While writing this paper, I feel very sad as elder abuse incidents happened repeatedly in Chinese society. Jan. 17, 2011, an elder woman who had dementia was frozen to die (Agrell, 2011) and recently, a 68 - year- old woman was banished to live in her son's unheated garage. (Yang, 2011) Both of the cases happened in Chinese community.
I think that the actual mistreatment incident rate was most likely higher than the statistic result, as there are some hidden issues are not brought to light. This shows that elder abuse is not only an individual issue but also a social issue. The incidents of elder abuse increase cost of public health and set up a very bad model for the next generation. This paper will explore the results of an interview with a director of a Chinese community agency. The interview will be examined by analyzing Chinese culture toward elderly and potential cause of elder abuse. The agency's approach to dealing with the social issue will be critiqued, and an ideal agency response to the social issue as well as why from a critical social work perspective will be given.
Response to the social issue of elder abuse
Describe traditional Chinese culture view elder people, potential cause of the social issue and the agency's response:
The agency examined for the paper is Carefirst Seniors &Community Services Association, which is a charitable non-profit agency mainly provides services to Chinese seniors in Greater Toronto and the surrounding areas. The director, I interviewed, is from Hong Kong with a BSW degree. She used to work in a settlement agency and started acting as a director of Community Support Services Unit at Carefirst a year ago.
When she was asked about the responds to the issue, the director expressed that elder abuse is not a common topic in the community because Chinese Confucian tradition of "filial piety" and "respect to seniors" are the fundamental value of social life and relationships for all Chinese. Filial piety stresses children have responsibility to take care of their aging parents in return for the care one received as dependent child. Elders should be respected and comforted. Elder abuse is intolerable under this belief system.
However, staff of the agency notice that many elderly, most of them immigrant to Canada as family reunite numbers, live in three-generation households. They take care of their grandchildren and help their children manage housework. In examining the social world of elder Chinese women, Chan (1983) found "the elderly women, despite years of residence in Canada are still practicing the traditional value of family and morality characteristics of working classâ€¦their children, having spent prime years in Canada, have been more westernized and assimilated into core values of Canadian society."(Chan, 1983, p.46).Therefore, intergenerational conflicts arise from different values, lifestyle choices around child rearing, financial arrangement, and other family issues. Furthermore, in examine the social, structural and environmental factors that face Chinese elderly people and their families, "Chinese families were found to have high levels of stress, balancing paid work and family life, which makes caregiving for elderly relatives especially challenging" (Carefirst Seniors & Community Services Association, 2002 ).
Carefirst is the only agency providing services to Chinese elderly in the community. They adopt a "Triangle Model" (see rough notes of the interview attached) in dealing with the social issue.
This agency offers a broad range of programs and services such as outreach programs, education workshop, safety ambassador, drama club, elder abuse hot line, peer support group or focus group and counseling service to address the social issue so as to educate people, promote services, and provide preventions for elder people in abuse situation. In addition, the agency also provides crisis intervention to help people with high risks live in a safe and secure environment. Except for providing the programs and services, Carefirst also take part in ONPEA (Ontario Elder Abuse Network, Ontario Protection against Elder Abuse) and has partnership with other agencies and institution such as St. Paul, CHATS, and University of Toronto.
Wider circumstances leading to creation:
The agency, previously known as Chinese Seniors Support Services Association, was established in 1976. At beginning, it only provides meals-on- wheels service to frail elder people in Chinese community.
As aging population grows, over the last 35 years, in order to meet elder people's physical, social, emotional and spiritual needs, the agency has developed and expanded tremendously.
Being an accredited agency, the director indicated, Carefirst is funded by Ontario Ministry of Health and Long- Term Care, United Way of Toronto, United Way of York Region, United Way of Peel Region, Toronto Community & Neighborhood Services Grant, and donations from the community.
The agency has developed full range of community support services, covering Toronto, York region, and Mississauga areas. Their programs include social and primary health care services such as information & referral, client intervention and assistance, supportive counseling, transportation, MOW, personal care and homemaking, adult day program, renal social support centre, caregivers support and education, elder abuse prevention and education, Chinese elder abuse helplineâ€¦ (Carefirst community support services brochure).Despite efforts the agency has made, there are still some seniors' needs unmet. Seniors with cognitive impairment such as dementia and Alzheimer's are more in risks and are targets of elder abuse incidents. People with dementia need 24 hours supervision services and their caregivers also need community support. In this respect, the agency's services are limited due to not have enough funding.
With regard to the political environment and its impact on the agency, the director did not mention the cutback of settlement funding by Harper Conservative government. According to Canada's Immigration News, " the federal government was cutting $43 million from Ontario's budget for helping immigrants" This massive slashing will have profound effects to Chinese seniors. Since 1998, China has been the top source country for immigrants (Citizenship Immigration Canada, 2001). According to the 1996 Census, for the Toronto Census Metropolitan Area (CMA), the Chinese population over the age of 65 totals approximately 32,000, 97% of them are immigrants and 56% are women (Statistics Canada, 1999). The cutting of the funding predicts that people working in the social agency will lost their jobs or the previous full-time positions may be changed as part-time position; the quality of the programs and services will decline, some services will be cutâ€¦ all of these directly affect elderly immigrants' well-being.
With regard to social policies, the director more emphases the importance of social housing. In her mind, if seniors can get their apartment sooner, family conflicts will be reduced and elder abuse incidents will be avoided. Her assumption may work for some people at certain level, but it can not eliminate elder abuse incidents thoroughly. If all seniors could get their apartment, but none of their children or family numbers goes to visit them, they still face being neglected abuse. I believe she, as a director and social work practitioner, needs to mindfully exam one of current Ontario health care policies "aging at home". The policy encourages seniors aging at home and staying in their community. The purpose of policy is helping government save huge cost of building long-term care facility and maintaining hospital beds. The defect of this policy is that it ignores caregivers' work and makes caregivers invisible. The policy takes advantages from hundred and thousand caregivers. As caregivers can not get resources and support, Novak and Campbell (2006) indicates that caregiver's stress leads to elder abuse (p.320).
Critique of the agency's responses:
This agency appears the surface of anti-oppressive approach in its response to the social issue of elder abuse. According to the director, Carefirst has had the elder abuse program for more than 10 years. The agency creates policies and programs to prevent elder abuse and neglect. These policies and programs include: support education for social isolated seniors and overextended family caregivers; expand homecare services; allocate funding for developing and expanding social and recreation programs, and providing consultation services to seniors. As a result of this client centered approach, isolated elderly "is empowerment" (Ife, 1997, p.129). To this end, more seniors actively involved in the agency's programs and received services. The agency have developed and expanded in three areas and is serving 6500 clients a year. However, the director did not realize the limitation of the agency's services defects as most of the staff in this agency only speaks Cantonese. But the majority of Chinese population in GTA speaks Mandarin.How can workers understand clients' issues without direct and effective communication with them? This is no surprise that many Mandarin speaking clients are excluded from the programs and services.
Through the interview with the director, more oppressive situations are discovered. Carefirst was established 35 years ago and most of Chinese people came to Canada from Hong Kong at that time. Although people from Hong Kong and mainland China both call themselves "Chinese", there are language and cultural differences for them. People from Hong Kong speak Cantonese and received more influence from western culture, because Hong Kong used to be British colony. However, people from mainland China speak Mandarin, have less religious belief and more influenced by communism ideology. In this case, the distinction between "us and them", between the service providers (agency staff who are from Hong Kong) and the clients (people who are from mainland china) was evident. Many Mandarin speaking clients "have been excluded frommeaningful participation in social, cultural, and other forms of human activity"(Jenson, 2000) they could not equally access social and health care resources due to the language barrier. For instance, an 85-year-old Mandarin speaking woman lived alone in a subsidized apartment; fell two times within a week. Her only son rarely visited her. She lefts several messages to staff of this agency for help, but she never received a call. In her case, she was an elder abuse victim due to her son's neglect ion. Nonetheless, as a social service agency, did the staff's behavior match the Ontario social work code of ethics? The elder woman was in a critical condition at the moment, she desperately waited for a help. Finally, she could not get a call. How much oppressive the old woman has endured? Young (1990) states that "old people remain oppressed in their marginal status, respected their freedom and dignityâ€¦" (p.55) to resolve this kind of problem should be the responsibilities of this agency's staff.
From the above case studying, power issue clearly displays. Being a "worker" in the agency is absolutely has power to make a decision on he or she should reply the call or should ignore the call. Unfortunately, the behavior represents the agency is unprofessional and unmoral. Social worker's duty is setting a role model and promotes "a better, fairer, more just or more liberated society"(Ife, 1997, p.132)
As helping professional, in my opinion, all people who work or will work in this field should always bear in mind that our power may relate to a person's life, may change a family's future or may create a new lifeâ€¦ The power should be shared with clients through the interaction process of mutual respecting, mutual learning, and mutual growing.
An ideal agency response to the social issue from a critical social work perspective and why
I think an ideal agency response to elder abuse should adopt a client centered approach combined with anti-oppression, anti-racism, empowerment and client's self-decision making frameworks.
Critical social work practice is based on critical theory e.g. identify client's problems, empower them, and help them make a change. Staff of the agency uses their professional knowledge and communication skills to mindfully listen to clients' stories, "fully present the moment and non-judgmental" (Wong, 2004, p. 447) view clients as unique individuals and understand clients' needs, feelings, oppressions, challenges and the power relations between the issue and the environment around them.
Except the awareness and mindful listening, staff's mind, body, and emotion engagement with clients are very important. Through power of language, staff provides room for clients to explore. Together with clients to discuss and question their concerns, and analyses the relations of power, use deconstruction, reconstruction, anti-oppression and empowerment framework to challenge clients' existing thinking and working. Helping clients to understand oppression and its relation with justice, accessing client's cognitive capacity, assisting them to access social housing, financial, transportation, medicationâ€¦encouraging clients to attend peer support group or focus group, offering one on one or group counseling, working together with other professionals to make care plans, facilitating them to set up goals and objectives, finding clients' strength and empowering them so that they can make a change. In the meantime, staff also needs to organize education workshop for abusers, let them know the consequences of elder abuse.
How to use the notion of critical theory directly affects critical social work practice. Being helping professionals in the agency, staff can apply individual and structure approaches when dealing with vulnerable populations. By establishing and maintaining communication through language, staff value client's life experience, acknowledges the importance of reality, help them access social and health care resources, identify and resolve tensions, link issues between personal and politics, facilitate individuals to understand the forces of capitalism, patriarchy, and mainstream media, let them recognize the power imbalance, understand power relationships are constantly defined and redefined as part of a fluid, empower clients and their families to take actions to control their own life.
Staff needs to strive to take a holistic perspective, avoid using simplistic way when building dialog with clients. Through respect, empowerment, empathy, genuineness and combine with clients' rights on decision-making and participation. Clients have specific wisdom and first-hand oppression experience. They know themselves best than what staff know. They are the experts of themselves. Staff's job is to share skills, learn from and grow with clients in the process of mutual empowerment and mutual education. As a result, clients identify their own strength and commit to make a change. Finally, rather than simply supporting clients and focusing on the centre point for change, staff would participate actively in advocacy for clients on social injustice and social inequalities and evaluate their day-to- day practice by using clients' feedback so as to fulfill their role as critical social worker.