Saturday, 23 April 2016 16:27

Ethnic Seniors Wait for Long-Term Care

Commentary by [             ] in Toronto

The wait to get a long-term care bed in Ontario has increased significantly in the last six years. An individual on a wait-list to transfer from a hospital bed to a long-term care facility waits just over two months, while those who have applied for long-term care while living at home wait 116 days for placement.
Yet, a report released last week by the Wellesley Institute has found that seniors from ethnic communities in Toronto have even more difficulty getting placed in ethnic long-term care homes.  Seniors waiting for an ethno-specific long-term care home wait for 18 months on average for placement into an ethno-specific long-term care home. The report noted that some of the longest waits for these high-demand services can be as high as eight years.  
Further, the report found that income is a factor. Basic accommodations provided in a long-term care home are in high demand. Yet, the report finds that for people able to pay for more expensive private accommodation, the wait time decreases by nearly three months.
Pricey care
Long-term care can be pricey. In 2012, Michel Grignon and Nicole Bernier priced the cost of long term care for “24/7 assistance in an institution costs around $60,000 per person per year.”
And the prices are only likely to go higher.
[quote align="center" color="#999999"][T]hose who have applied for long-term care while living at home wait 116 days for placement.[/quote]
People looking for long-term care services have high needs.  In addition to providing living support for individuals, staff care for people with physical limitations, helping them get up from a bed or chair, eating, and using the bathroom.  With higher than average rates of dementia, depression and chronic diseases such as diabetes, heart conditions and arthritis, these homes require highly skilled staff to give the medical attention needed by the elderly population using these homes. 
Ethno-specific long-term care homes are in high demand. They offer care in the same language as their residents, provide ethnic- and religion-sensitive food options and conduct social activities and entertainment specific to the community they serve.   
The ethnic familiarity provided by these homes are important.
Happier and healthier
The report notes that elderly individuals in ethno-specific long-term care homes are happier and healthier, “feeling less social isolation, lower rates of depression, and fewer falls and hospitalizations.”
Unfortunately, the limited access to these homes is only getting worse.  
While, the ethnic population has grown due to increased immigration in the Greater Toronto Area, there hasn’t been a similar increase in bed numbers in ethno-specific long-term care homes.  People in Canada are generally living longer than ever before, increasing overall demand for long-term care. This is good news overall, but those who would have normally stayed at home in their old age are now requiring more specialized medical attention.
Cultural acceptance
Finally, there is more cultural acceptance in immigrant communities for long-term care.  In some ethnic communities, there is an expectation that children will take care of their elders into old age.  Yet, attitudes within the community have shifted amongst second and third generation immigrants.  And the evidence that people have an improved quality of life in long-term care has resulted in less stigma and increased demand.
[quote align="center" color="#999999"][A]ttitudes within the community have shifted amongst second and third generation immigrants.[/quote]
There are a few ways that immigrant families can prepare for long-term care needs in the future.  One option is long-term care insurance, which could help offset future costs for families. Further, governments could consider supporting a universal insurance program for long-term care that could share costs amongst Canadians. 
Finally, investments in long-term care would be key to ensuring the future of our seniors. Even more than governments, entrepreneurs could be encouraged to consider investments into the development of long-term care, especially for immigrant communities that do not currently have a place to go in their old age. While there are homes specific to the Chinese, Italian, Greek, Polish and Ukrainian communities, other immigrant groups will inevitably require these services.

[            ] is a contributor who has chosen to remain anonymous and has worked in the the health care industry for the last five years.
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Published in Commentary
Thursday, 17 March 2016 15:24

Breaking Silence Around Elder Abuse

by Beatrice Paez in Toronto

Asking seniors subtle questions about their daily routines opens up dialogue – and can point to signs of elder abuse, which rarely reveals itself in obvious ways.

Nirpal Bhangoo-Sekhon often asks seniors she meets about what they’ve been eating, who handles their finances and if their basic needs are being met. It is her job as case manager of the Punjabi Community Health Services (PCHS) to be curious.

“Unfortunately, if we don't ask those questions, we wouldn't know what's happening,” she says. “It gives you a better picture of what goes on at home.”

[quote align="center" color="#999999"]Abuse isn't limited to physical violence; it can extend to the withholding of financial resources, verbal threats and isolation from the household.[/quote]

In a 2009 report, Statistics Canada found that two-thirds of seniors who experienced family violence – physical force or threats – didn't sustain injuries. Seniors most at risk, based on reports to the police, are between 65 and 74.  

During her one-on-one meetings with seniors, Bhangoo-Sekhon will also illustrate scenarios to raise awareness of how common an issue elder abuse is. Holding such conversations regularly helps ease reservations about breaking their silence, which can take months, if not longer, she says. 

Reluctance to speak up

While elder abuse cuts across different cultural groups, they may contend with different obstacles. 

Language barriers and distrust in the police – mostly worries about being deported – aren't the only concerns stacked heavily against the decision to come forward, says Kripa Sekhar, the executive director of the South Asian Women's Centre (SAWC) in Toronto.

There's the perception that speaking out would fracture family ties and bring shame on the community. 

“I don't think they want to be seen as a community that's going to expose their families or seen as betraying their families," says Sekhar. "They've almost accepted that ‘this is what's meant for me.’”

[quote align="center" color="#999999"]Cultural groups have different attitudes about what constitutes abuse.[/quote]

Burial customs can also play a role in the struggle to come forward for seniors of certain faiths.  

With funeral rites traditionally being the responsibility of the son or a male family member, some express concern that their spiritual needs will not be looked after if they speak out, says Sekhar. “They're not worried about today. They're worried about the afterlife. It's hard to understand that – you're struggling in this life, but it's such a part of who they are.”

Abuse isn't limited to physical violence; it can extend to the withholding of financial resources, verbal threats and isolation from the household, she explains. 

Statistical profiles on elder abuse as it relates to the South Asian community aren't traced by front-line agencies such as the police and social services. Statistics Canada instead analyzes the prevalence of family violence along gender lines, while acknowledging that cultural groups have different attitudes about what constitutes abuse.

Possibilities for intervention

The immediate response to cases of physical abuse might be to find alternative housing, but in other instances, intervention through education is crucial, says Bhangoo-Sekhon.  

"If we can go in and educate the families – that, in the end, would be much more helpful and useful for the community than just pulling seniors out [of the home] and placing them in shelters," she says. 

Finding subsidized housing or placing elders in shelters isn't always the most feasible solution in cases of neglect or isolation, particularly if they're not used to living independently and are in need of a personal support worker, she says. 

PCHS has a caregiver support program, an extension of its efforts to address elder abuse, which is offered to those who are caring for family members. It is intended to relieve the strain of household demands. The program attempts to engender a culture of empathy, recognizing that the caregiver may be stressed, while getting him or her to understand the vulnerabilities that seniors face. 

"We help them understand the aging process," says Bhangoo-Sekhon, adding that changes in a senior's behaviour may create friction within the family if it's not recognized as a health issue.

[quote align="center" color="#999999"]"Housing for seniors should be guaranteed. They need enough funding to live in dignity."[/quote]

"[It's to help] them understand what's happening to their body, their brain, and that's out of their control."

Networks for seniors living alone

SAWC, through its community network, tries to locate housing for seniors so they can live independently, but finding affordable housing can take an average of seven years, according to the Ontario Non-Profit Housing Association. Thirty per cent of seniors make up the wait list, as cited by the Toronto Star from the organization's 2015 report.

Sekhar communicates regularly with seniors who live independently and tries to ensure that their landlords are responsive to building safety issues. "Many say they do that, but their concerns aren't always attended to," she says. 

SAWC holds a seniors’ workshop every Thursday where they can gather to discuss health and safety issues, along with abuse. It's a support network for seniors who live on their own, where they feel comfortable conversing in their mother tongue, says Sekhar. 

"Housing for seniors should be guaranteed," says Sekhar. "They need enough funding to live in dignity."

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Published in Health

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