On Ageing by Marian Sherratt, M.A., Executive Director, Bermuda Council on Ageing

When it comes to caregiving and elder abuse, we like to think about these two subjects as being at either end of the spectrum. We like to think that caregivers are angels and abusers are devils. Unfortunately, life isn't quite that simple. Caregiving and elder abuse are linked through increased demand for care and shrinking resources. As our population ages the potential for elder abuse, whether in the home, in the long term care facility, or in the hospital, grows.

Family caregivers – those family members and friends who are "giving back" to their loved ones – are increasingly at risk to themselves and others. We know the number of seniors will double by 2030 while we have a shrinking birth rate.

We know that women form the majority of family caregivers but they must also work, maintain the home, and raise children with or without the support of a partner. We also know that the hospital is discharging 'quicker and sicker', while modern medicine is allowing people to live longer with care-intensive, long-term medical conditions. Added to this is the knowledge that caring for someone with Alzheimer's disease or dementia is the most stressful form of caregiving, and these disorders are not only on the rise they are affecting people at younger ages.

We are also experiencing a critical shortage of health-care workers, making the cost and coordination of home or long-term care a serious challenge. Health-care workers themselves are working harder, longer, in smaller teams and with fewer resources in the form of training, supervision, and psycho-social support. Nurses, especially, are in critically short supply. This puts added pressure on this profession. Health-care workers who are not fully trained in geriatric care and who are under-supported are at risk of increased stress as well as becoming abusers themselves.

While on the subject of abuse, the worst form of elder abuse - sexual abuse - makes us all shudder. But the most common type of abuse is neglect. Neglect takes many forms, such as failing to visit family members, failing to provide basic care or failing to provide simple kindness and consideration. This neglect takes place in the home, the long-term care facility, and the hospital. As a result the potential for angels to move along the continuum toward the abusing devil grows as stress on caregivers and care workers increases.

To further compound matters, the impact of the current economic climate is yet to be fully understood as it relates to caregiving and elder abuse. On the one hand, as more people are laid off work there may be a return to stronger family bonds with more time to devote to our loved ones.

On the other hand, as financial pressures increase, the temptation to financially abuse our seniors increases. Unfortunately, once the Power of Attorney is signed the temptation is sometimes too great and financial exploitation begins, while bullying for money takes place with or without legal powers.

To turn this around we can start by recognizing the enormous contribution caregivers make to our economy. Without them, our health care system will collapse.

Imagine if every family caregiver said "No, I'm not doing this. It's government's problem, they can provide a home, bedroom, laundry, nurses, food, transportation, etc. etc." No government could possibly do this, but they can support caregivers by at least acknowledging their contribution, support them with readily available and affordable services in the community, and even find ways to reward them for their contribution to the health care system.

Legislation on elder abuse is cumbersome with any resulting prosecutions being few and far between. Very often prosecutions take so long to complete they rarely help the victim of elder abuse. Indeed, there is research to show that when there is a report and intervention that results in removal of the senior from an abusive situation, other than a life-threatening one, that senior will die sooner than if left in familiar surroundings with adequate support.

A less draconian approach of education, support, home-care resources, supervision, advocacy and personal responsibility would do far more to reduce elder abuse. By reducing the risk of under-supported caregivers and over-worked health-care workers becoming abusers, we can reduce the incidences of elder abuse.

Marian Sherratt is Executive Director, Bermuda Council on Ageing. She writes on issues concerning our ageing population each month in The Royal Gazette. Send email responses to info@bdaca.org .