Elder Abuse in Nova Scotia: Journey on the Path to Policy

Nova Scotia’s Aging Population:

Every month, there are 700 Nova Scotians who turn 65. (Discussion Paper for Positive Aging in Nova Scotia, 2004, p. 1). In 2005 in Nova Scotia “there were 132,600 seniors and that number is expected to double by 2026.” (Nova Scotia Elder Abuse Strategy: Towards Awareness and Prevention, 2005, p. 8)

That being said, with the numbers of older adults rapidly increasing, and given the multiple cuts to our healthcare system, it isn’t surprising that our government has been giving some serious thought to the potential drain that a large number of older adult Nova Scotians could have not only to the healthcare system, but to pensions, nursing homes, paid elder care, etc… and would naturally look to develop new ideas and initiatives in order to alleviate the ways that the older adult population will apparently deplete our welfare state, while still being able to live better quality lives while using less resources. So, in anticipation of an increase in the older adult population, in 2004 a Discussion Paper for Positive Aging in Nova Scotia was written – and was noted to have been completed through working with and receiving input from the Nova Scotia older adult community, themselves and subsequent to that, many more documents, reports, strategies and initiatives have been drafted and publicized to the same effect. (See Appendix I)

But while “older people are not only perceived as a burden on society, [in an effort to try and assume some agency, it appears as though they might be] increasingly exhorted, or [even] choose, to become involved in “successful aging” [initiatives] which [would] enable them to remain independent as long as possible. (Harbison, 2008, p. 3) So, with the notation of community assistance from the older adult population, one of the strategies put forth by the government was that of keeping seniors in their own homes longer and also encouraging family members (as unpaid caregivers) to take on the bulk of their care.

Elder Care:
In Canada’s Aging Population: Seizing the Opportunity, Marcus J. Hollander notes,
“Taking the time to give a senior who needs care, a bath, preparing a meal, feeding the individual and ensuring a safe and sanitary environment in the home does not necessarily have to be done by a health professional. However, for people who are too frail to shop, cook or take baths on their own due to their medical conditions, this type of personal support allows them to maintain their independence for as long as possible. It may actually save the health care system money by avoiding repeated hospital admissions and premature entry into long-term care facilities.”(Canada’s Aging Population: Seizing the Opportunity,2009, p. 51)

The demand for caregivers paid and unpaid, will continue to grow. Families can expect to continue to play a large role in providing care. And in fact, 70 percent of Canadian baby boomers can expect to care for an older family member in their near future. The number of caregiver households in Canada had tripled since 1987, and then doubled again by 2007. Of note, women make up 61 percent of caregivers, with 64 percent of them working full time, and 42 percent raising children under the age of 18. The delicate art of balancing a full-time job with raising children and providing care to older adults brings significant challenges and the Nova Scotia government does acknowledge the obvious, indicating that they do believe that greater efforts must to be made in order to ease this burden. (Discussion Paper for Positive Aging in Nova Scotia, 2004 p. 15/16) – And while back in 2004 some goals had been recommended, it is now 2011 and affirmative action on the bulk of these goals has not yet fully transpired. Some of these goals were:

Community Care Options:
(Discussion Paper for Positive Aging in Nova Scotia, 2004 p. 15/16)
1. Develop standards and monitor compliance to ensure boarding homes and assisted living facilities provide seniors with a safe and secure residence quality services, and quality of life.
2. Respect individual autonomy, enhance empowerment, and maximize functional capacity of seniors in long-term care facilities (e.g. offering rehabilitation, providing accommodations for couples, respecting cultural beliefs and traditions, and facilitating access to the community outside the facility.
3. Increase opportunities to provide support for self-care, care provided by family and friends, and formal care provided by paid providers
4. Increase awareness among Nova Scotians of the home care support options available to them.

Family Caregivers:
(Discussion Paper for Positive Aging in Nova Scotia, 2004 p. 15/16)
5. Provide appropriate education and supports, such as tax credits, in-home assistance, expanded respite care, adult day care, employment leave benefits, and continued pension benefits, so caregivers (family and friends) can carry out their responsibilities as family members and citizens’ without compromising their own financial security or health.
6. Help small businesses identify affordable ways to create family-friendly workplaces that accommodate the needs of workers with caregiving responsibilities.
7. Ensure special provisions for child care benefits relating to the care of a dependent child also apply to caring for a senior family member.

And while many family members are happy to take on the care of their older family members, some may not find this such an easy or even wanted, task. And other’s still may do so out of obligation to family; however do so at their own financial or personal detriment. And if that is so, situations such as these have much potential to create an inordinate amount of stress on family caregivers and families. And while there is no excuse for elder abuse, caregivers being subject to high amounts of stress and frustration, combined with lack of resources, finances, respite care, etc… could inadvertently perpetuate the abuse of an elder.

And it just may be that the government has considered this potential possibility – admitting that “on occasion, the abuse might arise due to an inability on the part of the caregivers to cope with the many stresses of providing care. While the stress of providing care is real, it never justifies an abusive response.” (Canada’s Aging Population: Seizing the Opportunity, 2009, p. 26). So on “June 15, 2007, the Nova Scotia Department of Seniors launched its new senior abuse awareness campaign [entitled, Respect]. The campaign [aimed] to give a face to senior abuse, to bring it out into the open, to expose this often hidden injustice. By putting a face on the issue, it is no longer anonymous”. (Senior Abuse Awareness Campaign, 2009) So along with the Strategy for Positive Aging; additional strategies, reports, initiatives and awareness campaigns (such as Respect) were simultaneously rolled out to the public (via television, print media, web media, etc…) in order to bring attention to the topic of elder abuse. The media showed faces of downtrodden elderly persons, being physically grabbed, yelled at and looking frightened, despondent, sad and hopeless. Yet, in reality, if only abuse could be so easily recognized.

Elder Abuse Defined:

Through this campaign, the types of elder abuse were outlined in detail:
Elder abuse is defined as “any action by someone in a relationship of trust that results in harm or distress to an older person. Neglect is a lack of action by that person in a relationship of trust with the same result”. (Nova Scotia Elder Abuse Strategy: Towards Awareness and Prevention, 2005, p. 9 – 10) “It is believed that at least between 4% and 10% of older adults experience abuse. However, “because abuse and neglect are thought to be seriously under-reported, these figures are often challenged”. (Senior Abuse Awareness & Prevention, 2011)

Commonly recognized types of elder abuse include:
1. Physical Abuse – “the infliction of pain, injury or discomfort or an older adult. It can involve physical assault (eg. Hitting, shaking, pulling, hair pulling, rough handling), medication abuse (over/under medication), physical restraint, and medical maltreatment.”
2. Emotional/Psychological Abuse – “the infliction of anguish or emotional pain. It can involve name calling, humiliation, threats or intimidation, provoking fear, emotional deprivation, treating the older person like a child, and isolation.”
3. Sexual Abuse – “any form of sexual activity with a person without the consent of that person. It can include unwanted sexual touching, sexual relations with voluntary consent, or the forcing or coercing of degrading humiliating, or painful sexual acts.”
4. Financial Abuse – “the unethical or illegal misuse of the money, property, or other financial assets of an older adult, including placing inappropriate pressure on an older person in order to gain access to her or his assets.”
5. Neglect – “the failure to provide the necessities of life such as proper food, fluids, suitable clothing, a safe and sanitary place of shelter, proper medical attention, personal care, and necessary supervision.
6. Violation of Human/Civil Rights – “the unlawful or unreasonable denial of the fundamental rights and freedoms normally enjoyed by adults. It can involve denial of information, denial of visitors; denial of opportunity for religious worship, denial of the right to provide informed consent to medical treatment, interference with mail, or unwarranted confinement in a hospital or institution”.
(Nova Scotia Elder Abuse Strategy: Towards Awareness & Prevention, 2005, p. 9 – 10)

And it was often noted that more than one type of abuse occurs at the same time. And abuse can occur as either a single incident or a repeated pattern of behavior. (Elder Abuse: It’s time to Face the Reality, 2011)

It was also noted, again as above, that elder abuse is often caused by someone the older person knows and trusts, such as a family member, a friend; a health care provider (ie. home care or institutional setting) or someone who provides them with basic needs assistance. In some situations, the abuser is often dependent on the elder financially or for food or housing. (Elder Abuse: It’s time to Face the Reality, 2011)

The Abusers:

So, conclusively if older adults are most often abused by a family member or by someone they know, due to the healthcare cuts in our welfare state (ie. lack of free or affordable and timely home care/respite care) the elder abuse strategy could be viewed, as, in itself, a form of abuse. Lack of resources in the form of respite care, etc… (other than private care that many cannot afford) mean that families may have to provide the bulk of the care to the older adult. This can be a tremendous source of stress for a care giver, especially if the older adult has a physical limitation or degree of dementia. In a sense, it appears as though families are being set up for the difficulty, stress and frustration that could potentially lead to abuse. And while this again, is no excuse for elder abuse, frustration and fatigue can sometimes give way to inadvertent abuse of an older adult by a caregiver – resulting in even one isolated incident.

Consider this situation:
“A son who physically neglects his elderly, disabled mother, berates her for allowing his stepfather’s bad treatment of him, and defrauds her of her pension, may be seen not only as a criminal, but as an unemployed person of poor education in an ageist society. He may also be understood as someone of limited social and intellectual abilities and the object of long-term mental and physical abuse by his mother’s ex-partner. In his mother’s perception, the son may be seen as a protector against the ex-partner and as representing the last vestiges of her family life. She may also feel tremendous guilt as a result of the abuse he suffered. The mother in this situation cannot be seen only as the subject of family dysfunction to be treated, as a victim of family violence to be rescued, or as a victim of a criminal act of fraud who should seek legal redress. She is also a person in complex and difficult circumstances who has the right to make choices, for instance not to charge her son and go on living in neglect. From a legal point of view her rights should be acknowledged and discussed with her. From a socio-psychological point of view her own understanding of her well-being should be respected.” (Harbison, 2008, p. 4)

The above example of a case of elder abuse highlights the fact that situations of abuse can be much more ambiguous and complex than the written definitions and pictures.

Additionally, Government strategy also puts forth in a positive light that “seniors contribute enormously to their families, often through direct financial contributions in the form of substantial loans and gifts, and in important and valuable in-kind services, such as childcare.” (Discussion Paper for Positive Aging in Nova Scotia, 2004, p. 8) So, under this gaze, the government is praising older adults for their contribution to their families, however by what they have already outlined as acts that would fall into their categories of elder abuse – to some this could also be construed as either financial abuse or even a violation of the elder’s rights in their unpaid care for grandchildren. One potential view could be that the older adult may have worked hard all their life and could use more leisure time, however because of their love for their grandchildren and/or guilt or a need to feel they are contributing, will provide this unpaid labor.

So, from the images alone present in the media along with the government definitions provided, elder abuse, on the surface appears to be relatively easy to spot and define – similar to woman abuse – as we have all seen the posters, brochures and images in the media of women who have experienced spousal abuse – pictured with bruising, tears, and a frightened, hopeless expression.

Reportability of Elder Abuse:

However, what makes elder abuse different from woman abuse is that elder abuse is reportable by law under the Adult Protection Act or (or in a seniors complex, the Protection of Persons in Care Act), yet woman abuse is not. The Adult Protection Act was designed to help protect adults who are unable to protect themselves – someone over the age of 16 years who is neglected or abused and cannot physically or mentally protect or care for him or herself. In most cases, it does not apply to adults who are mentally competent and the act will only include financial abuse if it is in conjunction with one of the more visible forms of abuse. Oddly enough, when a woman is abused by her spouse, oftentimes she is unable to physically and mentally protect herself from both the physical and psychological scars of abuse – however, the Act does not apply to her. (Appendix II)

For, if a younger woman presented in a physician’s office with suspicious bruises and was questioned by the physician in order to determine potential abuse, even if abuse was obvious, if the woman was unwilling to admit abuse, the abuse would not be reported. However, if a child of this woman was involved in the abusive situation, this abuse must be legally reported. Alternately, if an older woman, 65 years or older (who had either a physical limitation or mental limitation – such a varied degree of dementia) presented in a physician’s office with the same suspicious bruising, if the physician believed that the woman was abused, the physician would be legally bound to report this, whether the elderly woman admitted to being abused or whether she consented to the reporting of the abuse or not. So while the government is proclaiming a positive stance on aging achieved partly by actively listening to and incorporating the opinions and voices of our elderly, this legal reportability distinctly sends the opposite message that ambiguous groupings of elderly can be viewed as children; without their own voice, and needing the protection of others in a position of power.

As noted above, it is felt that between 4 – 10% of seniors experience some form of abuse. However, “because abuse and neglect are thought to be seriously under-reported, these figures are often challenged”. (http://www.gov.ns.ca/seniors/senior_abuse_prevention.asp) So although elder abuse is reportable, it isn’t always reported – and with families and their intricate complexities involved, it isn’t difficult to understand why this is so. “Older adults may feel ashamed or embarrassed to tell anyone they are being abused by someone they trust. They may fear retaliation or punishment, or they may have concerns about having to move from their home or community. They may also feel a sense of family loyalty. Often, older adults may not be aware of people and resources that can help.” (Senior Abuse Awareness & Prevention, 2011) Or they are often afraid to say anything because of ‘the devil you know’ mentality. Then, add in the fact that some older adults could have varying degrees of dementia – which could make the discerning of abuse, more difficult. Furthermore, if abuse is noted, reported and the older adult is removed from the abusive situation what particular steps or system (if anything) is put in place to make life any better for this person? The older adult could be removed from the familiar (which could be anywhere along a broad spectrum of unpleasant) to the unfamiliar – and who is to say that this would any better for the older adult – as people are all individuals and have different personal preferences of how and where they would prefer to live. This could create an unknown and potentially very stressful situation for the older person. And depending on the extent of the abuse (ie. financial or verbal vs. extreme physical abuse) the older person may prefer to stay in an environment where they are financially abused as opposed to being placed in an unfamiliar senior’s home or moved from their own community.

This position creates a tension – on the one hand the government is trying to give the impression that older adults are still vital, active members of society who can work longer, live in their own homes longer – and thus will not need to rely so much on ‘the system’ – trying to step “outside of the dominant discourse (which understands older people as frail, vulnerable, dependent, and incapable of full participation in decisions involving their own lives or in society.” (Harbison, 2008, p. 3) While, on the other hand, with their strategy on elder abuse, “the views and wishes of seniors are themselves are not prominent. It has been suggested that professional/legal responses to what has come to be known as ‘elder abuse and neglect’ and which are associated with institutionally based programs can promote dis-empowerment of older people through ageist assumptions and behaviors” (Harbison, 2008, p. 4) where the senior is treated as being the mental equivalent of a child. And once one begins to actually break down and study the forms of elder abuse, the abuser, the strategies designed to end elder abuse and the legal reporting process of said abuse – its definition, provability and the ability to achieve the best outcome for the senior, becomes a slippery slope of murky ambiguity, with no clear-cut solution.

Present State of Ambiguity = No Policy:

So, with all that is being done to put an end to elder abuse, Nova Scotia is left with the burning question – how helpful have the strategies and awareness campaigns for elder abuse really been? It has been 9 years since The (2005) Nova Scotia Elder Abuse Strategy: Towards Awareness and Prevention document indicated that its future action [would] be to “advocate for the development of policies that prevent and respond to elder abuse and contribute to the protection of older adults, ensuring that they reflect and address the very broad scope of issues inherent in elder abuse” (p. 3) however, this has not yet transpired and the province is still without its own policy on elder abuse. One may wonder what good are strategies and awareness if they are not policy. Well, I believe the answer to that is that when strategy is combined with legal reportability – while a policy is ideal, it becomes less of a priority. And to further understand why I believe a policy has not yet been developed, one must understand the difference between a strategy and a policy.

What is a Strategy?

“Strategies are the “hows” of pursuing a mission and achieving goals. A strategy is a managerial action plan for achieving targeted outcomes, mirrored in the pattern of moves and approaches devised to produce desired results. It is a long term plan of action designed to achieve a particular goal. Strategy is differentiated from tactics or immediate actions with resources at hand by its nature of being extensively premeditated, and often practically rehearsed. Strategies are used to make the problem easier to understand and solve”. (Webster’s On-Line Dictionary 2011)

What is a Policy?

“Policy is a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions. It is a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body.” (Merriam Webster On-Line Dictionary 2011) Policies frequently have side effects or unintended consequences. Therefore a policy formulation process is typically followed, which would include attempts to assess as many areas of potential policy impact as possible, and to lessen the chances that a given policy will have unexpected or unintended consequences. Because of the nature of some complex adaptive systems such as societies and governments, it may not be possible to assess all possible impacts of a given policy. (Webster On-Line Dictionary 2011)

So, despite the fact that the Nova Scotia government moves back and forth between its view and portrayal of older adults as both active, vital members of our society and then as frail, dependent and unable to make their own decisions, given the above explanations, it is understandable that there is not, as of yet, a policy on elder abuse. I believe that the reason for this is that because elder abuse is so under reported, the circumstances that perpetuate the abuse are so diverse, and while some forms of abuse (ie. physical, sexual, and neglect can be more towards the obvious) – other forms such as financial, emotional/psychological and violation of rights, can be more difficult to discern. And while the present strategies continue to be implemented, tested and reviewed for efficacy, the government has achieved what it has outlined as its main goal in that it has “appropriate legislation in place to protect all seniors from abuse and neglect and ensure appropriate supports available to assist victims of abuse. [It also feels it has developed] effective strategies to prevent and remedy the consequences of abuse, including increasing knowledge among caregivers, care providers, the media and the general public about the problem of abuse and neglect, how to spot abusive situations and how to provide the necessary support to victims.” (Discussion Paper for Positive Aging in Nova Scotia, 2004, p. 27)

The government and our policy makers must remember and hold high their own statement that “every situation of abuse is unique… there is no one single response to senior abuse.” (Senior Abuse Awareness & Prevention 2011) Therefore, time and very careful consideration must be given to the development of an actual policy on elder abuse. The more the strategies are tested, the better the chance of developing a stronger policy with hopefully less in the way of negative side effects.

Overall, I believe that bringing awareness to the subject of elder abuse has been helpful in the respect that hopefully those providing care to older adults and experiencing high levels of stress or lack of resources in their care giving roles can, in a moment of frustration, having a better knowledge of what constitutes abuse, can take a step back and just breathe, take a moment and decide not to cause hurt or harm. And that if older adults are aware of what actually constitutes abuse, if they wish to do so, they can understand how to make themselves more informed or reach out for help, if desired. However, the government should more clearly outline what can and does often happen to the older adult once an allegation of abuse has been confirmed. The older adult has a right to know what to fully expect as an outcome from ending an abusive situation. Also, if the government is going to push for more older adults to be cared for by unpaid caregivers, more so than a policy on elder abuse, priority and clearly implemented solutions need to acted upon in order to provide the much needed support for these families to alleviate the financial, physician and emotional burden of providing care.

Appendix I

Government Documents on Positive Aging/Elder Abuse:
1. Discussion Paper for Positive Aging in Nova Scotia (2004)
2. Strategy for Positive Aging in Nova Scotia (2005)
3. Nova Scotia Elder Abuse Strategy: Towards Awareness and Prevention (2005)
4. “On June 15, 2007, the Nova Scotia Department of Seniors launched its new senior abuse awareness campaign entitled, Respect.
5. Government of Canada – The National Senior’s Council: Report of the National Seniors Council on Elder Abuse (November 2007)
6. Special Senate Committee on Aging (Final Report) – Canada’s Aging Population: Seizing the Opportunity (April 2009)
7. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2010: Growing Older – Adding Life to Years (2010)

Appendix II:

Key Legislation (for Nova Scotia) Regarding Elder Abuse:
• Adult Protection Act, R.S.N.S 1989, c.2
• Protection for Persons in Care Act, S.N.N. 2004, c. 33
• Protection for Persons in Care Regulations, N.S. Reg. 364/2007
• Domestic Violence Intervention Act, S.N.S. 2001, c. 29
• Freedom of Information and Protection of Privacy Act, S.N.S. 1993, c. 5
• Personal Information Protection and Electronic Documents Act, S.C. 2000, c.5 [Federal Act]
(Strategies for Occupational Therapists to Address Elder Abuse/Mistreatment. Provincial Legal Information: Nova Scotia 2011)

References

Canadian Association of Occupational Therapists. (2011). Strategies for Occupational Therapists to Address Elder Abuse/Mistreatment.
Government of Canada. (2011). Elder Abuse: It’s Time to Face the Reality. Retrieved from http://www.seniors.gc.ca/c.4nt@.jsp?cid=154
Government of Nova Scotia. (2011). Senior Abuse Awareness Campaign. Retrieved from http://www.gov.ns.ca/seniors_abuse_campaign.asp
Government of Nova Scotia. (2011). Senior Abuse Awareness and Prevention. Retrieved from http://www.gov.ns.ca/seniors/senior_abuse_prevention.asp
Harbison, J. (2008). Models of Intervention for “Elder Abuse and Neglect”: A Canadian Perspective on Ageism, Participation, and Empowerment. Journal of Elder Abuse & Neglect, 10:3 – 4, 1 – 17.
Nova Scotia Task Force on Aging. (2004). Discussion Paper for Positive Aging in Nova Scotia.
Merriam Webster On-Line Dictionary. (2011). Policy. Retrieved from http://www.merriam-webster.com/dictionary/policy
Senior’s Secretariat, Province of Nova Scotia. (2005). Nova Scotia Elder Abuse Strategy: Towards Awareness and Prevention.
The Special Senate Committee on Aging, Ottawa, Canada. (2009). Canada’s Aging Population: Seizing the Opportunity. Retrieved from http://www.senate-senat.ca/age.asp.
Webster’s On-Line Dictionary. (2011). Policy and Strategy. Retrieved from http://www.websters-online-dictionary.org/definitions/strategy

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3 thoughts on “Elder Abuse in Nova Scotia: Journey on the Path to Policy

  1. Oh, but it’s pretty dry and not-so-much a ‘fun’ read! I’ll work on that! I’m still a ‘novice blogger’, you know! Hmmmm…perhaps a trip to Sin City will make for some more interesting posts! 😉

  2. Pingback: We Are Going To Be Elderly One Day | terry1954

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