Status of Women Committee on Oct. 18th, 2011

[The Chair, NDP, Niki Ashton]

We're actually past the seven minutes. Perhaps you could add it later in your conversation.

[Marla Israel]

Yes, we'll come back.

[The Chair, NDP, Niki Ashton]

Thank you very much.

We'll move to Ms. Sgro.

[Judy Sgro, Liberal, York West, ON]

Thank you very much, Madam Chair.

To our witnesses, thank you very much for coming and for the good work you do and for your commitment.

You mentioned earlier that there were six questions asked that helped to define whether a person was suffering from violence or abuse. Do you know what those six questions are?

[Cathy Bennett]

I could check to see if I actually brought them with me. I'm not sure that I have.

[Judy Sgro, Liberal, York West, ON]

As my colleague mentioned, we meet with an awful lot of people in our offices and we hear horrendous stories like that. Given our commitment and the fact that we interact so much with the community, it's very helpful for us to start to get an idea of some of those signs that we might be seeing. It might be helpful to all of us if we had an idea of what those questions were.

[Cathy Bennett]

I'm sorry, I don't have that in front of me, but it's something I would be happy to table. I would say, though, that those six questions I'm talking about as part of that suspicion index are really for physicians talking to their patients.

We do have a resource I could direct you to. It's called “It's Not Right!” That's one of the things about societal communities taking a look at the issue and about how you address the issue. There is a pamphlet that accompanies it, as well as a presentation. We'll give you the link. It gives you very clearly and very quickly some things to look for. If you see these kinds of signs, this is what you need to consider doing.

It's very informational. It gives you solid information upon which to base your comments, your concerns, and your observations--and, more importantly, it tells you what to do with them, and that's really key.

[Marla Israel]

I think that's where the reluctance is. That's where society's awareness is growing. We've all been taught to definitely respect our elders and we've been taught that for a reason, but in so doing we sometimes give too much deference to seniors and we do not want to intervene because of that deference. I think there's a fine line, and one should err on the side of caution when presenting suspicions, or at least raise them in a way that's not going to be confrontational, but in a way that's going to facilitate a conversation.

Cathy's right. The tools that were developed were for physicians, towards screening and awareness in an office, but I do believe that document, which is available in English and French, is something to help society start to recognize the signs.

[Cathy Bennett]

If there's time and if it would be helpful, I can certainly give you what this document indicates very clearly are some of the warning signs.

The first one, and it's pretty straight-forward, is if an older adult tells you they're being abused, believe them. If they've come forward and said it, chances are pretty good that it's true.

Look for physical signs of abuse, such as bruises, sprains, broken bones, of course, and scratches, especially if the explanation of the injury doesn't fit. They've said how they've gotten this broken arm and it just doesn't make sense to you.

Another one would be observable changes in their behaviour, such as depression, withdrawal, or fear.

Look for changes in regular social activity, such as missing church or other social events. If they start withdrawing socially, this could be an indicator they are experiencing some form of abuse.

Are there changes in living arrangements, such as relatives who were previously uninvolved are now becoming more involved, in particular with their financial affairs? That's a sign, as is a change in the financial situation, such as cancellation of services, for example television, Internet, or phone, because the bills are not paid, or things disappearing from the house.

These are signs of abuse of a senior living in their home, in their community, not within an institutional setting.

Look for signs of neglect, and this is a big one. For example, there are no signs of food in the house or there is limited food. Being left alone for long periods of time, not having glasses or hearing aids that are needed, not having proper clothing, not having a walking cane, and not having a walker in good repair are all examples of neglect.

This is suspected abuse. Then there's suspected abusive behaviour and there's a whole list for that as well. By illustration, we're trying to make the public aware of those signs of abuse.

[Marla Israel]

One can listen to that list and assume that several things may be the cause. If a person stops eating, maybe that's a cause of disease or there's illness. It's a little bit like detective work. That's why I say it's a relationship of trust. Oftentimes I find, especially for professionals, that if their instincts are up, they should be aware of those instincts, because people have a lot of experience, and if it doesn't fit the norm it usually is not the norm.

[Judy Sgro, Liberal, York West, ON]

There's that whole issue of providing information so that as people get older they themselves are aware of the opportunities for abuse, whether you're talking financially or emotionally. I would suggest that your relationship with the provinces, the work that you're doing on distributing information well before someone gets into their eighties, and from a funding perspective as well, all this would be part of where we need to be going. So what's going on there with that relationship with the provinces?

[Marla Israel]

I want to talk a little bit about that, because it is an important relationship, but there's a relationship as well at the community level. Public health really happens locally, and public health prevention and promotion happen through an unbelievable network of people who may be located in individual provinces and territories but who have links with community organizations.

While I don't want to discount at all the roles and responsibilities of the federal government in linking directly with provinces and territories, I also don't want to understate the important role that communities play, which is why we deal with a number of stakeholders. We deal with non-governmental and community organizations because oftentimes they're the ones who have the relationship. While the federal government sometimes sets policy for health promotion and prevention of chronic disease, and so too do the provinces and territories, local public health and local communities are the ones dealing with seniors. A lot of our efforts are focused on sharing information using those networks.

Cathy can talk about one of the documents that was prepared about upstream prevention and promotion to try to avoid elder abuse by even young children, to expose them to positive health messaging and positive health promotion.

[The Chair, NDP, Niki Ashton]

We're over time, so maybe we can pick up on that one, if it's pertinent, in response to another question.

We're now moving on to the five-minute segment and Ms. Ambler.

[Stella Ambler, Conservative, Mississauga South, ON]

Thank you to our witnesses today, especially Madam Israel, for appearing here on day seven of your new job and for your very thoughtful comments.

Continuing along the lines we were just on, I'd like to ask you what kinds of community programs you think make the most difference and are the most beneficial. I'm thinking specifically of the New Horizons for Seniors program. Do those locally based, on-the-ground types of programs help?

I'm thinking also that when we talk about related issues like, for example, youth delinquency or crime, we always get into prevention and we talk about after-school programs and community programs. Are there parallels with senior abuse? If the more vulnerable in our society--widows and older women--are more active and involved in their community, are they less likely to be abused? Have you found that? Do you believe that?

And do you believe that these local groups, which are funded through programs like the New Horizons program, are helpful in that regard?

[Marla Israel]

That's a great question. I don't want to pass any bucks, because I will hate myself for doing that, but the New Horizons initiative is the responsibility of the Minister of Human Resources and Skills Development, so they will come here and talk about New Horizons.

I would like to talk about something similar, which is age-friendly communities. That's something that is within the purview of the Public Health Agency, and Cathy can elaborate on it.

[Stella Ambler, Conservative, Mississauga South, ON]

That's great, because that was actually my follow-up question.

[Marla Israel]

Well, let me talk about communities generally. Definitely, communities in general are very much part of the initiative. New Horizons, as well, looks at the voluntary sector and looks at developing a solid infrastructure at the community level so that seniors don't feel isolated, that they have an out.

I will talk about something that is predominantly within provincial and territorial jurisdiction, but that I think is important in answering your question. What happens is that in a number of provinces you have community supports in the health sector combined. So you have not only doctors, but also nurses, social workers, psychologists, physical therapy--all housed within the same rubric. It doesn't always happen in each province and territory, but it does happen in many. That is a community of support that is very helpful. Because if a physician feels that there may be signs of abuse, he or she can go into the social support system and be able to direct the senior accordingly.

This was something the honourable member raised as well, the importance of professionals. Seniors trust professionals. They may not always trust their family, and I really want to stress that it's not because of abuse, it's because the relationship between parent and child at an older age is sometimes very difficult. The intentions may be somewhat different. Children are looking at trying to do their best and want what's best for their mother or father, and the mother and father may be fighting them because they want to keep their independence. So professionals can then intervene. If a child fears for their parent, then that can happen.

As well, I think it's really important--as Cathy was talking about--for a neighbour, etc., in the community to have the right support to be able to address that.

[Cathy Bennett]

Yes, and we've talked about the expression “age-friendly communities”. What that means, quite simply, is that many communities are not designed to take into consideration the needs of an aging population, and that's what age-friendly communities are about. It's looking at what a community that would support seniors as they age would look like. It includes things like public transportation, access to health care, having a doctor--those kinds of issues.

What are those elements that can make a community better and safer for a senior? It includes things like road design. How wide is that sidewalk? What is the gradient on that sidewalk for rain runoff? Is it too much for somebody who has a walker or a cane? Is it too slippery? The grade is too steep when slippery. We have winters here, and that's a problem. A lot of seniors fall in winter.

[Marla Israel]

And if seniors have access in their communities to feel safe out the door, then if they are suffering from abuse they can go out of their door and seek help.

[Cathy Bennett]

Exactly right. We are very involved in this at the Public Health Agency at this point, the age-friendly communities. We're looking at how the issues we deal with.... And elder abuse is very much one of those issues that fits quite well. I think you can see that some of the risk factors for elder abuse that we've talked about--social isolation, safety issues, community support issues--can also be addressed with an age-friendly approach or context. So we're very much looking at how that can happen, what those intersections are.

[The Chair, NDP, Niki Ashton]

Thank you very much.

We will move on to the next member. Ms. Borg.

[Charmaine Borg, NDP, Terrebonne—Blainville, QC]

Thank you.

You mentioned that elderly women are more likely to be abused than elderly men. From what I gleaned in the report, it is primarily because of health reasons, because women live longer and are more prone to certain diseases.

I am wondering whether sexism plays a certain role in that.

[Marla Israel]

Agency analysts observed the differences between men and women. This is very important, because women have a life expectancy of 83 and men have a life expectancy of 78.

For women who are now 80 years and older, men played a very important role, because they were responsible for finances. It is therefore very important that we truly understand these differences and develop policies for women and for men. My colleague could provide you with more details about a report prepared for the agency. This was an analysis of the differences between the two genders. Professionals have to adapt and act differently with seniors, depending on whether they are dealing with men or women.

[Cathy Bennett]

Yes, that's definitely true.

Part of this report we did on gender-based analysis also looks at the elder abuse of men. They are also subjected to it. They also live with it. It's important to know what the differences are in terms of what kinds of interventions work best with either sex within a particular culture--there are many cultural differences in how you interact--and also within potential level of disability in which you find that senior also dealing with that issue. So you begin to see that it's a very complex, multi-layered issue. And you begin to appreciate how difficult it is to assess it, and then look for all of those potential services within a community to address it. It's very large and encompassing.

But the point of the gender-based analysis was exactly to try to distill out those specific points between men and women in terms of how they experience the issue of abuse and what interventions work best. Then you further parse that down and you begin to look at whether you are talking about the younger old or the older old. These distinctions are extremely important. What might work for a 65-year-old woman as an appropriate intervention for elder abuse may not work for an 85-year-old woman. You have to understand these nuances and differences. You also have to understand what cultural perspective they bring. What is the particular cultural context in which they live? That's extremely important. You have to understand that if you're going to engage them and gauge the community in providing those services.

[Marla Israel]

That is accurate. There is a way to communicate. Professionals know exactly how to communicate with senior men and senior women, because the interaction is very different.