Thank you.
Madam Chair, honourable committee members, ladies and gentlemen, thank you very much for inviting me here to talk about this important issue.
As you no doubt already know, intimate partner abuse against older women is a problem that falls between two major areas. There are two different resource networks. One we can call elder abuse; the other, domestic violence. There have been,up until very recently, two very distinct bodies of research, two bodies of knowledge, and two very different ways of conceptualizing the problem and therefore its solutions.
I came to research this issue when I was asked by an expert elder abuse intervention team, a social work team in a Quebec CLSC, to help them develop a model of intervention for intimate partner abuse. They recognized that, despite their expertise, they were really struggling with these scenarios, and that these scenarios were different in nature from other forms of elder abuse.
I interviewed 30 social workers from Quebec CLSCs working in home care, asking them to bring to me and to our research team their most difficult and complex cases and to discuss them. Then we held some focus groups.
Out of that came some interesting new things that I hadn't thought about. One is that they all brought to us cases that had extended for many decades. I realize that it can start later in life, but the cases the workers brought sometimes had gone on for as long as 60 years. They talked about intimate partner abuse over the lifetime as having a life of its own and said that it changes shape at different points in the couple's life. It can escalate, it can get more physical, it can get less physical, and it can appear to go underground for a short period of time, but it's always there.
In particular, retirement seems to be a trigger. It's a point where husbands are now in the home all the time. The workers really highlighted how now they micromanage and have ultimate control over a woman's life from the moment she wakes up till the time she goes to bed.
Another trigger that appeared to be important was health changes--changes in the health status of one member or the other or both.
The cases they brought to us were across a real spectrum, from healthier young or older women to older women who were very sick and very old. I just want to talk about a few recommendations; you'll see how that spectrum manifests a little bit.
In terms of the healthier women, let's say, for example, that it's the case of a woman in her mid- to late-sixties who is relatively healthy. She actually comes to the social worker wanting to talk about the abusive relationship and make some decisions about it. That kind of case was a minority of the cases encountered in the aging system.
But the issue there was that the social workers in the aging system need to have a better understanding of the dynamics of intimate partner abuse, because in some of the cases what we saw was that they tried, with the best of intentions, to help empower women to be more assertive and stand up to their husbands, and it backfired. If you're looking at a situation where there are dynamics of power and control, then the reaction is that men need to exert more strategies of control, which can result in escalating violence, and that creates a much higher risk scenario.
So the lack of that knowledge can at times put women at risk, and I think it's important that workers in that intervention system have that kind of knowledge.
In terms of the intimate partner abuse systems, the women's shelters, and the services around that, I think what they have lacked has been an understanding of some of the dynamics of intimate partner abuse after retirement. We don't know a lot about some of those triggers yet. We need to learn more, and the workers need to understand how it manifests in the later years of life so that they can be more helpful. They need to also understand how to adapt services to the concerns and needs of older women, which are different from those of younger women in some ways. I think the case that I described could have been well dealt with in either system, with those caveats.
The second type of scenario happens when there are more serious health concerns involved. Physical issues, mobility problems, or maybe somebody had a stroke...these types of cases tend to come into the aging network, and they come in because of the health issue. They don't come in as a relationship or abuse issue, but as a request for services.
If you have such a case come in as a request for home care services, you may end up with two clients with competing needs and intervention priorities. You might end up with an older man who needs some home care services but is abusing the older woman.
So who is your client and what is the ultimate priority? Is it to help keep the man living in the community? That may require keeping his wife with him because she's helping him with his day-to-day living. Or is it to take care of the problem of intimate partner abuse? That would prioritize the woman's needs, but it might end up with him placed in long-term care. It gets a lot more difficult when you have complex health issues entering the picture. We had some cases that were at the extreme end of complex health issues. These come in through the aging system, and it's a whole different ballpark from the first type of situation I talked about.
For example, there was the case of a woman in her late eighties, an immigrant who spoke neither English nor French. She displayed strong evidence of dementia, but had not been legally declared incompetent, and was physically ill as well. Her husband was keeping her isolated in the home. There was a nurse coming in occasionally, and a home care aide, but the husband never left them alone for a second. There were bruises and other evidence of physical abuse. He was not allowing her to have proper medical care. Because she had not been declared legally incompetent, it was extremely difficult for the health care team to adopt a more protectionist approach that would draw on the legal system. The laws vary from province to province, and they're part of the ethical and legal issues that complicate the health and the abuse issues.
It's little wonder that many of the workers we interviewed expressed great feelings of powerlessness. One of them asked how we could unravel 60 years of abuse. I felt this was something that needed to be addressed. We need to consider the structure of practice and the ways these workers are supported and equipped.
I have a couple of recommendations. They're interconnected. As social workers, we're the health care professionals who are most specifically mandated to promote the self-determination of the client, so there's a real tension here between a risk-and-protection scenario versus an empowerment scenario.
For example, in the latter case that I mentioned, it's quite clear that there's a fair bit of protection needed. But do we need to take away an older woman's voice or her right to make her own decisions?
Based on our practice with younger women, we tend to think that the only way to resolve some of these problems is for the woman to leave. That has been discussed through some reports and research, and I think we need to rethink that. I think we need to listen a lot to older women. We've heard very little from older women about how they understand this problem, about what their experiences are, and what their choices would be in these situations.
We need more conversations across resource networks. Had I remained in Quebec where the research was done, I was hoping to do a next step, which was to bring women's shelters and CLSCs into conversation with each other, and to bring policy-makers and older women into that conversation. I think we need to do that. That kind of conversation would allow us to develop research questions that will help us to form a response. I don't think there is a one-size-fits-all response for this whole gamut of situations.
It is important that this whole research and intervention agenda be driven by the voices of older women, as opposed to being driven by the voices of professionals and policy-makers.
Thank you.
