Presentation to Victim Services Program Volunteers on the Abuse of Older Adults

Monday, May 6, 2013

Yellowknife, NT

The Society was incorporated under the Societies Act as a non-profit organization in March 1983

However, it was not until 1993 that seniors from across the NWT were able to get together to hold an AGM and elect an NWT Seniors’ Society Board of Directors

The Society celebrated its 30th anniversary on February 26, 2013

The Society Board at this time is made up of Directors from the communities of Fort Smith (2); Fort Resolution; Hay River; Fort Providence; Norman Wells; Yellowknife; Aklavik and Uluhaktok

Vision: All Seniors are valued and respected by the community

Mission:

Ensure Seniors have dignity, independence, participation, fairness and security within the community

Mandate:

Dedicated to promoting the independence and wellbeing of older citizens through the provision of programs and services in partnership with responsible government departments and other organizations.

1.Support more seniors/elders living independently in their own homes

2. Maintain existing level of health benefits to seniors in the NWT

3. Encourage more seniors to live active, healthy lifestyles

4. Encourage and support community-based elders/seniors groups

5. Enhance the capacity of the NWT Seniors’ Society

6. Eliminate abuse of older adults

Seniors’ Information Line since 1995 Raising awareness about abuse of older adults –

ongoing since the mid-1990’s Canada Senior Games - 2004; 2006 & 2008

Elders & Youth Forum – Bridging the Generations –

2004/2005 Arctic Ambassador Program – YK; HR; Ft Smith - 2008 Charter of Rights and Freedoms for Older Adults, September 2006 World Elder Abuse Awareness Day (WEAAD) June 15

Senior Citizens’ Week and Grandparent Day Emergency Medical Information Kits -2008 Youth & Seniors’ Literacy Events 2009-2012 Advocacy on behalf of Seniors in all sectors –since

the very beginning and ongoing Since 2010, the Society has renewed its focus on

addressing abuse of older adults…

Building Networks (2010-2011) ◦ Research; ◦ NWT Wide Symposium; ◦ Framework for Action

Leading the Way: The Work Continues (2012- 2015) ◦ Establishment of the NWT Network to Prevent

Abuse of Older Adults ◦ Developing Regional & Community Support

Networks ◦ Workshops & Information Sessions on Abuse of

Older Adults in NWT Communities ◦ Training of Frontline workers/caregivers ◦ Intergenerational Initiatives

Abuse takes many forms including: ◦ physical; ◦ sexual; ◦ psychological; ◦ verbal; ◦ financial; ◦ emotional; ◦ spiritual; ◦ political ◦ as well as incidences of neglect

Interviewed over 500 older adults and 98 service providers/caregivers in 11 communities:

All forms of abuse exist but the most common forms are financial (77%), neglect (68%), emotional (63%), and verbal abuse (54%)

71% of older adults surveyed said that abuse of older adults is a problem in their community

28% did not know if it is a problem

There is a high level of uncertainty and silence

47% said they did not know how to protect themselves, and

38% said they didn’t know where to go for help

Dispelling myths and misconceptions about abuse of older adults is one place to begin raising awareness about the issue

The handout will gauge your knowledge of the myths & misconceptions associated with the abuse of older adults

Take a few minutes to complete the True or False Quiz.

As you will have noted, all nine (9) statements on the quiz sheet are false

The handout provides a commentary on each of the false statements in the quiz.

Regardless of the factors involved, nothing justifies the abuse or neglect of others.

Understanding all aspects of aging enables us to better understand and provide assistance to older adults who are victims of abuse and neglect

◦ Universal ◦ Normal ◦ Variable

◦ Dying is normal & inevitable

◦ Ageing & illness are not necessarily coincidental

◦ Older persons often represent three or four generations ◦ Older persons can and do learn ◦ Older persons can and do change ◦ Older persons want to remain self-directed ◦ Older persons are vital human beings

◦ Competency – being old does not necessarily mean being

incompetent.

Ageism colors our attitudes and lead to negative attitudes towards older adults

Ultimately, ageism leads to the disempowerment of older adults

Sexism combines with ageism to magnify the disempowerment of women.

A good place to begin addressing the issue of ageism is with our children and youth

The Society’s current work has an intergenerational component

Hope to test out various ways in which to engage older adults and youth in activities in schools, the community and on the land

Face age discrimination

Often in conflict with adults

Have to deal with loss

Into the drug scene

Have changing bodies

Have limited income

Are dependent on others

Face language/communication barriers

Not taken seriously

Often bored/looking for things to do

Sometimes feel alone and unwanted

Sometimes feel unsafe

These factors do not function alone; it is often the interaction of several contributing factors that result in abuse:

1. Behavioral problems of the abuser

2. Inter-Dependencies

3. Family pattern of violence

4. Social isolation

5. Negative attitudes about the elderly

6. Stress

7. Difficult family relationships.

8. Any thing else?

The challenge for communities lies in creating an environment which is not conducive to the abuse of older adults:

Primary prevention goal is to decrease risk factors for abuse

Secondary prevention goal is to detect situations of abuse early and ensure prompt treatment

Tertiary prevention goal is to reduce the effects of abuse.

Primary Prevention: Encourage educational opportunities and promote

general awareness

Strengthen or build Informal social networks: caregiver support; community gatekeepers; neighbors supporting neighbors; peer support

Coordinate and develop services

Promote research and panning

Advocate on behalf of seniors.

Secondary Prevention: Train service providers

Develop assessment tools for elder abuse

Develop and use protocols

Develop and implement a plan of intervention for both victims and abusers

Tertiary Prevention: Provide rehabilitation assistance to the victim

Provide rehabilitation assistance to the abuser.

Reducing the isolation of older adults – e.g. developing and maintaining informal and formal support networks

Empowering older adults – enabling seniors to take control of

their lives and to make decisions that are in their best interest Counsel and support for caregivers – e.g. promote and

facilitate self-help groups for caregivers and family members to help them talk about their concerns

Advocacy by service providers – e.g. dispelling the myths of

ageism, raising awareness about abuse of the elderly, etc.

Educating the public – increased awareness and understanding by the public tends to encourage older adults to seek help.

Working with older adults who have been abused can arouse strong feelings ranging from anger to sadness

Acknowledging , understanding and dealing with these feelings is imperative for service providers/caregivers to be effective in their interactions with elderly victims and abusers.

The very nature of the problem

Identification with the victim and/or abuser

Influence of personal experiences and standards

Management of elder abuse cases.

Be aware of your own attitudes and feelings towards aging, dependency, and family violence so as not to impose your own biases on clients

Recognize your own limitations in order to avoid feelings of powerlessness and eventual burnout

Draw on the resources available to you. Share your feelings and thoughts with your supervisor, colleagues, and/or other professionals in the community

Make every effort to further your knowledge and understanding of the elderly and elder abuse through continuing education, case discussions and attendance at workshops and conferences – see www.nwtseniorssociety.ca

Elderly persons who are most likely to become victims have some, but not necessarily all, of the following characteristics:

◦ Advanced age ◦ Female ◦ Experiencing progressive physical and/or mental impairments which lessen

their ability to live independently ◦ Under the control or influence of the abuser and/or dependent upon the abuser ◦ Exhibit problem behaviors e.g. demanding, ungrateful, childish, etc. ◦ Misuse of alcohol, medication and/or other drugs ◦ Abused in the past ◦ History of marital and/or family conflict and poor relationships ◦ Blame themselves for the abusers’ behavior ◦ Poor social support network e.g. isolated from friends, neighbors and other

family members.

Studies indicate that: Victims of financial abuse and neglect are more likely to be

widowed and living alone and to report that they have no one to help them in the event of illness or disability

Those who experience psychological and physical abuse tend

to be married and to be living with the person who is abusing them

No group of seniors is immune to the possibility of abuse.

Victims of elder abuse are from all incomes and educational levels and racial and ethnic groups

However, there are indications that risk factors tend to be

more pronounced among some minority and immigrant groups.

Lack of consistency as to the profile of an abuser in the literature

Canadian research suggests that characteristics of the

caregiver are more crucial predictors of abuse than characteristics of the elderly victim. Emerging profile:

◦ Middle-aged or older

◦ Adult children, spouses, or family members

◦ Emotionally or mentally impaired

◦ History of alcohol and/or drug abuse or other problem

behaviors

◦ Physically, financially and/or emotionally dependent on the elder

◦ Past history of abuse and relationship difficulties

◦ Ill-informed or ill-prepared regarding responsibilities of caring for an older adult

◦ Expectations of older adults are unrealistic

◦ Resentful of caregiver role

◦ Have a blaming attitude

◦ Experiencing external stressors

◦ Lack of personal and community supports in providing care.

Abuse of older adults is often described as the invisible or hidden crime

Reasons for non-reporting include the

following: ◦ Unlike children, older persons are more easily

isolated and hidden from public view ◦ Family members often actively conceal or deny

the problem ◦ Service provider role on reporting not always

clearly defined ◦ No legislative requirement to report

Non-recognition i.e. may consider family violence a normal

Inability to express themselves – language barriers and/or physical or mental impairments

Fear of a lack of confidentiality

Shame

Rationalization – believing the abuse is deserved

Privacy of the family – turning inward for strength instead of outward for help

Feelings of powerlessness

Fear of consequences

Lack of awareness of available options and services.

The general public are often concerned but many will not voice their suspicions. Reasons for this include: ◦ Consider it to be a family matter ◦ Lack knowledge as to where to go with their concerns or

how to assist the victim ◦ Reluctant to get involved and may not want to get drawn

into a court case as a witness if charges are laid ◦ Fear of negative consequences for the elderly victim ◦ Afraid of the abuser and of going into the home after abuse

has been reported.

Service providers often have to rely on their own powers of observation in determining whether or not abuse has occurred

Particular attention needs to be given to the following:

physical signs or symptoms;

presenting behavior of the older adult or caregiver;

physical condition of the home and surrounding environment.

Three important points to consider when determining if there is abuse:

◦ Many signs of abuse can be attributed to other

factors such as the changes that accompany aging or illness

◦ Any situation may be characterized by more than

one form of abuse ◦ Some indicators are common to more than one

category of abuse.

Hard to detect but some signs to look for include: ◦ Unexplained discrepancy between income/assets and

standard of living

◦ Unusual bank account activity by persons in positions of trust

◦ Unexplained or sudden inability to pay bills, purchase food or personal care items

◦ Missing possessions

◦ Expectations of disproportionately high contribution by the senior to household expenses

◦ Money loaned with no indication of repayment or cheques signed by senior when made out by someone else.

◦ Legal documents signed by an older person without a basic understanding

◦ Suspicious signatures on cheques or other documents

◦ Confused or inaccurate understanding of financial

situation or purpose of meetings with lawyers or financial advisors

◦ Fear and anxiety when discussing finances

◦ Extraordinary interest by family member in older persons’ assets

◦ Reluctance by the older adult or caregiver to purchase needed services when he/she can afford it.

Presenting behavior of the older person: ◦ Low self-esteem

◦ Withdrawn, passive

◦ Difficulty sleeping or excessive sleep

◦ Change in appetite; significant weight loss or gain

◦ Loss of interest in self, activities, environment

◦ Reluctance to participate in decision-making

◦ Feelings of helplessness/hopelessness

◦ Agitated

◦ Fearful, especially in presence of caregiver.

Presenting behavior of caregiver: ◦ Withholds companionship, love ◦ Treats older adult as a non-person or as a child ◦ Leaves the elderly person unattended for extended

periods of time ◦ Excludes the older adult from family gatherings,

prevents friends and/or family from visiting and makes excuses for social isolation

◦ Prevents the older adult from sending and/or receiving their own mail.

Environmental Indicators:

◦ Evidence of unwarranted use of restraints on a bed

or chair

◦ Padlocks on doors inside the home

◦ Absence of warm, positive, supportive, caring atmosphere

◦ Lack of access to telephone, email, radio, TV, reading materials.

Presenting behaviors of older adult: ◦ Signs of depression or anxiety

◦ Reluctance to participate in decision-making

Presenting behaviors of caregiver: ◦ Prevents older adult from attending religious services,

exercising a civic right, etc.

◦ Makes decisions for the older adult without consulting him/her

◦ Forces the older adult to do something he/she does not want to do e.g. marry, divorce, change will, give power of attorney, etc.

Service providers have a professional and moral responsibility to explore the situation further and to gain as clear a perspective of the situation as possible if they suspect abuse

This may be done in a number of ways but is based primarily on the following: ◦ Additional formal or informal meetings with alleged

victim and/or abuser to observe and assess their needs more clearly

◦ Obtain information from other sources including family members, other service providers.

Physical signs include: ◦ Unexplained injuries ◦ Injuries incompatible with medical history ◦ Signs of hair pulling ◦ Evidence of unjustified physical restraint ◦ Signs of over medication, lack of medication or other

misuse ◦ Signs of sexual assault ◦ Evidence of malnutrition ◦ Evidence of untreated medical problems ◦ Signs of hypothermia ◦ Lack of eyeglasses, hearing devices, dentures, etc. ◦ Evidence of overall poor personal hygiene ◦ Cloths incomplete, dirty, in poor condition or inappropriate

The presenting behaviors of the older person includes:

◦ Evidence that the older adult is afraid ◦ Denial that a problem exists ◦ Reluctance to provide information ◦ Consistently defends the caregiver or is over-protective

of them ◦ Obtains medication from numerous pharmacies ◦ Frequently seeks medical care from a variety of doctors

and medical clinics in order to conceal previous injuries ◦ Delays seeking treatment for trauma/illness.

Presenting behaviors of the Caregiver: ◦ Postpones seeking medical attention for the alleged victim

◦ Obstructs access to treatment

◦ Provides contradictory medical history and/or attributes injury to a

third party

◦ Exhibits a blaming, critical, angry attitude towards the senior

◦ Responds to questions defensively or provides vague explanations

◦ Avoids physical, verbal and eye contact with elderly person and/or service provider

◦ Does not want the senior interviewed alone

◦ Appears under or overly-concerned about the older adult

◦ Exhibits signs of destructive and aggressive behavior that have a definite element of danger and possible violence

Environmental Indicators: ◦ Unsanitary conditions ◦ Lack of heat, light, ventilation or water ◦ Lack of adequate and operable appliances,

washroom facilities, furnishings ◦ Lack of required safety features in home.

NOTE: some or all of these indicators may be a result

of poverty and not necessarily mistreatment.

Clients have the right to determine and control their own affairs to the full extent that they are able Clients have the right to access to information required to make meaningful and informed decisions The focus of the intervention is not the alleged mistreatment but rather the total solution. Assistance should be offered to both the alleged victim and abuser Every situation of alleged abuse needs to be assessed individually

Assessment and evaluation are ongoing processes Clients have the right to confidentiality

Non-judgmental attitudes on the part of service providers are essential.

Intervention should: ◦ Be undertaken with the voluntary and informed consent of the older

person ◦ Be the least intrusive or restrictive alternative to ongoing abuse ◦ Be based on maximizing the older adults/family’s strength and

abilities for positive action ◦ Respect the elderly person’s right to privacy and confidentiality as well

as that of their family

When interests compete, the older adult (client) is the only person to whom the service providers are obliged to provide assistance

Certain kinds of behavior directed toward older adults is criminal activity – in such instances, call the RCMP

All interactions with older persons should be sensitive to language, culture, religion, race, gender and ability.

Obstacles to effective intervention by service providers may include the following:

◦ Variations in the definition of abuse of older adults or

“elder abuse”

◦ The hidden nature of abuse

◦ Organizational and professional barriers

◦ Personal barriers

◦ Inadequate community resources.

Intervention Plans must be designed on a case-by- case basis while carefully considering the following:

◦ Access ◦ Severity and duration of mistreatment

◦ Mental capacity of the victim

◦ Physical and functional capabilities of victims

◦ Willingness to accept help

◦ Types of abuse

◦ Contributing factors to abuse

◦ Organizational and Professional responsibilities and capabilities

◦ Past and present interventions

◦ Availability of resources

◦ Potential risks of intervention.

Document observations and indicators of abuse

Report and/or refer to another agency or service provider.

Determine if the victim is safe

Provide information/training

Initiate counseling referral and/or provide counseling

Facilitate interaction with support system

Explore alternative living arrangements

Assist with financial management protection

Assist with legal procedures

Establish precautionary safety plans.

While under reported, in over two thirds of abuse cases that are reported the victim is a woman

The following video is based on the real experiences of several women brave enough to come forward and tell their story

The video is about 14 minutes long and may be quite disturbing to some of you – viewer discretion is advised.

*What’s Age Got To Do With It? (The BC/Yukon Society of

Transition Houses, 2003)

Contributing factors to abuse

Intent of abuse

Types of abuse

Severity and duration of abuse

Abuser acknowledgement of behavior & willingness to accept help

Past and present interventions with abuser

Availability of community resources

Potential risks to senior and service provider.

Voluntary:

◦ Provide or refer for counseling and/or treatment

◦ Address the need for respite care and support services

◦ Provide education/information

◦ Explore alternative living arrangements

Involuntary:

◦ Involve law enforcement and courts

◦ Ensure that mental capacity is assessed.

In 1995, with funding from New Horizons: Partners in Aging Program, posters, PSA’S for radio and television were produced after workshops were held in various communities throughout the NWT and Nunavut

Interestingly enough, while a variety of topics were covered in this initiative, abuse of older adults was not a major issue raised at the community workshops.

In 1995 the Seniors Information Line was established – 1-800-661-0878

It is operated by the NWT Seniors’ Society with funding from the GNWT’S Department of Health and Social Services

Links elders from communities across the NWT

Provides information services, advocacy and support to elders.

Established in 1999/2000 to: ◦ Continue to raise awareness about elder abuse;

◦ Provide information to caregivers, professionals families and elders;

◦ Provide information about the Seniors’ Information line and the work of the Society as it relates to the abuse of older adults;

◦ Offer workshops on the abuse of older adults at the community level.

In 2001-2002, the Society participated in the GNWT review of seniors programs and services

Involved travelling to eleven communities throughout the NWT and listening to seniors

The Report on the Review was released in 2002

It identified that elders, caregivers and the general public viewed elder abuse as a grave concern in all 11 communities visited.

In 2004, the Society released its report entitled, A Plan for Action: Respect Our Elders – Stop the Abuse

The report and action plan was the culmination of direction provided by participants at workshops in N’dilo & Dettah, Behchoko as well as the K’atlodeechee Reserve

The Action plan set out a number of objectives and associated actions for the Society to tackle in its role to stop elder abuse.

The Bridges Between the Generations Conference held in N’dilo during November 2005 was a follow-up to a commitment made in the 2004 Plan for Action to Stop Abuse of Older Adults

The report was released in early 2006 Among other things, the report ended on a positive

affirmation that we can put a stop to elder abuse It spoke to what individuals can do; the role of community

service providers; the role of community leaders and what the NWT Seniors’ Society can do to put and end to abuse of older adults

The actions set out in these two reports continue to be the basis of the Society’s commitment to the eradication of elder abuse.

In its work, the Society is guided by the principles as outlined in the National Framework on Aging: ◦ Dignity – being treated with respect, regardless of the situation,

giving a sense of self-esteem

◦ Independence – being in control of one’s life

◦ Participation – being involved, staying active & taking part

◦ Fairness – having needs considered equally with others

◦ Security – having adequate income in a safe and supportive environment