Chapter 4: Family Dynamics – Working with Seniors
Elder Abuse
Elder Abuse and Neglect
Elder abuse and neglect takes place within the households of seniors of Canada (Statistics Canada, 2003, p. 28). This occurs between the older adult and the person they rely on for financial, emotional, or physical support (p. 28). Podnieks (1993) found that financial abuse was the most commonly reported form of elder abuse, followed by verbal and physical abuse, then neglect. Elder abuse affects the quality of life of non-migrant and immigrant elders in Canada, resulting in low self-esteem, injury, loss of autonomy, depression, and social isolation (Podnieks, 1993; Choi & Mayer, 2000; McDonald & Collins, 2000; Spencer, 2000; Lachs et al., 2002; Dong, 2005). Perpetrators of elder abuse may have challenges with depression, substance abuse, and finances (McDonald & Collins, 2000; Podnieks, 2008; McDonald, 2011). Older adults are most often abused by an intimate partner, adult child or child-in-law or other family member (Lithwick et al., 1999; Brozowski and Hall, 2004; Guruge et al., 2010; McDonald, 2011). As a settlement practitioner, cultural sensitivity can be complex. Furthermore, research in this area is limited. The next section will explore some opportunities for settlement practitioners to build understanding and provides strategies for addressing elder abuse among older immigrants. It focuses on sample case studies among Chinese elders and their experiences with elder abuse.
Yan (2015) reports in her study that “elderly persons subjected to abuse had a greater mortality risk than their intact counterparts” (p. 2684). Yan (2015) also explains that in Chinese culture, there is an emphasis on filial piety in that adult children are responsible for the care and financial support of and obedience to their parents (p. 2684). However, elder abuse has been noted by Yan as an increasing issue in Chinese ethnocultural communities, specifically perpetrated by family caregivers (p. 2684). Zhang’s (2019) research in elder abuse and neglect (EAN) argues that migration and ageing processes, both of which engender cultural and contextual changes, shape and reshape views of EAN (Zhang, 2019, p. 341). Lai (2011) supports this argument in earlier research across seven Canadian cities, indicating that EAN suffered by Chinese immigrants is based on perceptions of elders being yelled at, ridiculed, or treated impolitely (Zhang, 2019, p. 343). In one case, Zhang (2019) reported that a daughter-in-law pushed her 70-year-old mother-in-law, who subsequently sustained a fracture and had to be hospitalized (p. 347). The mother-in-law reported that the daughter-in-law was rude and gave her the cold shoulder (p. 347). In other instances, respondents in the study reported feeling emotionally ridiculed because they had limited English skills and felt a loss of autonomy because their responsibilities were limited to child care and chores (p. 348). Many of the respondents indicated that they were professionals in their home countries and felt that their adult children looked down on them for having limited English skills (p. 348), which is a form of emotional abuse.
Additional challenges around perceived financial abuse were also examined. It was reported in Zhang’s (2019) study that many Chinese immigrants would leave the management and decisions about finances to their children, citing that they felt they “lacked language skills and familiarity with Canadian financial systems” (p. 349). Many reported an expectation that they would be treated well by their adult children. After all, they had sold their properties in China and provided their life savings to their adult children (p. 349). Problems reported included children refusing to give money to parents when requested. When older immigrants considered remarriage in cases of divorce or widowing, older children would intervene, which was a violation of the rights of an older person in Canada (p. 350). Finally, older immigrants in the study reported neglect, giving examples of being left to live alone with limited understanding of Canadian systems or to live independently without substantial income and little to no contact with older children or grandchildren (p. 351).
What are some ways to provide supports to older immigrants from a culturally sensitive perspective? It is important to note that any form of professional counselling must be conducted by a certified practitioner or clinician, particularly in the area of mental health counselling. These suggestions are a summary of findings from researchers in the field of elder abuse and should be used as guidelines for case management and forwarded where applicable to a licensed counsellor or psychotherapist. Thus, when working with elderly immigrants, listen empathetically. This means making eye contact, not interrupting the conversation, pausing where necessary, and repeating what you heard to clarify statements. Second, ask about available social supports. Take notes at this point. Third, ask questions starting with What would happen if? When [the care provider or support system] is [blank] what happens? Once you have jotted down notes, repeat what was said and ask if there is anything else that needs to be added. Thank the client for their willingness to share their experiences because it is typically uncommon for elderly immigrants to speak ill of a family or loved one in their community. Provide a list of resources to build social supports where possible. This could include free English-language classes, weekly walking clubs, or other community activities that may be of interest to the client. Last, ask the client if it would be okay if you met again and kept talking. Ask if it would be okay to provide more supports, which could include a counsellor and may be a difficult subject to approach because of the stigma associated with mental health in many cultures.
The following suggestions may support settlement practitioners in approaching the idea of counselling with an immigrant senior:
- Involve community partnerships between settlement practitioners and immigrant groups. “Culturally sensitive community mental health education programs empower minority newcomer communities and groups about their health, especially mental health” (Thomson, Chaze, George, & Guruge, 2015, p. 1900).
- Provide early intervention, particularly with the support of specialized psychiatric supports (p. 1900).
- Offer resources for language training with English-language classes that provide information and discussion on health services, processes, and access for newcomers (p. 1900).
- Provide credential recognition or evaluation services to foreign-trained counselling practitioners to become recertified or licensed in Canada and who can offer a holistic approach to counselling from an intercultural perspective (p. 1900).
Learning Activity 5: Situation 5 – Elder Abuse Role-Play Scenario
Chia is a client of Sally’s. Sally works for a local immigrant settlement agency. She is an intake worker in the counselling department. Sally and Chia have met several times during Chia’s settlement process, from landing to registering for English-language classes and discussing community activities of interest. Today’s conversation between Sally and Chia is a bit different because Chia has opened up to Sally about a potential abuse situation at home.
Chia: Good morning, Sally. How are you today?
Sally: I am well, thank you! It’s nice to see you. How are you doing?
Chia: I am okay. My grandchildren keep me busy. They are so smart, but they have so much energy all the time.
Sally (nods and maintains eye contact): Oh, I see. Before we get started with today’s conversation, do you want some tea or water?
Chia: Tea would be good. Do you have green tea?
Sally: Yes, I do! Do you want any milk or sugar in your tea?
Chia: No milk, no sugar.
Sally: So, just a reminder that I will be taking notes so that I can keep track of what you have shared, but I will be listening to make sure that I capture your thoughts. The notes I take will be seen by you and me. If I want to share the notes, I will always ask your permission first. Is that okay?
Chia: Yes.
Sally: Can you please complete this consent form while I get your tea.
Chia: Yes, for sure.
(Pause)
Sally: Here you are. I hope you are comfortable. Let me know if there is anything else you need.
Chia: No, thank you. I am good. Thank you so much.
Sally: You were saying that your grandchildren keep you busy. Can you tell me a bit about a typical day?
Chia: Oh, I wake up at 6:00 a.m. to prepare their breakfast and get their clothes ready. Then I get them to brush their teeth and eat breakfast. Next, I walk them to school. Sometimes it is very cold when I come back home. Then I clean up the dishes and the bathroom and prepare lunch when they come home to eat. Next, I prepare dinner for my children and grandchildren and maybe do some laundry if there is time.
Sally (nods): And do you feel at the end of a day like this?
Chia: Tired. I am not as fast as I was before, but I help my daughter and my son-in-law because they work a lot and are busy, and I do not want my son-in-law to be angry with me.
Sally: Hmmm. Why do you think your son-in-law would be angry?
Chia: He said that he brought me here, so I need to help as much as possible. He does everything for me. I do not have to worry about food or clothes or anything. Sometimes he yells if I forget something, but I do not want the children to see him angry, so I do my best to do things right.
Sally: Hmmm. What happens if you do not do things right?
Chia: It causes problems with my son-in-law and me or my son-in-law and his wife. I feel bad, but I cannot say anything.
Sally: Hmmm. Thank you for sharing. I am going to restate what I heard. You make breakfast and lunch for your grandchildren and walk them to and from school. You also make dinner and do some laundry for the family. You sometimes feel sad when your son-in-law is angry, and sometimes you feel tired.
Chia: Yes.
Sally: This sounds like a lot of work, and you are doing some things to help your children and grandchildren.
Chia: Yes, but I want to help because they are my family. I do not have lots of family back home.
Sally: Let us talk a little bit about what you like to do. Are you still attending English classes in the evening?
Chia: Sometimes, but my daughter says she cannot take me if she has to work late.
Sally: Would you like to have a free bus pass so you can go to class on your own?
Chia: Yes! That would help me.
Sally: There is also a potluck in four weeks with other newcomers. Do you want to go?
Chia: What time?
Sally: It is in the evening at 6:00 p.m.
Chia: I could go. Can you write down the date and time for me, please?
Sally: Yes, I will do that.
Chia: Thank you!
Sally: I am going to share your file with our counsellor, Jenny. She may want to talk with you in a few days. Is that okay?
Chia: Yes, that is okay. I like coming to talk to people.
Sally: Great! I will make an appointment and write it down for you.
(Pause)
Sally: Does this date and time work?
Chia: Yes, that is fine. The grandchildren are at school.
Sally: Awesome! I will see you soon. Take care.
Chia: Okay. Bye!
This role-play scenario shows the rapport and relationship-building between the settlement practitioner and the client. Notice that the settlement practitioner does not jump to conclusions and ask questions about violence because the client has not indicated that there is violence. Caution should be taken to be sensitive to the client’s cultural and family traditions.
Reflection
- What was your initial reaction to the situation?
- What did you notice about the communication between the settlement practitioner and the client?
The conversation between Chia and Sally is one example of cultural grandparenting expectations. The conversation begins a discussion around the norms and attitudes of the marginalized older immigrant person and immediate family members about the older immigrant parent’s role in the household in Canada. Elder abuse among Chinese immigrants and racial minority groups should be framed based on individual family characteristics such as roles, relationships, living arrangements, social networks, and informal and formal supports. Elder abuse should be examined from multiple contextual experiences and influences with a focus on the individual’s life transitions, such as family and social roles, interactions, and intergenerational relationships among adult children, grandchildren, and the elder immigrant person.
This activity can be done in pairs. If utilized in the OER, learners may choose to read through or listen to the role play.
Summary
Discussion with Focused Questions
- What are some of the reasons immigrant seniors choose to immigrate later in life to Canada? What are some of the challenges with aging out of place?
Immigrant seniors migrate to Canada because of conflict or family ties. Immigrant seniors who are sponsored by family members may arrive under an economic or parent or grandparent program, and resettlement may be impacted by adult children’s ability to provide financially. Cultural perspectives on elder responsibilities in the adult child or caregiver home differ, but generally speaking, older immigrants were once regarded as knowledge keepers of tradition. Migrating to Canada later in life may lead to challenges with aging out of place because some older immigrants feel a loss of autonomy, social connections, and respect. Other older immigrants find ways to connect in their new communities.
- What does effective communication look like between a settlement practitioner and an immigrant senior client?
Elderly immigrants want to maintain their dignity in all interactions, particularly those in unfamiliar spaces. Maintain an appropriate personal space with clients, and call new clients by their last name as a sign of respect until the client indicates that using their first name is appropriate. Avoid multi-tasking when speaking with the elderly person, and avoid jargon. Provide short amounts of information at a time to avoid confusion. Evaluate your personal assumptions about ability, gender, ethnicity, and age, and identify times when a statement about a group of people is made. Finally, avoid “elder speak” (communication that infantilizes the adult).
- What should the settlement practitioner consider when evaluating a client’s needs?
Listen empathetically. Maintain appropriate eye contact, nod, and do not interrupt the client. Take notes and offer opportunities for supports based on the client’s interests and statements. Ask “what if” statements and repeat what was said for clarity. Thank the client for their willingness to share their experiences. Provide a list of resources to build social supports where possible. Also provide opportunities for future follow-up to have difficult conversations with a licensed practitioner in the specialized and applicable field.
