The fourth commandment, “Honour your father and your mother, that your days may be long in the land which the Lord our God gives you,” opens the second table of the Decalogue. It shows us the order of charity. God has willed that, after him, we should honour our parents to whom we owe life and who have handed on to us the knowledge of God.
The commandment also reminds grown children of their responsibilities toward their parents. As much as they can, they must give them material and moral support in old age and in times of illness, loneliness or distress. “O son, help your father in his old age, and do not grieve him as long as he lives; even if he is lacking in understanding, show forbearance; in all your strength do not despise him...” My parents are my heroes, and consequently, the commandment has never been particularly difficult to abide by.
However, the fourth commandment also concerns the ties of kinship between members of the extended family. It requires honour, affection and gratitude towards elders and ancestors. This dimension of the commandment I have tended to find much more difficult. I will always remember my grandmother’s plea to sneak her out the nursing home and allow her to sleep under my bed. She hated the place and promised: “I won’t give you or any one else any trouble!”
Families should live in such a way that its members learn to care and take responsibility for the young, the old, the sick, the handicapped and the poor. Of course, there are many families who are at times incapable of providing this help. It devolves then on other persons, other families and, in a subsidiary way, on society to provide for their needs.
FAIRE (Families Allied to Influence Responsible Eldercare) has just completed a six-month project that explored the issue of abuse and neglect of older persons in Canadian nursing homes. The project involved the collecting of anecdotes from family members, government statistics and reports and other research materials to identify trends and issues affecting residents in Alberta’s Continuing Care Facilities.
The guiding principles of the study are independence, dignity and care which are endorsed by seniors as essential to their overall health and well being and acknowledged in the United Nations Principles for Older Persons. Independence is being in control of one’s life, to be able to do as much for oneself as possible and to make one’s own choices, e.g. decisions on daily matters; being responsible, to the extent possible and practical, for things that affect one; having freedom to make decisions about how one will live one’s life; enjoying a support system that enables freedom of choice and self-determination.
The report cites several examples of the extent to which older persons in some nursing homes lose control over their lives, e.g. resident’s access to a physician is limited and subject to the decision of nursing staff; residents are put in adult diapers whether they are incontinent or not, and expected to use them and diapers are rationed and are changed when time allows, not when requested or needed; residents are tranquillized and restrained against their will and/or the will of the substitute decision-maker; complaints lodged by residents and/or family are belittled, ignored, labelled as accusations or as reflecting unreasonable expectations.
Older persons should be able to live in dignity and security and be free of exploitation and physical or mental abuse. Older persons should be able to utilize appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a humane and secure environment.
Nevertheless, the report evidences a number of con-cerns expressed by Alberta families, e.g. life-threatening fecal impaction associated with inadequate fluid, poor nutrition, lack of exercise; unnecessary suffering due to undetected/untreated pain and infection; falls causing fractures that go undetected for days; injury to residents due to unskilled and inappropriate handling of mechanical lifts; muscle contraction/atrophy due to lack of exercise, physiotherapy and the inappropriate use of restraints; etc.
The Alberta Government Protection for Persons in Care Act came into force in January 1998 and it requires the abuse of adults in publicly funded care facilities to be reported. In order for an allegation to be considered “abuse,” the persons in care must experience one or more of the following: bodily harm; emotional harm—including but not limited to threats, intimidation, humiliation, harassment, coercion, or restriction from appropriate social contact; medication administered or prescribed for an inappropriate purpose; etc. In addition, the action must be intentionally caused.
I think that it’s bizarre to assert that “if there is no intent, there is no abuse.”
In any event, according to PPC Quarterly Reports, the number of reported allegations from January 5th 1998 to December 31st 2000 totalled 1884 and abuse took place most frequently in the older population.
Despite the increasing health problems and needs of the older person currently entering nursing homes, Alberta’s Nursing Homes Act has remained virtually unchanged since it came into force in 1985. Compared to nursing home legislation in other jurisdictions, Alberta’s regulations are extremely inadequate, including the minimum staffing standards that are among the lowest in the country.
The Alberta Health Facilities Review Committee Act affords little reassurance. Under this legislation, the reviewing and inspecting of facilities for the treatment and care of persons need only to occur on a “...time to time” basis. From 1995 to 1999, of the 174 facilities in the province, almost 90% received two inspections or less.
If we are to “honour” our elderly, we should attend to the care, funding, legislation, inspection and enforcement of standards issues concerning our long term care facilities.
☩ Frederick Henry