Status of Women Committee on Oct. 18th, 2011

[The Chair, NDP, Niki Ashton]

Good afternoon.

I'd like to begin on behalf of the committee by welcoming our two witnesses here today. We have Marla Israel, acting director general, Centre for Health Promotion. I should preface that both witnesses are from the Public Health Agency of Canada. Our other witness is Cathy Bennett, acting director for the division of aging and seniors, also at the Centre for Health Promotion at the Public Health Agency.

I would like to remind our witnesses that together you have ten minutes to present. And I would remind our whole committee that the witnesses will be here for one hour.

With that, I would like to ask our witnesses to present.

[Marla Israel, Acting Director General, Centre for Health Promotion, Public Health Agency of Canada]

Thank you so much, Madam Chair and members of the committee.

I'm very pleased to be here with you.

My name is Marla Israel. I am the director general, acting--this is day seven for me on the job--for the Centre for Health Promotion at the Public Health Agency of Canada, and Cathy Bennett is acting director. We're going to tag team between the two of us to answer your questions today.

I am very pleased to be here to discuss an issue that has received increased attention in recent years and one that will likely continue to gain greater attention as the number of Canadian seniors continues to rise.

I know you'll agree that abuse in any form is unacceptable in Canadian society, particularly abuse against older women, who, due to age, disability, income status or family situations, are the most vulnerable. Sadly, the abuse of older adults remains somewhat of a hidden social problem that affects the lives of many seniors. Victims of abuse and their families experience intangible social costs that include adverse health consequences that can undermine or destroy an individual's well-being.

Clearly, there is a strong role for the Public Health Agency to play in addressing elder abuse. We work towards promotion of better health outcomes for all populations, but in particular for the most vulnerable.

Society may not be fully aware of the vulnerabilities that affect different segments of the population, but seniors, in particular, are vulnerable to emotional and physical abuse, especially given the physical effects of weakening health or disease and the challenges associated with placement in an institutional setting.

The definition that the Public Health Agency employs to define elder abuse comes from the World Health Organization: "a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person".

Elder abuse takes many forms. It can be physical, psychological, financial, and neglect. It is somewhat difficult to know the full extent of this problem in Canada, since the data is somewhat under-reported. But data obtained from Statistics Canada indicates that approximately 8% of seniors were victims of abuse between 1994 and 1999.

When this percentage is applied to the current population, it's estimated that as many as 300,000 seniors are victims of abuse.

It has been also been estimated that only one in five incidents of elder abuse may come to the attention of those who can help. Of particular interest to this standing committee, it is estimated that four out of ten older adult women who were victims of violence were victimized by a member of their own family.

Actions may include pushing, slapping, and threatening to apply force. Even more disturbing is that among solved homicides between 1994 and 2003, more than two-thirds of older adult women were killed by a family member.

The challenges of addressing elder abuse are compounded by rapidly changing demographics. So while the rates of elder abuse may not change, the absolute numbers of seniors affected by abuse definitely will.

The Government of Canada is committed to addressing these pressing and complex issues, and has done so for several years through the Family Violence Initiative and more recently through the Federal Elder Abuse Initiative.

The Family Violence Initiative is led and coordinated by the Public Health Agency of Canada. Through the initiative, targeted investments and the collaborative efforts of 15 federal departments, agencies and crown corporations are leveraged in an effort to bring greater attention to the issue of family violence in Canada. The leadership and coordination role of PHAC focuses largely on:

Federal-provincial-territorial coordination, to ensure that the policy approach to family violence is shared and that we are not working at cross-purposes. For example, through collaboration with Status of Women Canada, we developed a policy brief entitled Engaging Men and Boys to Reduce and Prevent Gender-Based Violence.

This brief examined historical efforts to address violence, the deep-rooted causes that may precipitate men to be more violent, identified gaps and challenges and shared best practices that could be considered in program development at the provincial and territorial level.

Secondly, through the National Clearinghouse on Family Violence, the Public Health Agency of Canada plays the role of knowledge broker on behalf of the partners to health and social service providers, the general public, academia, and NGOs.

And thirdly, through data collection, research, and evaluation the Public Health Agency of Canada is better able to support policy-to-practice efforts.

In 2006 the federal government created the National Seniors Council, and in so doing began to address the complex issue of elder abuse in more detail. I understand that the NSC will be testifying later on, so I will defer any detailed descriptions to that body. But in 2008 the federal government launched the federal elder abuse initiative, a three-year, $13 million initiative to raise awareness of elder abuse among seniors, their families, and key professional groups, and to develop resources and tools to support them in responding to elder abuse.

Our public health action relied upon scientific evidence to identify the risk factors for elder abuse in order to determine which interventions work best to prevent that abuse or reduce its impact.

As I mentioned earlier, reliable information on elder abuse was limited. Part of the problem lay in the need to develop better guidance and information for public health professionals to recognize the emerging signs of abuse. For medical professionals, tracking abuse statistics begins with recording the tell-tale signs of abuse, and making a determination that abuse exists in the first place.

As a result, the Public Health Agency examined the quality and availability of resources available to physicians and other medical professionals to identify and respond to the suspicion of elder abuse and improve the guidance available to practitioners. I should say that work is still in progress, and we can address that. A lesson learned through this exercise is that solid clinical knowledge is a prerequisite for good screening and assessment. Similar work was done in first nations communities. The conclusion was the development and adaptation of learning tools and resources for first nations community health workers.

The Public Health Agency also developed other knowledge tools and resources for front-line professionals such as pharmacists and social workers, who deal with and support seniors on a daily basis. As well, the agency examined other facets of elder abuse in more detail. For example, we looked at elder abuse through the lens of gender-based analysis. This perspective recognizes that treating women and men identically may be beneficial in some ways, but ineffective in other ways. For example, compared to older women, older men were more reluctant to go for help; outreach interventions provided at home on their own turf are particularly effective for them.

The federal elder abuse initiative ended in March 2011; however, we continue to focus on preventing elder abuse as part of our work to foster inclusive, accessible, age-friendly communities. Many communities are improving the information they provide to seniors about available community support services--for example, access to transportation for medical appointments.

In closing, the devastating impact of elder abuse on our older Canadians cannot be overstated. It needs continued action from all sectors of government and society as a whole. As a result of our collective efforts we have a better understanding of the tools needed for health professionals to be better equipped to identify, assess, and take action on elder abuse.

There is also a need to have current and comprehensive data on elder abuse, particularly for older women. Good and reliable data is the foundation for developing strong public health policy and program directions that support seniors' health and well-being.

Thank you so much for your attention. We would be pleased to answer any questions you have.

[The Chair, NDP, Niki Ashton]

Thank you very much.

We will now have seven minutes for each party, and the order will be Conservative, NDP, Conservative, Liberal.

For the first seven minutes we'll go to Ms. Truppe.

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

Thank you for your time in coming here. We were all looking forward to this, and I do have a few questions.

You spoke about producing numerous analytical reports on elder abuse prevention and intervention under the federal elder abuse initiative, and mentioned that the reason for the Public Health Agency's development of several examinations and analyses on elder abuse was an essential starting point, because very little available and up-to-date published information existed on elder abuse in Canada. You mentioned that statistics specifically about older women's experience of elder abuse are somewhat scarce.

Were there recommendations made to improve the availability of statistics and knowledge specifically geared to research gaps in that area? And what new knowledge did it make available on the abuse of older women in Canada?

[Marla Israel]

Thank you so much for your question. It really does draw attention to some of the challenges associated with gathering statistics as a whole. I say that from the perspective of public health information.

In the context of public health professionals, as I said, information starts with being able to recognize the signs of abuse and being able to track that abuse. So for specific questions with respect to the types of reports, we did undertake a gender-based analysis of existing evidence that led to several recommendations, including data to analyze trends by culture, by aboriginal identification, by immigrant status, or socio-economic status.

In the Public Health Agency, part of our responsibility is to be able to work closely with professionals and be able to acquire the information that is charted by those public health professionals. When we are able to undertake that kind of work, then the type of information and the type of guidance and the type of reporting will improve.

All of this is really important to understanding women's experience of abuse. There will be differences with an individual's desire or reluctance to share information about abuse. For example, women who are in certain communities may be very reluctant to question or challenge authority in any form, because of the way they were raised. We have to be mindful of that in working not only with public health professionals, but when working with other organizations at the community level, so they're aware that the tracking of that information is very, very important.

As a result of the analysis that we've undertaken, we've also come to understand--which we apply in our policy work--that disability is a risk factor for abuse in older women. That may seem obvious, but, again, I think we make several generalizations about seniors, whether it be older women or not, and we have to break that down and start to understand the effects that abuse may have, depending on the population of where the person comes from.

Simply to give you statistics, women live longer with more disabling conditions such as arthritis, osteoporosis, and women with disabilities are 1.5 to 10 times more likely to be abused. This information coming to light and being able to report it will have the impact of being able to change public policy and to be able to be more mindful of that.

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

Thank you.

You also mentioned that the Public Health Agency of Canada produced a number of public health-related resources and knowledge products under the federal elder abuse initiative. Could you describe the purpose of these tools and the target audience?

[Marla Israel]

I'll ask Cathy to respond.

[Cathy Bennett, Acting Director, Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada]

That's a good question.

Under the public health component of the federal elder abuse initiative, we did undertake to develop a number of resources. I'll break them down into two categories.

One is tools or resources that could help a front-line worker such as a doctor or a social worker be able to better identify what the risks of abuse are and what it looks like. Once they know that, what do they do about it? How do they connect the abused to services and support in their community, and how do they have that discussion with them? So there were resources that are for those folks.

We've also developed resources that are for the community at large, such as looking at the issue of elder abuse as a societal responsibility. For example, how would a neighbour be able to address a concern that Mrs. Jones next door may be experiencing some form of abuse or neglect? How would I as that neighbour be able to address that? What information do I need? That's very intimidating. It's scary. You're worried about repercussions. How could I navigate that to best support my neighbour? At the end of the day, what you're trying to do is help the senior who is potentially going through that issue. We've developed resources that would look to support that.

Those are the resource types and the audiences—if you will—that we've targeted. We've also worked with health professionals and, more to the point, key researchers in the field, such as Dr. Mark Yaffe from McGill University, to help develop better screening tools to support our front-line workers, in particular physicians, in being able to identify their suspicion of abuse. He's come up with a very clever indicator of six questions called EASI, which is elder abuse suspicion index. You may have heard of it.

It's six or seven key questions that a physician can ask a patient very gently and very quickly to get a sense of whether that person is in a position of risk. There's that, and then as mentioned and alluded to by Marla, we have also done some work that looked at the gender-based analysis, because if you're going to target resources you need to know something about the population you're targeting. It's extremely important, because depending on the type of abuse you're dealing with and the sex being abused, the type of thing that you develop becomes very different. It can take very, very different forms.

That's the overall range of the issues we looked at. Over a very short period of time we tried to focus on key targets, and again, on health professionals and other front-line workers—the way I would describe it—who would be in a place to see abuse happening. We also looked at societal role and responsibility.

[The Chair, NDP, Niki Ashton]

Thank you, Ms. Truppe. Thank you, Ms. Bennett.

We move on to Madam Hassainia.

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

I would like to thank the witnesses for coming here.

How much money does the Government of Canada allocate annually to the various elder abuse prevention programs or to assist elder abuse victims? Since the percentage of elders in the population is growing, so should our efforts to deal with abuse be growing. Is that the case?

[Marla Israel]

Thank you for your question.

Balancing allocations and priority spending, including efforts to eliminate violence, etc., is always a challenge. Over the past three years that this program has been in effect, it has received $13 million. This involved four departments. At PHAC, we allocated $1.4 million to this initiative. The other part of this amount, or budget, was allocated to the Department of Human Resources and Skills Development, Justice Canada and the RCMP. A total of $13 million was therefore allocated. We always have to strike a balance between the targeted group in Canada and the amount of money required to deal with the problems.

As far as I am concerned, the main responsibility of the federal government with respect to these initiatives is to work together with other departments to ensure that more attention is paid to this issue.

My colleague may have additional information.

[Cathy Bennett]

Just to add another piece to that, you were asking about what's currently happening. While the federal elder abuse initiative sunsetted in 2011, HRSDC continues to support elder abuse initiatives through their “New Horizons for Seniors” program and through ongoing research. I'm sure when they are invited to this table they will tell us more, and I believe some of them will be with us shortly. I'm just letting you know that there continues to be federal support in the area of elder abuse.

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

Since we are talking about funding, I would point out that the programs were primarily awareness campaigns. However, unless I am mistaken, these campaigns are over. I would like to know whether or not the government intends to repeat or enhance the funding of these awareness campaigns to fight senior abuse and assist victims. If the answer is yes, I would also like to know which programs these campaigns will come under.

[Marla Israel]

Thank you very much.

Questions on funding or federal government plans for future expenditures must really be addressed to those people who look after this area. As government officials, we are responsible only for those plans and programs that are currently in effect. This is why I cannot talk about specific future plans.

However, as my colleague alluded to earlier, even if it were decided to give greater priority to public campaigns, so as to better inform people about elder abuse, it would still be important to proceed with this work. This is not only a federal responsibility, it is also a matter that comes under the jurisdiction of provinces, territories and communities. It is really important that we work with communities, with professionals.

As far as I'm concerned, timely initiatives involving the media or newspapers are very important, but I also think it is just as important to draw on the skill and expertise of doctors and other professionals, in order to develop a relationship of trust with the seniors and to ensure that the family participates in the discussions with a professional.

[The Chair, NDP, Niki Ashton]

We have one minute remaining.

Ms. Hassainia, if you have no further questions, perhaps you could share your time and allow another NDP colleague to ask a brief question.

[Mylène Freeman, NDP, Argenteuil—Papineau—Mirabel, QC]

I think that we can continue.

[The Chair, NDP, Niki Ashton]

Fine. Thank you.

We will now go to Ms. O'Neil Gordon.

[Tilly O'Neill-Gordon, Conservative, Miramichi, NB]

Thank you, Madam Chair.

First of all, I want to thank you both for being with us this afternoon and sharing your ideas and thoughts. This is a very important topic, one that's dear to our hearts. That's why I'm so proud to say that I'm part of a government that took the initiative to see that the federal elder abuse initiative became a reality. This helped seniors and made Canadians aware of the signs and symptoms of elder abuse. It also raised awareness about where to get help, which was an important part of the whole picture.

We know that it can happen in homes, communities, and institutions. We can see symbols and signs of it in the home and in the community. I'm wondering if you could elaborate on some of the things you see as signs of abuse in an institution. What are the common ones?

[Marla Israel]

That's a great question. We're pleased as officials to be able to talk about it, because the more we talk, the more people become aware—at every level.

In our experience, one has to tread carefully about being able to recognize the signs, because you can present signs that could be something else. Oftentimes people are looking for the physical signs—a scar or a bruise—and it may not always happen that way. In fact we have come to discover that emotional abuse is sometimes as destructive, if not more destructive, as physical abuse of the elderly population. They're so much more susceptible to abuse because of their physical limitations, especially when they get into their eighties.

We have to be mindful, which is why we work with public health professionals to recognize the signs earlier on, so they can have a conversation in a way that is very respectful and that develops a relationship of trust. A person can get very silent, very isolated. Suddenly a person who was quite sociable is not as sociable. Suddenly a person who was able to go out is not able to go out. Suddenly that person is being accompanied by a caregiver and the relationship might appear to be somewhat suspicious. There are analogies to be drawn between child abuse and elder abuse, because oftentimes the abuse is done by someone they know.

It's important for us in the Public Health Agency to work with our partners even within the federal family--there is Veterans Affairs, the RCMP.... The reach of the federal family into the lives of individuals directly—sometimes the role is not that direct, but in this case it is—is an opportunity to use our mechanisms to share information with the networks so they are aware; they don't just think, oh, that person is just old, or that person is just suffering from dementia, or it's natural to be subject to these kinds of signs. It's not. A person can be very, very productive into their much later years, and that needs to be fostered.

Quality of life needs to be fostered, even into a person's nineties. This is what the work has focused on.

[Tilly O'Neill-Gordon, Conservative, Miramichi, NB]

I think I brought that to your attention as well because this summer I had a lady come to my office. She was not from my constituency but she wanted to talk to me, nobody else. She had a husband and he was a veteran—you know, with veterans, they do get extra money and all this—and she had to put him in a home because he was not able to manoeuvre and she wasn't able to take care of him. But he was very bright, she said.

One thing led to another. It was a long story; it was a heartbreaking story. It ended up that he fell in love with a nurse and the nurse took him out of the home to live with her.

The lady who came to see me lost everything. They even went ahead and took $25,000 out of the account. She was a lady from the old school. She never had her name on anything. She never had her name on the hydro bill. They shut the power off. She never had her name on their bank account. They took $25,000 out of the account. It just went on and on and on; it was very heartbreaking.

I'm just wondering if you see much of that, and what are the signs?

[Cathy Bennett]

You've touched on a heartbreaking story, but what you've touched on is financial abuse, which is one of the more insidious forms of abuse against seniors. A lot of the initiatives, the federal elder abuse initiative and some of the ongoing work at Human Resources and Skills Development Canada, are looking at increasing awareness, not just for those looking for signs that someone they care about is being financially abused, but also teaching people themselves that they are being subjected to financial abuse. Knowledge is power, right?

I'm aware that Human Resources and Skills Development Canada has developed a series of pamphlets for seniors, to explain in a way they can understand and relate to that financial abuse is a crime. It's a serious issue. People have rights and there are things they can do.

[Tilly O'Neill-Gordon, Conservative, Miramichi, NB]

But she gave me to understand, and I believe her too.... I mean, she was 82, but she had her caregiver with her, and she wouldn't be telling this story if it wasn't true. Anyway, she went on to say that someone told her she had to go and see a lawyer. God love her, she was 82 years old. She said she did go to see the lawyer and she said “Glory be to God, you know what he wanted me to do?” And I said “What?” and she said, “She wanted us to get a divorce. Sixty-two years married we are,” she said. She was heartbroken.

The last and most important thing she said when she called my office and wanted to speak to me and nobody else was that she wanted me to be sure to let other MPs know this. She said she was going to tell her story to every MP across Canada. I don't know how she'd do it.

[Marla Israel]

If there's time I'll add one more thing to that. It's a critical issue.

[The Chair, NDP, Niki Ashton]

Go ahead if it's just a quick thought.

[Marla Israel]

It's a quick thought.