When does elder care become elder abuse?

Leanne Kaufman:

It’s a sad fact that abuse of older adult Canadians is becoming a bigger issue in our society. Grandparent scams seem to get the most media attention, but unfortunately, this isn’t the only form of elder abuse that’s happening. Many of our elderly find themselves alone, isolated, lonely, possibly all three. And this kind of vulnerability sometimes coupled with diminishing cognitive function, may create the breeding ground for situations of abuse. While we are hearing more and more about it, this remains an issue that many shy away from talking about, perhaps because of stigma, shame, or simply not recognizing what actually constitutes abuse.

Hello, I’m Leanne Kaufman, and welcome to RBC Wealth Management Canada’s Matters Beyond Wealth. With me today is Mélanie Couture, a professor at Sherbrooke University and the chair holder of the research chair on mistreatment of older adults.

Melanie, thanks for being here with me today to explore what is elder abuse, how to recognize the signs, and perhaps most importantly, how to prevent it and why all of this Matters Beyond Wealth.

Mélanie Couture:

Thank you very much for the invitation.

Leanne Kaufman:

So, let’s start with this concept of the forms of elder abuse and it not just being about the fraud or the scams that we hear about frequently on TV. Can you outline for us, how do we define elder abuse in Canada and what types of abuse are most commonly recognized?

Mélanie Couture:

Well, when you think about abuse, you have to think about a relationship where trust is expected. So, it’s really a relationship issue. So, you have to think that way. It’s about having a bad attitude, doing bad actions, and also saying bad things—if you want to make it simple—to someone, to an older adult.

Also, it’s about not doing things. So, when we say you’re doing a bad action, then it would be, for example, violence. When we talk about not doing something and causing harm, then it would be more negligence. When we think about abuse, we often think about bad behaviors, but not doing anything, we don’t see it as abuse, but it is, because you’re causing harm. For example, if you’re not providing groceries for somebody who needs it and they can’t eat, then you’re not acting badly in a sense that you’re hitting them or screaming out obscenities. But you’re actually causing harm. So, we have to think about causing harm and causing distress within a relationship where there’s supposed to be trust. This is the important part of mistreatment.

If you think about different types, we’re talking about financial mistreatment, but there’s also emotional mistreatment, physical mistreatment, and these are the main forms that we encounter in real life.

• Emotional: is screaming at someone can cause harm and distress.
• Physical: people think about hitting, but like I said, not bringing food and causing physical harm would be included in physical mistreatment for example.
• People also forget about sexual mistreatment. It’s not just about sexually abusing the older adults, it’s also about maybe you’re cleaning someone and you’re being rough. That could be sexual abuse. Also not respecting their personal intimacy can also be included in sexual mistreatment.

So, like I said, always think about causing harm by doing something or by doing nothing.

The one we see the most is really the psychological mistreatment, emotional mistreatment, but it’s rarely alone. Usually there’s physical, financial, sexual that’s also included. You rarely have one type. It’s usually a whole mix of things. So, you have to keep in mind that mistreatment is a complex issue because of that too.

Leanne Kaufman:

So, I think it’s a really important point that you made at the outset, which is—and I sometimes draw this distinction myself—I started us off talking about grandparent scams and fraud, but that’s stuff that’s done by strangers. What we’re talking about here when we talk about abuse is like you said, people in a position of trust, right?

Mélanie Couture:

Yes, but what you’re talking about, the grandparents fraud would be considered mistreatment because they’re kind of mimicking relationship where there is trust. They’re saying, “I’m your child,” for example, so we would include it. What would not be included is being attacked by a stranger in a parking lot somewhere, that wouldn’t be it. When we think about trust, it’s not just about family members, it’s also about workers that come into your house maybe for health and social services workers, but also maybe somebody who’s doing renovation. You’re supposed to trust them, they’re coming into your house. That’s also counting neighbors, [and] friends also. So, you have to think about these people too when you think about mistreatment.

Leanne Kaufman:

Yeah, so recognizing them that this isn’t always a straightforward definition and it can show up in these sometimes more subtle ways. We have done a full episode on this podcast on financial elder abuse, so I think for today’s conversation, we’ll stay focused a little more on the physical and emotional side. Can you give us some of the signs that someone might be experiencing this form of abuse or suffering from this form of abuse? And do those signs differ depending on whether it’s physical, which might be a little more obvious or emotional?

Mélanie Couture:

Well, you’re talking about physical, usually physical isn’t that obvious because bruises, unexplained injuries sometimes are due to disease, but it’s worth investigating. You know what I mean? If you see something like that, ask questions, [and] go to the doctor. It’s important because they’re the one that going to determine is it somebody being mistreated or it’s more [a] disease that actually needs to be treated or something. So, you have to be careful. These signs are important. Do something about it, for sure.

The part that’s harder is the emotional response. So, what we’re going to see is maybe depression. The older adult is going to be depressed, is going to be anxious. It might be caused from mental health issues, but it can also be a result of mistreatment. What I would say, it’s somebody that’s scared that this is important because normally in real life, we’re not supposed to be scared of someone. So, if somebody’s scared, that’s a sign. If somebody is also kind of not there anymore, they’re in their head and really anxious all the time, that might be a sign too, because people won’t come forward. They won’t say, “Hey, I’m being mistreated.” It’s more, somebody has to ask questions, go a little further, and they’re usually scared to talk about this and also ashamed to talk about it. So, it’s worth investigating and talking and gaining their trust and trying to talk to them and see what’s going on because they won’t just come out blatantly and just say, “Yes, I’m being mistreated,” so that’s the hard part I would say.

Leanne Kaufman:

So, there are laws of course in this country that are designed to protect our older adults from harm. What are some of those legal protections, or what are those rights that Canadians have to guard against this and how can they exercise those rights?

Mélanie Couture:

So, when we’re thinking about mistreatment, often people are going to think about criminal laws. There are provincial and there are Canadian laws, so of course assault and things like that, sexual abuse involved, there’s laws for that. Usually the first step, it can be calling the police if the person might get harmed even more, [and] there’s an emergency situation, but often since it’s within a relationship where there should be trust, the first step is to have maybe a social worker get involved. Go and reach for [an] organization who advocate for the rights of older adults. Because the first thing is actually to sometimes take care of the relationship, talk about it, it’s not always a legal issue per se. The first step is more about what’s going on and trying to look at the relationship and try to fix it.

One important thing I have to say is really that you have to bring no judgment when there’s a mistreatment situation because usually one person is being mistreated, or maybe they’re both mistreating each other. It’s something [that’s] going bad within a relationship.

I always say that anybody can mistreat and anybody can be mistreated. You have to be careful. Usually the person being mistreated and the one mistreating are both feeling bad and need help. It’s not necessarily about one person is a criminal, we’re going to bring them to justice. People have to understand that it’s not about necessarily bringing it to the criminal justice system. It’s more about resolving the situation that both people are in and not feeling good about it, probably. The idea is more about trying to work on the best situation and make it better for both people.

Leanne Kaufman:

Yeah, that makes sense. So, there’s sometimes, I guess ethical, moral part to all of this, or a difficult position that the caregiver might be in where on one hand you’re trying to care for someone and respect their autonomy and their dignity at the same time. What are some of the considerations you think families and caregivers should be bringing to mind to make sure that they’re making that balancing act between respecting dignity and autonomy and fulfilling on caregiving, which the caregiving may actually feel to the older adult, like abusive or somehow disrespectful, right?

Mélanie Couture:

Exactly. Well, actually we’re doing a big research project on mistreatment in the context of caregiving. What we’re seeing is that caregiving is actually a big risk factor for mistreatment, for both the older adults and the caregiver. Because you’ve got social isolation, usually one or both are getting depressed or anxious because of the disease. All the work that’s involved, all the family changes, responsibilities. So, it’s a really stressful situation. And this means that both people are not necessarily feeling good, like I was saying earlier. The older adult that’s sick can actually become…maybe yell at the caregiver for doing something wrong, and then the caregiver gets angry too, so [is] a little more rough when she’s cleaning the older adult, etcetera. It’s a really stressful, frustrating time usually for both people, so we have to be careful and respond to the needs of both.

The idea here, I would say to really go with the principle of shared decision making. Shared decision making means taking into account everybody’s needs, so everybody’s happier within the difficult situation. It’s not just about the older adults, it’s also about the caregiver, and we have to be careful about that. The caregiver can also be mistreated by other family members who’s putting too much pressure, the healthcare system putting too much pressure. So, the mistreatment can come from a lot of different people, government instances, organization[s], everything. We have to be careful about that.

We also have, for example, in Quebec, the concept of organizational mistreatment, which means that sometimes not giving services or having practices that cause harm or distress to older adults or caregiver can also be considered mistreatment. So, you have to think about all of these things.

Even in the case of [an] organization, the shared decision-making, making sure that everybody’s heard and are involved in the decision-making usually helps to make sure that there is less mistreatment because we know what we need to do to make everybody happy, if possible. Like I said, depending on the resources, but that usually helps. So, I would say that in this context, try shared decision-making and family members and everybody involved.

Leanne Kaufman:

So, you mentioned one of the risk areas being the social isolation, and we know that that can be a big risk factor, particularly if it leaves those older adults without the support they need to protect themselves or that support network, maybe. What role do you see social connections and community involvement playing in reducing the risk of this kind of abuse? And is there a way to help foster those connections?

Mélanie Couture:

The idea is not necessarily the number of connection that is important, but how trustworthy the connections are. So, do you have somebody to talk to you can trust when something goes wrong? You don’t need 50 people if you have one or two that can help you. So that’s really important. It’s also about not relying on only one person, either. Even the caregiver who has only one friend or only one other person that[‘s] helping or something. It’s all about having different people for different needs. So, you might have people around that you can talk [to] about anything. So, they’re more like friends, but you do need some people that can help you with maybe mobility issues, cleaning the house and other things.  You have to clarify your needs and have people to be able to fulfill those different needs. Sometime having somebody clean the house and help you for some things is not enough. You also need human connection, so you have to get this type of connections. When you don’t have anyone, then you can also go to different resources for older adults, like I said earlier about organizations that help with older adults rights. Also in some of the provinces in Canada, for example, Ontario and Quebec, we have helplines, so they actually specialize in older adult mistreatment. So you can call and talk about if something is wrong and you can trust them, and they also have the knowledge to help you go a little further. But I would say that in mistreatment situations, you first need to talk to somebody you know well and trust before sometimes you can talk to professionals. People don’t realize it’s about talking about the issue and realizing, yes, it is mistreatment. Because, at first you say, “Well, he’s angry or he is sick, that’s normal.” But you don’t have to live like that. It’s the same with any type of violence. You first have to realize, “Wait a minute, that’s too much,” or, “That’s not normal.” And you usually have to talk to other people to realize that something is wrong and make sure you’re not crazy because you don’t trust yourself at one point when you’ve been in that type of environment for a long time. So, you need to talk to someone first and then get help also even more. But just realizing and recognizing that you’re dealing with mistreatment is kind of the first step.

Leanne Kaufman:

Okay. So once someone has sort of recognized that and realizes that they do need some help on a practical basis, what resources are available in Canada for these vulnerable Canadians or maybe their families to find support, to find information, maybe even intervention services if needed?

Mélanie Couture:

So, it varies from one province to the other. What you’re trying to look for is usually a social worker.  They are trained to deal with violence issues, neglect and things like that. It might be your social and healthcare system. You can talk to your family doctor. Usually, they should know where to find a social worker to help you with these types of issues. If you don’t have specialized resources available—like I said, in some provinces there are helplines—you can look on the web to see if there are resources within your region. On your provincial government website, they might have something. I know that the Canadian government is looking more and more into elder abuse right now also. Normally in your region there might be an association for older adults and you can go and talk to them also.

Leanne Kaufman:

Yeah, great tips.

So this has all been very useful and I think some practical information as well as giving us a bit of the overview of the whole issue. If you hope that our listeners just remember one thing from our conversation, Mélanie, what would that one thing be?

Mélanie Couture:

No judgment, because you might lose your temper too, so don’t judge the person that is mistreating. Also, you might be the victim at one point too. You don’t have to be that old to live in an environment with violence. Sometimes it’s insidious, it starts slow and then it escalates, and then you’re stuck in something you didn’t think you would be stuck in, so don’t judge anybody. Both people are suffering, and both people need help. I think that’s important to understand [that] and don’t be ashamed. I mean, like I said, it can happen to anybody, so don’t be ashamed. Just try to get out of it and get help.

Leanne Kaufman:

Well, thank you, Melanie, so much for joining me today to help us better understand these different potential areas of abuse of our older Canadians and why this Matters Beyond Wealth.

Mélanie Couture:

Thank you.

Leanne Kaufman:

You can find out more about Melanie on LinkedIn or at the University of Sherbrooke website .

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Until next time, I’m Leanne Kaufman. Thank you for joining us.

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