Status of Women Committee on Oct. 20th, 2011

[Barb Mildon, President-elect, Canadian Nurses Association]

Good afternoon. Thank you for the opportunity to be here.

I am pleased to be joined by my colleague Josette Roussel. Both of us bring to you a clinical background in gerontology. It is indeed a subject dear to our hearts.

On behalf of Canada's 250,000 nurses, thank you for the opportunity to bring you the nursing profession's perspective on a significant and hidden problem: elder abuse.

Elder abuse is any action or deliberate inaction by a person in a position of trust that causes harm, or could reasonably be expected to cause harm, to an older person. This includes all types of abuse, including emotional, physical, sexual, and financial, as well as instances of neglect and violation of rights. According to Statistics Canada, seniors over the age of 65 represented 13% of our population in 2009. In that year, almost 8,000 instances of elder abuse were reported, an increase of 14% since 2004.

Elders are the pearls of our society. Just think of your own parents or grandparents and the many older adults who have had an impact on your lives. Recognizing the value of their contributions to our culture and our society must remain at the centre of their care and treatment.

Canada's nurses are concerned about elder abuse across the continuum of care and throughout the country, not simply because the rates are increasing, but also because it exists at all. As a society, we must have zero tolerance for elder abuse. By approaching this issue in a comprehensive, multi-faceted way, we can lay out a strategy that will build the culture of caring, dignity, and respect that our older Canadians deserve.

Elder abuse is not only a patient safety issue. It is also a public health imperative.

Our first recommendation to the committee is to develop a comprehensive strategy to prevent elder abuse. This strategy should include targeting outreach programs anchored in public heath services, supportive housing, and tax credits for seniors, as well as an accelerated focus on populations affected by conditions that create vulnerability.

Many of these populations are immigrants who experience barriers to accessing help, senior women who are homebound and living in poverty, and first nations, Inuit, and Métis peoples. An incomparable opportunity exists to challenge, through friendly visitor and day care programs and especially through public health nurse visits, the isolation and loneliness many seniors face.

Looking to an international example, Copenhagen has a program whereby public health nurses visit people over the age of 70 in their homes. They assess their needs, provide care, and generally ensure they have access to the wellness supports they need.

Evidence demonstrates that in addition to the visible interventions of nurses when working with the elderly, nurses bring a personal engagement and caring that reduces the feelings of isolation and profound loneliness that so many older Canadians experience. Such programs have the potential to address the high rates of depression that plague our elderly and are associated with the high rates of suicide in this vulnerable population.

We need a genuine investment in public health to restore the professional presence of nurses in the lives of our seniors. Nurses, through their holistic education and experience, and through their time spent with patients and families, see very real signs of neglect and abuse. Nurses are in one of the best positions to act.

As public health is our recommended vehicle to address elder abuse, education and awareness are the resources we need as care providers and as a society. We would like the thank the federal government for the funding they are directing to some important projects, such as the new horizons for seniors program. Through one of these projects, CNA has partnered with the Registered Nurses' Association of Ontario on the PEACE program, which is promoting the awareness of elder abuse in long-term care homes. This program is building these resources amongst care providers.

Ten long-term care settings were selected from across Canada to participate in the project. Each of these PEACE partners has developed and implemented tools, such as an education curriculum for health care providers, patients, and families, as well as printed materials, that are enhancing resident safety and quality of care.

Awareness programs based on these tools are currently being implemented to educate front-line workers. Topics include understanding and recognizing elder abuse; provincial, territorial, and federal laws surrounding elder abuse; what to do when elder abuse is present or suspected; and creating a work environment that values residents' safety and well-being.

Let me share with you one of the experiences reported by a PEACE project participant. A resident of a long-term care facility asks for toast. A care provider brings toast with jam. The resident says, “I wanted peanut butter, not jam.” The care provider says, “Well, I already brought you jam.” A colleague of the health care provider overhears this, remembers the learning module, and recognizes this as disrespectful behaviour toward the resident. The colleague intervenes to bring the resident what they requested, and then intervenes with the co-worker in a constructive way to identify the behaviour and promote dignity and respect.

This is the impact that a program can have. It may seem like a small example, but this kind of neglect is a pervasive problem in care settings across Canada. Programs like PEACE, that build awareness and give caregivers the tools to recognize and intervene in these situations, also give us hope and the power to promote the values of dignity, caring, and respect.

We'll include more of these examples and tangible results and impacts from the PEACE program in our written submission to each of you.

The PEACE partnership is an excellent first step, but we need to do more. Therefore, we recommend that the federal government fund the adaptation and implementation of the PEACE elder abuse tool kit across additional health care settings, such as acute and community care, and the development of the technological resources to support its implementation. Because the foundations of the program are universal, we could make a real difference by transporting it to other settings, such as hospitals, seniors residences, and home care situations.

Community-based service providers are an excellent front-line resource for preventing elder abuse. For example, a home care nurse or personal support worker is in an excellent position to identify signs of abuse in the home of a client, signs that might otherwise go unnoticed. They may notice that a client cannot buy food or personal care items, or pay bills, that valuable items suddenly go missing, or that bank statements are no longer going to their homes. Their client could well be a victim of financial abuse.

In addition to adapting the PEACE partner tools for use outside long-term care settings, they should also be delivered in the format that is the most appropriate for the end user. For example, if the home care worker described above uses a smartphone, a software app might be the best medium for her to access the necessary information. She could refer to it for an immediate, on-the-spot intervention, and to develop a specific plan of action for that particular instance of abuse.

Such tools could also be adapted for use in other sectors and settings, and for other age groups, allowing social workers, first responders, and family members to quickly and easily access advice, direction, and reassurance.

The beauty of this model is that elder abuse prevention tools adapted to various audiences and settings would be developed from a common framework. This would prevent a piecemeal approach, where concepts and terminology vary widely across regions and across settings. That spells better integration of services and interventions for the victims of abuse no matter what their circumstances.

Registered nurses across Canada will, of course, continue to promote the prevention of elder abuse, and we ask for your assistance in stepping up the intensity of our efforts. By transposing the successes of the PEACE project to new areas and investing in a public health-based prevention strategy, Canada can take a tangible and positive step towards ending the cycle of elder abuse, wherever it may occur--a crucial step towards a safe and healthy future where dignity and respect are a right, not a luxury.

Thank you so much for your time and attention today. I look forward to your questions.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

Thank you for being with us.

We will start with our first question from Susan Truppe.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you, Barb and Josette, for being here today. It means a lot to the committee to hear your facts and your thoughts on elder abuse and women. I just have a couple of questions.

I wanted to know a little more about a project that you called “promoting the awareness of elder abuse in long-term care homes”. I think you touched on it. You said that this project is to develop education sessions on elder abuse prevention and deliver them to front-line service providers in five long-term care homes across Canada.

Could you tell us about the further benefits of this project on elder abuse?

[Barb Mildon]

Yes, I will, and I will also invite my colleague Josette to respond.

The further benefit of this is simply a ripple effect. When you teach behaviour that should be emulated across sectors and settings, and when you embed that within a care professional group, you begin to show all of society what needs to happen.

We know there is mobility amongst health care providers. If they learn the right way to be in one of their settings and then choose to work in a different place, they take that learning with them. They then also become the vectors of change, as we saw in the example of the toast. It's a simple example, but that care provider taught another care provider. This is a ripple effect that can happen. That would be one of the further changes.

Josette, do you see others?

[Josette Roussel, Nurse Advisor, Canadian Nurses Association]

I see that as a team approach: you create that awareness, that ownership of an issue, and that sharing of knowledge, and you learn from each other. That is also shared amongst the families and the residents. It has a really powerful effect overall on the culture around the long-term care homes, which sometimes do not have those resources--the educational material or even the tools--to support them in those difficult situations.

That, anecdotally, is what we are learning from the PEACE project. The initial evaluation is showing that staff, especially the unregulated health care providers, feel that they can recognize it and that they know what to do. They feel that they have that support and knowledge, that they can make changes and do better. The overall goal of their practice is to do no harm and to do the best for their residents. The project is creating that effect, and we'll know more after it's completed in March 2012.

Thank you.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you.

Am I still good for time?

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

You have four minutes.

[Susan Truppe, Conservative, London North Centre, ON]

That's good.

When the Public Health Agency of Canada presented to the committee, they mentioned that a gender-based approach that considers treating older women and older men identically will not ensure beneficial outcomes because men and women occupy a different socio-economic status and experience different living conditions. I was wondering if you could tell me more about the gender-based differences that you have experienced with your organization.

[Barb Mildon]

It's a difficult question. I would always go back to at what point we're targeting the interventions. As we teach people about elder abuse across the age spectrum.... We should be starting to teach people in grade school, to be honest with you, from my perspective.

In that case, yes, I believe there needs to be attention paid to gender-based differences. We know that women still do not often occupy positions of power in their family circumstances, in society as a whole, or in their workplaces. Understanding that power imbalance at a young age is quite important. We also know that we need to address cultural differences and the way that various cultures perceive women and their place in society. That's important.

I would see that as the main emphasis for gender-based differences in teaching about elder abuse. However, in settings where our elders are vulnerable to elder abuse, I cannot personally see a difference with health care providers around gender-based differences. We need to teach health care providers a general way of being, a respectful way of being--in nursing, we would say a caring way of being--but also, certainly, a human way of being. To me, those principles are universal.

[Susan Truppe, Conservative, London North Centre, ON]

Thank you.

If I still have two minutes, my colleague, Ed Holder, has a quick question. I'll share the remainder of my two minutes with him.

[Ed Holder, Conservative, London West, ON]

Thank you.

Thank you to our guests.

Ms. Mildon, you indicated that there were some 8,000 incidents of elder abuse in I think 2009, a 14% increase since...forgive me, was it 1994 you said?

[Josette Roussel]

It was 2004.

[Ed Holder, Conservative, London West, ON]

It was 2004. Was that because there's an environment where it's more acceptable to declare that kind of abuse? I'm not even sure how to ask that. But if you understand what I'm saying, is it because there's more abuse or just that more is being reported? Do you have a sense of that?

[Josette Roussel]

That's a very good point you're making.

I would have to go back to the statistics, but if I remember correctly from the report, it's related to, as you say, there being more awareness, and more reporting goes with the awareness. That would increase the numbers. But I would have to go back and double-check if they've made a link between the two.

[Ed Holder, Conservative, London West, ON]

Speaking of links, we had three very thoughtful guests before you. On the information that relates to the incidents of abuse, how do you feed that into the kinds of information they utilize for their purposes?

[Barb Mildon]

Is it specific statistics that you're talking about?

[Ed Holder, Conservative, London West, ON]

Yes, please.

[Barb Mildon]

My sense would be definitely that it's what we use to create the imperative for the kinds of programs that we're promoting, the kinds of programs that we're designing. So the first thing is that statistics at least raised the flag about the actual incidence of this problem, the actual scope and span of it.

I would add two other points to your question regarding statistics. Indeed, we are making it not only more acceptable to report incidents of elder abuse, but we're recognizing them sooner, and that, I think, underpins those statistics.

[Ed Holder, Conservative, London West, ON]

What I'm trying to understand is in regard to the 8,000 incidents of abuse that you have in terms of data collected. Are you using that as the basis for programs that you see as appropriate to put in place? Or do you somehow give that information to others so they take a greater macro approach to appropriate programs? I guess is what I'm trying to understand is, are you using it for your own individual purposes?

[Barb Mildon]

I would say it's both, absolutely. Number one, it tells us that this in an important place to put our resources, our interest, and our focus. Number two, it gives us a baseline from which we can measure. The problem with that baseline is simply that there's a whole lot of abuse we're not measuring and not reporting, so to some extent it becomes an artificial baseline.

[Ed Holder, Conservative, London West, ON]

Thank you very much.

[The Vice-Chair (Mrs. Tilly O'Neill Gordon), Conservative, Tilly O'Neill-Gordon]

We'll now go to the NDP. They are sharing their time between Ms. Hassainia and Ms. Borg.

Ms. Hassainia, please begin.

[Sana Hassainia, NDP, Verchères—Les Patriotes, QC]

Thank you.

First, I would like to thank the witnesses for being here today.

We are seeing that people who take care of the elderly in nursing homes are also victims of abuse, and that may lead to more situations of abuse toward their patients. Could this violence be the reflection of poor screening of staff, insufficient training, or a combination of the two? Could there be other factors?

[Josette Roussel]

Certainly, the factors related to the abuse of residents may include lack of staff knowledge, insufficient initial training, experiences with an elderly person or the approach used.

As for the situation you spoke about of a member of the nursing staff being abused, that may also happen. We also see that type of situation. Programs have been put in place in the care environments. These programs are there to support the employees and help them report cases of abuse. There is a specific model that needs to be followed. It's a different approach, but it's also what happens in reality.

[Sana Hassainia, NDP, Verchères—Les Patriotes, QC]

Are there tools for that?