Elder abuse & neglect

“Elder abuse and neglect should be identified as abuses of human rights.”
(Canada’s Association for the Fifty-Plus (CARP))

Many individuals and organizations provided comment on the issue of elder abuse. The submissions emphasized that elder abuse is a human rights issue requiring an effective response by government and by communities throughout Ontario. The Commission heard that any action concerning elder abuse, whether by government, community organizations or by individual caregivers, must be grounded in a respect for the dignity, independence, full participation and the security of older persons. The following pages provide an overview of the comments offered to the Commission throughout the consultation process.

Although a universal definition of the term elder abuse does not exist, Health Canada has defined it as “the physical, psychosocial or financial mistreatment of a senior”. [33]
Physical abuse of an older person can include assault, rough physical treatment, sexual exploitation, or the failure to provide an older person with food, or with appropriate personal, hygienic or medical care. Psychosocial abuse includes verbal abuse, the social isolation, the failure to provide affection, and the denial of the opportunity to make or take part in decisions concerning one’s own life. Financial abuse includes the mishandling of an older persons money or property, and also includes fraud. [34] However, a 1999 report by the Ontario Legislative Assembly adds to this list a number of additional forms of elder abuse including: medication abuse (e.g., the misuse or withholding of medications), the denial of fundamental rights and freedoms, abandonment, and self-neglect.[35]

Financial abuse tends to be most common (62.5%), with verbal and physical abuse second most common (35% and 12.5% respectively) followed by neglect (10%).[36] Submissions received by the Commission highlighted that elder abuse and neglect occur in all contexts; in the home, in hospitals, in long-term care facilities, and in retirement homes.

The Under-Reported Nature of Elder Abuse

The Commission heard that approximately 4% or 60,000 of the 1.5 million older persons living in Ontario experience elder abuse.[37] However, many older persons are not willing to report elder abuse because of the social stigma attached to it or because of concern regarding the consequences of reporting a loved one or caregiver. As a result, this percentage may be under-estimated.[38]

A number of the submissions highlighted the complex nature of elder abuse. As one group told the Commission, the dependency of older persons upon their caregivers means that abuse inflicted by a caregiver is more difficult to address. The embarrassment experienced by older persons who are abused by their family members and caregivers makes elder abuse a “hidden form of familial abuse” (The Ontario Association of Social Workers). Older persons who are experiencing abuse are often faced with the decision of whether or not to report their abuser, the result of which could mean the loss of their caregiver, making their decision to report that much more difficult (Chatham-Kent CCAC). Others told the Commission panel about the serious dilemma facing older persons who are abused by those for whom they themselves are caring for, wherein the older person’s desire to care for that person conflicts with their own need for safety.

CARP discussed the issue of elder abuse in the context of care facilities. It noted that for those who experience abuse within care facilities, fear can act as a real deterrent to reporting abuse. A number of consultess told the Commission that families may also be too afraid to complain about the abuse of their older relatives because they fear retribution against their loved ones in the form of poorer care or further abuse (ARCH and Karen Henderson). As the Council on Aging noted, the problem of elder abuse is very much like domestic violence and requires a systemic approach to ensure that victims of elder abuse are not further victimized in the process of seeking recourse and in defending their rights.

Abuse of Deaf and “Deaf-Plus” Older Persons

Several consultees told the Commission of the particular experience of elder abuse faced by Deaf, deafened and hard of hearing older persons. While Deaf seniors experience the same forms of abuse as other seniors (e.g., financial abuse, physical abuse, emotional abuse, etc.), they also experience communication abuse. The communication barriers faced by Deaf older persons makes this group particularly vulnerable to the other various forms of abuse (The Canadian Association of the Deaf). The Canadian Hearing Society provided the Commission with several anecdotal descriptions of situations of communication abuse:

“A client who went into hospital uses hearing aids and speechreads. The client needed information from the nurse regarding her medical situation. The nurse refused to turn on the light so the client could speechread, even though the client requested it and told [the nurse] why.”

“[A] Client’s medical condition [was] discussed over the person’s head to a third party rather than being discussed with the client.”

“A colleague of mine had a client who was misdiagnosed with dementia and was hospitalized. It took my colleague a year to get that person out of the psychiatric ward and back home...he had been tested without his hearing aids in.”

The vulnerability that occurs in the context of elder abuse is heightened for “Deaf-Plus” older persons, that is, those who experience hearing impairment in addition to other disabilities such as blindness, Cerebral Palsy or intellectual disabilities. This group of older persons is often the easiest to abuse because they are vulnerable and unlikely to report the occurrence of abuse (The Canadian Association of the Deaf). The Canadian Association of the Deaf emphasized that, “people with this kind of special vulnerability often simply do not know where to go or how to seek assistance, so they endure the abuse as being almost a birthright of ‘superior’ hearing people”.[39]

A report by the Canadian Association of the Deaf entitled, Keeping the Hands in Motion[40] highlighted the communication barriers faced by “Deaf-Plus” older persons. For those who have arthritis in their fingers or hands, the ability to communicate through sign language and writing is limited. Given the importance of vision for Deaf persons in communication, where a person experiences a visual impairment, communication barriers are further compounded. These barriers further exacerbate an older person’s vulnerability in the context of an abusive situation.

Throughout the consultations, organizations emphasized the need for broad public education and awareness building with respect to elder abuse and neglect. Others suggested the need for targeted education, particularly geared toward professionals who work with older persons on a regular basis (i.e., doctors, nurses, social workers, etc.). In addition, a number of consultees called for more education and supports for caregivers.

With respect to Deaf and Deaf-Plus older persons, the Canadian Association of the Deaf suggested that a network of advocates should be set-up to assist Deaf seniors with abuse and neglect-related issues, to protect Deaf seniors from abuse and ensure that they are aware of their rights. Others suggested that more funding should be provided to develop educational programs that could alert Deaf and Deaf-Plus older persons to the issues of elder abuse, neglect issues, to their rights and to possible mechanisms of recourse.

Causes of and Contributors to Elder Abuse

“Until the elderly are fully recognized as individuals with the same human rights...as other citizens, abuse of the elderly will prevail – whether it takes place in the home, community or institutions.”
(Ontario Association of Social Workers)

The Commission heard that the causes and contributors to elder abuse are varied and extensive. A number of submissions noted that ageism and a general negative attitude toward seniors is a key underlying contributor to elder abuse. ESAC told the Commission that elder abuse is tied to a lack of services in the community as well as the lack of available long-term care beds and available, affordable and accessible housing. Still others noted that the economic and social vulnerability of older persons contributes to elder abuse.

The Ontario Coalition of Senior Citizens’ Organizations told the Commission that elder abuse frequently occurs when primary caregivers experience “burn-out or significant stress”. This includes professional caregivers who are facing a growing caseload, as well as complex care responsibilities within the context of an under-funded system of services. This also refers to family caregivers who are expected to provide care for aging relatives in the context of dwindling government services and supports. Reports by Health Canada and the Government of Nova Scotia also support this notion. They both report that elder abuse can result when a caregiver’s stress is exacerbated by a lack of available information and resources about caring for an aging person. Furthermore, a caregiver’s own issues such as unemployment, substance abuse, personal relationship problems and unresolved family conflict can contribute to the occurrence of elder abuse.[41]

Submissions noted that many well-intentioned adult children or other caregivers want to make decisions for older persons, especially when they perceive that an older adult cannot make decisions for themselves. However, a number of organizations noted that seniors often lose their rights to self-determination, independence and dignity in the process (Ontario Association of Social Workers and The Canadian Mental Health Association). As Health Canada’s work on elder abuse notes, the denial of the opportunity for an older person to make or take part in decisions concerning his or her own life can be a form of psychosocial abuse. The Canadian Mental Health Association suggested that in order to ensure that an aging person’s rights to independence and dignity remain in tact, widespread public education is needed.

The lack of regulation of privately-run care facilities was also noted as a contributor to the vulnerability of older persons to abuse. The need for regulation of privately-run care facilities and for standards for all such homes across the province was discussed in the section on Health Care, Institutions & Services.

The lack of emergency shelters available for older persons who have experienced abuse was also mentioned as a factor that contributed to elder abuse. The Ottawa-Carleton CCAC told the Commission that existing emergency shelters are often full and tend to address the needs of younger women and children. Such facilities are not appropriate for older persons and options for people suffering abuse by caregivers are limited. Other organizations told the Commission that barriers to accessing shelters include a general lack of knowledge on the part of older persons regarding how to access emergency shelters. Furthermore, language and cultural barriers exist that further limit the accessibility of these facilities. ESAC suggested that temporary shelters should be established to aid older persons and those with disabilities in their transition from an abusive situation to a safe environment. The Ottawa-Carleton CCAC suggested that shelters should exist for both men and women, should be walker and wheelchair accessible and staffed with people who are able to address the complex needs of older persons.

Programs to Combat Elder Abuse

A number of organizations told the Commission about programs to combat abuse of older persons. One such program is Phone Busters, a program implemented by the Ontario Provincial Police. Phone Busters accepts calls from across North America from older persons who have fallen victim to telemarketing fraud. Representatives from Phone Busters told the Commission that, “80 per cent of the people that call Phone Busters are seniors [and] have lost money to telemarketing fraud”. Others added that single older women are particularly vulnerable to financial “scams” such as telemarketing fraud. As with other forms of abuse, financial abuse of older persons is under-reported. Phone Busters estimates that, “only one per cent of the losses are actually being reported due to embarrassment and shame on the part of the victim”.

“We are teaching them to [regain] their dignity because a lot of [older persons] are embarrassed and will not talk to their family members...If you lost [money], the last thing you would want to do is tell your children...”
(Ontario Provincial Police, Phone Busters)

The statistics for the Phone Busters program illustrate that it has been very successful in reducing the dollars lost by older persons who are vulnerable to financial abuse. As a result, the group sought new mechanisms through which further outreach to older persons could occur. The result was a partnership between the Near North CCAC and Phone Busters to implement an elder abuse hotline pilot study. The pilot is aimed at addressing systemic abuse, neglect, physical and psychological abuse of older persons. The Commission was told that the six-month pilot ended early this year and that the Ministry of Citizenship, Seniors’ Secretariat will determine the next steps for the program.

Recommendations for Government & Community Action

26. THAT mechanisms currently in place to address other forms of familial abuse should be extended to apply to elder abuse.

27. THAT the provincial and municipal governments take steps to support specialized programs, including shelters, for victims of elder abuse.

Commission Commitments

8. The Commission will continue to monitor the outcomes of the provincial plan of the Round Table for Ontario’s Elder Abuse Strategy that are within its mandate.

[33] Health Canada, National Clearinghouse on Family Violence, Elder Abuse, at 1, online: Health Canada ,<http://www.hc-sc.gc.ca/hppb/familyviolence/html/eldereng.html>.
[34] Ibid.
[35] Andrew McNaught for the Ontario Legislative Library, Legislative Research Service, Elder Abuse Prevention Laws (Office of the Legislative Assembly of Ontario: Toronto, 1999) at 2.
[36] Ibid at 2.
[37] This is supported by the August 1999 study by the Ontario Legislative Library, supra note 35 at 2.
[38] The Ministry of Citizenship, Seniors’ Secretariat notes that up to 10% of the 1.5 million seniors in Ontario experience elder abuse. See “Putting a Stop to Elder Abuse” online document at <www.gov.on.ca/mczcr/seniors/english/elder-abuse-update.htm>.
[39] Ibid at 27.
[40] Kenopic, supra note 13 at 10.
[41] Government of Nova Scotia, Ministry of Community Services, Fact Sheet 7: Elder Abuse, online document at <www.gov.ns.ca/coms/facts7.htm>.