an environmental scan of abuse and neglect of older adults in

AN ENVIRONMENTAL SCAN OF ABUSE AND

NEGLECT OF OLDER ADULTS IN CANADA:

WHAT’S WORKING AND WHY

Report prepared for the Federal/Provincial/Territorial Committee of Officials (Seniors)

September 2003

Participating F/P/T Jurisdictions:

Government of AlbertaGovernment of British ColumbiaGovernment of ManitobaGovernment of New BrunswickGovernment of Newfoundland and LabradorGovernment of Northwest TerritoriesGovernment of Nova ScotiaGovernment of NunavutGovernment of OntarioGovernment of Prince Edward IslandGovernment of QuebecGovernment of SaskatchewanGovernment of YukonGovernment of Canada

The opinions expressed in this document are those of the authors and do not necessarily reflectthe position of a particular jurisdiction.

Prepared by:

Marie Beaulieu, Ph.D.Director, Gerontology Masters ProgramUniversité de Sherbrooke

Robert M.Gordon, Ph.D.Director, School of CriminologySimon Fraser University

Charmaine Spencer, LL.M. Research Associate,Gerontology Research Centre, Simon Fraser University

Également disponible en français sous le titre :Abus et négligence envers les personnes âgées au Canada : une analyse de l'environnement -Constats et évaluation

Every person—every man, woman, and child—deserves to betreated with respect and with caring.

Every person—no matter how young or how old—deserves tobe safe from harm by those who live with them, care for them,or come in day-to-day contact with them.

American Psychological Association Elder Abuse and Neglect: In Search of Solutions (1999)

Acknowledgments

We wish to thank the over 30 key respondents from acrossCanada who helped to inform this report. The knowledge,insights and experience of these seniors, service providers,researchers and policy analysts in the area has helped tounderscore the significant progress which Canada has madeduring the past decade in this area, as well as some of theongoing gaps and challenges.

We would also like to offer a special thank you to NancyLeclerc, who is a social worker Master of Gerontologycandidate at the University of Sherbrooke. All her hard workin arranging and conducting interviews and tracking downsources, as well as her preliminary analysis, helped us tobring together pieces of the puzzle.

An Environmental Scan of Abuse and Neglect of Older Adults in Canada

September 2003 i

Table of Contents

Executive Summary iv

I. Introduction 1

A. Purpose and scope of this report 1B. Background 1C. The methodology 2D. Why abuse of older adults is an important issue 2E. Who is "an older adult”? 3F. Demographics of Canadian seniors 3G. Looking back over the past decade 3

II. What Is Meant By Abuse and Neglect of Older Adults? 5

A. The World Health Organization definition 5B. Who defines the issue? 5C. What are the commonly identified types of abuse and neglect? 6D. What are the principal needs of abused or neglected older adults? 6

III. What Do Abuse and Neglect of Older Adults Look Like in Canada? 8

A. What are the most prevalent types of abuse of older adults in Canada? 8B. The magnitude of the problem 8

1. From surveys 82. From crime reports 9

C. Who are the key abusers and key persons harmed by abuse? 101. Abuse in a family context 102. Abuse in new relationships 103. Abuse and caregiving 104. Abuse by non-family 115. Systemic abuses 11

D. Factors affecting the risk of abuse or neglect 121. Gender 122. Age 123. Cognitive impairment 124. Substance abuse 135. Mental health 136. Disabilities 13

E. Factors affecting risk of abuse or neglect and the likelihood of assistance for specific groups of older adults 13

1. Rural communities 132. Ethnocultural communities 133. First Nation and Inuit communities 144. Gays and lesbians 145. Low literacy 14

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September 2003 ii

F. What is the impact of abuse and neglect of older adults? 141. Health impact 142. Social and economic cost of abuse of older adults 15

IV. What is Canada Doing to Address Abuse of Older Adults? 18

A. Government action 18B. Community commitment 19C. Volunteer commitment 19D. Key legal approaches in Canada 19

1. The current national situation 19(a) Adult protection 20(b) Adult guardianship 20(c) Human rights law in Quebec 20(d) Family violence statutes 21(e) Criminal law 21

2. Discussion 22(a) Limited scope in adult protection 22(b) Paternalistic over-reach in adult protection 22(c) Inadequate resourcing at all levels 23

3. A glimpse at mandatory reporting 234. Possible new directions 23

(a) Justice training needs 23(b) Looking for alternatives 24

i. Restorative justice 24ii. Family violence and domestic violence courts 24

E. Key program approaches in Canada 251. Prevention and education 25

(a) What is the purpose of prevention and education in this area? 25(b) What are the key prevention and education approaches? 26

i. Prevention and education for older adults 26ii. Prevention and education for family 27iii. Prevention and education for business 27iv. Prevention and education for the media 28v. Prevention and education for service providers 28vi. Other learning opportunities 29

2. Network development 293. Support and assistance for abused and neglected older adults 29

(a) What we are trying to accomplish when assisting abused older adults? 29(b) What key assistance approaches are offered? 30

i. Adult protection approaches 30ii. Domestic violence programs 30iii. Advocacy programs 31iv. The integrated model 31v. A new direction: a coordinated community approach 32

F. What is known about the success of legal and program approaches in Canada? 32

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September 2003 iii

1. The impact of legal approaches 32(a) Raising awareness 32(b) Utilization and impact 33

2. The impact of program approaches 33(a) Process measures 33(b) Outcome measures 33

V. Conclusions 36

Appendices 38

Appendix A - Definitions of Abuse and Neglect 39

Appendix B - Interview Protocols 41

Appendix C - Governmental and Intergovernmental Opportunities to Address Key Aspects ofAbuse of Older Adults in Canada 44

Appendix D - Adult Protection Statutes and Provisions: Canada 2003 46

Appendix E - Prevention and Education: Methods of Disseminating Information and RaisingAwareness about Abuse of Older Adults in Canada 51

Appendix F - Approaches Used to Assist Abused or Neglected Older Adults in Canada 55

Bibliography 58


September 2003 iv

Executive Summary

This report provides a review of currentcircumstances across Canada in addressingthe important issue of abuse and neglect ofolder adults, looking at key communityapproaches, as well as programs, policy, andlegislative directions. It draws on theexisting literature and on the observations ofmore than 30 leading seniors'representatives, practitioners, researchers,government consultants and policymakerswho are involved in programs addressingabuse and neglect of older adults in Canada.

Canada is maturing, as a greater proportionof the population moves into the senioryears. By 2016 there will be over 4.85million people in Canada over the age of 65,with the greatest increase among those whoare 80 years and older. Canada's provincesand territories, as well as the federalgovernment, have important roles in helpingto ensure the wellbeing of all older adults,which includes promoting freedom fromabuse and neglect. “Abuse and neglect of older adults” refers toseveral forms of mistreatment, violence orother harms directed at older adults,including physical, psychological, financial,or sexual harms, active or passive neglect,violation of rights, and systemic harms.When discussing abuse and neglect of olderadults, people conventionally refer toindividuals aged 65 years and older. Abuseoften occurs in a family context, where theperson committing the harm is a spouse oradult child. In many cases, abuse of olderadults is “spousal abuse grown old”.However, abuse and neglect may arise in thecontext of new relationships or inrelationships with persons who are inpositions of trust or authority.

Abuse and neglect of older adults reflects acomplex combination of many sociological,

psychological and medical factors operatingat and between structural, organisational,family and individual levels.

What is Known

Definitive data on the abuse of older adultsis limited. Various studies indicate thatbetween 4 and 8% of older adults in Canada(or approximately 157,000 to 393,000) arelikely to experience one or more forms ofabuse or neglect at some time. The rate maybe higher among certain groups of olderadults, such as those with cognitiveimpairments or physical disabilities, andthose who are socially isolated. Fewer thanone in five abuse situations involving olderadults ever comes to the attention ofauthorities.

More older women are abused than oldermen. This may reflect the greater proportionof women among the older adult populationor other factors such as ageism, sexism,lower social status, poorer health of olderadults, and fewer personal resources. Oldermen experience special problems indisclosing abuse. Age may be a factor inabuse of older adults – some studies indicatehigher rates of abuse reported to authoritiesfor older age categories. As people age theymay have fewer physical and psychologicalreserves to withstand the abuse and moredifficulty finding ways to rebuff abusers.

Most older adults who are abused orneglected are clearly capable of makingdecisions about their own lives, but mayneed time, information or support. Othersmay have difficulties with mental capacity.Like all other adults, abused or neglectedolder adults need psychological security, astable living environment, financial stability,respect and a sense of purpose.

Executive Summary


September 2003 v

Characteristics of Abuse of Older Adults

Based on what is known in the field so far,the most prevalent types of abuse in olderadults in Canada are financial abuse andpsychological abuse, typically representing40-70% of the cases. Multiple forms ofabuse occurring at the same time are fairlycommon. Physical abuse and neglect,although less common, can have seriousconsequences and may be life threatening.Some forms of abuse and neglect becomecriminal matters, and approximately onequarter of all of crimes against older adultsare committed by family members, usually aspouse or adult children.

Abuse often leads to depression and manyother serious health problems associatedwith highly stressful living conditions.Abuse and neglect also significantly shortenolder adults' lives. Substance abuse ormental health problems are frequentlyidentified as factors in abuse situations(occurring in up to one third of cases).

Many forms of abuse experienced by olderadults involve tangible social and economiccosts such as costs to the health care system,community services and the justice system.There are also intangible costs associatedwith abuse of older adults such as pain andsuffering, family break-ups, and poorquality of life.

What is Canada Doing to Address Abuse?

Abuse and neglect of older adults has beenidentified by the federal government andseveral provincial and territorialgovernments as a matter of concern, withthis social issue increasingly being voiced asa priority either on its own, or as part ofoverall family violence prevention. The“solutions” to abuse and neglect of olderadults cut across many different federal,

provincial and territorial ministries, as wellas both the public and private sectors, andoften require joint efforts.

Many Canadian communities have had along standing commitment to addressingabuse of older adults during the past decade,leading to promising developments inprevention and assistance by grassroots andfrontline organizations, as wellgovernments. Over time some of thiscommunity potential has been diminished asa result of limited resources, and broadsectoral restructuring (e.g., in health care,social services and legal services).Volunteers are the backbone to many of theprograms and services to help abused orneglected older adults, but the volunteerbase across Canada has droppeddramatically in recent years.

Prevention and Education

Compared to other forms of family violenceor other important social issues, the publicand professional level of awareness of theproblem is low. A number of preventionapproaches exist and often overlap withintervention to stop or mitigate existingabuse.

Abuse of older adults tends to be“invisible”. Over the past decade, manycommunities have made efforts to informseniors and service providers in contact witholder adults, helping them to recognize theproblem and know where to turn. Certaingroups of service providers who work moreclosely with older adults or who deal withabuse and neglect situations on a regularbasis need increasingly more specializedand sophisticated training in the area.

Prevention and education programs mayinclude community presentations andtheatre, workshops and conferences for

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service providers, service directories,Internet information, clearinghouses, publiclegal information, and social marketingcampaigns.

Intervention

The key types of assistance currently offeredinclude: adult protection approaches;domestic violence programs; advocacyprograms; integrated models; and acoordinated community approach.Communities often take a multi-prongedapproach that may include crisisintervention services (e.g., telephonehotlines and emergency shelters), formaladvocacy through legal clinics, supportgroups for the abused or the abuser,individual and family therapy, and the use ofa whole range of health and social services.The valuable roles of seniors as volunteerpeer supports and advocates are increasinglybeing recognized. The resources available toprovide services in rural communities areoften less than in urban settings.

At present, few of the existing approaches tohelping abused or neglected older adultshave been evaluated, reflecting in part theearly stage of development in knowledge inthe area. However, programs in this area aremore likely to be successful where they havecontinuity of staff, assured and adequatecore funding, provide regular staff training,and have management support. At present,many programs operate as pilot projects ormust piece together funding from severalsources. As a result, even very goodinitiatives may falter and communities risklosing the skills, knowledge, experience andcommitment developed along the way,leaving them in a constant process ofrebuilding and relearning.

Canada’s key legal approaches

The primary laws that are used in Canada toprotect older adults from abuse are: adultprotection, primarily in the Atlanticprovinces; adult guardianship; human rightslaw in Quebec; family violence statutes; andcriminal law. Abuse cases involving olderadults are frequently diverted from thecriminal justice system to health care andsocial services. Older adults experiencemany barriers to the legal system, includinga lack of knowledge about their rights andwhen to contact the authorities; lack oftraining among police officers about seniorabuse; a lack of victim assistance servicesfor older adults; and ageism in the justicesystem. Restorative justice approaches andspecial family violence courts have thepotential as promising alternatives for casesof abuse of older adults. Public legaleducation and other support and advocacyresources for seniors can help removebarriers, as can appropriate training forthose in the justice system, and a senior-focussed examination of policies andpractices.


September 2003 1

I. Introduction

A. Purpose and scope of this report This report is intended to assistFederal/Provincial/Territorial (F/P/T)Ministers Responsible for Seniors todetermine potential priority areas forcollaborative action to support safety andsecurity for older adults. It provides anoverview of current circumstances acrossCanada in addressing the important issue ofabuse and neglect of older adults, looking atkey community approaches, as well asprogram, policy, and legislative directions.

There is a need to understand abuse andneglect of older adults, not only as theactions of individuals, but also from abroader perspective of societal factors thatsupport or undermine well-being of olderadults and that increase or decrease thelikelihood of abuse or neglect occurring. Inthis broader context, there are many parts tothe issue; consequently, the “solutions” cutacross the boundaries of many federal,provincial and territorial ministries, as wellas both the public and private sector.

As an “environmental scan”, this reportcannot begin to describe comprehensivelythe wide range of programs and approachesin this country. Instead it describes generaltrends.

This report concerns abuse occurring incommunity. Abuse and neglect of olderadults who reside in long-term careinstitutions is an important and yet poorlyunderstood issue that needs to be consideredin an in-depth manner, but is beyond thescope of this report.1

Certain types of harms included indiscussions of abuse and neglect of olderadults are not addressed in this report. Thereport does not cover issues of self neglect,or harms committed by persons who are

strangers engaged in repair or bankingscams or telemarketing frauds. However,these and similar forms of exploitation areoften included in abuse prevention work andmay have some of the same underlyingfactors as abuse and neglect as they areframed here.

B. Background

In 1994, F/P/T Ministers Responsible forSeniors established a Working Group toexamine the broad issue of seniors safetyand security including injury prevention,elder abuse and crime prevention. An issuepaper on seniors safety and security wasdeveloped and Ministers agreed tostrengthen government and communitypartnerships leading to safe and secureenvironments for seniors, to share policy,program and legislative responses to safetyand security issues, and to coordinateresearch efforts.

In recognition that falls among the olderpopulation cost one billion dollars annuallyin direct health care costs, at the F/P/TMinisters Responsible for Seniorsconference in 1999, Ministers requested anevaluation of current falls preventionprograms and practices. This led to thedevelopment and dissemination of AnInventory of Canadian Programs for thePrevention of Falls Among Seniors Living inthe Community and A Best Practices Guidefor the Prevention of Falls Among SeniorsLiving in the Community to various levels ofgovernment and community groups inCanada.

In 2002, F/P/T Ministers Responsible forSeniors directed officials to develop acritical analysis of existing elder abusestrategies and legislation across jurisdictionsin order to identify effective strategies and

Introduction


September 2003 2

initiatives to determine priority areas forpotential action by Ministers. Federal,provincial and territorial governments havean important role to play in sharinginformation about effective strategies andinitiatives, as well as challenges to beaddressed, regarding the abuse of olderadults. In addition, governments are in anexcellent position to work together toincrease awareness of the issue of elderabuse and promote research to enhance thelevel of existing knowledge about elderabuse in Canada.

C. The methodology

This report draws from two primary sources:• the existing literature on abuse and

neglect, highlighting Canadianinformation wherever possible, and

• semi-structured telephone interviewswith more than 30 leading seniors'representatives, practitioners,researchers, government consultants andpolicymakers from across Canada. Mosthave been involved with abuse andneglect issues affecting older adults forat least a decade; several were pioneersin the work that has been done inCanada and have witnessed its successesand growing pains in the course of theirwork.

(See Appendix A for the interviewprotocols.)

D. Why abuse of older adults is animportant issue

Throughout life and across the lifespan, allpeople in Canada have a right to live free ofharms from others. Sometimes that does nothappen. Abuse and neglect of older adultscan occur within the family or other close

relationships, or in relationships with otherpeople in positions of trust or authority.

Abuse or neglect of older adults hasimmediate and long-term effects on theindividuals. It also leads to significantintergenerational effects and ripple effectsfor communities and Canadian society as awhole.

Abuse and neglect of older adults:• create significant social costs, much of

which currently are not easily visible;• undermine and, in some cases, destroy

individual wellbeing; • have health implications, for the

individual, families, and serviceproviders;

• have economic implications at theprivate and public level.

The issue of abuse and neglect of olderadults is largely under-detected in Canada.Although important inroads have beenmade, Canada has only scratched the surfacein terms of:• raising public awareness about abuse

and neglect of older adults; • developing policies and services to

assure that older adults do notexperience mistreatment and that harmsare appropriately addressed;

• ensuring the involvement of older adultsin identifying issues and developingapproaches;

• meeting the education, training andresource needs of those in contact witholder adults; and

• strengthening social norms against abuseor neglect of older adults.

Abuse and neglect of older adults is acomplex issue that crosses different fields ofexperience, and is not open to simpleanswers. The related issues reflect acombination of sociological, psychological

Introduction


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and medical factors operating at and amongstructural, organisational, family andindividual levels.1 A better understanding ofthis social, health and legal issue in Canadawill help to give it the high priority itdeserves.

E. Who is “an older adult”?

When discussing abuse and neglect of olderadults, people conventionally refer toindividuals aged 65 and over. To someextent, this is an arbitrary cut off point.Some types of harms that older adultsexperience (such as conjugal violence) mayhave been occurring for many years. Abuseat age 64, or earlier does not magically turninto “senior abuse” upon the person’s 65th

birthday.

Many factors, such as changes in health orsocial environment, can leave adultsvulnerable to the harms of abuse andneglect. Some groups of people seem togrow old faster or die earlier because of theunsafe or less healthy physical and socialenvironments in which they live. However,throughout most of this report, the focus willbe on people aged 65 and over.

The terms “elderly” and “elder abuse” arepurposefully avoided in this report. They aretoo narrow to accurately capture thediversity of older adults and they create acaricature of abused older adults as frail anddependent, and mentally incapable, which isnot the case for many older adults in abusiveor neglectful situations.

F. Demographics of Canadian seniors

Older adults now represent the fastestgrowing age group in Canada, particularlythose aged 85 and over. Canada is not only

growing older, its older population isbecoming increasingly diverse, ethnically,socio-economically, culturally, andgeographically.2 Consequently, there aremany different “agings” in Canada.3 Policiesand approaches for both prevention andassistance endeavours addressing abuse andneglect of older adults need to reflect thisdiversity.

G. Looking back over the past decade

Canada has made important strides inbeginning to address abuse and neglect ofolder adults over the past decade.Nonetheless, the level of knowledge and theextent of policy development remains farbehind that in other areas of public policysuch as wife abuse and child abuse and othersocial problems.

In the early and mid 1990s, the federalgovernment launched two major FamilyViolence Prevention Initiatives whichhelped to stimulate interest in abuse of olderadults. Provinces moved to action throughresearch, and initiated numerous pilotprojects, primarily aimed at prevention.Researchers began to offer rudimentaryfigures on the extent of the problem,concentrating on comprehensive elements ofthe abuse process rather than on causalmodels. Many jurisdictions starteddeveloping structured intervention programsto assist older adults. Some jurisdictionsundertook reviews of laws that had beenenacted in the 1970s and 1980s to identifynot only whether they met the needs of olderadults and society to protect “vulnerableadults”, but also whether they wouldwithstand Charter scrutiny.

Over the decade, as knowledge grew, theways of looking at abuse of older adultsexpanded. Today, the issue is far less likely

Introduction


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1 For exam ple, Beaulieu, M . (1994). Les cadres d’accueil publics

et les pratiques d’intervention face aux abus à l’endroit des

personnes âgées. Thèse de doctorat en sciences humaines

app liqués . M ontréal, QC: U niver sité de M ontréal;

- Spen cer, C . (June 1994). Abuse and Neglec t of O lder Adults in

Institutional Settings: A Discussion Paper Building from English

Languag e Sources. Ottawa , ON: H ealth C anada. O nline a t:

http://www.hc-

sc.gc.ca /hpp b/fam ilyviolence /htm l/ageins tituten_e.h tml;

- Beaulieu, M ., & Bélanger, L. (1995). Intervention in long-term

care institutions with respect to elder mistreatment. In M . J.

M acLean (Ed.). Abuse and N eglect of Older Cana dians: Strategies

for Change. (pp. 27-37). T oronto, O N: T hom pson Edu cational.

- Charpentier, M . (2002). Priver ou privatiser la vieillesse. Presses

de l’Université de Québec.1 Pen hale, B . (1999) . Elde r abu se an d olde r m en. O nline a t:

www.eurow rc.org/13.institutions/3.coe/en violence coe/14.en coe

oct99 .htm2 A significant proportion of seniors in Alberta, Saskatchewan, and

M anitoba, as well as those living in Toronto or Van couver are

likely to have an ethnic origin other than British, French,

Aboriginal or Canad ian. The three largest ethnic groups for

Canad a's seniors other than British, French or Can adian are

German, Italian, and Ukrainian. In Toronto, Italian, Chinese and

Jewish seniors predominate; Italian, Jewish and Polish

predominate in Montreal; while Chinese, German and South Asian

constitute the dom inant grou ps in V ancou ver. M ata, F. &

Valentine, J. Selected Ethnic Profiles of Canada’s Senior Age

Co hor ts. Strategic Research and Analysis, Canadian Heritage:

Multiculturalism Program, Citizens’ Participation and

Mu lticulturalism , at pg. 5. On line at:

www.pch.gc.ca/progs/multi/assets/pdfs/sen-pub1_e.pdf3 Carrière, Y. (A ugust, 1998 ). More than just a question of

num bers. GRC News, 17 (2), 3-4. Gerontology Research Centre:

Simon Fraser Universi ty, Vancouver, BC.4 Ekos R esearch (M ay, 2002). Public A ttitudes Tow ard s Fa mily

Violence: A Syndicated Study Final Report. Online a t:

http://www.ekos.com/media/files/family31may02.pdf

to be characterized in somewhat simplisticways, such as assuming most abuse wascaused by caregiver stress. Instead the issueis understood as a much more complexsocial and legal issue. It is situated in thebroader social context of attitudes to aging,expectations of families, and the resourcesbeing allocated to older adults. At the sametime, hesitancy continues in some quartersto acknowledge that older adults in Canadaare physically, emotional, or financiallyharmed by people in their lives.4

http://www.hc-sc.gc.ca/hppb/familyviolence/html/ageinstituten_e.html


http://www.eurowrc.org/13.institutions/3.coe/en-violence-coe/14.en-coe-oct99.htm


http://www.pch.gc.ca/progs/multi/assets/pdfs/sen-pub1_e.pdf



September 2003 5

II. What Is Meant By Abuse and Neglect of Older Adults?

As is the case for most fields in their earlystages of development, inconsistencies mayexist in terminology and definitionsnationally and internationally. This sectionprovides an overview of the most recentdefinitions in the field of abuse and neglectof older adults.

A. The World Health Organizationdefinition

In 2002, the World Health Organization(WHO) defined abuse and neglect of olderadults as:

“...single or repeated acts, or lack ofappropriate action, occurring withina relationship where there is anexpectation of trust, which causesharm or distress to an older person.”1

This definition is a helpful starting point,capturing some of the primary features ofharms occurring to older adults. However,not all abuse or neglect is the action ofindividuals and not all occurs within thecontext of a personal relationship.

B. Who defines the issue?

Various jurisdictions in Canada have beenworking to agree on what is or is not"abusive", as well as ways in which theissue should be characterized. Much of theearly perspective given on abuse of olderadults was developed by practitioners –older adults as a group had limited input intoidentifying the boundaries of abuse. Someresearchers note there can be differencesbetween these two perspectives.2 In someinstances, older adults may show morelatitude and set a higher threshold for what

is abusive. In other instances, older adultsmay consider broader social harms as part ofabuse or neglect.

According to the WHO publication“Missing Voices”,3 older adults around theworld tend to frame abuse and neglect morebroadly than simply one person harminganother. Instead, they place the issue ofabuse under three broad categories:

• neglect where older people are isolated,abandoned, excluded from society or nottreated as a valued member of society;

• violation of rights that other people takefor granted such as privacy, non-discrimination, control over health careand treatment, lack of access toappropriate care and support, not havinglegal rights respected; and

• being deprived of choices concerningpersonal decisions, status, finances, andrespect.

Differences exist between rural and urbanunderstandings of abuse and among agegroups.4 In addition, some cultures may nothave a word in their language for abuse ofolder adults, but instead may frame theharms in terms of mistreatments, notshowing proper respect, or a failure to liveup to family or societal responsibilities.5

The thresholds for identifying situations asabusive are not static. As people'sunderstanding of and sensitivity to abuseand neglect issues affecting older adultsincreases, the social tolerance shifts. Forexample, within the past five years, majorseniors organizations such as Fédération del'âge d'or du Québec (FADOQ),l'Association québécoise de défense desdroits des personnes retraitées et

What is Meant by Abuse and Neglect of Older Adults?


September 2003 6

préretraitées (AQDR) and the PrinceEdward Island Seniors Federation not onlyhave recognized the existence of abuse inolder people, but increasingly haveemphasized the importance of the issue as asignificant social problem affecting the livesof older adults in Canada. Locally andprovincially, these seniors organizations arestrong advocates for appropriate resourcesand approaches to better address the issue ofabuse and neglect of older adults.

C. What are the commonly identifiedtypes of abuse and neglect?

Abuse and neglect of older adultsencompass diverse forms of harmsincluding:6

• physical, psychological, sexual andfinancial abuses;

• physical and psychological neglect(active and passive forms);

• violation of rights; and • systemic abuses.

(See Appendix B for related definitions.)

In looking at abuse and neglect of olderadults, it is important to examine more thanindividual actions or individual actors.Abuse or neglect exists within a socialsystem that allows it to flourish or not. Theresponses of public and private systems canreduce or compound the impact of an abusesituation.

D. What are the principal needs of abusedor neglected seniors?

Older adults experiencing abuse or neglecthave the same needs as all other adultsincluding the need for psychologicalsecurity, a stable living environment,

financial stability, respect, a sense ofpurpose, and being valued.7 Those livingwith abuse want it to stop or at least, theywant to reduce the harms to themselves andothers.

Other important needs of abused olderadults include the need to:

• have the abuse of the older adultidentified for what it is, neitherminimizing or justifying it,

• feel they have choices and control overtheir own lives,

• have appropriate support for themselvesand other family members,

• have coordinated safety and interventionservices, and

• reduce the risk factors.8

Those who provide services to older adultsunderscore two primary and complementarygoals for assisting older adults – protectionand respecting autonomy. Practitioners oftenfocus on physical security as the primarygoal, protecting the the older adult fromdeath or severe injury. For an abused olderadult, “security’ is much broader andincludes being believed, knowing there areoptions, and feeling they have control overthe direction the help takes.

In the majority of abuse or neglect cases,older adults are clearly capable of makingdecisions about their own lives, but mayneed time, information or support to makethose difficult decisions. In other cases, theperson may be marginally capable or clearlymentally incapable. For some individuals,mental capacity and psychological andphysical reserves fluctuate depending on thesupports around them. These differences inmental capacity can affect the responsesneeded.

What is Meant by Abuse and Neglect of Older Adults?


September 2003 7

1 World Health Organization & International Network for the

Prevention of Elder Abuse (2002). Missing voices: views of older

pers ons on e lder ab use . (Geneva, S witze rland : WHO . Online a t:

www.who.int/hpr/ageing/Elderabuse 3 screen.pdf2 Stones, M. J. (1995). Individual differences in attitudes about

elder abu se: the E lder abuse Attitude Tes t. Canadian Journal on

Aging. 14, (2) 6 1-71 . Also :

- Harbison, J. (N ov. 1998). R e-Exam ining the Social Construction

of 'Elder Abuse an d N eglect': A Canadian P erspec tive, Ageing and

Soc iety, 18 (6), 691-711.

- Harbison, J. (1999). “Models of Intervention for Elder Abuse and

Neglect: A Canadian Perspective on Ageism, Participation, and

Em powerm ent”. Journal of Elder Abuse and Neglect. 10 (3/4), 1-

17.3 World Health Organization & International Network for the

Prevention of E lder Ab use. (2 002). Missing voices: views of older

persons on elder abuse. (Geneva, Switze rland : WHO . Online a t:

www.who.int/hpr/ageing/Elderabuse 3 screen.pdf4 Stones, M .J. & B edard, M . (Winter, 200 2). Higher thresh olds for

elder abu se with age and rural res idence . Canadian Journal on

Aging, 21 (4), 577-586.5 Ward-H all, C. E ducating S enior s and O thers about Abus e: A

Decad e of Experience from a Provincial Organization. Presentation

at In terna tion al Association on Ge ron tology. 17 th W orld

Congress, July1-6, 2001, Vancouver, B.C.6 Kinn on, D . (2001). Com munity Aw arenes s and Response.

Ottawa, ON: H ealth C anada, F am ily Violence P revention Un it.

Online at: http://www.hc-

sc.gc.ca /hpp b/fam ilyviolence /htm l/ageins tituten_e.h tml7 B.C. C oalition to Eliminate Ab use of Sen iors (May, 200 3).

Profile of Later Life Abuse in British Columbia. Prepared for and

the Ministry of Children, Aboriginal and W omen's Affairs,

Victoria: B.C.8 Devon D odd, J ., Chaulk, P. & Sm ith, N. (D ecem ber 20 01). Abuse

of Older Adults: A Report of Priorities in Prince Edward Island

[Consultation Results]. (PEI Centre for Health and Aging & PEI

Sen ior C itizens Federation ). O nline a t:

www.upei.ca/~csh a/research/abuse/consu ltationresults/consultation

res ults .htm l

No matter what the degree of a person'smental capacity, helpers of abused orneglected older adults should respect theirdignity and not disregard their capacity tomake choices and their right to control theirlives.

http://www.who.int/hpr/ageing/Elderabuse-3-screen.pdf



September 2003 8

III. What Do Abuse and Neglect of Older Adults Look Like In Canada?

This section provides a brief overview of themost prevalent types of abuse of olderadults; the magnitude of the problem inCanada; the key abusers and persons harmedby this abuse; and factors of abuse situationsthat affect the likelihood of abuse happeningand the level of assistance they receive.

A. What are the most prevalent types ofabuse of older adults in Canada?

Most of the Canadian research has tended tosuggest abuse of older adults is primarilyeither financial abuse or psychologicalabuse.9 In a survey of 542 abuse casescoming to the attention of 32 agenciesacross Canada, percentages were 40.7%,28.6%, and 26.6% for psychological,physical, and financial abuse, respectively.10

A review of 128 mistreatment casesinvolving adults aged 60 and older in threecommunity service agencies in Quebecfound the most common types of abuse werepsychological abuse (70%), financialexploitation (41%), and neglect (32%).Physical abuse was found in 20% of thecases.11 In addition, research consistentlyshows multiple types of abuse often occur atthe same time.12

It is important to understand the significantand often long lasting effects ofpsychological abuse on people of any age.Although society tends to minimize itsimpact, victims often view psychologicalabuse as more harmful than being hit.

B. The magnitude of the problem

Statistics Canada has observed that it is verydifficult to obtain an accurate sense of the

extent of the problem of abuse of olderadults in Canada from either victimizationsurveys or police statistics. Victimizationsurveys capture only what the victimsthemselves disclose. Data from policerecords provides information only on theabuse that comes to their attention.13

Data is not readily available fromcommunity service providers. Keeping andanalysing data on abuse is not usually apriority for community organizations. Theylack the tools, time, resources and support todo so. However, as more and more policybecomes "evidence- based", serviceproviders are recognizing the value of bothquantitative and qualitative information – numbers of cases, social and economicimpacts, and the complex factors of manyabuse and neglect situations.

The following represents what is knownabout the extent of the problem of abuse ofolder adults in Canada:

1. From surveys

There have been two national studies inCanada on the prevalence or incidence ofabuse.14 In the 1989 Ryerson Study, 2008older adults were interviewed by telephone.The study found that 4% of those surveyedreported having experienced one or moreforms of abuse or neglect at some point inlater life, thus offering a measure of lifetimeprevalence for late life abuse.15 Financialabuse accounted for more than one-half ofall cases in this study. Chronic verbalaggression (psychological abuse) accountedfor another one-third of the cases.16

In 1999, Statistics Canada conducted aGeneral Social Survey on victimizationissues, sampling approximately 26,000

What Do Abuse and Neglect of Older Adults Look Like in Canada?


September 2003 9

people across Canada. The survey over-sampled older adults and asked over 4,000of them six questions about emotional andfinancial abuse occurring during the pastfive years. Approximately 1% of olderadults reported experiencing some form ofphysical abuse (similar to what was found inthe Ryerson Study), and approximately 8%reported experiencing some form ofemotional or financial abuse, with thepreponderance of the abuse reported beingemotional forms.17

It is generally recognized that the number ofabuse situations reported by people in theRyerson Study and the General SocialSurvey represent only “the tip of theiceberg”. The samples did not include anyolder adults whose primary language wasnot English or French; people with cognitiveor hearing problems; those isolated by theirabuser and not allowed to answer; andanyone without a telephone (e.g., some poorand rural seniors).

A British Columbia study on financial abuseconducted in the mid 1990s (the NotaryStudy) involved personal interviews with200 older adults who were drawn from asemi-random sample. The survey askedabout financial abuse within the broadercontext of financial decision making infamilies. In the study, 8% of the older adultsidentified having experienced one or moreforms of financial abuse, a rate three timeshigher than suggested by the Ryersonstudy.18 Financial abuse in combination withpsychological abuse was common.

Several provincial surveys of serviceproviders conducted in the 1980s alsoprovided indirect evidence of abuse of olderadults. Surveys conducted in Quebec,Manitoba, Newfoundland, Nova Scotia,Alberta, and Ontario suggested that anappreciable proportion of Canadian seniorswere being mistreated.19 For example,

Stevenson (1985) reviewed 500 cases ofabuse reported by 267 Alberta agencies overa span of five years and found two-fifths ofthese cases consisted of financialexploitation.20 More recently, a preliminarystudy of service providers in Prince EdwardIsland identified 256 cases where there wassuspicion of abuse, for a prevalence rate of5.6% for cases coming to the attention ofservice providers in that province.21

Abuse cases coming to the attention ofspecific service providers can giveimportant information about numbers andprofiles. However, the types of abuse orneglect situations an agency sees depends oninternal factors such as the scope of its workand external factors such as its geographicboundaries, and sources of referrals.Consequently, it is not advisable togeneralize from one agency to describe whatabuse of older adults looks like.

2. From crime reports

Criminal charges provide another snapshotof harms against older adults, particularlythose involving serious physical harms.Criminal statistics suggest that, in general,older adults are much less likely to bevictims of crime than younger persons. Amuch smaller percentage of family violenceis reported by older adults than by youngeradults. Most of the violent offences againstolder adults are committed by non-family,and more often these are strangers.22

It is not clear whether this low level of casesreported to police reflects:• less criminal abuse occurring for older

adults;• less willingness among older adults and

others to identify the harmful actions offamily or other trusted persons as“crimes”;



September 2003 10

• the responses within social service andjustice systems to abused or neglectedolder adults; or

• other factors such as greater isolation ofolder adults, making the crime by familymore likely to be hidden.

In 2000, police statistics indicate thatcommon assault was the most common formof crime by family members against olderadults (54% of the crimes by family). Olderadults were also victims of threats (21% ofthe crimes by family) and assault with aweapon or causing bodily harm (13%).

Between 1974 and 2000, 26% of homicidesof older persons were committed by familymembers. Spouses were the most commonperpetrators of homicides (39%), followedby adult children (37%) and extended familymembers (24%).23 Older husbands weremore likely to kill older wives, than viceversa.24 Beatings, shootings and stabbingswere the most common causes of death infamily homicides of older adults.25 From1991 to 2001, 31% of persons accused ofcommitting a homicide against a seniorfamily member had a prior history of familyviolence with that victim.26

C. Who are the key abusers and keypersons harmed by abuse?

1. Abuse in a family context

Abuse that arises in a family context differsdepending on whether the abuser is one’s spouse, one’s children, or another relative. Ifthe alleged perpetrator is a spouse and thereis evidence of a poor marital relationship, itis more common to find psychological andphysical abuse, than neglect or financialexploitation.27 Abuse by other family (e.g.,siblings, son, daughter, in laws,grandchildren) may reflect past family

relations, or diminished social role or statusof older adults.28

Abuse by a spouse may have begun early inthe couple’s relationship and continued intolater life to become “spouse abuse grownold”. Canada’s most recent General SocialSurvey found that 7% of people who weremarried or living in a common-lawrelationship had experienced some type ofviolence by a partner during the previousfive years, with provincial estimates rangingfrom 4 to 12%.29 It is unclear how much ofearly life abuse in marital relationshipsceases in middle or later life, and how muchcontinues.30

2. Abuse in new relationships

Abuse of older adults can occur uponremarriage or in new relationships. Canadais a changing society, with more divorce andmore non- married couples. The FamilyViolence Survey indicated that the one-yearfamily violence rates in general wereconsiderably higher for people in common-law relationships than in maritalrelationships (4% versus 1%).31

Although violence is only one of manypossible reasons for separation, the rates ofolder women deciding to separate in a newrelationship are notable – 25% of womenaged 60-69 in new relationships who hadbeen married, decided to separate in theirnew relationship. However, this is stillconsiderably lower than the rates ofseparation for younger women (63% ofwomen aged 30-39).32

3. Abuse and caregiving

Abuse can also occur in the context ofcaring for a spouse or relative with decliningphysical or mental capabilities. Mostcaregiving is done by spouses or femalefamily members (daughter, daughter-in-



September 2003 11

law). The caregiver literature consistentlypoints out that providing care to a personwho is cognitively impaired can be highlystressful. More than 80% of Alzheimercaregivers report that they frequentlyexperience high levels of stress, and nearlyhalf say they experience depression.33 Whilemost caregivers do not become physicallyabusive, most have reached points wherethey feared becoming so.34

Caregivers who are depressed are morelikely to engage in harmful acts.35

Appropriate levels of community supports,combined with family supports, and trainingto help caregivers to assess their own risk ofcausing harm, may help to reduce the risk of“stepping over the abuse line”.

4. Abuse by non-family

It has been suggested that abuse outside of afamily context (e.g., friends, landlords,neighbours) is often likely to reflect broadersocietal factors which may include:

• increased opportunities;• negative attitudes towards older adults;

and • the relative status of specific groups of

older adults.36

By way of illustration, researchers lookingat harms to older adults who live in rentalhousing have found the most common formsof abuse included violations of rights andpsychological abuses – intimidation,harassment, and to a lesser degree, assaults.These older adults may be in a morevulnerable position because they have lowincome or live in poverty, and they may lackknowledge of their rights. A lack ofaffordable housing alternatives precludesthem moving. Additional factors includeowner’s expectations of the buildingmanager (e.g., focus on the physicalbuilding, not on tenants' needs) and the type

of training the manager receives. A policyshift in the focus of low-income housingfrom seniors’ to mixed low-income withyounger tenants with mental illness maylead to increased chances of abuse fromyounger tenants.37

5. Systemic abuse

The term “systemic abuse” refers topolicies, rules and decision making thatcause harms to older adults. Mostpractitioners would find it surprising toconsider that their approaches, policies, orrules might create or support abusiveenvironments. However, there can be“incompetence of the practitioners”.38

For example, a care provider who suspects afinancial abuse situation for an older clientmay not be aware of community resourcesthat address the civil law aspect orpsychosocial and support aspects of theabuse. As a result, the care provider mayrespond to their client in a manner thatsuggests that nothing can be done about it,reinforcing and perpetuating abuse bysuggesting that such situations are hopelessand that the person is helpless.

Systemic abuses may also occur in thecontext of overall resource allocation forolder adults. There is increasing evidence oflarge unmet needs among older adults insocial, physical and mental health services.39

Older adults are frequently given muchlower priority at a policy level, whether infamily violence, health, housing, or incomesecurity.40



September 2003 12

D. Factors affecting the risk of abuse orneglect

1. Gender

Most Canadian research focussing oncommunity agencies and organizationssuggests that older women are more likelyto be the victims of abuse than older men,often at a rate of two to one.41 Yet the percapita rate appears to be equivalent for bothsexes. Similarly, men are more likely to bethe abusers than women, again usually by aratio of two to one.

Some researchers have urged cautionhowever, pointing to under-recognition ofabuse of older men and strong social normsagainst men acknowledging being abused.42 It has been suggested that aging and ageismare great equalizers, leaving both olderwomen and men open to abuse or neglect,especially when the person has disablingconditions and must rely on others.43

Gender differences introduce other factorsinto cases of abuse of older adults. Oldermen and women differ in terms of theirsocial and financial positions. For example,financial abuse may hurt older women more,because they tend to have fewer financialresources and live longer so that any asset“diversion” will hurt them more.

There can also be gender differences inimpact of physical abuse: women tend to besmaller than men, and older women aremore likely than older men to have disablingconditions, in part because of genderdifferences and in part because of women’slonger longevity. There is a higher incidenceof chronic diseases such as osteoporosisamong older women generally than amongmen. Any combination of these factors canlead to greater risk of injury in abusivesituations.44

2. Age

U.S. research of cases coming to theattention of Adult Protective Servicessuggests that age is a factor – a much greaterpercentage of cases, irrespective of the formof abuse or neglect, are seen among thoseaged 85 and over than those 60 and over.The study also found a trend for the numberof abuse situations to increase from one agecategory to the next.45 However, someCanadian research has suggested thatyounger seniors may be more at risk thanolder seniors.46

3. Cognitive impairment

Cognitive impairment may place olderadults at risk of being abused, and in somecases, at risk of abusing. The division ofgeriatric psychiatry at a Montreal hospital,which regularly conducts assessments ofcognitive capacity, found 20 cases ofsuspected or confirmed abuse or neglect(16%) in a one-year period among 126patients who had been living in thecommunity. More than one in three (35%)of the patients were experiencing multipleforms of abuse. Two out of three involvedfinancial abuse, 35% involved neglect, 25%involved emotional abuse, and 15%involved physical abuse.47

In 1993, the Victoria Elder Abuse Project(VEAP) in British Columbia found that 28%of the abused or neglected older adultsreferred to the pilot project had mentaldysfunctions that limited their understandingof what was happening.48 The VEAPresearchers noted the special vulnerability ofthis group of abused older adults who maynot recognize what is happening or be ableto take action.

While only 2% of all adults aged 65 andover have a degree of dementia, thispercentage increases significantly to



September 2003 13

approximately 35% among adults in theirmid 80s.49 Although this group of abusedolder adults represents a small subset of allthe abuse situations, these abused olderadults need special consideration as theymay have less ability to protect themselves.

4. Substance abuse

Substance abuse is a factor in up to 35% ofolder adult abuse and neglect cases comingto the attention of community-basedagencies in Canada.50 Research indicatesthat heavy alcohol drinking and pastchildhood abuse by the father may lead toabuse by adult children.51

In abuse cases, either the abuser or thevictim (and occasionally both) can beexperiencing a substance use problem withalcohol, psychoactive medications, or streetdrugs.52 Approximately 10% of older adultswho drink or use prescription medicationsdevelop a substance use problem, whichmay impair their ability to judge their risk ofabusing or being abused.

5. Mental health

Mental health problems of the abuser or thevictim (e.g., depression, bipolar disorder,anxiety disorder, borderline personalitydisorder, schizophrenia) were a factor inbetween 16 and 37% of abuse and neglectcases reported to community agencies inCanada in 1994.53, 54 For victims, prior abusemay lead to poorer mental health,depression, anxiety and suicidal thoughts.55

6. Disabilities

It is estimated that persons of any age withdisabilities are approximately 1.5 timesmore likely to encounter violence than thepopulation at large.56 Numerous factorsaffect the relative risk of abuse for personswith disabilities as they age, including:

• dependence on family, friends or paidcaregivers to provide care;

• lack of access to support services;• reduced mobility; • cognitive or communication

impairments that leave the person unableto go for help or report their abuse;

• societal paternalism; and • societal devaluation of people with

disabilities.57

E. Factors affecting risk of abuse orneglect and the likelihood of assistancefor specific groups of older adults?

Certain groups of older adults are at greaterrisk for abuse or neglect and also experiencebarriers to assistance.

1. Rural communities

In rural communities, addressing abuse isaffected by isolation, distances to services,and scarcity of resources. It is much harderto maintain confidentiality where “everyoneknows everyone else’s business”. Inaddition, situational stresses such asunderemployment can affect abusesituations.58

2. Ethnocultural communities

Older adults in ethnocultural communitiescan be subject to different influences thanolder adults in mainstream culture. Culturecan influence the way that abuse and neglectare perceived and addressed in specificethnocultural communities.

For older immigrants, particularly thoseunder sponsorship, immigrant policies andsponsorship rules can have a profoundinfluence, creating significant isolation andstrong dependency on the family. Povertyand underemployment in many immigrantfamilies can act as a family stressor. Issuesof acculturation and status reversal of oldercommunity members (from high status inthe country of origin to low status in



September 2003 14

Canada) can make older immigrantsparticularly vulnerable to abuse or neglectand make assistance difficult .

3. First Nation and Inuit communities

First Nation and Inuit communities inCanada are often cultures in transition, witholder members no longer holding the samestatus as earlier generations. Otherinfluences include loss of customarypractices, and the residual effects ofresidential schools – the absence of familialrole models, and personal abuse or seeingothers abused.59 Poverty, endemicunemployment in some communities, and asevere lack of housing that “throws peopletogether” are other factors affecting thelikelihood and the impact of abuse orneglect of older adults.60 In contrast,important protective factors exist withinnative and other communities that tempernegative factors and make abuse of olderadults less inevitable.61

4. Gays and lesbians

Older gays and lesbians may experiencespecial difficulties such as stigmatization,sexual stereotyping, discrimination andfamily alienation, leaving them vulnerableto neglect or self neglect. Professionalattitudes are a significant barrier,62 andtherefore, gays and lesbians may havedifficulty accessing health and socialservices. Discrimination over a lifetime canleave older gays and lesbians mistrustful ofhealth and social services63 – if abuse orneglect occurs in a gay or lesbian couple’srelationship, they may remain isolated withfewer formal protections.

5. Low literacy

Although there is considerable diversityamong older adults as a whole, they aremuch more likely than other age groups tohave low functional literacy which makesthem vulnerable to certain forms of abusesuch as violation of rights. According to the

1994 International Adult Literacy Survey,eight out of ten seniors in Canada operate atthe two lowest levels of functional literacy.64

Functional literacy and educational levelsare often closely tied: a significantproportion of older adults in Canada haveless than a high school education, and atleast a quarter have less than grade nine.65

F. What is the impact of abuse andneglect of older adults?

1. Health impact

Abuse and neglect at any age can havesignificant effects on a person’spsychological and physical health, socialand financial wellbeing, and security.

The 1999 Canada General Social Surveyshowed that female victims of spousalviolence were two to three times more likelythan women who had not been victimized tohave trouble sleeping, or to use medicationsto help them sleep, calm down, or deal withdepression.66 Depression is much morecommon among abused older adults thanother older adults.

Biological evidence suggests that peoplewith more negative interactions in their livesare more likely to have elevated stresshormones, increased cardiovascular activity,and depressed immune function, conditionswhich may present as depression orangina.67

Women who have endured violence most oftheir lives may experience indifference fromsome community practitioners who arereluctant to ask about the source of thepresenting symptoms. As a result, thepractitioner may address only the physicalsymptoms with medication, withoutidentifying the underlying causes.

Abuse can have a number of other effects onthe health of an older person:



September 2003 15

9 E.g., Gravel, S., Lithwick, M. & B eaulieu, M. (1997). Quand

vieillir ensemble fait mal; les mauvais traitements dans les couples

aînés. Crim inolog ie, 30 (2), 67-85.10 Pittaway, E., & G allagher, E. M. (199 5). A Guide to Enhancing

Services for Abused Older Canadians. Victoria, BC: British

Columbia Office for Seniors.11 Lithwick, M., B eaulieu, M., G ravel, S. & Straka, S.M . (1999).

Mistreatment of older adults: perpetrator victim relationships and

interventions. Journa l of Elder Abuse and Neglec t. 11 (4 ), 95-11 2. 12 Pittaway, & Gallagher, supra, n. 2.13 Canadian Centre for Justice Statistics, (July, 2002), supra., n. 12.

14 Prevalence focuses on how com mon the problem is in later life

among older Canadians; incidence refers to the number of new

cases.15 Pod nieks , E. (199 2). N ationa l survey on abus e of the elderly in

Can ada. Journal of Elder Abuse and Neglect. 4 (1/ 2), 5-58.16 Ibid., p. 54.17 Can adian C entre for Justice S tatistics. (July, 200 0). Family

Violence in Canada: A Statistical Profile, 2000. Ottawa: Statistics

Canada. Cat. N o. 85 -224 -XIE, at pg. 27. On line at:

http://www.statcan.ca/english/freepub/85-224-XIE/0000085-224-

XIE.pdf 18 Spencer, C . (1996). Diminishing Returns: An Examination of

Financial Abuse among Seniors. Vancouve r, BC: G erontology

Research C entre , Sim on Frase r Univer sity.19 Bélanger, L. (1981). T he types of violence the elderly are

victims of: personnel working with the elderly. Paper presented at

the 10th C anadian Associa tion on Geronto logy An nua l Scien tific

and Educational Meeting

- Grandm aison, A . (1988). Protection des personnes âgées: Étude

exploratoire de la violence à l’égard. De la clientele des personnes

âgées du C SSM M. Montrea l. Centre de Services Sociaux de

Montréal Metropolitain (CSSMM )20 She ll, D. (198 2). Protection of the Elderly: A Study of Elder

Abuse . Winn ipeg, MB : Man itoba Council on Aging. A lso:

- G. A . Frecker Association on G erontology (19 83). Summ ary

Repor t on Aging and V ictimization Including 19 83 St. John 's

Sur vey R esu lts. St. John's, NF: M emorial Un iversity of

Ne wfound land. Extens ion S ervice ;

- King , N . R . (1984). Exp loita tion and abuse of o lder family

mem bers: A n overview of the problem . In J. J. Costa (Ed .), Abuse

• Stress from abuse or neglect mayaggravate and accelerate thedevelopment of other health problems.

• Abuse itself can cause health problemsor death.

• Older adults typically have significantlyless physical resiliency (older bonesbreak more easily, take longer to heal)than younger persons experiencingsimilar abuse.

• Older adults in general have lessphysical strength and are less able todefend themselves.

• Certain injuries that might cause minorharm in younger persons, may lead todeath in older adults or life alteringsituations (e.g., disability, hip fractures, chronic pain, need for supports, move toassisted living).

Financial abuse also negatively affects thehealth of older adults. Not only doesfinancial abuse often involve psychologicalabuse, it also depletes the person's finances,reducing the ability to take care of their ownhealth with good nutrition and healthyactivities.

Abuse and neglect of older adults have asignificant impact not only on theindividual, but also on family andcommunity. For example, abused orneglected older adults with compromisedhealth may need increased help from familyand community services.

Abuse and neglect of older adults have asignificant intergenerational impact, notonly in terms of long-standing accusations,recriminations and guilt within families, butalso in terms of younger persons taking theircues from others on how older familymembers should be treated – they may cometo view these negative behaviours as thesocial norm. In native communities, abuseand neglect are considered the community’sproblem even more than the individual’s,because abuse undermines the health of allaround him or her.68

2. Social and economic cost of abuse ofolder adults

Significant tangible and non-tangible costsexist in the private and public sectors fromnot addressing abuse of older adults.Community health and social services,businesses serving older adults, andgovernment all feel the impact of abuse andneglect of older adults – frequent use ofhealth service, more medical insuranceclaims, police called to domestic disputes,more lawsuits over questionable financialtransactions, premature institutionalplacement, and more need for monitoring.69



September 2003 16

of the Elderly: A Guide to Resources and Services (pp. 3-12).

Lexin gton, M A: Lexing ton B ooks ;

- Haley, R . C. (1984). Elder abuse/neglect. Halifax, NS:

De partm ent of Soc ial Services ;

- Stevenson, C . (Oc tober, 19 85). Family Abuse of the Elderly in

Alberta . Edmonton , AB ;

- On tario Advisory Council on S enior C itizens (19 85). Repor t On

Survey of Elder Abuse in the Comm unity. Toronto, ON : On tario

Adv isory Cou ncil on Senior C itizens. 21 Weeks, L, Nilsson, T. & Begley, L. E lder Abuse in P EI:

Attitudes of Professionals. As noted in: Devon Dodd, J. , Chaulk, P.

& S mith, N. (D ecem ber 20 01). Abuse of Older Adults: A Report of

Priorities in Prince Edward Island, (PEI Centre for Health and

Agin g & PE I Sen ior C itizens Federation ). O nline a t:

www.upei.ca/~csh a/research/abuse/consu ltationresults/consultation

resu lts .h tml and

www.upe i.ca/~csha /re search/abuse /factsabou t/factsabou t.h tml22 Canadian Centre for Justice Statistics. (2000), supra, n. 4 at

page 2 7. 23 Dauvergne, M. (M arch, 2003). Family violence against seniors.

Canadian Social Trends, No. 68. 10-14, at 13.24 Canad ian C entre for Ju stice S tatistics . Fam ily Violence in

Canada: A Statistical Profile, 2002. Ottawa, ON: Statistics Canada:

Cat. No. 85 224 XIE at pg. 30. On line at:

www.statcan.ca/english/freepub/85 224 XIE/85 224 XIE00002.pdf25 Can adian C entre for Justice S tatistics, ibid. 26 Can adian C entre for Justice S tatistics. (July, 200 3). Family

Violence in Canada: A Statistical Profile 2003. Ottawa: Statistics

Canada Cat. N o. 85 -224 XIE., at pg . 25 . Online a t:

http://w ww .statcan.ca/english/freepub/8 5-22 4-XIE/free .htm 27 Lithwick, B eaulieu, G ravel & S traka, (1999), su pra, n. 3 . 28 World Health Organization , Prevention of Elder Abuse. Online

at:

http://www.w ho.int/hpr/ageing/elderabuse.htm#Risk% 20factors.

Retrieved: July 6, 200329 Can adian C entre for Justice S tatistics. (July, 200 2). Family


Canada Cat. N o. 85 -224 XIE, at page12. O nline a t:

http://www.statcan.ca/english/freepub/85 224 XIE/85 224

XIE00002.pdf30 E.g., Gravel, Lithwick, & Beaulieu (1997), sup ra, n. 1. Also:

- M ontm iny, Lys e (2 000). Les re présentations sociales de la

violence psychologique vécue par des conjointes âgées. Thèse (de

doctorat)--U niver sité Laval;

- High tower, J ., Sm ith, M . J. & High tower, H . (2001). Silent and

Invisible: A report on abuse and violence in the lives of older

women in British Columbia and Yukon (B.C./ Y ukon Society of

Transition Houses), p . 18 . Executive su mmary on line at:

www.bcysth.ca/ExSum.pdf31 Can adian C entre for Justice S tatistics. (July, 200 0). Family

Violence in Canada: A Statistical Profile 2002. Ottawa, ON:

Statis tics C anada. C at. N o. 85 -224 -XIE, at page 15.O nline a t:


XIE.pdf 32 Statistics C anada, sup ra, n. 933 Alzheim ers A ssoc iation. Caregive r Stre ss (C oping). O nline a t:

http://w ww .alz.org /Caregive rs/C oping/care givers tress .htm

Retrieved July 6, 200334 Ibid.35 Williamson, G .M . & Shaffer , D .R. (Jun e, 20 01) . Re lationship

quality and potentially harmful behaviors by spousal caregivers:

how we w ere then , how we are now . Psychology and Aging. 16

(2), 217-226.

36 Spencer, C . STEPS: U nderstandin g vic timization of senior s in

rental housing. Paper presented at Ontario Elder Abuse

Conference: Sharing Solutions, Defining the Future. November 18-

20, 2002 , Toronto , ON37 Spencer, ibid . 38 Bergeron, R . (1999). D ecision-making and adult protective

services worke rs: Identifying critical factors. Journal of Elder

Abu se & N eglect. 10(3/4), 87-113.39 See for example, Ontario Hum an Rights Comm ission (2001)

Time For A ction: Advancing Huma n Rights For Older O ntarians.,

pg. 5 1-54 . Online a t:

http://www.ohrc.on.ca/english/consultations/age-consultation-

rep ort_1 .sh tm l.40 Ontario Human R ights Comm ission (2001), ibid.41 Pittaway & Gallagher (1995), supra, n. 2.42 M outon, C . P., Talamantes, M ., Parke r, R.W ., Esp ino, D .V.,

M iles, T.P. (2 001). Abuse an d neg lect in older m en. Clinical

Gerontologist. 24 (3-4), 15-26; - Kosb erg, J.I. (1998). Abuse of

elderly men. Journa l of Elder Abuse and Neglec t. 9 (3), 69-88;

- Kosberg J. I. & M angum, W . P. (2002). Invisibility of older men

in geron tology. Gerontology and Geriatrics Education, 22 (4), 27-

42.43 B.C. C oalition to Eliminate Ab use of Sen iors. (May, 200 3).



Victoria: B.C 44 B.C. Coalition to Eliminate Abuse of Seniors (2003), supra, n.

31

- Lithwick, B eaulieu, G ravel, & S traka, (1999). su pra, n. 3 . 45 National Cen ter on E lder Ab use. (S eptem ber 19 98). The

National E lder Abuse Inciden ce Stud y; Fina l Repo rt., Washington,

DC: National Center on Elder Abuse. 133p, at Chapter 4-12.

On line at:

http://www.aoa.gov/abuse/report/default.htm#TopO fPage.

Retrieved July 8, 2003.46 Crichton, S., Bond, J., Harvey, C. & Ristock, J. (1999). Elder

abuse: fem inist and ageist pers pectives. Journal of Elder Abuse

and Neglect. 10 (3/ 4), 115-130.47 Vida, S., M onks, R.C ., & D es Rosiers, P. (Ju ne, 2002 ).

Prevalence an d correlates of elde r abu se an d neglect in a geriatr ic

psych iatry service. Canadian Journ al of Psychiatry, 47 (5), 459-

68.48 Gallagher, E. (M ay 1993) . Vic toria E lder A bus e Projec t.

(Victoria, B C).

- See also, A netzberger, Palmisano, Sanders, B ass, Da yton, E cker t,

& Schimer, (2000), supra, n. 23.49 Rosenbe rg, M . & M oore, E . (19 97 ). The health o f C anada's

elderly popu lation: current s tatus and future implication, Canadian

Medical Association Journal, 157, 1025-32.50 See fo r exam ple, Pittaway, & G allagher (1995), su pra, n. 2 . 51 Reay, A. M . & B rowne, K .D. (Febru ary, 2001). Risk factor

characteristics in carers w ho physically abuse or neglect the ir

elderly depen dents. Aging a nd M enta l Health . 5 (1), 56-62.52 Seeking Solutions: Canadian Community Action on Seniors and

Alcohol Issu es. "Elder abu se." On line at:

http://w ww .aginginca nada.ca /Sen iors% 20A lcohol/1e6.h tm53 Pittaway & Gallagher (1995), supra, n. 2 at 31.

54 Gallagher, supra, n. 39.

55 Osgood, N. & Man etta, A.A. (2000-2001). Abuse and su icidal

issues in older w om en. Journal of Death and Dying. 42 (1), 71-81.56 See fo r exam ple,

- Association canadienne des centres de vie autonome/ Canadian

Association of Independent Living Centres. (1995). Modèle de

prévention des mau vais traitements exercés à l’endroit des

http://www.upei.ca/~csha/research/abuse/consultationresults/consultationresults.html


http://www.upei.ca/~csha/research/abuse/factsabout/factsabout.html

http://www.statcan.ca/english/freepub/85-224-XIE/85-224-XIE00002.pdf

http://www.who.int/hpr/ageing/elderabuse.htm#Risk%20factors



http://www.bcysth.ca/ExSum.pdf

http://www.statcan.ca/english/freepub/85 224 XIE/0000085 224 XIE.pdf


http://www.alz.org/Caregivers/Coping/caregiverstress.htm



September 2003 17

pers onnes aîn ées ayant une incapacité: u ne approche de la vie

auton om e en com munauté ru rale (O ttawa , ON: L’ Associa tion);

- Roeher Institute (1995). Harm's Way: The Many Faces of

Violence and Abuse Against Persons with Disabilities. (Ontario:

Roeh er Institute). 57 Nova Scotia Department of Comm unity Services. Fact Sheet 8:

Abuse of Persons w ith D isabilities. O nline a t:

http://w ww .gov.n s.ca /com s/files/fa cts8 .asp#front158 Jiwan i, Y. (1998). Rural Women and Violence: A Study of Two

Comm unities in British Columbia. On line at:

ww w.h arbour.s fu.ca/fred a/articles/rural00.htm Retrieved July 6,

2003.59 B.C. C oalition to Eliminate Ab use of Sen iors. (Fall, 2002).

Spiritua l Unity: Respect an d N ative Elders . A Shared Concern, 10

(4) 1, 5.60 Sp encer, C . (1995). Abuse and neglect of na tive senio rs. In

Changing Families, Changing Directions Conference Proceedings

Nov. 16-1 9, 1994. Va ncouver BC: BC Ins titu te A gains t Family

Violence .

- Also, Sm ylie. J. (January, 2001 ). A Gu ide fo r Health

Professionals Working with Aboriginal Peoples: Health Issues

Affec ting Ab original Peop les. Journal of Society of Obstetricians

and Gynaecologis ts of Ca nada. On line at:

www.sogc.org/SOGCnet/sogc_docs/common/guide/pdfs/ps100_2.

pdf Retrieved July 8, 2003.61 Carlson, D. K. (1995). American Indian elder abuse: risk and

protective fac tors am ong the o ldest Am ericans . Journal of Elder

Abuse and Neglec t. 7 (1), 17-39.62 Brotman, S., Ryan, B. & Cormier, R. (2003). The health and

socia l services needs of ga y and lesbian elde rs and the ir fam ilies in

Can ada. Ge ron tolog ist , 43 (2), 192-202.63 D'Augelli, A. R. & G rossm an, A.H . (Oct. 2001 ). Disclosure of

sexual orientation, victimization, and mental health among lesbian,

gay, and bisexu al older adu lts. Journal of Interpersonal Violence.

16 (10), 1008-1027.64 Rob erts, P. & Fawcett, G. (N ov. 199 8). Internatio nal A dult

Literacy Survey, At Risk: A Socio Economic Analysis of Health and

Literacy Among Seniors . Ottawa, O N: Statistics Canad a. Cat. No.

89-5 52-M IE, no . 5, a t pg. 2 8. O nline a t:

http://w ww .statcan.ca/english/freepub/8 9F0 104 XIE/high3.h tm65 Gutm an, G., W ister, A., Carriere, Y. & Tredw ell, S. (2000 ).

Factbook on Aging in British Columbia, (3rd ed.) Vancouver, BC:

Gerontology Research Centre, Simon Fraser University, p. 47.66 Can adian C entre for Justice S tatistics. (July, 200 0). Family

Violence in Canada: A Statistical Profile 2002. Ottawa, ON:

Statis tics C anada. C at. N o. 85 -224 -XIE. On line at:


XIE.pdf at 18.67 See, Seeman, T. E. (July/August, 2000). Health promoting

effects of friends and family on health outcomes in older adults.

American Journal of Health Promotion. 14 (6), 362-370.68 Aboriginal Nurse s Association of Can ada. (Augu st, 1992).

Abuse of Elders in Aboriginal Comm unities. 69

Spencer, C . (July, 200 0). Exp loring So cial and E conom ic Costs

of Abus e Ag ains t Sen iors in Canada . Unpu blished report. H ealth

Canada: Fam ily Violence P revention Un it.

http://www.gov.ns.ca/coms/files/facts8.asp#front1

http://www.harbour.sfu.ca/freda/articles/rural00.htm

http://www.sogc.org/SOGCnet/sogc_docs/common/guide/pdfs/ps100_2.pdf





September 2003 18

IV. What Canada is Doing to Address Abuse of Older Adults

A. Government action

The federal government and severalprovincial and territorial governments haveidentified abuse and neglect of older adultsas a matter of concern, and haveincreasingly voiced this social issue as apriority, either on its own or as part ofoverall family violence prevention (e.g., LeQuébec et ses aînés: engagés dans l'action,Engagements et perspectives 2001-2004;the 2001 Alberta Seniors Policy Initiative).

Since the mid 1990s, a Working Group ofthe Federal/Provincial/Territorial MinistersResponsible for Seniors has addressed thebroad issue of seniors safety and securityand currently is focussing on abuse. Thispaper is a step in identifying potentialpriority areas for action, and is beingdisseminated to promote informationsharing among jurisdictions and variousministries about Canadian strategies andlegislation, and the challenges to beaddressed.

Federal, provincial and territorialgovernments are responsible for the variouslegislative tools that may be used tointervene in cases of abuse and neglect ofolder adults. In addition, some governmentresources are available to support bothprevention and intervention efforts at thecommunity level.

Over the years, the Family ViolencePrevention Unit of Health Canada hasaided the development of a variety ofprevention and education materials on theissue. Recently Justice Canada has fundedseveral community projects in differentparts of the country that address abuse and

neglect of older adults through the CrimePrevention and Community MobilizationInitiatives.

Several provinces have begun allocatingdedicated funding to abuse of older adults.Manitoba has established an elder abusestrategy including two provincial positions (anelder abuse consultant and an elder abuseresource coordinator); the Seniors AbuseLine; education and awareness; andcommunity development to ensure thatresources are available and accessible toabused older adults.

In March 2002, Ontario allocated $4.33million to a five-year Elder Abuse Strategy,concentrating on three priority areas:

• co-ordination of community services; • training for frontline staff working with

seniors; and • education to raise public awareness about

elder abuse.70

The Strategy included the hiring of eightRegional Elder Abuse Consultants, oneProvincial Elder Abuse Coordinator, and onePublic Education and Training Developer.

Drawing from diverse federal and provincialsources, Quebec community groups haveobtained funding for the Quebec Network forthe Prevention of Elder Abuse and aprovincial conference, and have embarked ontwo major research endeavours

These efforts, as well as those in otherjurisdictions, are valuable first steps.For community programs to be effective, theyrequire sustained political commitmentdemonstrated with both government andcommunity level funding and personneldedicated to the issue. Governmentsincreasingly recognize the need for keystarting points to have abuse and neglect ofolder adults addressed in a morecomprehensive and coordinated manner overthe long term.

Abuse and neglect of older adults is a multi-layered, multi-disciplinary and multi-sectoral

What Canada is Doing to Address Abuse of Older Adults


September 2003 19

issue crossing many mandates withinprovincial, territorial, and federalgovernments. As a result, comprehensiveinterventions to address abuse and neglectof older adults require various ministries torecognize how their policies and prioritiesaffect the likelihood of abuse and thesuccess of mitigation when abuse occurs.

Appendix C illustrates a number ofministries with mandates that provideopportunities to address facets of theproblem of abuse and neglect of olderadults.

B. Community commitment

During the past decade, many Canadiancommunities have had a long standingcommitment to addressing abuse of olderadults, leading to promising developmentsin prevention and assistance by grassrootsand frontline organizations. However, someof this community potential was diminishedby recent broad sectoral restructuring (e.g.,in health care, social services and legalservices), which reduced key staff at boththe government and community levels.Community programs endeavour tomaintain some level of services to abusedand neglected older adults but their effortswould be much more effective withsustained commitments from all levels ofgovernment.

C. Volunteer commitment

Volunteers are the backbone of manyCanadian programs and services geared tohelping abused or neglected older adults.Those working in the volunteer sector toprovide supports to older adults note thepool of volunteers in Canada has beendecreasing seriously.

Among seniors, the percentagevolunteering decreased from 23% in 1997to 18% in 2000, and among younger groups

the decrease was even more pronounced. Theaverage number of hours that the remainingseniors volunteered increased from 202 hoursto 269 hours annually. In addition, 55- to 64-year-olds volunteered on average an extra 21hours annually in 2000 compared to 1997. Inother words, fewer people are carrying onmore of the volunteer workload, oftenresulting in burnout. This is a dismaying trendas much of abuse prevention and interventionwork is done by senior volunteers.

The volunteer commitment remains, but needsto nurtured. Non-profit organizations point outthat there is an ongoing need to activelyrecruit and retain volunteers, and to monitorand support them in their work. To besuccessful requires paid volunteer coordinators.

D. Key legal approaches in Canada

Legal approaches to abuse and neglect focuson stopping or reducing harms after abuse hasoccurred.

1. The current national situation

The main legal approaches to the protection ofolder adults from abuse and neglect that haveevolved in the common law provinces andterritories of Canada are:• adult protection and adult guardianship

legislation;• family violence statutes; and • criminal law.

The Province of Quebec relies upon thecuratorship provisions of the its Civil Codeand, to some extent, provincial human rightslegislation.

Laws are applied in a wide range ofcircumstances, from situations where abusedor neglected older adults have no difficultieswith mental capability, to situations where itis in flux, deteriorating, or minimal.



September 2003 20

The scope of the laws and the ways in whichthey are operationalized are importantfactors in their effectiveness in preventingabuse or addressing it if it occurs.Appendix D provides an outline oflegislation across Canada, scope andcoverage, and principal remedies.

Following are descriptions of the principaltypes of legislation and how they are usedin various jurisdictions.

(a) Adult protection

In general, adult protection legislationprovides for both emergency and moregradual intervention in the lives of abusedor neglected adults so that a range ofhealth, social and other services may beprovided, preferably on a voluntarilyreceived basis.71 These initiatives firstappeared in the mid 1970s (beginning inNewfoundland and Labrador), and therehas been extensive legislative developmentsince, particularly over the past 10 years.72

Interventions under adult protection lawsare the responsibility of a statutorilydesignated service, usually a provincialhealth and social service department.Services may include the kinds of short-term, financial management servicesprovided by a provincial public guardianand trustee service without the need to gothrough the expensive, time-consuming andstigmatizing process of applying to a courtfor a guardianship order.

As a last resort, health and personal careservices may be imposed upon an abused orneglected adult for a limited period of time(usually up to 12 months). The servicesmust be needed, the adult has to bementally incapable of making decisionsabout the services, and a court must grantan order for the services to be providedwithout consent.

The orders may include provisions thatrestrain the person responsible for the

abuse of a mentally incapable adult, and mayrequire adult children to pay maintenance totheir abused parent. Adult protection statutesmay be strengthened by new public guardianand trustee legislation that sets out clearpowers for personnel to conductinvestigations, especially in cases of financialabuse.73

(b) Adult guardianship

Under adult guardianship laws, if an abused orneglected adult is mentally incapable ofprotecting him or herself, or property from anabuser and needs health, social, legal, andperhaps financial services, then a temporaryguardianship order may be obtained by aninterested party (e.g., a near relative, or aprovincial public guardian and trusteeservice). The temporary order may beconverted into a long-term order, dependingupon the needs of the incapable adult. As analternative, provincial legislation governing“substitute consent” to health care, personalcare, and admission to a care facility may beused to secure these services without aguardianship order. An increasing number ofjurisdictions are adopting “substitute consent”legislation, including Yukon, BritishColumbia, Saskatchewan and Ontario. Thefamily or domestic violence legislationdiscussed below may be used in conjunctionwith the protection provisions of the new adultguardianship statutes to provide for restraintof abusers.

(c) Human rights law in Quebec

In Quebec, although curatorship(guardianship) may be imposed in emergencysituations to protect an adult’s property, thereis no provision under curatorship for theprotection of the physical person. Instead,there may be some recourse through article 48of the Quebec Charte des Droits et Libertés dela Personne, which recognizes an olderperson’s right to protection againstexploitation and abuse. An abused older adultor someone acting on the adult’s behalf, maylay a complaint with the Commission des



September 2003 21

droits de la personne et des droits de lajeunesse, which in turn may lead to aninvestigation and mediation. If mediation isunsuccessful the Commission can proposeother measures including the cessation ofthe abusive act and the payment of anindemnity. The matter may be referred tothe Human Rights Tribunal, or to a courtwith appropriate jurisdiction, ifenforcement measures are required. 74

The scope of the Charter section and theprocess required have several limitationsthat may reduce the potential effectivenessof the remedy.75

(d) Family violence statutes

Family violence or domestic violenceintervention statutes are a relatively newapproach to the issue of abuse and neglectof older adults. The provisions of theintervention statutes vary slightly betweenjurisdictions but, generally, follow the samebasic approach: a court can issue protectionorders directing an abusive family member(usually, a spouse) to stay away from thetarget of his or her violence (e.g., the otherspouse), as well as the abused individual'sproperty. Restraining orders are issued atthe discretion of the court, on theapplication of any affected party or thepolice. Temporary emergency interventionorders (restraining orders) may also beobtained from a justice of the peace. Ineither case, if an abuser defies the order, heor she may be arrested by the police.

The primary focus of family or domesticviolence intervention legislation is onsafety and physical protection (althoughsome of the laws also cover threats,intimidation).76 The legislation does notdeal with other forms of abuse such asfinancial abuse, one of the main categoriesof abuse affecting older adults,77 althoughsome victim assistance orders deal withcertain kinds of financial matters.78

Domestic violence intervention legislation

is crisis oriented and used only in domesticabuse situations.

Domestic violence directed at older adultsmay come from the person’s spouse, a new orformer partner, the adult’s grown children,grandchildren or other relatives. The abusiveperson may be living with the older adult, orin a separate residence. Depending on thejurisdiction, the legislation may or may notcover the types of domestic violencerelationships that older adults can experience.(See Appendix D for details.)

For example, some jurisdictions do notprovide for interventions if the abuse iscommitted by someone other than a spouse.Other jurisdictions may include abuse bysomeone outside the victim’s family, but mostdo not cover an abusive relative or otherperson who is not residing in the samehousehold.79 Manitoba has proposedamendments to its domestic violencelegislation to make it more applicable tosituations of abuse of older adults.

The legislation provides for emergency andlonger-term restraint of an abuser, but doesnot address the need to provide a victim withsupport, assistance and services, especiallywhen the abused adult is incapable and wouldbenefit from such services. These services, atleast for incapable older adults, may beobtained in other ways; for example, through aguardianship application, mental healthlegislation, or substitute consent legislation(where it exists) for health care, personal careand care facility admission.

One danger associated with the use oftemporary guardianship orders to provideservices is that the adult may be subjectedunnecessarily to a more permanentguardianship order.

(e) Criminal law

It is widely recognized that many forms ofabuse or neglect may constitute violations ofthe Criminal Code of Canada. These include



September 2003 22

sexual and physical assaults, and crimes ofdishonesty such as theft and fraud. At thesame time, it is acknowledged that: • the criminal law is not used very often

to address abuse and neglect of olderadults;

• charges are laid only infrequentlycompared to domestic violence forother age groups; and

• prosecutions are difficult.

The victims may be reluctant co-operatewith criminal prosecutions that may resultin a close relative (often an adult child)being convicted and punished. Inparticularly serious and protracted criminalcases, the abuser can simply outlast thevictim, whose health may deteriorate in theinterim. In other instances, the primarywitness (the victim) may experience mentalincapacity.80

Barriers exist within the justice system thateffectively “shut out” many older adultsfrom having their abuse situations treatedas crimes, including:• lack of police training to recognize and

appropriately respond to abuse of olderadults;

• lack of appropriate interviewingtechniques to draw the best and mostreliable information from older adults;

• under-utilization of collateralinformation from those with directknowledge of abuse;

• under-development of special skills forlawyers regarding the needs of olderclients and aging issues;81

• an unsupportive legal environmentwhich may ignore older adults or treatthem in a paternalistic way, and lacksappropriate victim services to helpolder adults in the legal process;

• policies that divert cases of abuse ofolder adults;

• lack of recognition of abuse issuesaffecting older adults by the Crown andjudges.82

Many of these existing barriers have beenidentified in other areas of family violencesuch as wife abuse, with ongoing efforts toreduce the barriers through training, educationand policy development. However, progresshas lagged in addressing attitudes andpractical barriers that older adults canexperience.

2. Discussion

There are many challenges with the currentsystems of legislative approaches:

(a) Limited scope in adult protection

Adult protection provisions focus on meetingthe needs of mentally incapable victims ofabuse. The intervention that occurs throughadult protection legislation seldom includes allor even most of the forms of abuse or neglectthat the older adult may experience, 83 and theprovisions of the law may be selectivelyapplied.84

The adult protection statutes do not precludeuse of the Criminal Code to deal with thoseresponsible for abuses but, in reality, they areseldom used together. Adult protectionlegislation and protection provisions incriminal law can and should work incombination, and in some jurisdictions,significant efforts have been made to ensurethat they do so effectively.

(b) Paternalistic over-reach in adultprotection

Adult protection legislation has been criticizedas an overly paternalistic form of interferencethat inappropriately parallels child protectionlegislation leading to an infantilization ofabused older adults. The problem may beparticularly acute when the personnelintervening in abuse cases have not beensensitized to the need to respect an abusedadult’s right to autonomy and self-determination.



September 2003 23

(c) Inadequate resourcing at all levels

The lack of availability and use ofappropriate assistance and support servicesfollowing an intervention in a situation ofabuse or neglect of an older adult continuesto be a matter of concern. With shrinkinghealth and social service budgets in mostjurisdictions, any intervention that occursmay not be followed up with the provisionof appropriate services and support becausethey are non-existent or have beendrastically reduced.85 This casts doubt onthe value of intervening at all.

3. A glimpse at mandatory reporting

The issue of whether the public or certainprofessions should have a responsibility toreport abuse of older adults (similar to childabuse) frequently surfaced in communityand legislative discussions in the 1980s,and continues to arise in communitydiscussions from time to time.86 Thearguments for mandatory reportingtypically centre on the need to demonstrateto society that abuse of older adults isimportant, and to move service providers toaction. Critics of mandatory reportinghighlight the potential breach ofconfidentiality, the cost of a reportingsystem, and potential undermining of trustin the relationship between the serviceprovider and the older adult. They alsoemphasize that abused older adults are notchildren, and they have the right to controland make decisions about their lives.

Only Nova Scotia and Newfoundland andLabrador (which has legislation dealingwith neglect rather than abuse) havegeneral mandatory reporting requirements.Manitoba has enacted mandatory reportingfor the members of the helping professionsand other key individuals when dealingwith abuse of persons with developmentaldisabilities. In Alberta, the Protection ofPersons in Care Act makes it a requirementto report any suspicion of abuse in publiclyfunded care facilities, including hospitals,

nursing homes, and seniors’ lodges. Thelegislation in Prince Edward Island, NewBrunswick, and British Columbia provides forvoluntary reporting for specific forms ofabuse and neglect. In the remaining provincesand territories, either no legislation exists or itis silent on the matter of reporting.

4. Possible new directions

A comparative analysis of the effectiveness ofthe legislative approaches in Canada is longoverdue. Very little data are publicly availableat this time although some informationundoubtedly could be recovered byresearchers from the operational statistics ofthe departments, ministries, and otheragencies responsible for interventions.87 AsGordon (2001) points out, with the possibleexception of Nova Scotia where an evaluationhas been undertaken, no one really knowswhat works and what does not, beyond theanecdotal.88 A comprehensive, nationalanalysis is warranted especially since thelegislative field is sufficiently settled to allowresearch of this kind to be undertaken.

(a) Justice training needs

A need exists for special awareness and skillstraining on abuse and neglect issues affectingolder adults, and the handling of such cases, atall levels of the criminal justice system.Community experience in several parts ofCanada has shown that training for police andrelated services (victim services) is mosteffective when it: • originates from within (an internal and

supportive peer approach) and• has the support of management to

legitimize the police officer’s work.

Adding other community partners to thetraining sessions provides additionalperspectives and can be the impetus for a teamor interdisciplinary approach to helping.

Protocols and templates are also helpful.British Columbia has established a “CriminalJustice System Working Group,” established



September 2003 24

under the auspices of the provincial PublicGuardian and Trustee and comprised ofrepresentatives of justice and otheragencies and groups. The Group hasrecently produced policy and practicetemplates for all R.C.M.P. detachments andmunicipal police departments in theprovince to aid the handling of cases ofadult abuse and neglect.

(b) Looking for alternatives

(i) Restorative justice

The restorative justice approach holdspotential for the future management ofcertain types of abuse cases. Restorativejustice responds to crime in ways that buildcommunity. The approach requires arethinking of how crime is understood andhow accountability is defined. It focuses ondealing with the harmful effects of crimeby engaging victims, offenders, and thecommunity in a process of reparation,healing and peace through communicationand joint problem solving.

Restorative justice can be achieved throughvarious practices including victim-offendermediation, sentencing circles, orcommunity conferencing. In the process,community members can become morecompetent to respond appropriately whenharm occurs. They learn to handle moreproblems effectively on their own before anissue becomes a criminal matter.89

Pilot projects in Ontario’s RestorativeJustice Program are contributing to theknowledge base.90 In the pilot projects,approximately 148 people were involved ineleven completed cases. While therestorative justice model may be a way ofproviding an opportunity for change andhealing to older adults affected by abuseand neglect, some concern has beenexpressed that it is easy for the abused to bere-victimized and the process may beanother way that abuse of older adults isdefined as something less than a crime.91

(ii) Family violence and domestic violencecourts

These courts, established as branches of courtsof summary jurisdiction (e.g., the YukonTerritorial Court), are now in operation in anumber of centres in Canada includingWhitehorse, Calgary, Winnipeg and manyparts of Ontario. The courts deal solely withthe different forms of family violence, andfocus on offenders’ problems, and relatedsolutions, rather than their culpability.

In Winnipeg, the court recognizes the specialnature of family violence and looks for waysof tackling the issues and dynamics that haveproduced violence. The court also expeditesthe processing of cases and ensures thatfamily violence cases are prosecuted. Casesare dealt with by specially trained personnel atall levels (including judges).

In 2003-2004, Ontario will expand itsdomestic violence courts program with anadditional 23 sites for a total of 54. Teams ofspecialized personnel including police, CrownAttorneys, and staff from Victim/WitnessAssistance, Probation Services, PartnerAssault Program and other communityagencies, work together to intervene early inthe cycle of domestic violence, improvesupport to victims, and more effectivelyinvestigate and prosecute domestic violencecases.

Any expansion of special family (domestic)violence courts to deal with cases of abuse ofolder adults should meet two essentialpreconditions:• proper court and community resources to

meet older adults’ needs, and • proper training on aging and abuse for the

judiciary and others in the judicial system.

The Winnipeg court has dealt with someabuse cases involving victims over 60 years ofage, and abusers have included spouses, adultchildren, and caregivers. It would bebeneficial to have evaluations of the use of



September 2003 25

domestic violence court initiatives forabuse cases involving older adults.

E. Key program approaches in Canada

1. Prevention and education

The primary program approach taken inCanada to address abuse and neglect ofolder adults understandably has been onprevention and education.

Abuse of older adults as a social issue is arelative latecomer having only beenrecognized as such in the early 1980s, withpreliminary education efforts beginningabout the mid 1990s. People are frequentlyunaware of abuse of older adults, or theymay see harms happening but not identifythem as abuse or neglect. Abuse andneglect of older adults typically happen inthe family, hidden from public viewbecause older adults tend not to have thesame social contacts that arise for children(schools) or younger adults (workplace).

Those working in the area of senior abuseprevention note the overlap betweenprevention work and intervention –prevention programs must be prepared tointervene with assistance if a seniordiscloses abuse and wants help.A recent national survey on family violencehighlights the relative lack of visibility ofabuse and neglect of older adults. Thereport notes:

“Violence between spouses and byparents toward their children are thetypes of relationships Canadianstend to think of most when thinkingabout violence occurring in theimmediate family. (Violence amongsiblings is considerably less likelyto come to mind when Canadiansthink about violence within theimmediate family and abuse ofelderly parents is rarelymentioned.)” 92

Abuse against seniors was mentioned in only1% of the responses of 2100 Canadians.93 While three out of five Canadians surveyedcorrectly identified failing to provide food,shelter or medical attention as “familyviolence”, far fewer identified financial abuse,one of the most common forms of abuse forolder adults, as family violence.94 Only 1 in 10people in the survey considered “abuse ofelderly” as the greatest cause for concern infamily violence. Most of those who did wereolder adults or residents of Quebec.95

Significant community and government efforthas taken place in the past three decades toraise the visibility of child abuse and wifeabuse, so that now far fewer people considerthese to be personal matters but ratherimportant social concerns. Similar effortsconcerning abuse of older adults will ensurethat harms across the lifespan are recognizedand addressed in an equitable manner.

(a) What is the purpose of prevention andeducation in this area?

The importance of educating older adultsabout abuse and neglect, as well as providinginformation about where to turn for help,cannot be overstated.96 Knowledge is powerand can help people to help themselves.Reliable information allows victims (orpotential victims) to protect themselves andtheir rights. This, in turn, contributes tofeelings of increased control and self-efficacy.97

Reliable information for service providersabout abuse and neglect of older adults ispivotal as well. Often it is service providers incontact with older adults who help in earlyidentification and intervention, so that furtherharms do not occur. Again, education alone isnot sufficient – service providers who giveolder adults information about abuse andneglect must be prepared to offer support orrefer a person disclosing abuse to appropriatesupport services.



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(b) What are the key prevention andeducation approaches being used?

In Canada, the focus has been a de-victimization approach directed at changingthe abused older adult’s sense of selfblame, rather than a responsibility approachwhich tries to change the abuser’s actions.98

Appendix E summarizes prevention andeducation approaches that are being used inCanada with specific examples. Following are some of the specialdirections that are being taken for specificaudiences. Different types of preventionmessages may be a needed depending onwhether the audience is the general public,older adults who have been abused or thosewho have not.

i. Prevention education for older adults

Effective provision of information on abuseand neglect increases self awareness andhelps abused older adults recognize thatthey are not alone. Prevention educationencourages people to consider, “Are theproblems I am struggling with ‘abuse’?”.Education and awareness help to de-stigmatize being abused. Older individualsand their families begin to recognize thatabuse is not a private matter of personalshame.

However, increased information is seldomsufficient to bring about change. A HealthCanada (2000) report points out “…knowing one's rights is one thing – actingon them is another.”99

The following are considerations forprevention education:

A shift in delivery: Initially prevention education tended to be small communitypresentations on abuse given at seniorcentres using videotapes, brief talks andbrochures. This approach tends to reach

those who are aging well, and it is less likelyto reach more isolated older adults.

The past decade has seen a shift in howprevention education is being delivered toolder adults. Increasingly, creative alternativesare developing. In some communities, olderadults are taking on the responsibility ofdelivering abuse prevention information in apeer-to peer-approach such as plays and skitsdeveloped by seniors’ theatre groups such as:• AQDR Granby “Des secrets bien gardes”

and “Parmi Nous” in Quebec,• Health Action Theatre by Seniors

(“HATS”) in Ontario.100

In the HATS approach, opportunities are buildin for the audience to actively identify keyissues and dynamics, as well as offeralternatives. Such interactive approachesreplace “talking at" older adults to "talkingwith them". Abuse and neglect are often twoof many issues that these groups present underthe broad topic of aging.

More information available about legalrights: Recently, more abuse preventioneducation has focussed on improving olderadults’ knowledge of their legal rights and ofcommunity resources. Much of this is beingprovided through community and publicorganizations such as Older AdultsKnowledge Network (OAKNET) in Alberta;BC Coalition to Eliminate Abuse of Seniors;the Advocacy Centre for the Elderly (ACE) inOntario; DIRA and Ligne info-abus inQuebec; and public legal education in severalprovinces. For example, OAKNET includesspecialized information on the Internet aboutemergency protection orders.

The Internet: The Internet is a useful sourceof information on abuse and neglect for familyand others who want to know more in order tohelp older adults: “Since many older peoplelive on low income, family and communityresources are important ramps on to theinformation highway for older generations.”101



September 2003 27

In terms of reaching abused older adultsdirectly, it is important to recognize thatmany of those who are abused may beamong the least likely to have access to theInternet, because of poor health, isolation,and lack of technological skills, literacyskills and interest. Also, the Internet lacksthe personal contact which is essential forhelping abused older adults.

Reaching beyond the mainstream: Canadais becoming increasingly ethnically diverse.One in three older adults has an ethnicorigin other than British, French, Canadianor Aboriginal.102

The challenge of diversity for abuseprevention work is much more than simplytranslating generic materials into anotherlanguage. Successful multiculturalprevention work involves:• capturing the essence of abuse and

neglect within the context of theparticular culture;

• framing the messages and educationapproach in a way that isunderstandable to that community;

• finding respected leaders to legitimizeand begin the education work;

• moving at the community’s pace,taking the time to do it right;103 and

• working with one ethnic community ata time.

Successful multicultural work also requiresappropriate community resources to meetthe support needs of abused or neglectedolder adults whose first language is neitherEnglish nor French. Education andawareness without locally available helpdoes little to change the status quo.

ii. Prevention education for family

Family is an important target group toreach concerning abuse of older adults.Aging spouses and other family provide80% of caregiving for older adults inCanada. Prevention messages can help toset and reinforce social norms of acceptable

and unacceptable behaviour toward olderadults. However, little prevention educationexists for families in Canada. Some schoolsoffer intergenerational approaches teachingabout respect, aging and abuse. Manitoba isworking with the Girl Guides, RCMP and theAddictions Foundation of Manitoba toestablish a guiding badge for Seniors Safetyand Security. Part of earning the badgeinvolves education about abuse of olderadults. The initiative includes use ofManitoba’s Seniors Are Cool video whichpromotes positive views of aging for youth.

The issue of abuse or neglect by familymembers giving care is seldom addressedhead on – the focus of education messages forfamily members providing care to older adultstends to be more on reducing stresses, andencouraging them to take better care ofthemselves.

iii. Prevention education for business

Overall only modest efforts have been madeto increase awareness about abuse and neglectin businesses serving older adults. Someintroductory work has been done in thefinancial industry through the “MoneyMatters” video and training produced by theB.C. Coalition to Eliminate Abuse of Seniorsfunded by Health Canada in the mid 1990s.

Private legal practice is another importantbusiness for consideration in this area. TheNational Elder Law Section of the CanadianBar Association was officially inaugurated onSeptember 1, 2002. It formally recognizes“elder law” as a legal speciality in Canada andopens up opportunities to build the skills andexpertise of formal advocates about legalissues affecting older adults, including abuseand neglect.104 The Quebec Human RightsCommission also has made specificrecommendations on the role and training ofnotaries in abuse prevention.105



September 2003 28

iv. Prevention education for the media

The media constitute one of the importantsources of positive and negative images ofolder adults in Canadian society. Abuseprevention education often involvesworking with the media to change negativeimages, raise awareness, and educate thegeneral public about abuse of olderadults.106

Recent social marketing campaigns providean opportunity to further raise publicawareness and increase commitment tobetter address abuse of older adults in thecommunity and in the political sphere.Alberta is undertaking a broad socialmarketing campaign on abuse of olderadults in the Fall, 2003. In 2002, the Mayorof Toronto dedicated the month of June asElder Abuse Awareness Month.

v. Prevention education for serviceproviders A wide variety of service providers are incontact with older adults at some time.Each of these groups needs education aboutaging and about abuse of older adults.Training is a means not only of impartinginformation, but also of buildingcommunity capacity and enhancing criticalrelationships among players. Trainingcontributes to a common understanding ofthe problem and of the appropriate meansof intervention, as well as to a shared senseof responsibility.107 The commoncomponents of education and training aboutabuse of older adults focus on recognizingabuse, expressing concern in a genuinecaring manner and helping the person linkto appropriate community resources.

All professionals and service providers incontact with older adults and their familiesshould know about aging and should have agood understanding of abuse of olderadults. They include professionals such asphysicians, lawyers, clergy, social workersand nurses, and also seniors organization

staff, speech therapists, Meals on Wheels,home support and many more. An examplecan be seen in faith communities. A survey inOntario revealed that two-thirds of faithleaders were aware of elder abuse among theircongregants.108 Although clergy are one of themost likely groups of caregivers to encountercases of abuse of older adults, they are theleast likely to refer cases to helping agenciesand have not been effective at intervention.Barriers to their effective involvement includelack of training, increased workload, andunfamiliarity with social and health caresystems.

What training resources currently exist?Health Canada is currently updating aninventory of the training resources, updatingan earlier resource publication. Thosedeveloping the inventory note the diverserange and quality of the training materialscurrently available.

What are the current challenges inprevention and education? Althougheducation and training is occurring,information is lacking about who is providingthe education and training, who is receiving it,who is being missed, and the depth of theinformation provided.

Challenges include difficulty reaching diverseCanadian cultures, and lack of time amongservice providers to take part in education andtraining.

Education and training takes time, money, andresources. Employers’ and employees’resources are often stretched, and in a time offiscal restraint, education and training areoften treated as luxuries. When they occur,they tend to be a “one shot deal”. Communityeducators find that basic awarenessinformation is not enough, and increasinglyservice providers are seeking practicalstrategies, sets of indicators, helpful resources,and local contacts.



September 2003 29

vi. Other learning opportunities

Some Canadian jurisdictions have createdvaluable opportunities to share informationon abuse through conferences and“stakeholder meetings” such as the OntarioStakeholder Networking Days. Provincialconferences dedicated to abuse issues forolder adults are often a valuable means ofsharing information about progress madeelsewhere in the province. Recentprovincial conferences include Ontario(November 2002) and Quebec (April,2003). Newfoundland and Labrador andOntario are planning elder abuseconferences for 2004.

The Canadian Association on Gerontology(CAG) holds an annual scientific andeducational meeting, where researchers,seniors’ groups and community serviceproviders present on abuse issues. Otherprofessional organizations, such as theAboriginal Nurses Association,Gerontological Nurses Associations, aswell as some seniors organizations, haveannual meetings with potentialopportunities to share abuse information.109

2. Network Development

During the past five years, there has beengrowing recognition among serviceproviders, seniors organizations,researchers and others, of the critical needto network at a local, provincial, nationaland international level on abuse and neglectissues in order to: • identify key issues and highlight new

ones that arise; • collaborate on developing strategies

and approaches; • ask questions, share information what

works well in different parts of aprovince or the country;

• develop an ethical framework forhelping;

• use the best information available; • compare approaches and continually

improve practice;110

• support each other in efforts in thiscomplex and difficult area; and

• advance the issue of abuse and neglect ofolder adults as a policy and resourcepriority.

To that end, regional and provincial networkssuch as the Quebec Elder Abuse PreventionNetwork, the Ontario Network for thePrevention of Elder Abuse and theInternational Network for the Prevention ofElder Abuse have been created. Canada has anascent national network, the CanadianNetwork for the Prevention of Elder Abuse. In some provinces, it has been difficult toplace abuse and neglect issues affecting olderadults on “the family violence agenda”. It isnot uncommon to find family violence reportsthat make little or no mention of olderadults.111

Other jurisdictions report greater success inbridging abuse of older adults and other typesof family violence. In the NorthwestTerritories, the 2003 Family Violence Weekcampaign focuses on older adults(“Respecting elders, respecting others”). Bill21, Family Violence Protection Act,introduced to the Northwest Territorieslegislature in June 2003 expressly offersfamily violence protection to older adults,including those who are being harmed by theirchildren or grandchildren.112

Support for networks will create manyopportunities to build on the promisingpractices and growing knowledge gainedfrom existing programs and pilot projects. Inthis way, new initiatives will not be forced tocontinually “reinvent the wheel”.

3. Support and assistance for abused andneglected older adults

(a) What we are trying to accomplish whenassisting abused older adults?

The type and degree of abuse createssubstantially different kinds of needs for theabused older adult including immediate and



September 2003 30

longer term needs. Where resources arescarce, the assistance available to abused orneglected older adults tends to have a crisisfocus – services become involved when theabuse reaches an “unacceptable” levelrather than focussing on working to reduceharms earlier or prevent the abusivesituation from escalating to a crisis.

(b) What key assistance approaches areoffered?

Appendix E provides descriptions ofvarious types of assistance available toabused and neglected older adults inCanada with specific examples. Below aredetails about some of those assistanceapproaches. i. Adult Protection approaches

The adult protection approach describedearlier under key legal approaches usuallyinvolves a combination of legal, health andsocial services that are primarily availableto “incapable adults”. Although sometimesdescribed in the literature as “allowing thewidest array of interventions”, in Canadathe “array” of services available for adultprotection in some jurisdictions is narrow.However, some provinces using an adultprotection approach have developed othermodels for assisting abuse or neglectedolder adults (e.g. peer support, expansion offamily violence approach to include olderadults).

ii. Domestic Violence programs

According to Health Canada (2000), thedomestic violence response to abuse andneglect of older adults consists of:

“a multi-pronged approach thatincludes crisis intervention services,such as telephone hotlines; astrengthened role for police in thelaying of charges; court orders forprotection; the use of legal clinics;emergency and secondary sheltering;support groups for both the abused and

the abuser; individual and family therapy;and the use of a whole range of health,social, and legal services. An integralcomponent of domestic violence servicesis educating the public, and especially,educating the abused about their rights.”113

Family violence approaches, which five yearsago might have been met with resistance byolder adults and service providers, areincreasingly being well accepted. Theyinclude specialized support groups for abusedolder adults (e.g., OWLS in Calgary,Edmonton Elder Abuse Peer Support Programrun through the YWCA) and “empowermentstrategies”.114 This growing acceptance mayreflect differences from one generation ofseniors to the next or differences in the waythe programs are being delivered (i.e., adeveloping sophistication based on experienceof what works and what does not work).

Nahmiash & Reis (2000) found that age-specific groups were more helpful thangeneral support groups.115 Peer support –visiting, or telephone support to break theisolation – is another important component ofthe family violence approach in severalCanadian communities, helping to rebuild theabused person’s self-esteem and to developnew supportive relationships. Little isavailable in most Canadian communities tohelp the person committing the abuse.

Concerning sheltering, recent reviews of thehousing needs and shelters for abused olderadults have identified many gaps. The report“Silent and Invisible” on B.C and Yukontransition houses identified significant barriersto older women.

The Kerby-Rotary Shelter located in Calgary,Alberta, is the only “purpose built” shelter forabused older adults. In Edmonton, the ElderAbuse Intervention Team utilizes “safesuites”, specific apartments allocated to meetcrisis and short-term needs of abused orneglected older adults.



September 2003 31

Throughout the country, there are significantgaps between need and capacity to meet itin terms of crisis, short- and intermediate-term housing for abused older adults. Thisin part reflects the overall lack ofaffordable housing across the country. As aresult of the shortages, staff in manyprograms are forced to prioritize dailywhich abused older adults they can help.Older men and older adults with complexneeds, such as mental health or substanceuse problems, are more likely to “fallthrough the cracks”.

iii. Advocacy programs

Health Canada (2000) notes:

“Advocacy refers to the actionsperformed on behalf of anindividual or group to ensure thattheir needs are met and their rightsare respected. …There can be twotypes of advocates, informal andformal. Informal advocates areusually volunteers, such as friendsor family, who do not take part in astructured program; formaladvocates are professionals, and arepaid for their services within thecontext of a structured program.”116

Examples of formal advocacy programsinclude the Advocacy Centre for theElderly (ACE) in Toronto, which has beenoperating since 1984 and funded throughLegal Aid Ontario,117 and BritishColumbia’s relatively new Legal AdvocacyProject which is coordinated by the B.C.Coalition to Eliminate Abuse of Seniorsand funded by the B.C. Law Foundation.Formal advocacy programs fulfill animportant function offering specializedlegal services. Formal advocacy programsalso produce materials and resources thatenable service providers and communityorganizations to work with older adults in amore knowledgeable manner around legalissues, an important detail in helping toovercome the myths and fears that oftenexist.

The “Seniors and the Law” project funded bythe B.C. Law Foundation is a blend of formaland informal advocacy.118 The objective ofthis project is to build a system of advocacyand legal services for seniors throughout theprovince. The project focuses onstrengthening the knowledge and skills ofadvocates for older adults and building thecapacity of communities to respond to thelegal needs of older adults. “Advocates” inthis context includes peer counsellors, seniorcitizen counsellors, community supportworkers, and natural advocates.

Informal advocates are essential to manyCanadian programs geared to helping.Increasingly they are part of structuredprograms, and receive training to carry outtheir work.

iv. The integrated model

This approach refers to the development ofmultidisciplinary teams of workers from abroad array of agencies such as a lawyer fromlegal aid, a community police representative, ahospital social worker, a social worker fromcommunity services, and representatives fromother community services, e.g., Meals onWheels.

In some cases, community-based teams orcommittees are organized to:

• provide consultations on difficult cases ofabuse,

• help to resolve agency disagreements, and • provide services not readily available in

the community, such as legal and medicalconsultations.

One of the challenges to the integrated modeland the coordinated community responsedescribed below is that in large centres, thegeographical boundaries of the differentagencies and services at the table may notalways be the same, which means thatagencies are pressed to send two or threerepresentatives to the table, which is not seenas a good use of personnel.



September 2003 32

The integrated model, as it has traditionallybeen seen, treats professionals as the key tohelping abused or neglected older adults.This is considered as one of its primarystrengths as it involves discussion aboutissues and specific abuse situations at aprofessional level. However, some teamsexclude key individuals who are notprofessionals (such as peer support andmembers of the faith community) as part ofthe “solution-building”.

The case conferencing model is still in itsinfancy. The model is slowly becomingmore sophisticated in the ways that issuessuch as client confidentiality are respected,and the ways that decision making and casemanagement occur to help avoid atendency to treat the proposed “solutions”as a shopping list of actions.

v. A new direction: a coordinatedcommunity approach

One of the primary challenges for olderadults seeking help is constantly having torepeat the details to yet another serviceprovider in the hope that someone may beable to help. Consequently, many Canadiancommunities are taking a coordinatedcommunity response to providing supportand assistance to senior experiencing abuseand neglect. It begins with the propositionthat the responsibility for addressing abuseand neglect does not lie with one agency –it is a general social responsibility in whichmany community partners havecomplementary roles and responsibilities.

To a large extent it is a communitydevelopment approach involving themapping of community resources, buildingcommon understandings of abuse andneglect of older adults, building trustamong agencies and organizations, andknowing what each is able or not able todo. The process is collaborative and, overtime, leads to the development ofinteragency protocols and coordination ofprevention and intervention efforts. Thecoordinated community approach also

creates a supportive network for serviceproviders.

The coordinated community support networksapproach is actively used by approximately 20communities in B.C. The approach is alsobeing used in sites in Ontario and Alberta andhas been used among First Nation people, inurban centres, and in rural communities.Community development is underway or inthe beginning stages in many regionsthroughout Manitoba.

F. What is known about the success of legaland program approaches in Canada?

Both formal reports and key informantsindicated that very little research exists on theeffectiveness of the various legal and programapproaches used in Canada.

Any assessment of program effectivenessdepends on how "effectiveness" isconceptualized. Whether or not anintervention is deemed useful is a matter ofperspective. For example, to a clinician, theremoval of the senior from an abusivesituation may constitute “success”, while thevictim may regard this as an unsuccessfulapproach.119

“Success” in addressing abuse or neglect ofolder adults often depends on the broaderresources and supports available to olderadults and family members from communityservices and local, provincial or federalgovernments.

The following is what is known abouteffectiveness of approaches.

1. The impact of legal approaches

(a) Raising awareness

Adult protection legislation and protectionprovisions have improved professionalawareness of the abuse of older adults.However, it is unclear to what extent this has



September 2003 33

occurred, and within which agencies andprofessions. Both formal reports and keyinformants point out the need for moretraining in this area for professionals whoare in contact with older adults, as well asmore specialized training. Currentlytraining and education occurs infrequentlywith few opportunities for refresher orupgrading programs.

(b) Utilization and impact

Little is known about the utilization and theimpact of adult protection legislation inCanada, and nothing is known about thecomparative effectiveness of adultprotection and family violence legislationin the common law jurisdictions. Virtuallyno empirical research has been undertakenin the area and the agencies responsible forinterventions maintain few, if any,accessible statistics. Agencies have neitherevaluation funds, nor the time to conductsuch research, primarily because of higherpriorities, particularly delivering effectiveservices with shrinking budgets.

Personnel responsible for intervening inabuse cases frequently have no need to usethe legislation beyond the initial contactand investigation phase. As previouslymentioned, research indicates that one halfof all abused older adults routinely declinehelp currently being offered120 and there isoften a process of further inquiries andnegotiated adjustments to plans for support.In most jurisdictions, it is only in unusualcircumstances that personnel will seek acourt order, or temporary guardianshiporder, to impose services. In the main,these last resort cases tend to be self-neglect situations involving mentallyincapable and aggressive individuals.

2. The impact of program approaches

Because abuse and neglect of older adultsare framed as “harms”, the primaryobjective is to stop harm completely orreduce its frequency and its immediate and

longer term effects. At a conceptual level, theliterature on abuse and neglect of older adultsis noticeably quiet on what is meant byeffectiveness or success related to thisobjective.

Where evaluation has occurred, it is moreoften process evaluation than outcomeevaluation. Outcome evaluations are usuallyof pilot projects and, consequently, tend tolook at only short-term outcomes. The FamilyViolence Prevention Initiative at HealthCanada is currently developing a database ofall evaluated family violence programs,including those for “elder abuse”.

(a) Process measures

Key informants were asked to identifyfeatures that they felt were necessary for thesuccess of community programs addressingprevention in abuse and neglect. Theirresponses included the following:

• assured core funding• continuity of key staff and leadership• perceived legitimacy of the approach

within the community and at governmentlevels

• community awareness of the program• reasonable community expectations or a

match between expectations and what canbe delivered

• “proof that it works”• continuous quality improvement• recognition and support from decision

makers including funding sufficient for theresponsibility and scope of program

• it makes sense to the users.

(b) Outcome measures

Identifying and measuring successfuloutcomes for individuals is difficult becausethere are multiple forms of abuse, and morethan one form can occur at the same time.Abuse is also multi-factored, and no approachis likely to work for all persons or even mostpersons.



September 2003 34

70 Ontario governm ent takes action on elder abuse. News release,

M arch 28, 200 2. O nline a t:

http://w ww .gov.on.ca /citizenship /english/about/n280 302 .htm71 Full details of the adult protection statutes in different

Canad ian ju risdic tions can be found in two m ain texts:

- Gordon, R .M . & V erdun -Jones, S . N. (1 992). Adult

Gu ardia nship Law in Ca nada. Toronto: Carswell, and

- Robe rtson, G . (1994). Mental disability and the law in Canada

(2nd edition). Toronto: C arswell.

72 Gord on & Verd un-Jon es (19 92), ibid .

- Rob ertson (1995 ). Lega l approach es to e lder ab use and neglect in

Canad a. In M.J. M acLean (ed.) Abuse and neglect of older

Canadians: strategies for change. Toronto: Thom pson Educational

Publish ing;

- Gordon, R .M. (19 95). Ad ult guardianship and ad ult protection

legislation in Canada : recent refo rms and future p roblem s. Canadian

Journal on Aging, 14 (2), 8 9-10 1;

- Gordon, R.M. (2001). Adult protection legislation in Canada:

models, issu es, and problem s. International Journal of Law and

Psychiatry, 24, 117 -134.73 Gordon, R.M. (2001). Ibid.74 Poirier D. & P oirier N. (in press). Advising older clients on elder

abuse and neglect, in S oden, A. (ed .) (200 3). Advising the Elderly

Client. Toron to: Butterw orths. 75 Beaulieu, M . (2002). La protection des person nes aînées contre

l’exploitation. Analyze critique du rapport <<L’exploitation des

personnes àgées vers un filet de protection resserre. Rapport de

consulta tion et recom mendation s. C om miss ion des droi ts d e la

personne et des droits de la jeunessse. Oct. 2001>> Le G érontop hile .

24(2), 34-39.76 See for example, Alberta.77 See, e.g., Gordon , R.M . & B rill, D. (200 1). Abu se and neglect of

the elderly. International Journal of Law and P sychiatry, 24 (200 1),

70 – 93.78 Can adian C entre for Justice S tatistics. (July, 200 2). Family


Canada Cat. N o. 85 -224 XIE, at page 14. O nline a t:


XIE00002.pdf79 M anitoba is currently considering removing the cohab itation

provisions so that the law can be used by extended family mem bers.

See:

http: //www.umanitoba.ca/resolve/newsletter/Volume%205/vol5%5B2

%5D 03.pdf

“Protec tion Notes”, Resolve News, 5 (2) (June, 2 003), p. 3

The Yukon legislation is also undergoing review, including

consideration of whether the Act should be changed to include close

person al adult relationship s not invo lving cohab itation. See: B ala, N.

C. & R ingseis, E. L. (July, 2002) Review of Yukon’s Fam ily Violence

Prevention A ct.

On line at : http://www.justice.gov.yk.ca/pdf/pubs/fvpa_report.pdf80 See, e.g., Gordon & V erdun-Jones (1 992). sup ra, n. 4; Poirier &

Poirier (in press), supra, n. 7.81 Beaulieu, M . & S pencer, C. (1 999). Older Adults' Personal

Relationships and the Law in Canada. (Ottawa, ON: Law

Commission of Canada). On line at:

http://www.lcc.gc.ca/en/themes/pr/oa/spencer/spencer.asp#ftnref8882

Beaulieu & Spencer (1999), ibid.83

In some jurisdictions (e.g., Nova Scotia), the legislation does not

provide for interventions in financial abuse cases. In Manitoba, the

adu lt protec tion legis lation is intended only for those with

developmental d isabili ties ; oth er vulnerable groups such as m entally

incapable older adults would not be excluded unless the person has

grow n old w ith a develop menta l disab ility.84 See H arbison , J., Coughlan, S .G., D owne-Warm boldt B., E lgie, R.,

M elanson , P., & M . M orrow. (1995). Mistreating elderly people:

question ing th e legal respo nse to elder abus e and neglec t. Halifax,

NS : Dalhou sie University H ealth Law Institute. 85 See fo r exam ple, Re J.J. [2003] N SJ No. 57 (N .S.C.A.) where a

Nova Scotia family court ordered particular services requested by an

adult who was under adult protection. The Court of Appeal upheld the

government's appeal, noting that the family court cannot dictate the

services to be given to an abused or neglected adult: this was a matter

for the provincial adult protection service to decide. Leave is being

sought to appeal the Court of Appeal decision to the Sup reme C ourt

of Canada .

Key informants made the followingsuggestions for outcome measures to assessthe success of interventions:

• Acceptance of help - Is the personwilling to accept the service beingoffered? For example, a review of 128cases coming to the attention of CLSCs(local community service agencies inQuebec) noted the greatest obstacle tointervention was refusal of serviceseither by the victim or the perpetrator.The victim declined help in 58% of thecases and the perpetrator declined helpin 47% of the cases they studied.121 Thehigh rates of refusal may reflect what isoffered and the way in which it isoffered.122

• Changes in harm - Has the specificharm stopped or is it occurring lessoften (a reduction of harm)? Does theolder adult feel as if she or he has morecontrol over the situation? And, veryimportantly, have other unintendedharms occurred?

• Sphere of control and autonomy -Has the approach been implemented ina way that is least intrusive in theperson’s life but still accomplishes thedesired ends? If the person stays in theharmful situation, does she or he feelgreater control of the situation?

• Ethical principles - Which ethicalprinciples are given prominence andwhich are given less weight? How is abalance between different valuesachieved?

http://www.gov.on.ca/citizenship/english/about/n280302.htm



http://www.umanitoba.ca/resolve/newsletter/Volume%205/vol5%5B2%5D03.pdf

http://www.umanitoba.ca/resolve/newsletter/Volume%205/vol5%5B2%5D03.pdf

http://www.justice.gov.yk.ca/pdf/pubs/fvpa_report.pdf




September 2003 35

86 See G ordon & Verdun -Jones (1992 ). supra, n. 4; also:

- Coughlan, S.G., Downe-Warmboldt, B., Elgie, R.G., Harbison,

J., Melanson , P. & M . Morrow . (1996). M andatory reporting of

suspected elder abuse and neglect: a practical and ethical

evaluation. Dalhousie Law Journal, 19 (1), 45 – 70.87 At least one jurisdiction has tried to do thart to determine

information about financial abuse, but with mixed success. Bond,

J. Cud dy, R., & D ixon, G. et al (1999). Th e financial abuse of

mentally incom petent olde r adults a C anad ian stud y, Journal of

Elder Abus e and N eglect, 11 (4), 23-38.88 Gord on, (20 01), su pra, n. 5 . 89 Sharpe, S . (1998). Restorative Justice: a Vision for Healing

and Change. Edmonton , Ab : Victim Of fend er M edia tion S ociety.90 Groh , A. (2003). A Healing Appro ach to Elder Abuse .

Kitchener, On: Pandora Press.91 Restorative Justice Conference, Vancouver, BC, June 2, 2003.

Panel presentation, Groh, A, Leaney, A. & Spencer, C.92 Ekos R esearch , (M ay, 2002). Public A ttitudes Tow ard s Fa mily

Violence: A Syndicated Study Final Report. Online at

http://www.ekos.com/media/files/family31may02.pdf93

Ibid, p. 894 Ibid, p. 1095

Ibid, p. 13 -15.96 Podnieks, E., & Baillie, E. (1995). Education as the key to the

preven tion of elder ab use an d neg lect. In M. J . M acLean (Ed.).

Abuse & Neglect of Older Canadians: Strategies for Change. (pp.

81-93). Toronto, O N: Th omp son Edu cational Publishing.97 Reis, M . & N ahm iash, D. (O ctober, 1995). W hen seniors are

abused: an in tervention m odel. Gerontologist, (5), 666-671.98 See for example, Damant, D. (2001). Le processus

d'empowerment des fem mes victimes de violence conjugale à

travers le système judiciaire. Montréal: Centre de recherche

interdisciplinaire sur la violence familiale et la violence faite aux

femmes, Collection: Études et analyses / Centre de recherche

interdisciplinaire sur la violence familiale et la violence faite aux

fem mes; no 14 , 130 p. ;

- Larouche, G. & M assicotte, L. (1993). Aux formatrices en

intervention auprès des femm es violentées. Montréal: Wilson &

Lafleur. 55 6 p.;

- Larouche, G.. (1987 ). Agir contre la violence. M ontréal: La

pleine lune;

- Devictimization Process: "The Lies that Horror Told Me"

Participant Notebook, Regroupement Provincial des Maisons d’

hebergement et de Transition pour Femm es Victimes de Violence

Conjugale, 1994 ;

- Guide: The Lies that the Horror Told me; Regroupement

Provincial des Maisons d’hebergement et de transition pour

femm es victimes de violence conjugale.99 M acdon ald, L. & C ollins, A. (20 00). Abuse and Neglect of

Older Adults: A Discussion Paper. Health C anada: Fam ily

Violen ce P revention Un it. Online a t: http://www.hc-

sc.gc.ca/hppb/familyviolence/pdfs/Abuse%20and% 20Neglect.pdf100 Palmar, I. & N ascimen to, O. (Fall 2002). Hea lth Action

Theatre by Senior s: com munity d evelop ment and education w ith

groups of diverse languages and cultures. Genera tions. 26 (3),

65-67. Information on HAT S is also available online at: Also

online : http://www.seniorstheatre.org/ 101 Silver, C. (August 20 01) Internet Use Among O lder

Canadians. Ottawa , ON: s tatistics Canada. O nline a t:

http://www.statcan.ca/english/research/56F0004MIE/56F0004MI

E2001004.pdf Retrieved July 8, 2003102

M ata, F. & Va lentine. J. (n.d.) Selected Ethnic Profiles of

Ca nad a’s S enior Ag e Coho rts . Ottawa, ON: Can adian Heritage,

Strategic Research and Analysis, Multiculturalism P rogram,

Citizens ’ Participa tion an d M ulticultu ralism . Online a t:

http://www.pch.gc.ca/multi/assets/pdfs/sen-pub1_e.pdf Retrieved

July 8, 2003.

103 Ward-H all, C. E ducating s enior s and O thers about Abus e: A

De cade of E xpe rience from a Provinc ial Organization . Pre sen tation to

International Association on Gerontology. 17th World Congress,

July1-6, 2001, Vancouver, B.C.104 (March, 2003). "National Elder Law Section Activity Report".

Report to the C anadian Bar Associa tion. O nline a t:

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March2003.pdf105 Bern ard, C . & Ledoyen, A . (2001). The Exploitation of the

Elderly: Towards a Tightened Safety Net. Report of the Consultation

and Recom mendations. Excerpts: Part Three: Corrective Measures,

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Persons on Elder Abu se. (Geneva, Switze rland : WHO . Online a t:

www.who.int/hpr/ageing/Elderabuse 3 screen.pdf

http://www.who.int/hpr/ageing/Elderabuse-3-screen.pdf107 Russell, D. & Ginn , D. (M ay 31, 2001). Framework for Action

aga inst Fa mily V iolence, 2 001 Review .

http://www.gov.ns.ca/just/Publications/russell/training.htm#N _9_108 Podnieks, E . (2001). need full reference109 E.g. in the Fall, 2003 the focus of the ann ual general meeting for

B.C. Coalition to Eliminate Abuse of Seniors will focus on housing

and comm unity care issues in the context of abuse. See:

http://w ww .bcceas.ca/bcceas.htm110 E.g. through the use the best information available, such as

detection or screening tools that have been determined to be valid and

reliable.111 See for example, Russell & Ginn, supra, n.56.112 Fam ily Violenc e Pro tection Act, New s Relea se, Dep artment of

Jus tice, N orthw est Territorie s, Ju ne 10th, 200 3. O nline a t:

http://w ww .jus tice.gov.nt.c a/Fam ilyViolence/Fa milyViolence.h tm

113 He alth C anada. (200 0). A bus e and neglect of O lder A dults : A

Dis cussion Pap er. H ealth C anada: Fam ily Violence P revention Un it.

Online at: http://www.hc-

sc.ca/hppb/familyviolence/pdfs/Abuse%20and %20Neglect.pdf114 Nah miash , D. & Reis, M . (2000). M ost successful intervention

strategies for abused older ad ults. Journal of Elder Abuse and

Neglect. 12 (3-4): p. 53-70.115 Nahm iash & Reis (2000). Ibid.116 Macdonald, & Collins (2000), supra, n. 46117 Advocacy Centre for the Elderly Online a t:

http://www.advocacycentreelderly.org/118 See http://w ww .bcceas.ca/projec t.htm119 Koz ak, J . (1994) . Difficu lties in addressin g abuse and neglect in

elderly patients. Ca nad ian M edical Association Journ al. 15 (10),

1401-3.120 Lithwick, M., B eaulieu, M., G ravel, S. & Straka, S.M . (1999).

Mistreatment of older adults: perpetrator victim relationships and

interventions. Journa l of Elder Abuse and Neglec t. 11 (4), 95-112.121 Lithwick, Beaulieu, Gravel, & Straka, supra, n. 3.122 Bergeron, (1999), supra, n. 26.


http://www.hc-sc.gc.ca/hppb/familyviolence/pdfs/Abuse%20and%20Neglect.pdf


http://www.seniorstheatre.org/

http://www.statcan.ca/english/research/56F0004MIE/56F0004MIE2001004.pdf


http://www.pch.gc.ca/multi/assets/pdfs/sen-pub1_e.pdf



http://www.bcceas.ca/bcceas.htm

http://www.justice.gov.nt.ca/FamilyViolence/FamilyViolence.htm

http://www.advocacycentreelderly.org/

http://www.bcceas.ca/project.htm


September 2003 36

V. Conclusions

Abuse and neglect of older adults havemany health, social, economic and legaldimensions. Canada’s progress to datereflects the commitment and efforts ofindividual seniors and other concernedpeople, seniors organizations, serviceproviders, and private industry. In manycases, local, regional, provincial/territorialand federal governments, as well asfoundations and researchers, have supportedthe efforts.

Canada has every reason to be proud of thesignificant strides it has made to addressabuse and neglect of older adults.Internationally, Canada is considered one ofthe leaders in terms of understanding andresponding to the complexity of the issues.Nonetheless, abuse and neglect of olderadults remains a significant social problemthat requires a long-term and concertedeffort by governments and organizations atall levels.

A recent report from the Family ViolencePrevention Unit of Health Canada (2001)states:

"A great deal more knowledge nowexists, and many more programs andresources have been developed acrossCanada in the past decade. However,more needs to be done to ensure allcommunities have an organized andcoordinated response to this importantissue."123

Over the past decade, Canada has producedexcellent reports on abuse of older adultswith recommended prevention andintervention options and curriculumguidelines for professional education. Someof these recommendations have beenadopted in innovative initiatives underwayin several jurisdictions including Ontario’s5-year Strategy to Combat Elder Abuse,Manitoba’s Elder Abuse Strategy and therecent creation of the Quebec Elder AbusePrevention Network.

However, the need still exists to shareinformation and raise awareness of the issuein order to stimulate development of moreprograms and policies. Canadian researchhas found that, at all levels – local, regional,provincial/territorial and national –governments, organizations and serviceproviders often lack awareness of what ishappening in other jurisdictions. This maylead to the loss of important knowledgeabout the issues surrounding the abuse andneglect of older adults and to duplication ofefforts. Information sharing acrossjurisdictions is an important way to keepinformed and to learn from promisinginitiatives and strategies.

Knowledge about the lives of older adultssuggests that they are often vulnerable toabuse and neglect because of ageistattitudes. A key gap in awareness educationexists in the private sector. Education isneeded for businesses serving older adults,about the aging process and ways thatageism creates harms in the lives of olderadults.

In addition, it is important that the generalpublic become more aware of abuse andneglect issues for older adults, know howthey can help to prevent and address abuseissues, and know whom they can turn to ifmore help is needed.

For any level of government to developsound policy on a complex social issue suchas abuse and neglect of older adults requiresa good understanding of the extent of theproblem and the far-reaching impact it hason society. Recognition exists in Canada ofthe lack of surveillance of abuse of olderadults and the critical need for quantitativeand qualitative information knowledge ofabuse of older adults and how it can best beaddressed.

There is still a long way to go before Canadacan reach the goal of being abuse-free,"where older adults not only feel secure but

Conclusions


September 2003 37

123 Health Can ada (2001). Com munity Awareness an d Response.

Ottawa, ON: F am ily Violence P revention Un it. Online a t:

http://www.hc-

sc.gc.ca /hpp b/fam ilyviolence /htm l/ageins tituten_e.h tml124 B.C. C oalition to Eliminate Ab use of Sen iors. (May, 200 3).



Victoria: B.C.

also integral and respected members of thecommunity. To meet that goal will requireboth community and political will, balancedby the necessary resources to make ithappen".124 It is possible to make this areality.

Appendices


September 2003 38

Appendices

Appendices


September 2003 39

Appendix A - Definitions of Abuse and Neglect

Physical abuse is the non-accidental use of physical force for coercion or to inflict bodily harm.May include the use of restraints, or over or under-medication.

Psychological (emotional) abuse is any act including confinement, isolation, verbal assault,humiliation, intimidation, infantilization, or any other treatment which diminishes the sense ofidentity, dignity, and self worth. Psychological abuse attacks a senior’s feelings of self worth orself esteem. Use of verbal abuse by taunts, put downs, withdrawal of love and affection, orwithdrawal of emotional support by the abuser, over a period of time, affects how a senior feelsand is extremely harmful to his/her wellbeing.

Financial abuse is the misuse of a senior’s funds and assets, loss of or damage to an olderperson’s assets or property, obtaining property without that person’s knowledge and full consent,or in the case of a senior who is not mentally capable, not representing or acting in that person’sbest interests. The abuser is usually a trusted person in the senior’s life (such as spouse orpartner, family member (often an adult child), caregiver, or friend). Financial abuse is oftenaccompanied by other forms of abuse, such as psychological abuse, physical abuse or denial ofrights.

Sexual abuse is any kind of sexual behaviour directed toward a senior without that person’s fullknowledge and consent. It includes sexual assault, sexual harassment, and rape. Sexual abusecan happen to mentally capable seniors by spouses, partner, family member or trusted people intheir lives. Neglect is a failure to live up to responsibilities to support and care for another. Neglect canbe physical or psychological in form. It has two forms:

- Active neglect is the intentional withholding of basic necessities of life (including care).- Passive neglect is not providing basic necessities of life because of lack of experience,

information, or ability.

Self neglect is not a form of harm discussed in this paper, but is mentioned in the AdultGuardianship Act. However, it refers to a person’s inability to provide care and support to self.Self neglect can result from an individual’s choice of lifestyle, depression, ill health, cognitiveability, or physical inability to care for self.

Violation of civil/human rights is denial of a senior’s fundamental rights as an adult, andincludes the negation or disregard for the human and legal rights of an individual. For example,withholding of information, mail censorship, denial of privacy, denial of visitors, restriction ofliberty and freedom. Unless the older adult has agreed to the restrictions, or has been found atlaw to be mentally incapable, no one has the right to deny the human rights of another person.When someone is denied their human rights, it affects their self-esteem and confidence, anddemoralization sets in.

Appendices


September 2003 40

Systemic abuse refers to - rules, regulations and policies developed for an apparently neutral purpose but which

significantly harm or discriminate against older adults in their effect, or - when the social responsibility to meet the needs of older adults is not being met.

Adapted from B.C. Coalition to Eliminate Abuse of Seniors “Facts Sheets on Elder Abuse”,which in turn were based on the Interministry Committee on Elder Abuse (1992) Principles,Procedures and Protocols for Elder Abuse

Appendices


September 2003 41

Appendix B - Interview Protocols

French Protocol

Mesdames, Messieurs,

Dans le cadre d’un projet subventionné par Santé Canada, nous sollicitons votre expertise dans ledomaine des mauvais traitements envers les personnes âgées. L’objectif de ce projet estd’obtenir un point de vue critique sur ce qui se fait, ce qui a été ou non validé ou évalué, ce quiva, ce qui va moins et ce qui devrait ou pourrait être mis en place :

· Lois· Règlements· Politiques formelles· Politiques informelles· Programmes· Actions ciblées· Actions concertées· Formation· Information· Intervention auprès des victimes· Interventions avec les personnes qui les maltraitent, etc.

Nous aimerions avoir vos commentaires et recommandations en lien avec votre expérience dansle domaine des abus et de la négligence envers les personnes âgées. Voici une liste de questionspour guider votre réflexion :

1. t-ce que l’abus et la négligence dans la vie des personnes âgées est vu comme étantprimordial au Québec? Pourquoi est-ce le cas?

2. ’est-ce qui semble bien fonctionner au Québec en rapport avec l’abus et la négligence despersonnes âgées? Pourquoi?

3. ’est-ce qui ne semble pas bien fonctionner en lien avec ce que les gens auraient souhaité?Qu’est-ce qui freine l’avancement?

4. ’est-ce que les gens au Québec entendent par «une approche efficace ou réussie » pour lesaînés abusés ou négligés?

· Quels sont les indicateurs des programmes de prévention efficace?· Quels sont les indicateurs des programmes efficaces pour aider les aînés abusés ou

négligés? Comment déterminer que ce qui est fait est bénéfique? Est-ce qu’il y a desstandards ou des principes directeurs?

· Est-ce qu’il y a des groupes de personnes âgées abusées ou négligées dont les besoinsne sont pas comblés?

5. Où devrions-nous être en train de se diriger par rapport à la problématique des personnesâgées abusées ou négligées? (En d’autres mots, pouvez-vous nommer quelquesrecommandations en lien avec les politiques et les pratiques?)

· À un niveau local· À un niveau provincial· À un niveau national

Appendices


September 2003 42

Serait-il possible pour vous de nous faire parvenir vos impressions, commentaires,questionnements et recommandations en lien avec cette problématique? Vous pouvez aussi merejoindre par téléphone au numéro indiqué ci-dessous. Veuillez profiter de cet occasion pour êtreentendu au sein du gouvernement du Canada ainsi que faire valoir nos forces ici au Québec enmatière de mauvais traitements envers les aînés! Une réponse dans les plus brefs délais seraitgrandement appréciée!

Sincères salutations,

Appendices


September 2003 43

English Protocol

My colleagues and I have been asked to prepare a report for a federal/provincial/territorialworking group on safety and security issues about abuse and neglect issues affecting olderadults. The report is an overview (“environmental scan”) of what is happening in Canada. In light of your work in this area, we invite you to be a key informant for this overview. We areasking about 25 people across the country for their ideas about “successful” and "effective” approaches in this area, as well as for some policy recommendations.

We have been asked to describe what is working well, identify gaps and challenges, and offersome recommendations where the federal and provincial/ territorial governments might be ableto work together to advance the issue in the future.

These are the questions we are asking for your consideration:

1. Is abuse and neglect in later life seen as a priority issue in your province? Why or whynot is that the case?

2. What seems to be working well in your province/territory in terms of addressing abuseand neglect of older adults (and why)?

3. What's not working the way people might have hoped (what holds things back)?

4. What do people in your province/ territory mean by “effective” or “successful”approaches for abuse and neglect in later life?

5. What are the indicators of effective prevention programs?

6. What are the indicators of a successful program to aid abused or neglected older adults?How do you tell that what is being done to help is “successful”? Any standards, guidingprinciples?

7. Are there any groups of abused or neglected seniors whose needs are not currently beingmet?

8. Where do we need to be heading on the issue of abuse and neglect of older adults? [Inother words, can you offer some key policy and practice recommendations]

o at a local levelo at a provincial levelo at a national level

Thank you


September 2003 44

Appendix C - Governmental and Intergovernmental Opportunities to Address Key Aspects of Abuse of Older Adults in Canada

Ministry Responsible for…Issues Examples of Opportunities to Address K ey Aspects of Abuse of Older Adults

Seniors Seniors needs often cross several ministries, and

decisions in one area can have an impact in another.

Addressing ageism in society may be an important

factor to reducing abuse.

Older adults are often unaware of benefits and

options available to them.

- Working with other ministries in consultative and leadership role

- Dissemination of information on aging issues

- Addressing societal ageism

Adult Protection The protection of vulnerable older adults needs to

be done in a manner that promotes choices, and

does not intrude in the person's life more than is

necessary.

- Developing a provincial approach to standards of care and intervention with older adults that is consistent among the health

regions

- Working in close collaboration with ministry and community groups dealing with family violence issues to develop a range of

resources to meet the needs of capable and incapable older adults

Health Abuse and neglect in later life can lead to poor

physical or mental health.

Abuse in later life can be affected by victim's or

perpetrator's changing health.

Some abused seniors and some seniors who harm

others need formal long-term care.

- Increasing the availability of appropriate mental health and substance abuse services for those who commit abuse and for abused

seniors; promoting cross training on abuse and substance use/mental health problems

- Expanding the abuse education/training available for health service and community service providers on abuse issues

- Increasing appropriate level of services in continuing care; long-term care to meet the needs of older adults and families providing

care

- Having adequate mechanisms for easy access to respite care to prevent abuse; and access to affordable long-term care when

community care needs become too high for the available community services

- Promoting abuse screening by staff in health facilities

- Developing collaborative approaches with ministry responsible for housing for increasing supportive housing opportunities that

combine health and housing services

Justice

(Attorney General & Solicitors General)

Older adults often do not know their legal rights,

know when to turn to the legal system, and may not

have equitable access to the legal system .

Many forms of abuse are crimes but are not treated

as such.

- Establishing and increasing police training on aging and abuse issues affecting older adults

- Improving data development and collection on crimes against older adults

- Monitor the diversion of abuse cases from the justice system

- Developing plain language public legal education information on la ter life abuse as crime; consum er issues;

- Reviewing domestic violence policies in light of the types of abuse situations experienced by older adults

- Developing / increasing legal aid, victim services for abused older adults [including those requiring capacity assessments]


September 2003 45

Ministry Responsible for… Issues Examples of Opportunities to Address Key Aspects of Abuse of Older Adults

Family Violence Abuse of older adults may not be given the same

level of attention as other forms of family

violence.

- Increasing awareness of abuse of older adults as an important and under-recognized form of family violence

- Promoting freedom from violence across the lifespan

- Developing a provincial/territorial/national public education strategy directed to older adults, families, and communities. The

public education strategy should be specific to older adults.

Housing Crisis and longer term affordable housing is often

the key to security for many abused older adults.

- Setting abuse or neglect of older adult as criteria for priority placement

- Improving overall availability of affordable housing for seniors, for families

- Increasing training for housing providers on aging issues and abuse prevention

- Increasing availability of short-term housing options

- Enhancing availability of a continuum of affordable housing that can meet changing needs of older adults

Higher Education Education is needed by professionals and other

service providers who may not be aware of abuse

issues.

- Encouraging more curriculum development on aging and abuse issues for post secondary education

Education All levels need to counter anti-old perspective and

promote respect for all ages.

- Increasing intergenerational information on abuse; increasing younger generation 's understanding of and respect for older adults

Human Rights Some abuse and neglect are also forms of

discrimination.

- Reviewing provincial and business policies re: age discrimination; intersection of age discrimination and other forms

- Reviewing "duty to accommodate" in terms of service provision to seniors

Women Older women may be at greater risk of abuse and

may experience greater impact.

- Gender-based review of government policies

- Supporting projects/program s geared to needs of abused older women

Aboriginal Some risk factors may be different; e.g., systemic

issues

- Reviewing policies, practices and laws that negatively affect wellbeing of older native persons

Imm igration & Multiculturalism Immigration policies on family-sponsored

immigrants may leave older members dependent

and at risk; they are often isolated because of

language and other barriers.

- Reviewing current immigration policies and provincial social assistance criter ia to assure older im migrants are not forced to stay in

abusive situations

- Enhancing availability of services and resources to reduce isolation of older immigrants and to enhance integration


September 2003 46

Appendix D - Adult Protection Statutes and Provisions: Canada 2003

JurisdictionTy pe of A dults

AffectedCoverage

Emergen cy

Intervention

Access

Orders/

Warrant

Investigative

Pow ers/Au thority

Ord ers to

Re stra in

Abu sers

Cou rt

Ordered

Services if

Incap able

Intervening Ag encyReporting

Requirement

BR ITISH CO LU M BIA

Adult G uar dian ship

Act R.S.B.C. 1996,

c.6, P t.3

All i f incapableAll forms of

abuse/neglectYes Yes Yes Yes Yes

He alth Authority ;

Min of Child and

Fam ily Developm ent;

Public Guardian and

Trustee

Voluntary

ALBERTA

Dependent Adu lts Act

R.S.A. 2000, c.D-11

Protection Against

Fam ily Violence Act

R.S.A. 2000, c.P-27

All i f incapable

Harm to physical

person or

prop erty

Yes

Further intervention occurs through the

guardianship/trusteeship provisions of the

De penden t Adults A ct.

— — —

Spouse, person

residing in the

same household

and related by

blood or

marriage; person

resid ing in same

household who

has care and

legal custody

over another.

Harm to physical

pers on, p rope rty

(1)

Yes Yes — Yes No — —

SASKATCHEWAN

Adult Gua rdianship and Co-

Decision-Making Act. S.S.

2000, c.A -5.3

Vic tims of D om estic

Violence Act. S.S.1994, c.V-

6.02

All 16+ if

incapable

Harm to physical

person or

prop erty

Yes

(expedited

temporary

guardian ship

order)

Further intervention through the

guardian ship prov ision of the Act.

Public Guardian and

Trustee if financial

abuse.

—

Persons who

reside or resided

together in a

family, spousal

or intim ate

relationship.

Harm to physical

pers on, p rope rty

(1)


(1) Includes physical abuse, sexual abuse, forced confinement

(2) Includes emotional/psychological abuse


September 2003 47

Jurisdiction Ty pe of A dults

Affected

CoverageEmergen cy

Intervention

Access

Orders/

Warrant

Investigative

Pow ers/Au thority

Ord ers to

Re stra in

Abu sers

Cou rt

Ordered

Services if

Incap able

Intervening Ag ency Reporting

Requirement

MANITOBA

Vulnerable Persons Living

with a Mental Disability Act

S.M. 1993, c.29

Dom estic Violence and

Stalking Prevention Protection

and Com pensation Act

C.C.S.M., c.93

Adults w ith

mental

disabilities Abuse or neglect Yes Yes Yes

Substitu te

decision

maker can

be processed

Supported Living

Program, M anitoba

Family Services

Yes,

limited to service

prov iders , Su bstitu te

Decision Makers and

Com mittees

"Cohabitants":

reside or have

resided together

in a family,

spousal or

intim ate

relationship

[under review]

Harm to physical

pers on, p rope rty

(1), (2)

Yes — — Yes No — —

ON TA RIO

Sub stitute De cisions A ct S.O.

1992, c.30

(as amended)

All incapable

adu lts

Harm to physical

person or

prop erty

Yes Yes Yes —Tem porary

guardian-

ship order

Public Guardian and

Trustee o f Ontario—




September 2003 48


Affected Coverage

Emergen cy

Intervention

Access

Orders/

Warrant

Investigative

Pow ers/Au thority

Ord ers to

Re stra in

Abu sers

Cou rt

Ordered

Services if

Incap ableIntervening Ag ency

Reporting

Requirement

QUEBEC

Civil Code of Quebec

L.Q . 1991, c.6 4 C hapte r III,

Section II

Charte de Droits et Libertés de

la Persone

L.R.Q. c.C-12

Those in ne ed of

protective

supervision

Property Yes — Curatorsh ip/ tutorship provisions apply Public Curator No

Handicapped

person or

vulnerable older

adu lts

Harm to person or

prop ertyYes — Yes Yes —

Com mission des

Droits de la Personne

et des Droits d e la

Jeunesse

No

NEW BRUNSWICK

Family Services Act

S.N.B. 1980, c.F-22

(as amended)

Disabled or

elderly adults

Harm to physical

personYes Yes Yes

Yes/

removal of

abuser

YesDepartment of Family

and Community

Services

Voluntary, for

profess ionals

PRINCE EDWARD

ISLAND

Adult Protection Act

R.S .P.E .I. 1998 , c.A.5

Victims of Family Violence

Act R.S.P.E.I. 1998, c.V-32

All incapable

adu lts

Harm to physical

person and

prop ertyYes Yes Yes Yes Yes

Ministry of Health and

Social Services

Voluntary

Those in spousal

or sexual

relationship;

mem bers of

same family

Harm to physical

person or

property ( 1), (2)





September 2003 49

Jurisdiction Ty pe of A dults

Affected Coverage

Emergen cy

Intervention

Access

Orders/

Warrant

Investigative

Pow ers/Au thority

Ord ers to

Re stra in

Abu sers

Cou rt

Ordered

Services if


Reporting

Requirement

NO VA SCO TIA

Adult Protection Act

R.S .N.S . 1989, c.2

Dom estic Violence Intervention Act

S.N.S. 2001, c.29

All incompetent

adu lts

Harm to physical

person

Yes Yes Yes Yes Yes Adult Protection

Services (M inistry of

Health)

M andatory

Those

"cohabiting in a

conjugal

relationship"

Harm to physical

person (1)Yes — — Yes No — —

New foundland and Labrador

Neglected Adults Welfare Act

R.S .N. 1990, c.N -3

Neglected,

incapab le adu lts

only

Physical person

onlyNo Yes Yes — Yes

Director of Neglected

Adults (M inistry of

Health and

Com mun ity Services)

M andatory

NORTHW EST TERRITORIES

Guardianship and Trusteeship Act

R.S .N.W .T. 19 98, c.G .2

Incapable adu lt

Harm to physical

pers on or to

prop erty

YesFurther intervention occurs through the guardianship/trusteeship of

the ActPublic Guardian --

NORTHW EST TERRITORIES

Family Violence P rotection Ac t, B ill

21

Introduced June 10, 2003

Spouse, former

spouse, persons

who resided or

are residing

together in a

family or

intim ate

relationship,

parents,

grandparents

Harm to physical

pers on, p rope rty

(1), (2)

Yes -- -- Yes -- -- --




September 2003 50


Affected Coverage

Emergen cy

Intervention

Access

Orders/

Warrant

Investigative

Pow ers/Au thority

Ord ers to

Re stra in

Abu sers

Cou rt

Ordered

Services if


Reporting

Requirement

NUNAVUT

Guardianship and Trusteeship Act

(R.S.N.W.T. 1998, c. G2)

All, if in capablePhysical person

onlyYes

Further intervention occurs through the guardianship/trusteeship of

the Act Public Guardian —

YUKON

Family Violence Protection Act

S.Y. 1997, c.12

"Cohabitants"

persons who

resided or are

residing together

in a family,

spousal, or

intim ate

relationship

[under review]

Harm to physical

pers on, p rope rty

(1)

Neglect

(deprivation of

necessities)

Yes Yes — Yes — — —




September 2003 51

Appendix E - Prevention Education: Methods of Disseminating Information and Raising Awareness

about Abuse of Older Adults in Canada

M ethod of Education

(Alphabetically)

How

Co mm only

Used

W ho has A ccess

(Key A udiences)

Strengths Limitations Fu nding Req uiremen ts Examp les

Community presentations

- May be com bined

with video, print

resources

M ost comm on

form of

educating,

raising

awareness

Often delivered

by volunteers, or

by community

coordinator;

may be peered

delivered

Older adults, service

providers, general

pub lic

Can tailor information to the

audience (older adults, general

public, schools)

Information can be gen eric or very

specialized

Relatively inexpensive to deliver

Sm aller than conference,

audiences tend to be

smaller; but training can be

more

Targeted, but only reaches

small aud ience each time

Most gea red to mainstream

Needs to be repeated,

reaching new audiences

each time; needs to be

refreshed

Unlikely to reach isolated

seniors or isolated service

providers

Comm unity presentations

as part of pilot projects are

at risk of discontinuing

once pilot ends

M uch of the com munity

education work is

prov ided by non-profit

organizations that have

no core funding

If delivered by

volunteers, requires $

for coordination

If geared to spec ific

groups of service

prov iders , $ for this

education need to be

integrated into

continuing education

Reg ular ly provided com mu nity

presentations:

Scotiabank ABCs of Fraud

Money M atters for Older adults

Projects: New Brunw sick Third Age C entre

"Se nior E ducators Enhancing C om munity

Safety" (1998)

Con ferences

Special conferences

Workshop in professional or

sector conference

Special abuse

conferences tend

to occur

irregularly (e.g.,

10-year gap

between 1st and

2nd national

conference)

Dep ends on

conference, and

subject matter; tend

to focus on

professionals,

service providers,

researchers; less on

older adults (type of

information d elivery,

and cost factors).

Excellent opportunities to learn

and share promising practices;

network; develop connections

Opportunity for policy and

strategic planning

Special conferences may be

developed loca lly, regiona lly,

prov incia lly

Materials from conference can be

developed into Proceedings or

other resources for broader

dissemination in print, internet

Relatively high cost

compared to other methods

(requires cost sharing)

Limited to those who can

afford to attend

(registration and travel

costs)

Ne ed to occur regu larly to

maintain value

Time to organize

Assum es that attendees are

able to share info; not

always the case

Special conferences

Most provinces and

territories have not had one

Usu ally through

combination of funding

from federal and or

provincial ministries;

and occasionally private

secto r sponsorship

1989 Elder Abuse Conference

(following publica tion of Ryerson stud y)

1999 N ational Elder Abuse Conference

2002 O ntario Elder Abuse Conference

2003 Q uebec Elder Abuse Conference

Yukon "R espect Our Elders " Conference

2004 N ewfoundland Elder Abuse

Conference (planned)

2004 O ntario Elder Abuse Conference

(planned)


September 2003 52

Manner of Educating How

Co mm only

Used

W ho has A ccess

(Key A udiences)


Directories of Services or

Programs Unknown [but

see note under

Examples]

Usually as resource

to service providers

Provide quick inform ation on

what's available locally or

regionally; focusses specifically on

abuse and neglect; may be

available in print (e.g., National

Clearinghouse) or Internet

Very qu ickly out o f date

(government or program

reorganizations); tends to

identi fy only m ore vis ible

res ource s or those that self

identify; no control on the

accuracy of info

$ to survey and collate

the information; publish

Directo ry o f Serv ices and P rograms

Ad dressing the N eeds of O lder Adu lt

Victims of Violence in Canada (National

Clearinghouse on Family Violence)

Man y comm unities and provinces also

produce sen ior resource directories or

guides to bene fits , which may carry some

abuse resou rce information

B.E.A.R. Bu ilding Elder Abuse Resources

[out of date]

Internet

Newer

developm ent,

a lthough some

information has

been available

on the Internet

for several years

Only 13% of older

adults use the

Internet

Free access at

libraries, some senior

centres bu t st ill

limits those older

adults that have

access

Significant % of

frontline workers do

not have acces s to

internet at work

Is an adjunct to and n ot a su bstitu te

for resources that provide supp ort

and assis tance to olde r adu lts in

planning, deciding what to do

Information can be added to and

updated fairly easily

Inform ation curren tly

availab le is often ba sic

Cost of maintaining and

revising the information

(especially if substantial

amount of information)

Variable quality of the

information

Ne eds to be w ell linked to

other s ites so more vis ible

Website (usually shared

with other resource) and

website development

and maintenance;

Initial development of

the ma terial; promotion

Specialized information:

Older Ad ults Knowledge N etwork

OAK Net (2003)

Legal Inform ation S ociety of Nova S cotia

Abuse Info provided by seniors or service

provider organizations:

BC Coalition to Eliminate A buse of

Seniors

National Clearingho uses Va riable Service providers,

com munity

organizations,

students, educators,

researchers

Central point of information;

opportunities to share written and

video resource s across coun try

increases accesss

Highly dependent on the

infusion of new m aterial

Need to promote existence

Need structure for

cataloguing,

maintaining and

distributing; promotion

National Clearinghouse on Family

Violence; Alberta's Office for the

Prevention of Fam ily Violence, and N ova

Scotia's former Fam ily Violence Prevention

Initiative


September 2003 53


Co mm only

Used

W ho has A ccess

(Key A udiences)


Netw orks

- provin cial, regiona l,

national

Developing

(most very new)

Service Providers,

com munity

organizations,

professionals,

stud ents

Op portu nities to crea te

partnerships between the various

stakeholders involved in senior

mistrea tment;

Can p romote collaboration

am ong s enior s and community

groups, police, justice services,

health and social service

prov iders and educators ;

Work to prevent senior

mistreatment by increasing

awareness through a coordinated

effor t; deve lop stra tegies to

intervene with senior

mistreatment through a

coordinated effort to maximize

the impact of initiatives

Cannot be done on a

volunteer basis; needs

infrastructure, ongoing

sup port and v isibility

Requires some pa id

staff for administration;

developing sources of

information to share on

a regular basis;

prom otion

Canadian Network for Prevention of Elder

Abuse (no s ecure fundin g at presen t)

Ontario N etwork for the Prevention of

Elder Abuse (funded to 2004)

International Netw ork for the Prevention of

Elder Ab use (fun ded intern ationa lly)

Also com mu nity response networks

developing in Ontario, Manitoba, British

Colum bia

Public Legal Information

Print and In ternet resources Va riable

Older adults, service

providers

Pam phlets can be produ ced on

special topics on legal issues

affec ting older adults

Information tends to be on

dea th (w ills, estate

planning) not other legal

issues important to older

adu lts

Some in formation m ay s till

be above functional

literacy level of many

older adults

Target audience often does

not kn ow resou rce exists

Funding to public legal

services has been

reduced in some

jurisdictions

Information on abuse or

other legal info for older

adults may not be

available in a ll

jurisdictions; promotion

Advocacy C entre for the Elderly, O N

Legal Inform ation S ociety of Nova S cotia

Saskatchew an's Public Legal Education

Association

Public Lega l and Information Service, NB

Social marketing and other

public campaigns

New to m ost

parts of Canada

[but see note on

"examples"]

General pub lic or

may be more

targeted audience

Broadly v isible

Is adjunc t to and not a s ubs titute

for resources that provide supp ort

and assis tance to olde r adu lts

"O ne shot deal"

Needs to be regularly

repeated

Canno t operate in

isolation; needs funding

for su pportive community

services once the

awareness c am paign is in

place

Funds to organize

campaign; develop key

social marketing

messa ges; w orking with

community that will be

identified; promotion

Alb erta's S ocial M arketin g C am paign (Fall,

2003)

Northw est Terr itor ies 2003 Family

Violence Week

Television and radio public service

announcemen ts have been used in smaller

communities in different parts of Canada

for at least the last 10 years; use varies

Theatre presentation Type of

com munity

presentation

General pub lic; or

specifically, older

adu lts

Can presen t inform ation in

interesting, thoughtful and less

threatening manner

Reaches sm aller audiences

(how ever that is usu ally a

strength)

If delivered by

volunteers, requires $

for coordination;

materia l deve lopm ent;

travel; prom otion

Parmi Nous

Health Action Th eatre for Seniors


September 2003 54


Co mm only

Used

W ho has A ccess

(Key A udiences)


Workshops

Occasional

M ost are gea red to

professionals,

service providers

Can p rovide very good

information

Sm aller than conference, audiences

tend to be smaller; but training can

be more targeted (1/2 d ay or fu ll

day)

Time to organize

M ust recognize the range

of knowledge need s of

audience (bas ic to very

skilled)

$ to deliver workshops;

materia l deve lopm ent;

travel; tim e off to

participate; promotion

Som e form of worksh ops are available in

man y jurisdictions, but need to know w here

to look


September 2003 55

Appendix F: Approaches Used to Assist Abused or Neglected Older Adults in Canada

Typ e of App roach

(alphabetically) Purp ose Service Delivery Strengths Limitations Fun ding Sou rce Examp les

Adu lt Protection Services Geared prim arily to

incapable or

incompetent older

adults

May deliver service

direc tly or negotiate

with home support and

other com munity

services

Formal system; has a

structure; receives

operational funding

Have been under-funded

for years; in some regions,

AP workers must split

time between child abuse

and abuse of adu lts

May interpret mandates

very narrowly in light of

scarce resources

Generally health and

socia l services or family

services

Atlantic Canada

Ad vocacy (Form al) Enforcement of legal

rights and

entitlements;

advocacy and system

negotiation; legal

research ; pub lic

education

Varies:

Specialized service of

non-governmental

organization (Advocacy

Centre for the Elderly)

or

Com ponent of other

legal services (poverty

law)

or

Pilot project (Seniors

and the Law)

M ay also b e private

lawyer

Specialized knowledge of

legal issues

Limited resources can

affect # of clients served

Varies:

Legal A id O ntario

(Advocacy C entre for

the E lderly)

BC Law Foun dation

(Seniors and Law)

Advocacy C entre for the Elderly, O N

Seniors and Law, BC

Elder Law, QC

Advocacy

(Inform al)

See also Peer Ad vocacy

Information on

rights; advocacy and

aiding self advocacy

Varies

Com ponent of other

services; la rge ly

volunteer based,

coordinated by seniors

org. or othe r non -profit

service

--- ---

Varies, usually project

funding; may receive

grant

BC Coalition to Eliminate A buse of

Seniors


September 2003 56

Typ e of App roach

(alphabetically) Purp ose Service Delivery Strengths Limitations Fun ding Sou rce Examp les

Consultat ion teams Collaboration and

"brainstorming" on

complex cases

Varies Draw s the skills of

professionals from

diverse fields

Lack of promotion. Service

providers may not be

aw are of team 's

existence/role

Varies. May be

"donated time"

Elder Abuse Consultation Team

(Edmonton, Toronto, Kingston)

Coo rdinated comm unity

response netw ork

Developing a broad

integrated approach

to helping;

developing links

among agencies and

organizations;

sharing skills,

protocol

development

Agency by agency, but

in coordinated manner

Bu ilds on skills in

community; often finds

variety of resources

Identifies gaps and works

to reduce them

M ay be m ore difficult to

develop in more complex

environm ents

Seed funding

BC

On tario

Man itoba

Counselling Psychosocial

support; information

about op tions ; safe ty

planning; advocacy

Transition homes,

shelters may have

counsellors

Several health and

social programs have

social worker counsellor

attached to other

p rograms

Rebui lds p erson's

strengths

One to one

Can deal with

complexities

M ay have sp ecial sk ills in

working w ith olde r adu lts

One to one

Takes time

Usually through existing

health or social service

Special elder abuse counsellor, VISTA:

Elderly Outreach Services, Victoria , BC

Age and Opportunity, Winnipeg , MN

Information and Education M ay be th rou gh fam ily

violence programs or

specialized abuse

education organization

Alb erta O ffice for the Prevention of F am ily

Violence

Hotlines Provide information

and referral to older

adults on available

services and

resources

Service can be

delivered by paid staff

or trained volunteers

Confidentiality; ease of

access; usefu l if

concerned about

Public often unaw are of

the resource; there also

needs to be "people

resources" in the

com munity

Only a few of these have a

follow u p process to see if

resource s were u sefu l to

person

Varies

May be project funding

(pilot project); or

Funded through a

foundation; or

Local or provinc ial

government funding

S en iors Ab us e Lin e , M N

Info-Abus (Quebec) receives about 1200

calls a year

BC C oalition for the Elimination of Elder

Abuse


September 2003 57

Typ e of App roach

(alphabetically)

Purp ose Service Delivery Strengths Limitations Fun ding Sou rce Examp les

Multi -discipl inary Teams Multiple skills and

knowledge to deal

with variou s asp ects

See "Fu nding" Multiple skills and

know ledge to dea l with

variou s asp ects

Various disciplines

develop expertise in the

area

Som e program s aid

community development

with b roader sk ills

build ing in the com munity

Can sometimes be

stretched thin

A lot of variability in the

philosophical approach of

the teams

Varies - can com e from

different sources

depending on team

comp osition

Or all from one agen cy

Edmonton (Elder Abuse Intervention

Team)

Montreal (CLSC)

Peer Support and

Ad vocacy (ind ividual)

Em otiona l support,

practical assistance;

information on

rights; advocacy and

aiding self advocacy

Usually tied to another

service; can be through

seniors organization or

other services that work

with older adults

Trained volunteers

Can "s tick with" person

for longer period than

service providers often can

Volunteer base is

dwindling; need volunteer

coord inator to sustain

Varies, m ay be pilot

project, or grant, or

"borrowing" services of

volunteer coordinator

from other service

Senior Citizen Counsellors Program

Peer S upp ort

(groups)

Em otional support

and information;

rebu ild self esteem ;

break social isolation

Organized/ facilitated

by service provider;

may be run by peers

Addresses many of the

risk factors for staying in

or returning to an abusive

relationship; not

expensive to run.

Need often outstrips

availability; lack of

transportation can be

barrier; requires trained

facilitator (can be senior)

to ope rate

Us ually fun ded in

conjunction with other

services provided by an

agency

Older Wom en for Long-Term S urvival

(OWLS, Calgary, AB)

Shelters Crisis or short term

housing and support

Varies

Cris is housin g; dea ls with

physical safety first Often under-funded

Crisis housing only one

part of greater housing

needs

M ay draw from

different pockets of

money for different

componen ts of p rogram,

e.g., public housing

Safe houses/safe suites, Edmonton, AB

Specialty-built Kerby -Rotary Centre,

Calgary, AB

Adapting transition houses policies to meet

needs of older women in BC

Resource C entre Provides inform ation

and resource s to

older adults, service

prov iders , public

All the in form ation is in

one place

People m ay not be aware

of its existence

Varies

Elder Abu se Resou rce Centre, W innipeg,

M N

Ontario Network for Prevention of Elder

Abus e resource library

National Clearinghouse on Family

Violence


Final: October 30, 2003 58

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an environmental scan of abuse and neglect of older adults in

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