication and estrangement. The case notes below indicate the complex nature of presenting issues:
In situations where there was identified elder abuse risk, at the root of the family's issues were often disrespectful behaviour and poor communication. In these situations, practitioners strove to resolve acute points of conflict and assist family members to have difficult conversations:
ConclusionsIn our evaluation of the service, we found improvements in clients' knowledge and awareness of services, and in their communication, safety, behaviour and mental wellbeing. The program was most effective if all relevant family members could be engaged and the older person was present. It was less effective if the service was unable to engage a family member who was significant to the family issue, there was long-standing entrenched family conflict, or if family members had already initiated a legal process (e.g. an application to an administrative appeals tribunal). We found that the service could place more emphasis on holistic and therapeutic approaches, including supporting clients between sessions, and in exploring innovative ways to increase engagement with resistant family members. We also concluded that engagement with the service would improve via: phone calls to disengaged family members, rather than letters; face-to-face outreach at facilities and local offices; using influential family members to broker contact between disengaged family members; and increasing awareness of the service among potential referring organisations. Overall, we found that the service was a natural fit with Relationships Australia's current business, workforce and service models. We also concluded that it was unlikely that the costs of service provision could be offset by client fees, especially if outreach was included, and that additional funding would be needed if the service was to continue beyond the short to medium term, or expand to additional locations. ReferencesAustralian Bureau of Statistics (ABS). (2008). Family characteristics and transitions, Australia, 2006-07. Cat. no. 4442. Canberra: ABS. ABS. (2012). Reflecting a nation: Stories from the 2011 Census, 2012-2013. Cat. no. 2071.0. Canberra: ABS. Australian Law Reform Commission (ALRC). (2016). Elder abuse: Discussion paper (ALRC Discussion Paper no. 83). Sydney: Commonwealth of Australia. Bagshaw, D., Zannettino, L., Wendt, S., & Adams, V. (2012). Preventing the financial abuse of older people by a family member: Designing and evaluation older-person-centred models of family mediation. Final report. Adelaide: University of SA, Flinders University, Dept for Families and Communities, Office for the Ageing, Alzheimer's Australia, Guardianship Board, Relationships Australia and the Office of the Public Advocate. Braun, J. (2013). Elder mediation: Promising approaches and potential pitfalls. Elder Law Review, 7 - Article 2. Conway, H. (2016). Where there's a will ... : Law and emotion in sibling inheritance disputes. In H. Conway & J. Stannard (Eds.), The emotional dynamics of law and legal discourse (pp. 35-57), Oxford: Hart Publishing. Ellison, S., Schetzer, L., Mullins, J., Perry, J., & Wong, K. (2004). The legal needs of older people in NSW. Sydney: Law and Justice Foundation of NSW. Millward, C. A. (1998). Family relations and intergenerational exchange in later life (Working Paper 15). Melbourne: Australian Institute of Family Studies. Silverstein, M., & Giarrusso, R. (2010). Aging and family life: A decade review. Journal of Marriage and the Family, 72(5), 1039-1058. Featured image: © JakoVo |