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Archives > Summer 1997 articles
"Who Will Speak For Me?"
"Advocate"
v. "To speak or write in favor of; defend"
n. "One who pleads the cause of another"
Webster's Collegiate Dictionary
Standing up and ensuring that people receive the information,
services, respect and recognition to which they are entitled
is not an easy task. That is where advocacy begins, and it
comes in many forms:
Self Advocacy
Self Advocacy refers to where the person most affected
by the issue or problem lets others know what he or she really
wants in the circumstances. The ability to be a self advocate
is not something that we are born with. For example, many
of today's seniors are relatively inexperienced when it comes
to self advocacy. Speaking up for oneself, particularly for
many older women, simply wasn't done.
Self advocacy is a skill that can be taught. It is also
a skill that can be lost if not used on a regular basis. Self
advocacy needs to be nurtured, fostered and encouraged. Self
advocates are made, not born. It is important to remember
that we can help people of any age learn self advocacy skills
- these include assertiveness and mediation skills. People
can't advocate for themselves without having good information
and realistic options available. In many cases, people feel
they don't have a choice, because no one ever told them that
anything else was possible.
Who Else Can Be An Advocate?
Even the most articulate and assertive person can find it
hard to be a self advocate when he or she is in crisis, his
or her health deteriorates, he or she has to rely on others,
or he or she moves into institutional care. In other cases,
it is extremely difficult for a person to be his or her own
best advocate. The person may have had a stroke and may not
be able to talk. That makes it hard for other people to listen
to what the person has to say. The person's mental ability
may fluctuate or be deteriorating. That makes it harder for
people to understand.
Even so, it is possible to have the person's wishes respected
through other kinds of advocacy. This works best where the
person chooses someone they trust to work with them
on their behalf. Often that person is a family member or friend.
In other cases it can be a staff member or volunteer.
To be a true advocate in these circumstances involves talking
with the person, finding out his or her wishes, understanding
the reasons behind it, and expressing those wishes to others.
But that is only the first step. When you advocate
on someone's behalf, that person is not frozen in time. Advocacy
involves going back to the person with information and options
and always returning decision-making power to the senior.
It is always important for us to recognize that even when
we think we are advocating on a senior's behalf, there is
potential for a conflict of interest. Sometimes it is hard
to separate out what is good and acceptable to the senior,
from what is good for you, the family, or in the case of institutional
settings, the facility.
Advocacy in Institutional Settings
These days, only a small percentage of people reside in
care facilities. Less than 7% of seniors are in care facilities
at any point in time and one in four will be in institutional
care at some point in their life. Often these are people most
in need of advocacy because of their level of physical or
cognitive impairment.
Some people experience difficulty having their or needs
and wishes acknowledged in a care facility. Medical approaches
in institutional settings may tend to reflect what care providers
consider as in the person's best interest, as opposed to what
the person wants. There tends to be an inherent imbalance
of power because the person cannot simply leave. Also, the
environment is very different and the person may feel as if
he or she had left their rights at the front door.
Self advocacy can be difficult in institutional settings
- in B.C. approximately one half of residents in intermediate
care have cognitive impairments. For this reason, it is important
to have other forms of advocacy available, including resident
councils, family councils (where families work together to
speak on behalf of residents as a whole) and advocacy by staff.
In resident councils residents speak on behalf of other
residents. A family council is an organized group of family
members of residents in care who meet regularly to discuss
problems that have arisen in the care facility and to explore
potential ways of formally dealing with their problems with
the administration. In British Columbia, the Association of
Advocates for Care Reform (a non-profit society) helps to
establish family councils. Because of their unique relationships
with residents and their life experiences, families often
see problems and solutions that staff may overlook. But as
with self advocates, family councils need good information
and real choices. Resident councils and family councils can
encourage two-way communication between the facility and the
people affected by the day-to-day care in facilities.
Changing the Big Picture
Each of the types of advocacy mentioned so far tend to focus
on changes on behalf of individuals. But sometimes change
needs to be broader - it might be a change in government policy,
a change in philosophy, a change in structure, or reform in
the system.
This requires a different kind of advocacy, sometimes referred
to as political or social advocacy. Potentially people
can do both advocacy for an individual's specific needs, difficulty
or circumstances, and advocacy for the benefit of all current
and future constituents. Sometimes organizations can work
together to express common concerns with a united voice. This
type of advocacy is hard. It is also extremely time consuming.
It means knowing who the players are, what the issues are,
and in what forum they are really being discussed. For individuals
and organizations, time is precious.
In spite of this, political and social advocacy is worthwhile.
People often take silence as a sign that everything is okay
and that the status quo can be maintained.
Advocacy lets them know otherwise.
Charmaine Spencer
Gerontology Research Centre
Simon Fraser University
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