Justice Committee on May 11th, 2021

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

—to the abusers.

[Stéphanie Bérard]

Precisely, the abuser could be ordered to receive counselling or rehabilitation therapy.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Is that something you see a lot—people who go into therapy because of the abuse?

[Stéphanie Bérard]

The justice system is inadequate in that regard. That's why, at Vigil'Ange, we endeavour to provide support to seniors and educate them when possible. Currently, though, that is not something available through the justice system.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Thank you, Ms. Bérard.

Ms. James, you talked about this earlier. Would you mind commenting briefly?

[The Chair, Liberal, Iqra Khalid]

I'm sorry, Mr. Fortin.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

You're faster than the translator, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

I know, and you had 40 seconds extra to cover that translation time.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Thank you, Madam Chair.

[The Chair, Liberal, Iqra Khalid]

Witnesses, if any of you would like to provide written responses to any of Mr. Fortin's questions, please do so.

Last, we will go to Mr. Garrison for two and a half minutes.

Go ahead, sir.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Madam Chair.

I've been focused on the extreme cases of deaths in institutional care as a result of COVID, but I don't wish to diminish in any way the seriousness of elder abuse that takes place in other forums.

I want to go back to Ms. Miller. She mentioned the role of the coroner. We had, in the evidence presented to the Ontario commission, a large number of deaths, in addition to those from COVID, that took place during the COVID epidemic as a result of insufficient care. I believe it was Ms. Miller who mentioned the role of the coroner and the cursory investigations by the coroner's office of deaths in long-term care.

Is that what you were getting at, Ms. Miller?

[Melissa Miller]

Yes. My clients had been asking for coroner investigations even long before COVID happened. In fact, it's sometimes one of the only ways we can even determine what happened, because they have access to records that my clients don't.

Many of my clients who lost loved ones in long-term care homes as a result of COVID are currently fighting with the coroner's office to try to figure out what the actual cause of death was. They want accuracy and they want answers. They want to know whether their loved one actually died from COVID or died from dehydration. Many residents weren't allowed to go to hospital.

It's something that is very much still under investigation. It's problematic for sure.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

In these cases that you end up dealing with, in which families are seeking some kind of remedy through private law, how would you explain the attitude of administrators and the owners of these facilities? How can they not be aware of the conditions in their long-term care? Is this plausible deniability or wilful blindness? What is their reasoning when they are presented with these cases?

[Melissa Miller]

Mr. Garrison, you said it. I think it's tantamount to wilful blindness. I don't think there's any answer other than that. You hear people pointing the finger at the government, but as I said, accountability needs to be bookended. There needs to be accountability by the homes that have the power, by the government in enforcing and with actual penalties at the end of it, financial and otherwise, including jail if necessary.

[The Chair, Liberal, Iqra Khalid]

Thank you very much.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you, Mr. Garrison.

Witnesses, at this time, I would like to thank all of you for your contributions to our study on elder abuse. If there are any additions you would like to make or any clarifications, please do write to us and to Mr. Clerk with those clarifications.

At this time, we will suspend the meeting briefly to let in our second panel of witnesses.

[The Chair, Liberal, Iqra Khalid]

I will call this meeting back to order.

Before we get going and continue our study on elder abuse, I want to welcome MP Raj Saini.

Welcome. I really appreciate having you here on our committee today.

I will make a few comments for the benefit of our witnesses.

Before speaking, please wait until I recognize you by name. When you are ready to speak, ensure that your mike is unmuted. Your mute button is at the bottom of your screen. Once you are done speaking, please make sure you go back on mute. Speak slowly and clearly.

The interpretation is available to you at the bottom of your Zoom screen. Select the language that you would like to listen to. You can speak in any language, English or French, as you desire. When speaking, please make sure you are speaking slowly and cleary.

At this time I would like to welcome our witnesses. We have the BC Care Providers Association, represented by Terry Lake, who is the chief executive officer. We also have the Canadian Network for the Prevention of Elder Abuse, represented by Bénédicte Schoepflin, who is the executive director, and Kathy Majowski, who is the board chair and a registered nurse. We are also joined today by Elder Abuse Prevention Ontario, represented by Marta Hajek, who is the executive director, and Raeann Rideout, who is the director of provincial partnerships and outreach.

Welcome, witnesses.

Each of the organizations will have five minutes to make their remarks. I have a one-minute card and a 30-second card to help you keep track of your time.

We'll start with the BC Care Providers Association.

Please go ahead for five minutes.

[Terry Lake, Chief Executive Officer, BC Care Providers Association]

Thank you very much.

Good morning, members of the Standing Committee on Justice and Human Rights.

My name is Terry Lake. I am the chief executive officer of the British Columbia Care Providers Association. I speak to you this morning from the traditional territory of the Secwepemc people in the beautiful city of Kamloops.

The BC Care Providers Association is the largest organization representing contracted providers of long-term care and assisted living in B.C. We comprise both non-profit and for-profit organizations. Through our operating arm, EngAge BC, we also represent private home health providers and independent living providers.

While I have served in this role for the last eight months only, I was the B.C. Minister of Health from 2013 to 2017, responsible for seniors care in the province.

In B.C., long-term care is provided by health authorities, non-profits and for-profit corporations, with each responsible for about one-third of long-term care residents, of whom there are about 30,000 in B.C.

It is my understanding the committee is interested in knowing if there are sufficient measures in place to protect against elder abuse, if existing penalties are sufficient, and how the Government of Canada can improve elder protections. This study is aligned with the 2020 Speech from the Throne, which stated:

The Government will work with Parliament on Criminal Code amendments to explicitly penalize those who neglect seniors under their care, putting them in danger.

While I have heard others opine on the current Criminal Code provisions that speak to neglect, I cannot with any authority tell you if these provisions are sufficient, so I will focus my comments on how protection against elder abuse and neglect can be improved in two very important ways.

The average age of an elder in long-term care is about 85 years. The majority of residents have multiple chronic, complex conditions that require 24-hour care and monitoring. About 60% of residents have some degree of dementia. For this reason, staff include registered nurses and licensed practical nurses, but most activities of daily living and management are carried out by health care aides or, as they are known in Ontario and some other provinces, personal support workers.

In most provinces and territories, health care aides are graduates of recognized programs delivered by public and private post-secondary institutions, although there are some provinces in which this is not a requirement. In British Columbia, there is a registry of health care aides, and any health care aide working in a publicly supported seniors care environment is required to be on the registry. The goals of the registry are to protect vulnerable patients, residents and clients; to establish and improve standards of care; to promote professional development for care aides; and to assist these workers in identifying career opportunities. It is my understanding that B.C. is an exception in having formal recognition of HCA credentials. However, unlike the nurses with whom they work, HCAs are not self-regulated, although the former government and the present government in B.C. have indicated the intention to move health care aides into the newly expanded College of Nurses and Midwives.

The professionalization of health care aides is a very important way in which elders in care can be protected. Even if a care aide is found to have abused or neglected an elder in care, they can find themselves removed from the current registry, but they can continue to work in privately provided care, and potential employers are not notified of their removal from the registry. A robust self-regulatory college will ensure that those delivering care to vulnerable seniors are held accountable for their actions at the bedside, no matter who is providing their paycheque. Another benefit of the professionalization of health care aides would be continuing education opportunities and increased stature for this important role, which would likely draw more people into this important career.

This leads me to the second important way in which we can prevent the neglect of elders in care: addressing the critical shortage of care aides and nurses in seniors care in Canada. The Royal Society of Canada's report on long-term care recognized that this is the first thing we can do.

We all heard terrible stories of situations in the first wave of COVID, particularly in Ontario and Quebec, in which elders were found to be dehydrated, often sitting in clothing that was soiled, and that was the result of the lack of care aides available to work. Many were off sick. Many were afraid to come to work. However, this health care challenge has been recognized for many years, so I think if there's one thing that we can do, it's to address the health human resources challenges in seniors care and invest as much as we do in seniors care as our peer OECD countries do in theirs. They invest about 30% more than we do in Canada today.

Thank you very much. I look forward to your questions.

[The Chair, Liberal, Iqra Khalid]

Thank you very much for that.

We will now go to the Canadian Network for the Prevention of Elder Abuse for five minutes, please.

[Kathy Majowski, Board Chair and Registered Nurse, Canadian Network for the Prevention of Elder Abuse]

Thank you for inviting the Canadian Network for the Prevention of Elder Abuse to speak today. We commend the committee for its decision to develop a study on elder abuse.

As mentioned, a few months into the pandemic, our country witnessed horrifying accounts of abuse and neglect in many long-term care homes. Two reports that were published recently documented the appalling conditions that residents endured. Outside of long-term care homes, older Canadians have also borne the brunt of this pandemic through deaths, social isolation and decreased quality of life.

This year brought ageism and elder abuse to the forefront. Elder abuse was rampant in our communities long before COVID, and the abuse is not limited to long-term care settings. Elder abuse has been a silent pandemic for years. From a 2015 national study, we learned that the prevalence rate of mistreatment was 8.2% among Canadians age 55 and over. That’s over 750,000 Canadians. Mistreatment includes physical, emotional, sexual and financial abuse, systemic abuse, neglect and the violation of rights and freedoms, such as interfering with spiritual practices, denying privacy or preventing visitors.

CNPEA is one of the many voices calling for this issue to be recognized and addressed at the federal, provincial, territorial and local levels, with an emphasis on prevention and early detection through a collective and sustained effort. Like domestic violence, elder abuse is a complex issue that requires nuanced responses because older Canadians are not a homogenous group. Layers of identity such as gender, race, sexual orientation, economic standing and disability have a direct impact on a person’s risk of victimization, their ability to report and to access adequate services and justice.

If we're serious about tackling elder abuse, we need to start by confronting ageism. By the World Health Organization’s definition, “Ageism arises when age is used to categorize and divide people in ways that lead to harm, disadvantage, and injustice.”

Ageism is rarely recognized as the violation of human rights it is. Little by little, it dehumanizes older persons. From jokes about “senior moments” to referencing a “silver tsunami”, it’s a quick slide to debating whether some lives are worth more than others during a pandemic. Ageism and how we think, or don't think, about older people has a drastic impact on the quality of the care and services that we receive as we get older. Ageism negatively impacts a person’s quality of life and increases social isolation and loneliness, which are high risk factors for elder abuse.

The World Health Organization and the United Nations emphasize the importance of age-friendly communities. A supportive, age-inclusive community that promotes health, safety and well-being across the life course leaves less room for abuse and violence to breed.

We're currently leading a project with a group of partners to develop a pan-Canadian road map to increase the prevention of elder abuse. Thanks to funding from the Department of Justice victims fund, we will develop a guide with multiple entry points, which will allow each of us, at an individual, organizational or governmental level, to play a role in preventing elder abuse.

Our consultations point to a collaborative approach as a meaningful tool to support older people. We hope to foster coordinated community response mechanisms and integrated teams that will connect policing, community, social and health services. Building bridges through training that promote trauma-informed principles and focus on equity can help address additional barriers to safety that are facing underserved seniors such as older women, especially older women of colour, indigenous and LGBTQ+ seniors.

Canada has shown increasing leadership in its approach to tackling gender-based violence. It's time to turn our attention to the needs of older citizens facing life-threatening abusive situations. This means providing adequate support and resources for research, direct services and public education across Canada. Supporting innovative research at the federal level would help address our knowledge gaps and propel the development of future policies and best practices.

The sector of elder abuse prevention is a fragmented one. Not all provinces and territories have a dedicated organization or network, and funding varies between jurisdictions. The results are disparities in prevention and response capacity. A well-resourced infrastructure would support an efficient, coordinated approach to detection, prevention and response. With the right support from the Government of Canada, existing practice and knowledge communities could work in unison, ensuring that we can all age in health and safety, with our rights protected and respected.

Thank you very much.

[The Chair, Liberal, Iqra Khalid]

Thank you very much.

We'll now go to Elder Abuse Prevention Ontario.

You have five minutes. Please go ahead.

[Marta Hajek, Executive Director, Elder Abuse Prevention Ontario]

Madam Chair, members of the committee, bonjour.

Joining me today is our director of partnerships and outreach, Raeann Rideout.

Thank you for inviting us to speak with you about elder abuse. Let me get straight to the point. We are now in a state of crisis.

Our parents, siblings, neighbours, friends and others within the community who have no one to turn to are facing unprecedented rates and increased risks of abuse, physical, psychological, and sexual, as well as financial exploitation.

Over the past year, call volumes to the 24-hour seniors safety line have risen 250% in Ontario—250%. Let that sink in.

Many more are victims of neglect. The lockdown measures intended to curb the spread of the virus have only exacerbated those issues arising from isolation, translating into increased vulnerabilities to abuse.

Here are but a few of the stories that we have heard each day: A woman was forced by her family to live in an unheated garage with the windows darkened. A senior man was found lying alone in a bed, covered in feces. A late resident in a Mississauga long-term care home was robbed of her life savings by the person who abused their authority as her power of attorney. These are heartbreaking yet all too common incidents of vicious abuse.

This problem needs to be identified and it needs to be named. Elder abuse cannot be buried within other strategies and programs. Systemic issues require deliberate and systemic approaches. If we do not answer the call now, we might not get a second chance.

What can the federal government do to effectively combat elder abuse? It starts with one thing: prevention.

First, the federal government should support the continued development and implementation of a national elder abuse strategy, one that includes diverse communities with a pan-Canadian awareness-building campaign. People need to know how to recognize the signs and how to take appropriate action, particularly in situations where someone is incapable of doing so for themselves. People need to know how to protect themselves and be able to access services in a timely manner.

Second, the federal government should provide tethered funding to provinces and territories to support the execution of this national strategy. It is fundamental that the federal government leverage its ability to engage provinces in bilateral agreements to increase safety and well-being outcomes for seniors, no matter where they reside.

Whether at the national, provincial or local level, community-based volunteer, non-profit organizations such as the Canadian Network for the Prevention of Elder Abuse, local area networks, and Elder Abuse Prevention Ontario need to be sustainably supported.

In Ontario, where there were once 57 networks, we are now down to 30. We are on the front lines, but our capacity is dwindling. These organizations are best positioned to raise awareness through education and to provide localized and culturally appropriate responses related to elder abuse.

Third, the federal government must invest in better data collection related to elder abuse. The mandate letter of the Minister of Seniors confirms this.

We need data for evidence-based decision-making to be able to tackle the issues with timely precision. To do so, the federal government should require federal, federally funded and regulated agencies to collect disaggregated data on elder abuse and neglect and to report it; integrate data collection requirements into future national standards for long-term care; and invest in research to better understand and respond to elder abuse and neglect.

The federal government must also consider public policies through an intersectional lens that takes age into account. In fact, ageism is at the core of elder abuse.

Demanding accountability from groups and individuals working with older populations is fair, but accountability needs to start with government.

In politics it is said that people regret the things they do not do. This is our opportunity to have no further regrets. The cost of not addressing the elder abuse crisis in Canada is too high.

Thank you.

[The Chair, Liberal, Iqra Khalid]

Thank you very much, Ms. Hajek.

Before we go into our first round of questions, I'll just ask you, Ms. Majowski, if you can double-check that your headphone is selected in your audio settings. My understanding is that we're still getting some questionable audio from you.

Madam Findlay, you have six minutes as our first questioner. Please go ahead.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Thank you, Madam Chair.

Thank you to all of the witnesses for being here on this important topic.

This is directed to the Canadian Network for the Prevention of Elder Abuse. With respect to the federal budget and in particular data collection, an April 29 blog post on your organization's website notes the following:

The Budget cites plans for better data collection and for improved access to justice in general but makes no specific mention of elder abuse. This is a somewhat disappointing direction, as “investing in better data collection and law enforcement related to elder abuse” features prominently in the mandate letters of the Minister of Seniors and the Minister of Justice....

Could you elaborate on this need for data? You talked about research. I assume we're talking about the same thing. What would you like to have seen in the federal budget on this? You also mentioned protection response. Do you want to elaborate on that a little more?