Wednesday, April 20, 2011

Elder abuse, elder neglect

Many great election headlines!
Canadian Elections: Layton (NDP) calls for tougher penalties for elder-abuse

What Is Elder Abuse?

Karen Boyer,
 Coordinator, Muskoka Network Against Elder Abuse
and legal aid lawyer, Joanne Bould
at an Elder abuse conference in Muskoka
Elder Abuse is most defined as: “Single or repeated acts, or lack of appropriate action, occurring within a relationship where there is an expectation of trust, which causes harm or distress to an older person.” (WHO, 2002)
It can be physical, verbal, emotional, sexual, financial abuse.
Theft, fraud, forgery and extortion are criminal offences. It does not matter the ages of the victims. To defraud someone cannot be called abuse. It is a criminal offence and should be punished within the letter of the law.

I do believe there is a myth about the numbers of elders who are abused. I am not saying that it does not happen, but that we really do not know how many suffer from it. Many argue with me, but there is no definitive Canadian study. The issue is different in the US and elsewhere. Our universal healthcare ensures that those needing some homecare are in contact with CCAC, and other agencies who will send in caregivers and nursing staff to a person's home. The more people involved with a senior, the more we can believe that they are safe.

I wrote on-line that I believe the myths of elder abuse abound.
One twitterer sent me this:
It is not a myth @. just to give you two examples:
1.  (April 5) or 2.  (Feb 28).

My full response...
Karen Boyer introducing Elder Abuse speaker, 2009
1. The former is an issue with a landlord and a tenant. It is NOT 'elder abuse'. Any landlord/tenant would be having such an issue. It is ageism to call it 'abuse' if the tenants are seniors. The government has rules and regulations about such. Many need help with landlord/tenant issues. The landlord/tenant act prevails in this situation. Unfortunately, it takes an ombudsman for some, as many seniors are unable to understand the law, and advocate for themselves in court. However, it is presumptuous to assume that they cannot act for themselves.

2. The latter in the above tweet is an awful case of neglect. And even one case of neglect is shameful.
But one case does not mean it is epidemic. We truly don't know how many cases there are. A large amount of our tax dollars are going to this cause, yet we don't really know how prevalent it is.

We do not have accurate studies, yet everyone calls for action. Here is one website: and a legal one, at that: 
Elder Abuse in Ontario | Estate Law Canada 
25 Mar 2010 ... The Ontario Network for the Prevention of Elder abuse estimates that there may be as many as 150000 victims of Elder Abuse in Ontario.

'As many as', and 'may be'. We do not know. This is the horror of abuse. For those with dementia, they may not understand that family members with Financial Power of Attorney are doing the best thing for them. Advance Care Planning is important for all of us. In some cases, Substitute Decision Makers must be appointed for seniors, and that really can be upsetting. My late mother didn't know what she didn't know. My late father had a brain tumour and dementia. They did not realize that they were having trouble making decisions.

Many seniors, who live in poverty for example, are unable to advocate for themselves, and they are living with self-neglect. They do not have transportaion, or cannot afford to fix their home, bringing it up to code, or pay taxes. Advocates living in small towns can determine this type of victim. But are they a victim, or are they simply living outside their means? This is a function of poverty, not abuse.

One article says, 'In Canada, not one province has regulations covering abuse in retirement homes.'

This, surely is a mistake, as laws for abuse and neglect are clear in Ontario. It doesn't matter if this is a retirement home or long-term care. Whether a senior lives with another, family member, or in an apartment. 
The question is can we identify it? In for-profit institutions, such as Charlotte Villa Retirement Residencewhere such abuse took place, it is difficult to understand that there is denial. Family members must be proactive. Those who run institutions must be aware. There are signs of abuse, just as there are barriers to identifying abuse of seniors. 

Barriers to identifying abuse
Dad's radiation burns
  • Seniors may have dementia and do not perceive what is happening. The grandparent scam is an old one: supposedly a grandson phones and asks for money, begging grandma not to tell mom and dad.
  • Seniors may have transportation issues, and difficulty meeting their IADLs, e.g., banking. 
  • Seniors my have communication issues, due to strokes, dementia.

As with those who are predators of children, con men who can suck someone into spending large sums of money, many are groomed. See section 32(1) of the Substitute Decisions Act which provides “A guardian of property is a fiduciary whose powers and duties shall be exercised and performed diligently, with honesty and integrity and in good faith, for the incapable person’s benefit.”

Signs of abuse

Dad's surgery scar
  • There are physical signs of injury, such as bruises, sores, burns, cuts, or black eyes. Such injuries may be hidden (e.g., behind sunglasses or with clothing)
  • The victim makes implausible excuses for injuries or absences ("I fell down the stairs").
  • The victim displays personality changes (angry, depressed, moody, defensive, etc.)
  • The victim becomes withdrawn, or suddenly fearful.
  • The victim becomes depressed, or more irritable or agitated than normal.
  • The victim has difficulty sleeping at night, or may display excessive tiredness (can be a symptom of depression)
  • The victim's appetite changes for better or worse. Weight loss or gain may occur (can be a symptom of depression). Many seniors face depression as they age, or are put into long-term care.
  • The victim's self-esteem lowers.
  • The victim is distracted and has difficulty concentrating.
  • The victim neglects hygiene (becomes smelly, goes unwashed; may be an attempt to ward off a sexual predator if a child, or as a consequence of depression).
  • Changes in personal appearance or in the appearance of his or her home or living environment. (Mind you, could simply be hoarding!)
  • The victim complains of pain in the genital region.
  • The senior 'acts out', becoming sexually promiscuous.
  • Elders may display confusion - but then, again!

Again, some of these symptoms are evidence of dementia, chronic diseases, polypharmacy, other medical issues. One must be careful. In fact, when my late father had his brain tumour removed, there was much bruising around his eyes and cheeks. No one told us this was normal. It was a result of the surgery, not falls.

In this case, it is up to loved ones to enter long-term care, and retirement homes frequently.
Checking arms for bruises. Checking for inappropriate behaviour: undue fears, evidence of feeling inhibited,  PTSD attacks (e.g., seeing the whites of a victim's eyes indicates extreme fear.) There will be  evidence of sexual abuse. It is up to Primary Care staff (the medical establishment) to ensure that there is no evidence. 

Financial Abuse/Fraud and Scams

From January to November 2010, 1073 complaints were made to the Canadian Anti-Fraud Centre (CAFC; formerly Phonebusters) by Ontario residents reporting this scam. 195 complaints in Ontario involved victims who were defrauded of more than $853-thousand. That money is often funnelled back into criminal organizations to perpetuate and expand the cycle of illegal activities further victimizing the unsuspecting public.
If you suspect you or someone you know has been a victim of an 'emergency' money transfer or "Grandparent Scam", contact your local police service or CrimeStoppers at 1-800-222-8477 (TIPS).
FRAUD…Recognize it…Report it…Stop it.

Canadian Anti-Fraud Centre - The Emergency or Grandparent Scam


Here are some resources which may be of assistance:

Ontario Ministry of the Attorney General website. See the section on Elder abuse
Advocacy Centre for the Elderly
Public Health Agency of Canada. This discusses the financial abuse of the elderly and possible ways to stop it.
Ontario’s Seniors’ Secretariat
Toronto Police services:  Strategies | Community Mobilization | Ontario Statutes |
Elder Abuse: The Hidden Crime” [PDF] by the Advocacy Centre for the Elderly and Community Legal Education Ontario (CLEO)

The duty to account is set out in the Substitute Decisions Act. There are regulations which set out how these accounts must be maintained. Please see ONTARIO REGULATION 100/96 ACCOUNTS AND RECORDS OF ATTORNEYS AND GUARDIANS

Ontario Criminal Code Offences

Financial Abuse

  • Theft (Sec. 322 C.C.)
  • Theft by holding Power of Attorney (Sec. 331 C.C.)
  • Stopping Mail with Intent (Sec. 345 C.C.)
  • Extortion (Sec. 346 C.C.)
  • Forgery (Sec. 366 C.C.)
  • Fraud (Sec. 380 C.C.)
Physical Abuse

  • Assault (Sec 265 C.C.)
  • Assault With A Weapon or causing bodily harm (Sec. 267 C.C.)
  • Aggravated Assault (Sec. 268 C.C.)
  • Sexual Assault with a weapon, threats to a third party or causing bodily harm (Sec. 272 C.C.)
  • Aggravated Sexual Assault (Sec. 273 C.C.)
  • Forcible Confinement (Sec. 279 C.C.)
  • Manslaughter (Sec 234 C.C.)
Psychological (Emotional) Abuse
  • Intimidation (Sec 423 C.C.)
  • Uttering Threats (Sec 264.1 C.C.)
  • Harassing Telephone Calls (Sec. 372.3 C.C.)
Active Neglect
  • Criminal negligence causing bodily harm or death (Sec. 220, 21 C.C.)
  • Breach of Duty to provide necessities (Sec. 215 C.C.)

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