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2001 Archives > Spring 2001
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Facilitating Change, Intervention and Prevention
of Abuse of Seniors
By Shelley Rivkin
Background
In the spring of 1999, the BC Coalition to Eliminate Abuse
of Seniors (BC CEAS) received Law Foundation funding to convene
a series of meetings with senior policy makers in the areas
of criminal justice, health and mental health, economic security
and human rights. The purpose of these meetings was to review
existing provincial statutes, regulations and policies that
potentially affect the intervention and prevention of abuse
to seniors. Specifically, participants were asked to:
- identify overlaps, gaps and barriers
- examine current program initiatives, and
- put forth recommendations regarding how these statutes,
regulations and policies need to be administered, strengthened
or changed to
- better meet the needs of abused seniors.
An initial planning meeting was held on November 19, 1999,
to determine the level of interest in the proposed process.
Thirty-six people representing various branches of the Ministries
of Attorney General, Children and Families, Health, Women's
Equality, Social Development and Economic Security and Aboriginal
Affairs were invited to attend. As well, senior officials
from the municipal police forces and the RCMP; victim services,
women's services and research and advocacy centres were also
invited. Twenty-two people attended this meeting and a further
six people expressed interest in being involved in some aspect
of the project.
The Planning Meeting: Four Key
Themes
The agenda for the planning meeting was designed to provide
participants with the context for the initiative, an overview
of the key issues, and an opportunity to have input into the
development of a work-plan. The focus of the morning session
was to share with participants a working definition of abuse
of seniors and to highlight the relevant aspects of
the New Adult Guardianship Legislation. To give the discussion
some depth, a case study was presented and some barriers and
obstacles currently in the way of effective intervention were
highlighted. The afternoon session was designed to enable
participants to begin to identify key areas requiring further
examination and analysis. To facilitate this discussion, participants
were asked to join a small working group formed around one
of four key themes: justice and victim services; health,
mental health and guardianship; housing and income issues;
human rights and advocacy. Participants were asked to
use the case study presented in the morning as a way to begin
their analysis. The final task of the day was to develop an
action plan to carry out the goals of the project.
Proposed Action Plan
Participants confirmed their interest in being involved and
additional names of individuals to be invited were suggested.
The group also supported the idea that each session focus
on a particular theme but that there be a consistent process
for analyzing all the issues. For each session, B.C.CEAS would
present a case study containing the key elements to be addressed.
Where possible, one or two individuals representing the area
under discussion would be asked to provide a brief overview
of the current situation and to assist participants identify
the barriers and concerns.
Working Sessions (February-October
2000)
It was agreed that the February and March sessions would
focus on criminal justice and victim services issues; the
April and May meetings focus on health, mental health and
guardianship issues and the June meeting would address housing
and income issues and human rights and advocacy. The final
two meetings would be dedicated to summarizing the issues
identified and developing a full set of recommendations.
Learning and Awareness Raising
Although the number of individuals involved varied somewhat
depending on the topic at hand, there was a core group that
attended all of the meetings. This core group represented
a cross section of senior citizen advocates, government policy
makers and non-profit agency staff. By having this core group
attend all of the sessions, there was little need to re-invent
the wheel at each session and there were strong links between
the issues raised from one session to the next. Common themes
emerged early on in the process and remained consistent throughout.
Two particularly outstanding aspects of the process were
the high level of interest in the topic from all sectors represented
and the extent of learning and awareness raising that occurred
from one session to the next. These were very powerful
and unintended outcomes of the consultation process. Another
notable feature of the process was the lack of defensiveness
and territoriality among working session participants.
Members from all sectors identified the gaps and barriers
and participated in the development of recommendations in
an open and candid manner. There was no evidence of individual
members trying to underestimate or deflect constructive criticisms
directed toward their area of work. This positive climate
and willingness to work together to affect change contributed
greatly toward the development of a common set of unifying
principles and a package of recommendations for each topic
area.
Overarching Principles and Common
Themes
As participants began to examine the issues and identify
possible solutions, common themes began to emerge. During
the final two meetings, it became increasingly apparent that
while these themes and principles needed to be separated out
from the actual recommendations, they did form the foundation
upon which the recommendations could then be implemented.
It is interesting to note the very close parallels between
these principles and themes and the United Nations Principles
for Older Persons (independence, participation, care, self-fulfillment
and dignity) endorsed by the General Assembly in December
1982.
The following principles and themes were identified and underlie
the recommendations that follow:
Safety and Economic Security
The safety of seniors in their homes and in their community
is of paramount importance.
Economic insecurity and violence against all women are inextricably
linked. Older women are particularly vulnerable because of
the historical and systemic economic discrimination faced
by these women. Many seniors between the ages of 55 - 64 are
in a precarious financial situation. This is particularly
true for women in this age group.
Human Rights
Seniors need to be afforded the same human rights protection
as all other adults in our society.
Consideration needs to be given to the development of a provincial
"Bill of Rights" for seniors residing in long-term
care facilities.
Respect and Dignity
Seniors are not a monolithic segment of our population. We
must recognize the diverse realities of their/our lives.
Policies, procedures, protocols and practices designed to
protect all individuals from abuse and violence must be viewed
through a "seniors'" lens and adjusted accordingly.
Data on the social impact of abuse and neglect of seniors
needs to be collected, documented and analyzed across the
criminal justice, health and community services systems. Without
comprehensive data, the issue of abuse of seniors continues
to be addressed in a piecemeal fashion. There needs to be
the political will to advocate for the necessary changes required
to improve the quality of life for seniors.
Education and Training
Economic security and human rights issues affecting seniors
need to be kept on the "front-burner" through public
education and awareness campaigns. Seniors need to be leading
and directing these campaigns.
Service providers from the health, human services and criminal
justice system need to have training in the following areas:
- ageism, what it means and how it affects seniors in concrete
ways
- general dynamics of aging
- power-based nature of abuse and neglect
- dynamics of violence against women, in
particular, older women
- extent of abuse perpetrated by persons known to individual
seniors
- representation agreements - scope and
limitations
- institutional abuses of power and the
consequences
- capability assessments - what they mean and their implications
for seniors
Service Delivery
More resources need to be made available to designated agencies
to ensure seniors are adequately protected.
Adults defined by the Adult Guardianship legislation need
access to help and support when required.
Seniors need to have access to appropriate systemic, individual
and legal advocacy services.
Summary of Key Issues
As stated previously, the process for identifying current
gaps and obstacles and proposing solutions to address these
gaps and obstacles involved a two-step process. Participants
were presented with two to three case studies from the case
files of BC CEAS and experts from each sector gave a brief
presentation on the current legislation, policies and procedures
that may require revisions or substantive changes. Participants
then formed small groups to review current relevant provincial
and federal statutes and existing policies, protocols and
practices for each topic. The following are a summary of the
obstacles, gaps and overlaps for the four areas under review.
Criminal Justice and Victim Services
Barriers/Gaps
- The current Violence Against Women in Relationships policy
is silent on the issue of age; in particular, concerning
the inclusion of adult children or caregivers as possible
perpetrators of the violence.
- There needs to be more discussion of the similarities/differences
between abuse and violence directed toward seniors and violence
against women.
- There are currently no protocols between victim service
agencies and designated agencies related to the abuse of
seniors.
- More attention and training needs to be done for criminal
justice personnel on the Adult Guardianship legislation,
and how the provincial statute relates to the criminal code
provisions.
- The protection order registry guidelines need to be reviewed
in relation to the protection of seniors who have experienced
abuse or violence in their homes or in facilities.
- The current record-keeping and record management systems
need to be examined to determine how data related to seniors
who have been victimized is being collected.
- Educating seniors about the criminal justice system and
preparing them to be witnesses needs to be addressed through
public education.
- A major concern relates to situations where a care facility
staff member is alleged to have abused a senior. In many
situations, the administration does not report the incident
to the appropriate licensing officer or police. In addition,
the facility is often reluctant to take disciplinary action
against the employee because of the cost and resources required
to deal with a labour relations issue. This too frequently
results in the person not being disciplined, or let go with
no criminal record. This individual may then be hired in
another facility and continue the abusive behaviour.
Health, Mental Health and Guardianship
Issues
Barriers/Gaps:
- There is a need to develop local protocol agreements to
ensure adequate staffing, effective responses, and licensing
and enforcement practices between health care services and
the criminal justice system.
- There is a major concern related to the treatment of seniors
in care facilities. Inappropriate behaviours range from
abuse of power to physical abuse. In unionized facilities,
managers and administrators must operate within the terms
of their collective agreement. This means that in some circumstances,
staffing decisions are based on seniority rights rather
than the person best qualified for the job.
- Seniors are routinely "tricked" into entering
residential care. Even those who choose admittance are commonly
not given information about what to expect or consulted
on a plan of care. Because Part 3 of the Health Care (Consent)
and Care Facility (Admissions) Act, which addresses admission
to a care facility, has not yet been proclaimed, there is
no assurance that a person entering a facility is legally
consenting to this admission for care or treatment at the
facility.
- Seniors who are being assessed for incapability are not
properly advised about their rights or the consequences
of this procedure (the loss of control over decisions related
to his/her financial or legal matters). Nor is there any
provision that they must be advised of their legal rights
or ensured legal protections or representations during applications
to the Supreme Court for appointment of a committee. The
current Patient's Property Act is very antiquated and does
not take into account the degree of capacity an individual
has but rather takes an "all or nothing" approach
to capability. Many individuals who are having a difficult
time managing some aspects of their lives are living at
greater risk because health professionals are reluctant
to take away all of their rights to make decisions by finding
them incapable. Part 2 of the Adult Guardianship legislation,
which has not yet been proclaimed could address some of
these problems through the appointment of associate or substitute
decision makers as well as guardians for specified periods.
- Seniors in care facilities need to have access to advocacy
services that can specifically address their current situation.
There is currently no infrastructure to provide such services.
Senior Citizen counsellors and peer counsellors are aware
of problems that likely represent the tip of the iceberg.
Seniors residing in care facilities need to be more aware
of what is happening in care facilities.
- Other bodies such as the Health boards and regional health
authorities need to be more aware of what is happening in
care facilities.
- There is a major concern about private facilities that
do not fall under the jurisdiction of licensing officers.
Seniors living in these facilities are afraid to speak for
fear of retribution. Even seniors in licensed facilities
feel reluctant to complain for fear of being "thrown
out". More lobbying needs to be done with government
to ensure that all facilities are licensed.
- There is a need to fund multi-disciplinary initiatives
to ensure a coordinated and multi-faceted approach to these
very complex problems and issues.
Housing
Barriers/Gaps
- While the provincial government has demonstrated its commitment
to housing by continuing to build subsidized housing units,
there is a need for more subsidized housing options. These
include "care-a-miniums" (independent living to
intermediate care) more housing stock for women age 55 years
and older, and more supportive housing.
- There are a growing number of seniors who are homeless.
There need to be shelter options that are safe and appropriate
for seniors who are homeless, who have mental health issues
and face other barriers to being housed.
- Caretakers and building managers responsible for seniors
housing need to have access to more training on issues related
to aging, including how to recognize abuse and neglect and
how to respond and refer appropriately.
- Seniors need to have more information on their rights
related to home ownership in particular, issues related
to the transfer of title to the children in return for care
services.
- There are a number of issues related to the rights of
seniors residing in manufactured homes. These range from
the landlord's right to restrict the type of purchaser of
a manufactured home; thus, reducing the ability of a senior
to sell his/her home; coverage under the residential tenancy
act and qualification for SAFER.
- SAFER rates have not risen for many years and seniors
are finding it increasingly difficult to pay their rent
and have adequate monies available for other necessities.
- While some older women who have experienced abuse or violence
go to existing transition homes, they are often not comfortable
in those surroundings. There needs to be "
senior friendly" transition houses where women can
stay for an extended period of time. Also, there are very
limited transitional housing options for men, and none that
specifically serve the needs of older men who have experienced
abuse.
Human Rights
Barriers/Gaps
- Currently there is no human rights coverage for people
over the age of 65 years. Inclusion of people over the age
of 65 years has been proposed since Commissioner Bill Black
made his recommendations in 1994. Political lobbying and
information awareness campaigns are required to ensure that
seniors know that the proposed inclusion would not negatively
affect seniors' only housing, seniors' discounts, etc.
- Residents in care facilities need to have clearly stipulated
rights that can be acted upon if violated. These rights
need to be developed in plain language and disseminated
widely.
- Consistent and quality service delivery is a right for
all seniors. A service provider code of conduct needs to
be developed and applied widely to ensure that all seniors
are informed of and receive all of the necessary services
without having to resort to lobbying or higher level intervention.
- The "Rights Document" produced by the Seniors
Summit needs to be reviewed by both levels of government
and a process for implementation needs to be developed.
Economic Security
Barriers/Gaps
It is acknowledged that the poverty rates among the poor
elderly have been reduced over the past twenty years, but
older women are still negatively affected. Many of the benefits
that will support older women in the future do not apply to
women who are 65 years and older at this time. One of the
areas where this age group has been negatively impacted is
in the area of past retirement policies.
After a review of a number of the issues that negatively
affect the economic security of older people, in particular,
older women, it was brought to the attention of the participants
that all of these recommendations had been made in numerous
reports at both the provincial and national levels. These
include the impact of mandatory retirement and the current
CPP "drop-out clauses" for women caring for family
members. Another issue that needs to be immediately addressed
is the issue of pension support for older immigrant women.
Sponsorships often fall apart for these older women and the
provincial government can only meet the most minimal of needs.
Rather than generate a specific list of recommendations,
it was agreed that the BC CEAS should remind both levels of
government of the many reports they have commissioned and
received on this issue and to urge immediate implementation
of the proposed recommendations in particular those related
to retirement income provisions.
Proposed Recommendations
Although efforts were made to generate recommendations in
a consistent fashion across topic areas, the concerns that
arose in each area varied considerably. Therefore in some
areas the primary focus is on the practices and protocols,
and in others it is specifically on legislative changes. In
presenting these recommendations, we have tried to categorize
those recommendations that could be implemented in the short
term (six-18 months), those that require more long term planning
(two-five years), and finally those that require some form
of legislative change.
Key:
Short Term=ST
Long-Term=LT
Legislative Change=LC
Criminal Justice System and Victim Services
Recommendations
- Develop provincial protocols between the criminal justice
system and the designated agencies to respond to cases of
abuse and neglect. ST
- Examine ways to ensure that the Violence Against Women
in Relationships policy and other criminal justice policies
are applied equitably across age and disabilities. ST
- Develop training on abuse, neglect and violence toward
older persons and emphasize the potential risk of adult
caretakers, caregivers and others that seniors rely upon
and trust as perpetrators of such abuse. ST
- Commit to greater coordination between health professionals
and criminal justice personnel. Explore the role of funded
VAWIR committees in facilitating initial meetings to undertake
this dialogue. ST
- Develop materials on safety planning that meet and reflect
the needs of older women. ST
- Develop fact sheets for seniors' counsellors on key issues
related to criminal justice system intervention. ST
- Develop fact sheets for seniors on issues related to no
contact orders, peace bonds and restraining orders. ST
- Initiate consultations regarding the use of restorative
justice processes in cases of abuse of seniors.LT
- Fund more crime prevention initiatives that address the
abuse of seniors. LT
- Change data collection process to include information
on abuse of seniors; in particular, the age of the victim
and their relationship to the offender. LT
- Fund interdisciplinary training for health professionals
and criminal justice personnel, the adult guardianship legislation
and the abuse of seniors. ST
- Review current protection order registry practices in
relation to seniors who have experienced abuse and propose
recommendations for change if required. ST LT
- Include specific fields related to the abuse of seniors
to enable specific data to be collected on the abuse of
seniors.
Health/Mental Health Guardianship Recommendations
- Explore the viability of developing a Bill of Rights for
Residents in Care Facilities. ST
- Proclaim the Care Facilities (Admission) section of the
Health Care (consent) and Care Facilities (Admission) Act
to ensure that seniors entering a facility are offered a
proposed care plan and are given an opportunity to make
an informed decision before entering a residential facility.
ST LC
- Proclaim Part 2 of the Adult Guardianship legislation,
which will replace the antiquated Patients' Property Act
and set out alternate methods for appointing substitute
decision-makers and guardians. ST LC
- Proclaim and provide funding for Section 54(c) of the
Adult Guardianship Act, which provides for serving a copy
of an application to court for a support and assistance
order on a prescribed advocacy organization. ST LC
- Develop policy to guide the actions of the prescribed
advocacy organization after receiving such a notice. ST
- Meet with the Health Association of BC to promote the
use of Continuing Care model standards in facilities owned
and operated by Health Authorities. LT
- Seek funding for a phase two of the Facilitating Change
project with a specific focus on opening dialogue with the
Health Unions regarding abuse of seniors in facilities.
ST
- Lobby the Chief Provincial Health Officer to undertake
a special report on the health care needs of seniors. ST
- Seek funding to conduct research on meaningful models
of consultation for seniors and other vulnerable populations.
ST
- Lobby government officials to ensure that the needs of
seniors are addressed in the Aboriginal Health Care Plan.
ST
- Lobby the Health Care Councils to raise awareness of
the treatment of seniors in long-term care facilities. ST
- Urge the provincial government to implement recommendations
made in the 1999 report on Continuing Care. ST
Human Rights Recommendations
- Include coverage of persons over the age of 65 years
in the current provincial human rights legislation. ST
- The Ministry of Health and the Office for Seniors in
collaboration with the Public Guardian and Trustees Office
and the Human Rights Branch should review the Rights Document
produced by the Seniors' Summit and prepare recommendations
for implementation. ST
Housing Recommendations
- Develop a wider range of housing options to reflect the
diverse needs of seniors. LT
- Fund and train caretakers and building managers in seniors'
housing to recognize abuse and neglect and respond and refer
appropriately. ST
- Review the current Residential Tenancy and Real Estate
Legislation with a view to increasing the protection of
seniors from abuse by adult children or caregivers. LC
- Explore the need for support services for seniors residing
in their own homes who may been vulnerable to neglect and
abuse. ST
- Implement a review of the manufactured homes industry
with a particular view to protecting seniors. ST
- Develop guidelines for designing seniors housing that
promotes safety and security. ST
- Work with the BC/Yukon Society of Transition Houses to
find suitable housing options for older women who have been
abused and to develop or adapt existing policies to create
a more "senior -friendly" environment in these
houses. ST
- Fund the development of housing options for the "hard
to house" seniors and older men who have experienced
abuse. LT Raise the rates for SAFER benefits to more accurately
reflect the current rental market. LT
- Research the current state of homelessness among older
men and women and prepare recommendations to address the
current situation. LT
Concluding Comments
The BC Coalition to Eliminate the Abuse of Seniors has engaged
in a year-long process to review existing provincial statutes,
regulations and policies that impact the appropriate intervention
and prevention of the abuse of seniors. Through this process,
policy makers from the fields of criminal justice, health
and mental health, economic security, human rights, as well
as seniors' advocates and service providers came together
to explore, analyze and propose changes that could increase
the safety and well being of seniors at risk of abuse.
Legislative changes are required in a number of areas to
affect the desired changes. These have been documented in
the report. New policies and protocols have also been identified,
that if implemented, would make a considerable impact on the
lives of seniors.
However, it is the very strong belief of this organization,
that unless there is the political will to place these issues
on the social agenda and the political commitment to concretely
address these issues, these recommendations will not move
forward. BC CEAS is committed to ensuring that these issues
remain in the public eye and in taking a lead role in facilitating
the necessary steps toward implementation.
BC CEAS wishes to thank the Law Foundation for funding
this innovative project.
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