Chapter 11.pdf

11/30/23, 10:37 AM Thompson Learn.   (/account/dashboard) DIGITAL TEXTBOOK Chapter 11: (/resource Social Work with Older Canadians  Notes ce/20/nodes/656/annotations) Search...  Media (/resource/20/nodes/656/student  × files) (/r —Betty Friedan (1921–2006) https://learn.thompsonboo...

11/30/23, 10:37 AM Thompson Learn.   (/account/dashboard) DIGITAL TEXTBOOK Chapter 11: (/resource Social Work with Older Canadians  Notes ce/20/nodes/656/annotations) Search...  Media (/resource/20/nodes/656/student  × files) (/r —Betty Friedan (1921–2006) https://learn.thompsonbooks.com/resource/20/nodes/656/read 1/34 11/30/23, 10:37 AM Thompson Learn. Older adults are the most rapidly increasing age cohort in Canada. Chapter author: Sandra Loucks Campbell tatistics Canada projects that by 2021 almost seven million Canadians will be over the age of 64, comprising 19 percent of the total population. By 2041, there will be over nine million older adults, comprising 25 percent of the population. Twenty-eight percent of older Canadians are immigrants, which presents special issues for social work practice with this age group. Because of the sheer size of this older adult cohort, their concerns will likely be heard loud and clear. In the coming years, these underlying demographic facts will increasingly affect most aspects of Canadian society, particularly in relation to health care needs and social service provision across the country. Already an important area of activity, social work with older adults may well become a veritable growth industry. In its recent “World Report on Ageing and Health” (2015), the World Health Organization has called for “Ageing Well” to become a universal priority. “The greatest costs to society,” the Report stresses, “are not the expenditures https://learn.thompsonbooks.com/resource/20/nodes/656/read 2/34 11/30/23, 10:37 AM Thompson Learn. made to foster this functional ability, but the benefits that might be missed if we fail to make the appropriate adaptations and investments.” It argues for strategies that extend beyond health care to include the development of communities where older adults are “healthier, happier, and more productive” members of society. In this chapter, you will learn how to… describe the diversity that exists within Canada’s oldest age cohorts identify some of the challenges facing older adults explain how federal and provincial/territorial governments can impact certain issues affecting older Canadians identify various types of elder abuse, and explain causes and preventative measures, both in private homes and in institutional settings describe the home care services available to older adults discuss the impact of dementia and what can be done about it compare various intervention approaches for social work with older adults explain the role of social workers in an aging society Key Concepts Baby boom Ageism https://learn.thompsonbooks.com/resource/20/nodes/656/read 3/34 11/30/23, 10:37 AM Thompson Learn. Medicalization Chronic illness Elder abuse Home care Respite care Focusing Question What are your preconceptions about older Canadians? What are the realities? Portraits of Canada’s Older Adults Understanding a population’s age composition can help policy makers plan for future social and economic challenges. This planning includes the funding of pension plans and health-care systems, as well as determining the number of immigrants needed to boost the labour force. Figure 11.1 shows the projected population growth for children and seniors in Canada, comparing data from 1991 to the present with figures projected through to 2061. The graph shows that the numbers of older adults will continue to increase relative to children in our population. Statisticians use data to calculate the median age of a population—the number signifying the halfway point in a group’s age range. In Canada, the median age is about 40: about half of Canadians are under 40 and about half are over 40. The median age of women is higher than men (41.1 compared to 39.4) due to the persistent higher life expectancy of women (although the gap https://learn.thompsonbooks.com/resource/20/nodes/656/read 4/34 11/30/23, 10:37 AM Thompson Learn. between genders has been narrowing). Overall, the median age of Canadians has been increasing, which means that the population as a whole is growing older. The Canadian government typically classifies people aged 65 and over as “elderly.” At this age, citizens are eligible for federal benefits, such as full Canada Pension Plan benefits and Old Age Security payments. The World Health Organization has no fixed standard but notes that 65 is the commonly accepted age for “senior” status in most core nations. Gerontologists (scientists who study aging) often divide the older adult population into three subgroups: the young-old (approximately 65–74), the middle-old (ages 75–84), and the old-old (over age 85). People aged 90 and over are sometimes referred to as “the frail-old.” Why Is Canada Aging So Rapidly? According to all projection scenarios, the Comparing Cohorts Canadian population will continue to A cohort is a group of people who share a grow over the next 50 years, reaching between 40.0 million people and 63.5 million people by 2063 (Statistics Canada, 2014). “The greying of Canada” is a term that describes how larger and larger numbers of our population are getting older and older. (See Figure 11.1.) Three main factors account for the aging of the Canadian population: statistical or demographic trait. People in the same age cohort, for example, were born during the same time frame. As of July 1, 2014, for the first time in Canada, there were more people in the 55-to-64 age cohort than there were in the 15-to-24 cohort (Statistics Canada, “Population Projections: Canada, the Provinces and Territories, 2013 to 2063,” 2014). The baby boom. Nearly one third of the Canadian population was born in the generation following World War https://learn.thompsonbooks.com/resource/20/nodes/656/read 5/34 11/30/23, 10:37 AM Thompson Learn. II (between 1946 and 1966), when Canadian families averaged 3.7 children each (compared to 1.7 children per family today). This period is referred to as the baby boom. The so-called baby boomers began to reach the age of 65 in 2011. A low birth rate. The proportion of old to young will continue to increase because the average number of children per woman has declined. Many couples are postponing having families, or deciding not to have children at all. This trend reflects the increased participation of women in the labour force, the importance placed on women establishing their own careers, and the increasing economic demands placed on young families. A low birth rate contributes to the higher percentage of older people in the population. Increasing life expectancy. Statistics Canada data that group older Canadians by age show that we are living longer, primarily as a result of healthier lifestyles and universal health care. Between 1983 and 2013, the number of citizens over 85 increased by more than 100 percent. In 2013, the number of centenarians (those 100 years or older) in Canada was 6,900, or almost 20 per 100,000 persons, compared to only 11 centenarians per 100,000 persons in 2001. Older Adults—A Diverse Group In Canada, as elsewhere, the population of those aged 65 and older is not a homogeneous group. For example, living Baby boom The large number of individuals born between 1946 and 1966, who are now reaching their senior years. Canada’s arrangements vary: 56 percent live as part growing senior population will place of a couple; 25 percent live on their own; increasing pressure on government 12 percent live with members of their extended family; and 7 percent live in a services, particularly health care and the pension system. long-term care institution (Statistics https://learn.thompsonbooks.com/resource/20/nodes/656/read 6/34 11/30/23, 10:37 AM Thompson Learn. Canada, 2011). Older adults living in rural areas as opposed to urban locations tend to remain in their home communities, where they support each other, despite fewer and limited services. In 2013, 67 percent of Canadians over the age of 85 were women. Seniors aged 85 and over are more likely than younger seniors to have serious medical conditions and disabilities, and therefore generally have a greater need for social support and health care. Almost 21 percent of our current population was born outside of Canada, but 28 percent of the country’s older adults were born elsewhere (Chappell, McDonald, and Stones, 2008). Older recent immigrants may face declining health, isolation, language barriers, discrimination, and other obstacles. Current research estimates that up to seven percent of the senior population is openly LGBTQ+ (lesbian, gay, bisexual, transgender, or queer). That number is expected to double by 2030 (Sheldon, 2014; Fredriksen-Goldsen et al., 2011). Becoming a senior does not automatically mean needing the services of a social worker, however. People age differently. Some remain physically and mentally fit; others face problems such as social exclusion, health crises, loss of mobility, inadequate income and housing, prejudice, crime victimization, and abuse. It is generally in these more difficult situations that the social worker and other social service professionals get involved. Figure 11.1 Seniors will become more numerous than children in Canada by 2017—a milestone in our history. Fertility has the greatest likelihood of either slowing or accelerating the aging of Canada’s population over the next 50 years. Source: Statistics Canada, CANSIM tables 051-0001 and 052-0005 (medium growth scenario). https://learn.thompsonbooks.com/resource/20/nodes/656/read 7/34 11/30/23, 10:37 AM Thompson Learn. Primary Challenges Confronting Older Canadians Many adults face challenges as they grow older, including loss of independence, diminished physical and mental capabilities, discrimination, and financial insecurity. The aging process involves major biological, emotional, intellectual, social, and spiritual changes. Ageism Common phrases such as “over the hill” reveal North American society’s frequently negative attitudes toward old age and older people in general. Ageism can be defined as any attitude, action, policy, or institutional structure that subordinates or oppresses a person or group on the basis of age. Some argue that ageism is different from other “isms,” such as racism or sexism, because Ageism Any attitude, action, or institutional structure that subordinates or oppresses a person or group on the basis of age. Former long-term mayor of Mississauga, Ontario Hazel McCallion stated in The Globe and Mail on June 6, 2016: “Canadians need to confront the reality that every day, its older citizens deal with the most widely tolerated form of social prejudice in the country: ageism.” at some point everyone will grow old First elected in 1978, McCallion oversaw (unless, of course, a person dies young) the massive growth of Mississauga from and will therefore likely experience ageism. But the prevalence of negative attitudes toward an entire cohort of citizens serves to emphasize and condone farmland to Canada’s sixth-largest city. Three months after retiring from office in 2015, she accepted a new job as special adviser to the principal of the University of Toronto Mississauga. She was 94. ageist attitudes even further. Additionally, older persons may be part https://learn.thompsonbooks.com/resource/20/nodes/656/read 8/34 11/30/23, 10:37 AM Thompson Learn. of more than one marginalized group. For example, an older individual may be female and living in poverty in addition to being old. In this situation, the individual may be subject to three societal “isms” simultaneously. Every culture has a certain set of expectations and assumptions about aging. Lena Dominelli, a professor of Social and Community Development at Southampton University in England, believes that the decline in the economic status of older people in the West is part of the explanation for ageism (Dominelli, 2004: 135). In Dominelli’s view, seniors in Western culture are often presented as a homogeneous group that is a burden to society. According to Dominelli, Western countries tend to regard people in materialist terms—people’s worth or value to society is often based on how much they make, the size of their house, or the kind of car they drive. In retirement, the income of seniors usually drops. Furthermore, with urbanization, and especially with the breakdown of the extended family, the elderly have tended to lose their status in the family and in society as a whole. Older persons have been inaccurately blamed for the high cost of health care. Also, they are sometimes portrayed in the press as “bed blockers” in healthcare settings, particularly in hospitals. (“Bed blocking” is a term used to describe the long-term occupation of hospital beds, chiefly by elderly people, due to a shortage of suitable care elsewhere.) Older individuals identified as “bed blockers” can be abruptly discharged from hospital without adequate preparation. Government policies may unintentionally reinforce bias by using ambiguous language when establishing practices intended to enhance safety. In some provinces, hospital patients who do not require acute care are labelled as needing an “alternative level of care.” This label could be leveraged https://learn.thompsonbooks.com/resource/20/nodes/656/read 9/34 11/30/23, 10:37 AM Thompson Learn. by care providers to move the identified person out of the bed as soon as possible, but it also may put individuals at risk if they are discharged from hospital too soon. North Americans generally seem to fear aging more (and be more ageist) than others. This is perhaps best exemplified by the high sales of beauty products and the common use of plastic surgery to restore a youthful look. Many media portrayals reflect dismissive and disrespectful cultural attitudes toward older adults. However, not all societies and cultures view older people this way. Many Aboriginal, Asian, and African societies (and many cultures within Western societies) place a high value on the wisdom and life experiences of the elderly. In many societies, older adults are traditionally viewed as sources of guidance and knowledge. Perhaps, as our population as a whole continues to age, some of our negative attitudes and perceptions will gradually begin to change. Aboriginal Seniors Are Respected Elders In contrast to various mainstream Canadian cultures, Aboriginal cultures tend to respect and even revere their seniors for their knowledge and experiences. Elders play an integral role in the well-being of families, communities, and nations, acting as key sources of traditional knowledge, wisdom, and cultural continuity. Aboriginal peoples comprise only one percent of the overall senior population in Canada (compared with three percent in the total population). Manitoba and Saskatchewan have the largest proportion of Aboriginal peoples in their senior populations (Turcotte and Schellenberg, 2007). Prevalent Myths about Aging and Older Adults https://learn.thompsonbooks.com/resource/20/nodes/656/read 10/34 11/30/23, 10:37 AM Thompson Learn. Some myths about old age depict aging negatively, while others portray an unrealistic picture of the joys of later life—travel, golf, dinner, and dancing. The following are a few of these myths. Myth: “To be old is to be sick.” Reality: Most seniors are relatively healthy. Three quarters of Canadian seniors report that their health is good, very good, or excellent. Myth: “Seniors and technology don’t mix.” Reality: Seniors are the fastest growing group online, and they are capable of using digital technologies for more than just email. For example, seniors in the Seniors’ Education program at Ryerson University developed, produced, and moderate an interactive website. Myth: “Most seniors live in nursing homes.” Reality: Just five percent of men and nine percent of women over age 65 live in health-care institutions; most are 85 or older. And the percentages have declined. Myth: “Seniors don’t pull their own weight.” Reality: Up to one third of seniors provide help to friends and family, including caregiving for spouses and grandchildren, and giving financial assistance to children. Seniors pay taxes, too—just as they have done all their lives. Myth: “Seniors increase the cost of medical care.” Reality: The increased cost to the health-care system due to aging is projected to be no more than one percent per year. The main causes of cost increases are inflation, a rising overall population, and advances in medical technologies (Evans, 2010). https://learn.thompsonbooks.com/resource/20/nodes/656/read 11/34 11/30/23, 10:37 AM Thompson Learn. Ninety-two percent of Canadians over the age of 64 lived in private homes at the time of the last census, while only 8 percent lived in seniors’ residences or health-care facilities (Statistics Canada, 2011). The Health Consequences of Inactivity Physical inactivity may not appear to be a social work issue, but many emotional, spiritual, and mental health issues—perhaps especially among seniors—are directly related to it. Inactivity can lead to preventable health problems, such as heart disease, stroke, and osteoarthritis (along with the chronic pain associated with it). According to the Fitness and Lifestyle Research Institute, physical inactivity can also lead to depression, lack of energy, chronic disease, weight problems, disability, and premature death. The Canadian government estimates that billions of dollars per year could be saved if physical activity rates increased. For many seniors, walking, gardening, or taking part in low-impact sports could lead to a better physical and emotional state. Unfortunately, the majority of seniors are inactive: “More than 40 percent [of baby boomers] said they are not moderately active for 30 to 60 minutes at least three times a week.” Given reduced strength and impaired physical fitness, Canadian seniors also face significant risks due to common accidents such as falling. Hospital admissions for unintentional injuries occur most often among older adults (Heart and Stroke Foundation, 2013). The Erosion of Income and Financial Vulnerability Canada’s pension system is held in high regard throughout the world for the way it combines basic income security with Pension Reform Canada’s pension system needs urgent attention, according to a report released by the Canadian Centre for Policy Alternatives (CCPA). https://learn.thompsonbooks.com/resource/20/nodes/656/read 12/34 11/30/23, 10:37 AM Thompson Learn. public and private pension plans. The Old Age Security and the Canadian pension system has three tiers: Canada Pension Plan provide Old Age Security and the Guaranteed Income Supplement. These plans provide income security for seniors independent of their prior participation in the workforce. Canada Pension Plan (Québec Pension Plan in Québec). The CPP provides pension benefits to individuals upon retirement or if they become disabled. It also provides benefits to the dependants of contributors who are disabled or deceased. The amount of the benefit depends on the level of contributions during the contributory period. only a modest income for people when they retire. Not everyone has a workplace pension—about 60 percent of Canadians must rely on public pension programs, supplemented by their own savings. Only about one third of Canadians take advantage of tax-assisted private savings through RRSPs. Almost $500 billion in unused RRSP contribution room is being carried forward. Private pension plans. These consist of workplace plans and Registered Retirement Savings Plans (RRSPs), both of which result in tax breaks upon contribution. Until recently, this three-tiered system has served seniors well. Canadian seniors’ financial status improved significantly over the last 30 years. However, a 2013 report from the Bank of Montreal states that the average baby boomer falls about $400,000 short of adequate savings to maintain their lifestyle in retirement. The average senior couple spends approximately $54,000 a year, requiring accumulated savings of $1,352,000 in order to sustain themselves (not taking into account CPP and Old Age Pension payments). https://learn.thompsonbooks.com/resource/20/nodes/656/read 13/34 11/30/23, 10:37 AM Thompson Learn. Individual Canadian boomers estimated they needed savings of $658,000 to feel financially secure in retirement but only saved an average of $228,000. Seventy-one percent of boomers said they plan to work part time in retirement. This will have a ripple effect on the economy as boomers continue to work but spend less (BMO Financial Group, 2013). Victimization by Perpetrators of Fraud Often isolated in their homes, seniors are the leading targets of fraudulent crimes, such as fake investment opportunities, phony contests, and false fundraising campaigns. Criminals are using more and more sophisticated techniques, often misrepresenting themselves as employees of a bank or other financial institution. In some cases, seniors have lost their life savings. Medicalization of Older Adults’ Problems Medicalization describes our society’s tendency to label the concerns of older adults as medical issues. Many older adults do experience chronic illnesses and discomforts and, in general, healing Medicalization A process through which normal behavioural, emotional, and even physiological conditions (such as aging and menopause) become viewed as medical problems, to be treated by medical professionals and recovery are slower when our bodies are old . But it is a mistake to assume that all older adults are physically and cognitively impaired in some way. And cognitive impairment is not necessarily a permanent condition—it can vary from day to day. https://learn.thompsonbooks.com/resource/20/nodes/656/read 14/34 11/30/23, 10:37 AM Thompson Learn. Current social work value systems shift Chronic illness the emphasis away from medicalization An illness that lasts for a long time or and toward self-empowerment and social that recurs frequently engagement, which can reduce feelings of loss and depression—mental health issues commonly faced by older adults. Aging and the LGBTQ+ Population An emerging field of study is how lesbian, gay, bisexual, transgendered, queer, and intersexed (LGBTQ+) people experience the aging process compared to mainstream groups. As they transition to assisted-living facilities, LGBTQ+ seniors carry the added burden of whether to disclose their sexual orientation and relationship identity to caregivers. In a longterm care setting, LGBTQ+ clients tend to conceal or “selectively disclose” their sexual orientation in order to feel safe. A study titled The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults found that older LGBTQ+ adults have higher rates of disability and depression than their heterosexual peers. For some LGBTQ+ people, aging in a care facility can mean a distressing retreat back “into the closet.“ Despite Canada’s legalization of same-sex marriage in 2005, LGBTQ+ seniors are less likely to have children who can provide care for them as they grow older (Fredriksen-Goldsen et al., 2011). End-of-Life Issues: Complex New Legislation https://learn.thompsonbooks.com/resource/20/nodes/656/read 15/34 11/30/23, 10:37 AM Thompson Learn. After much legal and public debate, Canadian Support for Doctor-Assisted Canada now has its first doctor-assisted Dying dying legislation. The law received royal assent on June 17, 2016 and sets out guidelines with respect to medical A Forum poll released on August 28, 2015, revealed that 77 percent of Canadians support doctor-assisted suicide for people assistance in dying. But the details of the who are terminally ill. This figure new legislation are not without represents a 10 percent increase compared controversy. In June 2014, the Québec National Assembly had passed “An Act Respecting to a similar poll the firm conducted just four years previously. The survey of 1,440 voters found strong support across all age groups and political affiliations. End-of-Life Care” (Bill 52). This legislation specified rights with respect to end-of-life care and regulates “continuous palliative sedation” and “medical aid in dying.” In February 2015, the Supreme Court of Canada followed suit and ruled unanimously that Canadian adults in grievous, unending pain have a right to end their life with a doctor’s help. The ruling established that the “sanctity of life” also includes “the passage into death.” The court then suspended its ruling for 12 months to allow time for the Canadian Parliament to draft new laws. In April 2016, the government introduced a more restrictive bill that requires a person seeking a doctor-assisted death to be a consenting adult, at least 18 years of age, in “an advanced stage of irreversible decline” from a serious and incurable disease, illness, or disability, and for whom a natural death is “reasonably foreseeable.” It did not extend the right to assisted dying to those suffering from mental illnesses or to mature minors. Nor did it allow advance directives ( “living wills”). This bill formed the basis of the new legislation that received royal assent on June 17. Conflicting Viewpoints on Contentious Issues https://learn.thompsonbooks.com/resource/20/nodes/656/read 16/34 11/30/23, 10:37 AM Thompson Learn. In defence of the new legislation, the Minister of Justice and Attorney General of Canada and Minister of Health issued a joint statement that reiterated that the new law “strikes the right balance between personal autonomy for those seeking access to medically assisted dying and protecting the vulnerable.” They emphasized that Health Canada will continue to work with the provinces and territories as provisions of the legislation come into force, and further study will be done with respect to medical assistance in dying in the context of mature minors, people for whom mental illness is the sole underlying condition and advance requests.” Some experts maintain that the end-of-life provision is unconstitutional because it narrows the eligibility criteria as established by the 2015 Supreme Court ruling that struck down the ban on assisted death. The right-to-die movement has gained strength as a result of the “greying” of the population. New legislation seems to be driven less by the desires of older adults, however, than by the anxieties of a younger generation, whose members seek comfort in knowing that they can control the end of their lives. In 2015, the Canadian Medical Association (CMA) produced a draft outline for a “principles-based approach” to physician-assisted death. The principles include the importance of patient consent and capacity, and respect for patient autonomy, as well as respect for a physician’s personal ethical values. (The CMA conducted an internal survey in 2015 and found that 63 percent of its members would not give medical aid in dying to a patient who requested it.) Gerontological social workers will find themselves handling complicated cases in which an individual’s right to a dignified death must be balanced with a need to protect vulnerable members of the population, especially https://learn.thompsonbooks.com/resource/20/nodes/656/read 17/34 11/30/23, 10:37 AM Thompson Learn. clients who have dementia. Most legal and medical experts agree that advance directives can serve as useful tools as long as they are frequently reviewed and updated, with current input from loved ones and primary health-care providers. Accessing Quality Palliative Care Each year, thousands of Canadians suffer because they do not have access to quality palliative care, according to a 2016 study by the Canadian Cancer Society. With end-of-life issues now on the national agenda, the study says, it’s time for governments to guarantee all Canadians access to quality palliative care. Some parts of the country are already addressing the issue. Québec, for example, has included palliative care as part of its new law on doctor-assisted dying. Yet the study finds there is inconsistent and inadequate palliative care in most parts of the country. Unprepared for long-term care costs The Financial Realities of Living Longer Elder Abuse—A Serious, Ongoing Problem Elder abuse is any action bysomeone in a position of trust or power that results in harm or distress to an older person. https://learn.thompsonbooks.com/resource/20/nodes/656/read 18/34 11/30/23, 10:37 AM “Abuse can happen when the aggressor wants to intimidate, isolate, dominate, or control another person” (Government of Canada, 2015). Abuse may take place in Thompson Learn. Caregiver Burnout Caring for an older family member is often a long-term job that can become more difficult and complex over time. the home or in an institutional care Exhaustion can put a great strain on setting. It can be a single event or a family members who have the pattern of behaviour. Like other forms of family violence, elder abuse in the home is largely hidden from view. Isolated and often frail, older adults are highly vulnerable to mistreatment, sometimes by those closest to and/or responsible for caring for them. In Canada in 2013, more than 2,900 seniors (56.8 per 100,000) were the victims of family violence. The perpetrator in 43 percent of cases was an adult child of the victim; in 28 percent of responsibility of caring for aging relatives, and can trigger frustration and resentment. For this reason, “self-care” is essential—before burnout occurs. Moreover, women dedicate almost twice as much time to these types of tasks. Even working outside the home does not appear to reduce the amount of time women spend providing care—26.4 hours a month, versus 14.5 hours for men (Stobert and Cranswick, 2003). There is an urgent need for social services that offer respite to informal caregivers. cases, it was the victim’s spouse. The rate of family violence toward senior females was 26 percent higher than toward senior males (62.7 versus 49.7 per 100,000) (Canadian Centre for Justice Statistics , 2013). Researchers have found that people over 85 years of age are most likely to suffer from dementia or other chronic illnesses and that this can render an individual physically or mentally incapable of reporting violence to the police (Welfel et al., 2000). https://learn.thompsonbooks.com/resource/20/nodes/656/read 19/34 11/30/23, 10:37 AM Thompson Learn. Besides physical violence, abuse can take other forms: emotional or psychological, sexual, and the most commonly reported form, financial (perpetrators of the latter form can be either close to the older adult or a complete stranger). Neglect is frequently associated with abuse. Understanding and Preventing Elder Abuse in Families The first step in preventing elder abuse within families is to understand the causes. Mia Dauvergne (2003) discusses several possible reasons: the stressfulness of the situation, especially if the family member has to balance a job, children, and other responsibilities in addition to caregiving; the fact that violence may be a learned behaviour for the caregiver and is now his or her way of responding to a stressful situation; the fact that the lives of the senior and the family caregiver are so intricately intertwined; and the possible effects of discriminatory attitudes toward the aging family member. Furthermore, “in some situations, the abuse may result from addiction issues (drugs, alcohol, or gambling) or mental health problems“ (Statistics Canada, 2015). The extent of informal caregiving is often understated. Most caregivers are looking after their own parents and their spouse’s parents, and many are providing help to close friends and neighbours. “While the majority of caregivers (57 percent) reported providing care to one person during the past 12 months, assisting more than one care receiver was not uncommon. In particular, 27 percent of caregivers reported caring for two and 15 percent for three or more family members or friends with a long-term illness, disability or aging needs” (Sinha, 2013). It is neither accurate nor fair, however, to ascribe most of the cause of elder abuse to caregivers. In households where abuse of an older person does occur, family relationships can sometimes be so complicated that the older person https://learn.thompsonbooks.com/resource/20/nodes/656/read 20/34 11/30/23, 10:37 AM Thompson Learn. may have played a role in the development of an unhealthy dynamic, such as co-dependency. For example, the older person may have provided many years of care, housing, and food to an adult child who is coping with unemployment, mental health issues, and/or a substance use disorder. When the parent grows old, the caregiving can become especially difficult as both parties can become angry, frustrated, and abusive toward each other due to years of built-up tensions. Relieving Caregiver Stress Can Reduce Elder Abuse Elder abuse It is troubling to note that fewer than The mistreatment or neglect of an older one in five care providers reported that they received help if they needed a break. Yet when asked to identify the most useful thing to allow them to continue providing help, the most common answer (51 percent of those aged 45 to 64) was “occasional relief or sharing of adult by a family member, a friend, a health-care provider in an institutional setting, or someone who provides assistance with basic needs or services. Elder abuse can be physical, emotional, sexual, medical, or (most often) financial. Any action that exploits an older person for personal or financial gain is a form of abuse. responsibilities.” Flexible work arrangements and financial compensation were also on the list. There is the additional complication of seniors looking after seniors. Stobert and Cranswick report that over one in twelve seniors is also looking after at least one other senior: a spouse (25 percent), a close friend (33 percent), or a neighbour (19 percent). The gap between men and women with respect to giving care in this age group is higher than for younger caregivers. Moreover, only 18 percent of the senior caregivers indicated that someone else could take over should they need, or want, time off—pointing to an even greater need for support. https://learn.thompsonbooks.com/resource/20/nodes/656/read 21/34 11/30/23, 10:37 AM Thompson Learn. The physical and psychological effects of abuse against seniors are traumatic —if not completely devastating—for the senior, for the family, and perhaps even for the abuser. In the face of all these concerns and the growing older adult population, it is essential that governments at all levels, employers, other family members, friends, and social workers find more ways to provide relief and support to those who are giving care to seniors. Family caregivers may do a variety of tasks, including transporting their loved one to appointments, running errands, cooking meals, cleaning, making phone calls, and providing personal and medical care. Abuse in Institutional Settings Another issue of concern to social workers is abuse in facilities providing Charter of Rights and Freedoms for the care to older people, including acute-care Elderly hospitals, nursing homes, and retirement homes. In this context, institutional abuse is any act or omission directed at a resident that causes the person harm, or that wrongfully deprives that person of her or his independence. This definition focuses more on the consequences of acts on residents and less on the intent. The abuse could be of an individual nature, whereby a staff The charter for the Yvon-Brunet residence for older adults in Montréal includes five basic rights: information and freedom of expression privacy dignity and respect continuity responsibility and participation member at an institution directly abuses https://learn.thompsonbooks.com/resource/20/nodes/656/read 22/34 11/30/23, 10:37 AM Thompson Learn. a resident. But often the abuse is systemic, whereby situations are allowed to develop that facilitate or permit abuse and neglect. It could also involve the failure to provide adequate safeguards for residents and staff. Guarding against such forms of abuse and neglect, both intentional and unintentional, is important not only for family members These rights translate into a variety of procedures that ensure residents’ needs are being met, such as a residents’ council, flexible schedules, and consultation about medications and menu choices. Lauren Colla, shown here, is a social worker with Baycrest Health Sciences in Toronto, a global leader in geriatric residential living, health care, research, innovation, and education. and relatives, but also for social workers associated with these older adults and the institutions in which they find themselves. Combatting Systemic Abuse Systemic abuse in institutional settings often results from policies, procedures, and processes that appear to be designed to maximize care and/or safety. For example, a facility may have a policy that permits staff members to search residents’ rooms at any time for alcohol or medication. The intent of the policy may be to protect cognitively impaired residents from harm, but the outcome is an invasion of privacy. Additionally, institutions typically have numerous policies regarding eating, wake-up, and sleep times. Often, these routines conflict with residents’ lifelong eating and sleeping patterns. Residents also might find it difficult to question these policies as they are framed in terms of protection. One important way that social workers can assist with preventing abuse of seniors is by using various advocacy strategies, resident councils, and family councils. Ongoing staff training and policy reviews are also important. https://learn.thompsonbooks.com/resource/20/nodes/656/read 23/34 11/30/23, 10:37 AM Thompson Learn. The “home” or “residence” model for long-term care can help overcome some of the problems of abuse in institutional settings. Some facilities have found that developing a charter of rights works well in addressing abuse. Awareness of the widespread abuse of older adults is growing, and social service agencies are responding with community-based initiatives that are proving effective in reducing the incidence of abuse and eliminating some of the causes. As of 2011, the Government of Alberta, municipalities, and local non-profit and voluntary sector organizations are collaborating to offer a variety of services and supports to stop abuse from occurring and to restore older adults’ safety if they have experienced abuse. These services and supports may include counselling, dispute resolution, legal aid, crisis response, shelter services, and safe and affordable housing. Community members are encouraged to “see it,” “name it,” and “check it” as outlined in the “It’s Not Right!” Neighbours, Friends and Families campaign developed under Canada’s Federal Elder Abuse Initiative. “Seeing it” means noticing if something seems amiss, but also not jumping to conclusions. “Naming it” means letting the older adult know what you are observing. “Checking it” means asking the older adult if they are alright and offering to assist. Signs and symptoms Abuse and Neglect of Older Adults https://learn.thompsonbooks.com/resource/20/nodes/656/read 24/34 11/30/23, 10:37 AM Thompson Learn. Home Care for Older Canadians: A Two-Tiered System In the past three decades, there has been a devolution from institution-based services to community- or home-based services, given that more and more seniors are healthy and living on their own. Most older Canadians express a preference for remaining in their own homes, and it is estimated that between 85 and 90 percent of care for older Canadians is provided in the home by relatives. As Canadians age, informal caregiving is becoming increasingly important to the well-being of seniors. According to the 2008/2009 Canadian Community Health Survey (CCHS)–Healthy Aging, an estimated 3.8 million Canadians who were aged 45 or older (35 percent) were providing informal care to a senior with a short- or long-term health condition. In 2012, more than 5 million Canadians cared for an older family member, most of whom were living in their own homes (Statistics Canada, 2015). Informal caregivers—family and friends who provide unpaid assistance with tasks such as transportation and personal care—help seniors remain in their homes, thereby reducing demands on the health-care system. Caring for someone with a health condition or limitation, particularly a cognitive impairment such as Alzheimer’s disease or dementia, can cause physical and emotional problems and create financial and social burdens for the caregiver. This may be especially true for caregivers who are seniors themselves. On the other hand, providing care can give individuals pleasure and pride, enhance their self-worth, and help them to build closer relationships with the care recipient. Home-Care Services Home care for older Canadians involves a range of services, including health promotion, curative medicine, https://learn.thompsonbooks.com/resource/20/nodes/656/read 25/34 11/30/23, 10:37 AM end-of-life care, rehabilitation, support and maintenance, social adaptation and integration, and support for the informal (family) caregiver. Home-care programs Thompson Learn. Meals on Wheels The Meals on Wheels program delivers low-cost, nutritious meals directly to the homes of clients who are unable to also link formalized health-care delivery prepare such meals themselves. Hot or services in the home setting with frozen meals are hand delivered, often by community-based services (e.g., Meals on volunteers. Wheels, respite care, recreational/social programs, and volunteer services). Home-care services can include the following: assessment of a client’s medical and social needs and determination of the best care setting based on the client’s health, social situation, and support network development of an in-home care plan, which includes family involvement, teaching, interventions, and community support provision of nursing services, therapy services, and home support services coordination of medical supplies, equipment, pharmaceuticals, and assistive devices ongoing monitoring and evaluation of the client’s, family’s, and caregiver’s status and needs respite care to assist informal caregivers and support families in their role as caregivers discharge planning and coordination of placement services to long-term care facilities (if required) Additional services, such as long-term care placement, mobility clinics, home adaptation/maintenance, and help with activities of daily living are coordinated and provided through or in conjunction with home-care https://learn.thompsonbooks.com/resource/20/nodes/656/read 26/34 11/30/23, 10:37 AM Thompson Learn. programs. Home-care services generally include the provision of health services by two tiers of workers: professionals (such as social workers, physicians, nurses, physiotherapists, occupational therapists, speech therapists, and dieticians) and unregulated workers (such as visiting homemakers, personal support workers, and personal care attendants). A Provincial Responsibility Home care falls within provincial jurisdiction. In Canada, there are at least 663 agencies providing home care Home care A range of services for older persons, including health promotion, curative medicine, end-of-life care, rehabilitation, services, with 93 percent of delivery support and maintenance, social agencies receiving some government adaptation and integration, and support funding and just over 50 percent for family caregivers receiving all of their funding from government sources. Under the Canada Health Act, home care is an extended health service, which is not insured and to which the principles of the act do not apply. The home care workforce is largely unregulated and largely composed of women. Many work part time and must hold multiple jobs to make an adequate income. They receive few fringe benefits and face limited career options. The type of services, the amount of service, and the criteria for accessing services vary from province to province. The responsibility for home care has been delegated to a regional or local health https://learn.thompsonbooks.com/resource/20/nodes/656/read 27/34 11/30/23, 10:37 AM Thompson Learn. authority in 10 of the 13 provinces and Respite care territories. Six provinces require an Temporary relief for an informal income test to obtain public funding for caregiver, either in the form of a home care. Veterans Affairs Canada substitute in-home caregiver or a short provides home care services to clients with wartime or special-duty area service stay at a long-term facility for the person receiving care when the service is not available to them through provincial and territorial programs. Home care services are also offered jointly by Indigenous and Northern Affairs Canada and Health Canada, which together have responsibility for on-reserve First Nations home care. The slow pace and piecemeal development of home care services have left many older Canadians without programs that properly meet their physical, emotional, and social needs. Many social workers are convinced that nothing short of a universal and comprehensive national home care system is necessary. As hospital care is cut and people are sent home to recover, resources go to those with the most acute medical needs. This leaves frail older persons and those with disabilities at a disadvantage (Armstrong, Armstrong, and Neysmith, 2015). “There is no information in Canada to tell us how many seniors may be falling through the cracks—people who don’t have home care support, but probably should” (Health Council of Canada, 2012). Are we ready? https://learn.thompsonbooks.com/resource/20/nodes/656/read 28/34 11/30/23, 10:37 AM Thompson Learn. Dementia—A Growing Health Priority Supporting family members with caregiving responsibilities Providing Relief to Caregivers Social work in institutional long-term care settings Seniors in Long-Term Care Homes Social work in palliative-care settings for older adults Respecting End-of-Life Choices https://learn.thompsonbooks.com/resource/20/nodes/656/read 29/34 11/30/23, 10:37 AM Thompson Learn. Social Work Practitioner Lorna MacGregor Lorna MacGregor began her social work career in child welfare. She then moved from community work to management, and finally, to community and institutional care for older adults. Chapter 11 Review https://learn.thompsonbooks.com/resource/20/nodes/656/read 30/34 11/30/23, 10:37 AM Thompson Learn. Review Questions What trends in Canadian society are likely to make working with older adults a “growth industry” in the future? Describe some of the preconceptions that contribute to ageism in our society. What are some of the issues of increasing concern regarding older Canadians? With which issues will social workers increasingly be involved? Define and explore the causes of the abuse and neglect of older adults in family homes or institutional settings. Explain why many older adults in Canada are not receiving the home care services they need. What are the advantages of using the life course theory as a lens for effective social work practice? https://learn.thompsonbooks.com/resource/20/nodes/656/read 31/34 11/30/23, 10:37 AM Thompson Learn. Exploring Social Work What kind of social work services do you believe are necessary for older adults to continue to live on their own? What are the roles of social workers in helping seniors “age in place”? A major part of social work practice with older adults is helping them deal with end-of-life difficulties, including pain and spiritual and emotional questions. Discuss this topic in small groups and do a group presentation that depicts how social workers might assist older adults in hospice care. Include reflections on the kind of training that might help social workers in this type of work. Write a brief response to the following comment by Dr. Chris Simpson, past president of the Canadian Medical Association: “We have emergency doctors treating patients in hallways because there are no beds. We have staff scrambling to free up beds. And we have social workers calling in favours to get a bed in a local nursing home.... We need a national seniors strategy to ensure that patients who are well enough to leave the hospital actually have some place to go. We need better home care and residential options so that we never again have to hear the term ‘bed-blocker.’” https://learn.thompsonbooks.com/resource/20/nodes/656/read 32/34 11/30/23, 10:37 AM Thompson Learn. Websites Seniors Canada (http://www.seniors.gc.ca) This site provides access to information and services that are relevant to those 55 and older, their families, caregivers, and supporting service organizations. The publications section is excellent, and the listing of services available for seniors is a valuable resource for social workers. Canadian Association on Gerontology (CAG) (http://www.cagacg.ca) Founded in 1971, the Canadian Association on Gerontology is a national, multidisciplinary scientific and educational association established to provide leadership in matters related to the aging population. CARP: Canada’s Association for the 50-Plus (http://www.carp.ca) Originally known as the Canadian Association for Retired Persons, CARP is an advocacy group dedicated to improving the quality of life for Canadians as they age. With an expansive membership and strong financial support, CARP is a powerful voice for seniors in Canada, promoting active lifestyles, financial security, access to health care, and an end to discrimination based on age. The Alzheimer Society of Canada (http://www.alzheimer.ca) The Alzheimer Society of Canada’s website is an excellent resource for information about Alzheimer’s and how to work effectively with those affected by it. https://learn.thompsonbooks.com/resource/20/nodes/656/read 33/34 11/30/23, 10:37 AM Thompson Learn.  (/resource/20/nodes/655/read)  (/resource/20/nodes/657/read)  About Us (http://thompsonbooks.com/about-tep/) Contact (http://thompsonbooks.com/contact-us/) Privacy Policy (http://thompsonbooks.com/privacy/) Terms & Conditions (https://learn.thompsonbooks.com/terms-and-conditions/) © Copyright 2023 Thompson Educational Publishing, Inc. All Rights Reserved. https://learn.thompsonbooks.com/resource/20/nodes/656/read 34/34