Raising Awareness of Abuse of Older Persons
Elizabeth Podnieks, C.M.
Ryerson University, School of Nursing, Toronto, Ontario
Churches can play a critical role in the prevention of elder abuse and neglect by fostering heightened public awareness of elder mistreatment, as well as providing services to families and others at risk for perpetrating abuse. Research indicates that faith leaders are one of the most likely groups of caregivers to encounter cases of elder abuse, but unfortunately they rarely refer or report these cases to agencies that can help. Religious leaders require training to educate them about elder abuse issues, as well as to identify the important roles they can play in prevention, intervention and treatment. Pastoral workers and theology students should also be exposed to educational concepts regarding this problem. In an age of ecumenicism and interfaith movements, religious leaders must become a conduit for the well-being and safety of older adults. This paper discusses a study undertaken in Ontario, funded by Health Canada (Ontario Region), the Ontario Trillium Foundation, and Justice Canada to determine the awareness level that faith leaders possess about elder abuse. An initial literature review reveals unsettling gaps in knowledge and information about this complex problem.
One professional group clergy has remained almost universally silent on the topic of elder abuse, yet clergy can no longer ignore this problem of suffering which will grow over time, given the accelerating increase in the proportion of our population that is aged. Religious leaders must become sensitized, and begin to lead their congregations to the forgotten and invisible, dependent elderly. They must use their special talents and privileges to help both the abused and their abusers (Pagelow, 1988). Family violence experts, such as Mildred Pagelow (1988) and leaders in the area of religious issues affecting seniors, such as Andrew J. Weaver and Harold G. Koenig (1997a, 1997b) have been clear in their challenge to faith leaders to become more pro-active with regard to issues of elder abuse. More than many other formal care providers, faith leaders are in a position to identify, assess, and intervene in abusive situations because they see older people in their own context over time, and have ongoing access to their residences (Boyajian, 1991). This paper discusses several methodologies that have been used to determine faith communities perceptions about elder abuse and what resources are needed to assist clergy, congregants, and others in the prevention and intervention of this social issue.
Genesis of the Study
Abuse and neglect of older people occurs worldwide. Canadians have been particularly troubled by the increasing number and severity of cases that are being uncovered. With the growing proportion of seniors in our society, we are constantly being challenged to address abuse and neglect of older persons in our country and ultimately prevent it from happening. In seeking to intervene and offer assistance to older persons whom we suspect are being abused or neglected, we look to faith communities for a new dialogue with service providers. Faith leaders are uniquely positioned to engender the trust of their congregants and become a helpful resource. Moreover, they are able to reflect theologically on their practice and on situations they encounter.
The majority of Canadians identify with a faith tradition, even those who do not attend churches or synagogues regularly, or at all. Only 10 to 12 percent of Canadians report "none" when asked about their religious group identification (Bibby, 1987). Moreover, one in every five Canadians report attending their church or synagogue the previous week (Bibby, 1993). This proportion increases if one considers sporadic attendance or participation in special religious celebrations, such as Christmas or Easter.
On the basis of the growing recognition of faith communities as a vital and realistic intervention in the prevention of elder abuse, funding was sought and obtained to work in this area. The project called "Raising Awareness of Elder Abuse in Faith Communities" was started in 1999. The overall goal of the study was to increase the knowledge of elder abuse among faith leaders and their congregants, as well as the public at large. The primary focus of the project was education, and intended outcomes are the development of materials and resources. It is timely to consider the role of education in promoting a greater understanding of the linked phenomena of elder abuse and the role of religious leaders.
Education is one of the most significant primary prevention interventions in elder abuse. Education can empower individuals to find solutions to the problems that confront them around the issues of elder abuse. It is essential that older adults have information to help them understand their rights and assist them in finding help. For older parishioners of faith communities, education equips them with a sense of control over what is happening to them; it helps them to understand information that may be provided to them by their faith leader. Education for faith leaders prepares them to intervene with greater understanding when congregants disclose abuse.
The target population for this project included the following groups: older adults and their families; ministers, rabbis, priests, nuns, religious orders, theology students; parish nurses; pastoral counselors and chaplains (i.e. in long-term care and hospitals); members of congregations, youth and ethno-cultural groups.
Understanding Elder Abuse
Elder abuse is a crime it is a multi-faceted social problem that must be addressed by all segments of society. According to a national prevalence study of elder abuse in Canada, an estimated four to six percent of all seniors are victims of neglect (Podnieks, Pillemer, Nicholson, Shillington and Frizzell, 1990).
The lack of precise and consistent definitions of elder abuse has generated ongoing controversy and debate (McDonald and Collins, 2000). There is general agreement on two basic categories of abuse and neglect: domestic elder abuse and institutional abuse. The major types are physical, psychological, and financial abuse. The focus of this study was on domestic elder abuse. Neglect is the refusal or failure to provide an older person with the necessities of life such as water, food, clothing, shelter, personal hygiene, medicine, comfort, personal essentials, and other essentials (National Center on Elder Abuse, 1998).
Domestic elder abuse is defined by the National Center on Elder Abuse (NCEA, 1998) as maltreatment of an older person by someone who has a special relationship with the senior, such as a spouse, sibling, child, friend or caregiver in the older persons own home. It is called domestic abuse because it occurs in the community rather than in an institution, such as nursing home (McDonald and Collins, 2000). Nandlal and Wood (1997) identify a key limitation of the information that is currently available: it is not grounded in older peoples understanding of elder abuse (Stones, 1993). For example, researchers have often assumed that physical abuse is more severe than mental or verbal abuse. In their study, Older Peoples Understandings of Verbal Abuse (1991), Nandlal and Wood examine the question: "What does the term abuse mean to you?" and found that some study participants defined abuse in terms of the consequences of actions. An example of a more subtle form of abuse is the isolation of the senior by a caregiver(s) or family member(s). The senior may be denied access to, and participation in, his/her faith community activities, such as religious services, fellowship with other congregants, visitation with a trusted faith leader, etc. The seniors withdrawal from activities may not be investigated it may instead be falsely attributed to age-related changes. Thus, a cycle of social isolation is reinforced and perpetuated.
Like older persons in general, persons with disabilities as a group are at higher risk for abuse. It has been estimated that people with disabilities are four to ten times more likely to experience abuse, neglect, or exploitation than other adults (Adults with Vulnerability, 1997). Specific studies have reported higher levels of sexual abuse (Sobsey and Doe, 1994), physical assault, and psychological abuse (Roeher Institute, 1995). It has also been estimated that seventy-five percent of persons who experience abuse have at least one major mental or physical impairment (Pringle, 1997).
Four Canadian provinces and all fifty American states have reacted to the problem of elder abuse and neglect by enacting special adult protection legislation (Robertson, 1995; Wolf, 1992). The legislative approach, heavily influenced by child welfare models, is characterized by legal powers of investigation, intervention, and mandatory reporting (Robertson, 1995). A review of these programs in the two countries suggests that actual responses vary widely across and between states and provinces. The variability appears to be related to the type of legislation and the financial commitment of the jurisdictions to community resources (Quinn and Tomita, 1986; Robertson, 1995; Wolf, 1992; Zborowsky, 1985).
Protective service programs usually combine legal, health, and social services to allow for the widest array of interventions. They require consideration, coordination, and interdisciplinary teamwork (McDonald and Collins, 2000). Several Canadian studies underscore some of the flaws of the adult protection legislation and its implementation. Bond, Penner, and Yellen (1995) surveyed Canadian professionals about the effectiveness of adult protection legislation. Most thought it was effective, but they also expressed a concern that there were insufficient funds to administer the program and to provide services to abused older persons (McDonald and Collins, 2000).
There has always been the concern that mandatory reporting may have a negative impact, particularly on how society views elderly people, thus encouraging "ageism" in society (Faulkner, 1982; Krauskopf and Burnett, 1983; Lee, 1986). As McDonald et al. point out (1991): "Mandatory reporting is based on the premise that the victims of elder abuse are unable to seek help for themselves. Many critics question that premise, and emphasize that one should not assume that older people will not seek assistance if it is available [E]ven if victims are reluctant to report elder abuse, it does not necessarily follow that others should be required to do so [McDonald, et al, 1991]."
The Research Component
In the spring of 1998, the Ontario based Older Womens Network (O.W.N.) conducted a study of the shelter needs of older abused women. As part of this study, 106 women speaking fifteen different languages in five communities across Ontario were interviewed about their experience with elder abuse and whom they turned to for help. Faith leaders emerged as contacts for comfort, guidance, and support for women experiencing abuse. It was therefore hypothesized that religious institutions and their leaders could offer enormous support to abused parishioners if clergy had the information and the skills to address the needs of this large and generally unacknowledged population.
The first question to arise was, "Do faith leaders have the necessary information and skills to fulfill their potential as crucial first contacts for elderly abused parishioners?" To answer this question, a strong coalition was formed for the purposes of conducting a study. Included in the partnership were the sponsoring organizations of Ryerson University Office of Research Services, the Older Womens Network, Women in Interfaith Dialogue/The League for Human Rights Bnai Brith Canada , University of Toronto Faculty of Social Work and the Ontario Network for the Prevention of Elder Abuse. It became obvious that there were many people and agencies that realized the importance of a comprehensive study on this issue. The project received subsequent funding from Health Canada (Ontario Region), the Ontario Trillium Foundation project , and Justice Canada.
A preliminary field test was undertaken to test one of the main research instruments for the subsequent pilot study. The following is an overview of the barriers that exist in doing a study of this kind, as well as preliminary observations culled from the data collected.
The sampling methodology of the field test consisted of a web design. Members of its advisory board and community contacts were asked if they knew of any faith leaders who might be willing to participate in an hour-long interview on the subject of elder abuse. From a maximum sample of ten faith leaders, six interviews were set up and four were undertaken within the allotted time frame. They included a Polish Roman Catholic priest, a Conservative rabbi, a Presbyterian Minister, and an Islamic Muslim lay preacher. Their ages ranged from early 40's to early 60's. Their training averaged five years.
When developing a proposal for the pilot study, several possible barriers to accessing information were discussed. In the field test, these barriers were present in varying degrees when attempting to access information from the participants. The existence of these barriers yielded useful information that was incorporated into the main pilot methodology. The first barrier is "confidentiality." This barrier was particularly true in the case of the Roman Catholic priest. This was the only setting in which the confessional was a part of the religious life of the congregants. The majority of information of elder abuse coming to the faith leader was through the confessional, both by abusers and those being abused. This information is held in the strictest confidence which limits not only possible intervention (such as alerting family or friends, or advocacy work), but also limits the amount of information that the study could access. In the cases of the other faith leaders, confidentiality was very important in the sense of "where is the data going that is collected in the study?" Barriers of confidentiality vary amongst the clergy, both by personal value system and religious denomination. An excellent overview of the issue can be accessed in "A Ministers Information Handling: Protections and Constraints on a Pastors Caregiving." In this article, Wicks (1996) observes that in North America considerable confusion exists over who actually owns and who can control the information a minister acquires and disseminates. Wicks provocative discussion raises questions about whether or not the faith leader has an obligation to transfer the information she/he has acquired in the area of counseling practices and confidential communications. In some cases, the law and/or professional standards suggest it belongs to the parishioner-client, in other cases to the faith leader, and in still others to society as a whole acting through its judiciary (p.40). Wicks postulates that the possibility of a charge of malpractice raises the question of ownership.
This concern raises another barrier, one that we called community protectiveness. Community protectiveness has two main components, both of which can prove to be barriers to a free flow of information. The first component has to do with public perception of the faith leader. "What if my level of awareness is not sufficient?" was a concern that manifested during the field test. "Could this have repercussions?" The second component has to do with public perception of the faith community itself. "Is this information going to make my community look as if its response to this problem is not sufficient?" It is important to all faith communities both to be doing what they can about the social problems within their ranks, and to be seen as doing such. "What does the researcher think of how we are doing?" was a question that arose. This question brings us to a third barrier to accessing information: the religious and ethnic background of the interviewer.
The community protectiveness barrier should be somewhat lessened when the faith leader is talking to a researcher of the same background. This is true for two reasons. One, when participants are faith leaders, they are passionate about their faith and their community. Now, someone is asking difficult questions about it. If the participants know that the interviewer is of the same background, they are going to feel more comfortable answering these questions. In addition, all religious communities preferred that their responses to the problem of elder abuse be kept within the boundaries of the communities. The perception, therefore, is that if the interviewer is of the same community, then the information will be held within it. Although the participants logically know that this is not true, it does seem to increase their comfort in talking about the issue. There was evidence of this barrier, or significant lack thereof, in at least two interviews, one where the participant was of the same background as the interviewer, and one where he was not.
The second reason for this barrier has to do with the more concrete issues of language and knowledge of the community. A knowledge of the first language of the participant, and a knowledge of the community, while not crucial to accessing the information, proved to be helpful. At the same time, in several instances a lack of knowledge of the participants preferred language and the religion or community proved to be a barrier.
The last barrier that arose was a very practical one of scheduling. The nature of the faith leaders work means that their unscheduled time is extremely limited. In one instance, an interview was set up and an unexpected death in the community meant that a funeral took precedence over the interview. The faith leaders full schedules necessitate that interviews be arranged well ahead of time and that there is no room to go over the time allotted to the interview itself. This barrier could also interfere with clergy being able to attend educational sessions on elder abuse.
An important question that the study sought to answer is, "What are the perceptions of faith leaders to elder abuse?" The answers to this question in the field test were quite comprehensive. Most mentioned physical, emotional, financial and verbal abuse from husbands, wives, children, and caregivers both inside and outside of institutions. Forcing elderly people into nursing homes was also seen as abuse. The one form of abuse on which there was a consensus was "neglect." "Neglect" was seen to be the most prevalent and malevolent form of abuse. The main forms of neglect were children neglecting their parents by not including them in their lives, and caregivers neglecting their charges by not attending to their emotional or physical needs. Neglect from children was where the strongest condemnations came from, with the effects of this type of abuse running into mental health problems such as Alzheimers and Dementia, as well as heartsickness and getting "sick to death." The most comprehensive definition of elder abuse came from one faith leader who said, "Elder abuse is behaviour that denigrates the dignity or infringes upon the personal liberties of the elderly."
Another question that the study sought to answer is, "What are faith leaders responses to elder abuse?" Contrary to what we might expect, responses do not range over a wide variety of interventions. The faith leaders interviewed here all involve themselves in advocacy. They will talk to family members or convene staff meetings at nursing homes. Above and beyond this response, they are mainly referral sources. By and large, they do not get into the area of counseling those who have experienced abuse. They do not have training either in general counseling or specifically with the elderly or the issue of abuse. They do offer spiritual counseling of a religious nature, but counseling around the abuse is referred out. The majority of the participants referred to counselors within their faith community, either nuns or ethno-specific social workers. None of the participants had ever called the police in a case of abuse. In the Muslim community there is a Social Welfare Board, within which there are social workers who specifically take care of seniors issues. They would always be the ones to contact an outside agency like the police. One faith leader responded that his credo is "Thou shalt not kill," which means, in this case, that one must examine an allegation of abuse very carefully so as not to "kill" the reputation of an alleged abuser if, in fact, he or she is innocent of wrongdoing. Only one faith leader talked about active prevention in his community as a response to elder abuse. They were building seniors homes adjacent to religious buildings so as to cut down on seniors isolation and therefore cut down the instances of neglect with their attendant effects.
Decreasing seniors isolation leads us into another area of study, that is, to look at the faith leaders perceptions of barriers to accessing the help that they offer. The question was asked, "What is your perception of the barriers to accessing assistance from a person such as yourself, for older persons experiencing abuse?" The responses varied. One participant said that if the elderly person was practising in his or her faith, there were no barriers. They would completely trust their religious institution. Another talked of the lack of a relationship with the faith leader as being a barrier. The more the elderly congregant knows the religious leader, the more likely she or he is to disclose the abuse. In addition, the effects of the abuse isolation, dependency, mental and physical illness would also be barriers. The age of the victims might be a barrier in that when they were growing up, no one talked about abuse. The stigma involved and the possibility of a victim-blaming mentality were also listed as possible barriers. Finally, it was suggested that the religious bias of the faith leader might pose a barrier in that their belief might be that if someone was a "Good Christian," or a practising member of the religion, that person simply would not be perpetrating abuse, in which case the victim would have to be mistaken.
The final phase of the study dealt with material development and dissemination. The participants were initially asked what they thought would be helpful in the way of education for themselves, their elderly congregants, and their community at large, on the issue of elder abuse. They listed two possibilities. The first was education for the community at large on the question of "What is abuse?" The second was education aimed at elderly congregants with regard to the same question. Interestingly, no one mentioned materials aimed at the religious leaders themselves. Qualifying both possibilities for education was the importance of the materials being culturally sensitive, which included their being produced in the preferred language of the seniors (with most leaders agreeing that this would be the seniors mother tongue). Ideas for dissemination included visits to homes for the aged, social groups, and using newsletters. Accessing avenues that already exist as forums for social and educational purposes was strongly advised. The overall response on the materials question was rather sketchy, however, because of the strong referral role most faith leaders take in response to elder abuse. This means that they are not doing the counseling and thus do not have a comprehensive view as to what would be the most helpful materials to fill those gaps.
Although the data collected during the field test was not statistically valid due to the small number of participants, it was impossible not to summarize some observations that stemmed from the analyzed information. Some of these observations come directly from participants and others come out of the researchers analysis of the data. These include:
All participants felt that resources must be developed in strict consultation with members of the community.
Faith communities have very little outreach to outside agencies that specialize in working with abuse or the elderly.
Religious leaders are often the first contact for the elder abuse victim and, as leaders, they are ultimately accountable to their community for their actions. However, they do not do the lions share of the work with this issue. Therefore, it would be crucial for the study to interview the participants who actually do the work. They will know what needs to change and what is needed overall to provide better service to this population.
There is limited awareness of the issue. Even though it is the first place of referral for many elderly victims of abuse and their non-offending family members, religious leaders are mostly in a "not in my backyard" frame of mind. The consensus seems to be one of, "Even though I know it is happening, it is not happening as much in my community as it is in others." Therefore, information tended to stray onto the general, rather than specific side, and responses to questions about the specific community were rather vague.
Religious leaders all talked about their lack of training in this issue, both at the seminary level and in subsequent theological training.
During the field study our research team went into nursing homes and long-term care facilities. This small pilot study (Podnieks 2001) examined the perceptions of elder adults in six long-term care facilities relating to their spiritual needs. Residents reported a lack of spiritual nurturance. They identified the need to attend religious services, the power of prayer, having religious articles nearby, visitation by clergy and others, as well as the opportunity to talk about God as all providing sources of spiritual strength.
Barriers to older clients not attending religious/spiritual activities within the long-term care facilities include, but are not limited to: having no one to transport them to and from the services; staff feeling that it is not worth the effort; staff thinking that resident would not benefit from services; and staff fearful that resident would be disruptive (Podnieks, 2001).
Following the field test, a pilot study was designed and carried out to assess faith leaders awareness of elder abuse. The Centre for Applied Social Research (CASR, Faculty of Social Work, University of Toronto, was contracted to collect data (Daciuk, Allen and McDonald, 2000).
Places of worship play a significant role for older persons who are experiencing abuse; therefore, information from faith/religious leaders is important. This information serves as a foundation for developing an inclusive and collaborative response to the problem of elder abuse as it relates to faith communities. The purpose of the survey was to:
examine faith/religious leaders perceptions of elder abuse;
examine actions taken by faith leaders in response to suspected or disclosed situations of elder abuse; and
examine faith leaders knowledge and understanding of resources/services available for elder abuse intervention.
The study represented a purposive sample of faith/religious leaders in Ontario. Lists of faith leaders were compiled, with the assistance of the multi-disciplinary community advisory board and community contacts of faith leaders who would be willing to participate in a study on elder abuse. The study team compiled lists of faith/religious organizations from directories (i.e. Yearbook of Religious Organizations, community directories, Internet searches). The CASR staf, in collaboration with the principal investigators and the advisory committee, developed the survey instruments. In order to have representation from diverse religious and ethno-cultural groups, the lists anticipated that twenty-five face-to-face interviews would be conducted in the City of Toronto, and fifteen to twenty-five telephone interviews were conducted in five regions of Ontario. It was a very difficult task to secure interviews with the faith/religious leaders. The refusal rate was approximately 40%. Interviewers had to make approximately six to ten calls to faith leaders before an interview was secured. A focus group was conducted with seven faith/religious leaders from diverse faith and ethno-cultural communities to validate the instruments, present findings of the interviews, discuss their perceptions and experiences of elder abuse, and discuss further resources that they felt would be helpful to deal with issues of elder abuse.
Results of this survey of faith communities in Ontario (N=49) revealed that two-thirds of faith leaders were aware of elder abuse within their community. Some of the barriers to churches becoming involved in the issue of elder abuse include: lack of time; clergy feeling bound by rules of confidentiality; and lack of knowledge and intervention skills. Congregants reported embarrassment, pride, fear, and the perception that the situation would not change as the main reasons which prevented them from asking for help from their faith leaders.
Following the pilot study, CASR (Daciuk, Allen and McDonald, 2000) conducted a focus group with faith leaders to obtain further information. The focus group participants from diverse faith and ethno-cultural communities reviewed the survey findings and discussed further resources that they felt would be helpful in dealing with issues of elder abuse. Aside from the information generated by the survey, the focus group identified new resource concerns. These needs were divided into three groups: what faith leaders need, what elder people who may experience abuse need, and what families and communities may need.
What further resources do faith leaders need?
A support group or network for faith leaders who work with these issues.
A database for resources specific and related to elder abuse.
A brochure or pamphlet that is condensed that defines elder abuse, lists resources, and offers crisis and other service phone numbers. An example of this resource material already exists for women who are victims of violence.
Videotapes or brochures that illustrate intervention/counselling techniques in working with elder abuse.
What elder people who may experience abuse need:
A large education/prevention campaign. This to include: Toronto Transit posters, daytime television advertisements, and posters in bingo halls and community centres, as well as other places older people frequent.
Legal legislation similar to Child Protection Legislation but for the elderly. Some places in the United States and Canada already have such law.
Any material must be culturally sensitive and in large print.
Information/crisis numbers to be put on business cards which elderly people could discretely pick up and put in their wallet or purse.
What families and the community need:
A large advertisement campaign that targets two different audiences: A) the perpetrator "Is this elder abuse?" B) the victim "Are you being abused?"
Education of the faith community at the place of worship during a service. This could be after a service or during the service in the form of a guest speaker.
Supports for the caregivers of the elderly. This issue addresses prevention in terms of support for caregivers so they dont become stressed, frustrated, or reactive. This reduces the risk of abuse.
The last area of concern explored by the focus group concerned community services. The group was asked if they had any recommendations or suggestions for services that address elder abuse.
The group agreed that more services need to be made available in terms of counseling, prevention, and support. They also emphasized that updated information was often difficult to obtain and that services that may have been around last month are now gone. The need for an online database that would be regularly updated was suggested. Culturally sensitive services were emphasized as being important for many of the elderly who come from different ethno-cultural communities. The information obtained from this research proved to be vital in the preparation of written materials and resources for faith leaders and their congregations.
Key Informant Interviews
The following section represents additional data collection that was undertaken to elicit a greater understanding of faith leader perceptions.
"My bishop said to me that he believes it is a ministry of reluctance. A lot of clergy do not like ministry to the elderly whether its in institutions or at home..."
(Roman Catholic Priest)
The findings came from several focus groups, including a group made up of clergy from four different Christian denominations and a Conservative Rabbi, two key informant interviews with two other Christian clergy, and an interview with the former Director of Continuing Education and Development at the Toronto School of Theology. Although these numbers are not large, they do give a glimpse into how clergy are thinking about the issue of elder abuse, and their response to it. This glimpse will help to form recommendations regarding next steps of material development.
Perceptions of Elder Abuse and the Role of Clergy/Congregation in Responding
Clergy participants said that it was important for them to gauge the extent of elder abuse within their communities. They were aware that elder abuse exists, especially in immigrant communities where the elderly and caregivers are under enormous stress from isolation due to language and socio-economic barriers. They felt that it was their obligation to follow up and follow through when they became aware of elder abuse. However, the barrier to this response was that many clergy do not hear about it first hand. Most participants agreed with the statement of one priest, "I still think its hard for people to name and I think its harder to do it in church."
Why is it harder for people to name abuse in church? One priest submitted that there is a religious value prominent in religious culture that can be summarized as, "Better to give than to receive." That is, it is difficult in this religious culture to admit that one is not being cared for or valued. This especially holds true for women. Women also tend to blame themselves when they are the victims of abuse. Concurrently, the church places a stress on respecting the elderly. For someone to come out and say that there are people in his or her family who dont do that is very difficult. In effect, it means that "My child or my niece or my nephew or somebody is really violating the Torah, the Bible." The question becomes, therefore, how does one create a culture in a church or a synagogue where people can feel safe and secure enough to be able to say, "This is my experience"? In addition, how does one create a climate for clergy to feel comfortable enough to go and ask the question, "Are you being abused?"
Barriers To Clergy Involvement In The Issue Of Elder Abuse
Clergy seem to need to define for themselves what their role is with regard to responding to or seeking out social problems.
Social service agencies and religious institutions are feeling overwhelmed. Religious institutions, because of our tradition to say, "Were there to help people in need and our tremendous emphasis on love and kindness and all of that, we as clergy, feel terribly guilty when were not able to do these things and I dont know one member of the rabbinate who is good at being able to say, Well, I would like to help, but..."
(Focus group participant)
This desire to help can be thwarted by a perceived desire on the part of the congregation to have a place of refuge and sanctuary in a place of worship. This perception can stop clergy from approaching people who may be in need, despite their feelings of obligation and their desire to do so.
Another reality that can stop clergy from reaching out to the elderly is that many times, the clergy have no contact with the elderly church goers family. That is the family does not attend church. If the clergy wants to intervene with a family member, they are faced with the prospect of connecting with someone whom they dont know and who doesnt know them. The clergy struggle, in terms of pastoral care, about when it is appropriate for a church person to intervene in a context where the family tends not to see the church as a "player." One clergy participant says, "I think that weve been somewhat reluctant to play an advocacy role and the parishioners seem reluctant to say, I have a relationship with a minister here that may be helpful to you in the event that I have to move or I break my hip..."
The issue of privacy is another formidable barrier for clergy to overcome. This barrier can be present in the value system of either the elderly person or the caregiver, or both. One participant talked about the elders in his church being intensely private. There is an apartment building right next to his church where a lot of his older parishioners live. All the neighbours will say, "Well, somethings got to be done," and he says, "O.K. Are you prepared to be involved in intervention?" The response is "No." In that case, how does one decide when it is appropriate for the church to intervene?"
Another barrier to the clergy intervening is that sometimes both the abuser and the abused are part of the same congregation. The cleric has an obligation to both of them. If one parishioner is talking about another parishioner, who may or may not be a close blood relative, who is to be believed? Encouraging family members to uncover abuse on the part of another family member is also problematic because it turns family members against each other in the eyes of the church, even though abuse is involved.
Time constraints are a barrier to clergy intervention in elder abuse. One clergy person talks about how it "is a heck of a lot more important to try to figure out how were going to address abuse in the lives of our community than put 57 hours into bazaar planning, which is the reason that people like me feel were really over-worked its because of the bazaar." Yet when directly asked if clergy would be willing to go to a day-long conference and talk about some of these barriers and how to intervene in elder abuse issues, no-one said "Yes." One participant said, "I dont know, to go to a conference feels like youve really got to reorganize your life in a big way. However, to go to a half-day, something or other, is a lot more do-able. Or, clergy would come to something where it can hook into something ongoing and established, like this annual clergy appreciation day." This response speaks to not just time restraints, but how the issue of elder abuse is not an extremely high priority at this time, not high enough to "reorganize your life."
As materials development was one of the major objectives at the time of the focus group, the participants were asked about what they would like to see in the way of resources developed for them. There were some resources that the clergy indicated would be helpful, when asked to think about the possibilities.
An understanding of elder abuse was identified as being crucial prior to being able to respond to it. This understanding could come in the way of definitions of elder abuse and identification of the signs of elder abuse. A pamphlet and/or a video were both mentioned as ways to put this information out. Another helpful resource might be a "best practice" guideline that would be "helpful for clergy in sort of wrestling with the problems and figuring out a way to do that so youre not betraying anyone in terms of your role as this persons faith leader." A pamphlet for youth was also identified as being helpful to get the message of elder abuse out to the parents. Role-playing or some sort of theatrical presentation was also cited as being a possible resource option that has proved to be effective at raising awareness of abuse issues (e.g., St. Christopher House Players in Toronto).
Another identified resource was the research of religious references that could be used in discussing the issue of elder abuse. "Sermonettes" were mentioned as being a possibility, where someone does the work for the rabbi or the priest and writes something that he or she could deliver on the subject from the pulpit. Another area of research would be anecdotes that could be used in relation to elder abuse. These resources could be put together with other source material and make up a sort of resource kit that the clergy could draw upon to raise awareness of the issue. The difference in preaching methodologies in different Christian denominations, as well as in Jewish and other traditions, was raised as a possible barrier to the utilization of such a resource. One participant said "I think youre probably better, instead of thinking of it as one document, thinking of it with multiple quotations or multiple documents for different faith communities."
Without exception, clergy admitted that training in the issue of elder abuse was
extremely limited within formal seminaries, rabbinical schools, and theological programs. Dr. William Lord of the Toronto School of Theology said that the school offers a standard course in pastoral care. One module in this course is on gerontology. Within that module, a brief mention of elder abuse does occur. He couldnt see a change in this curriculum in the near future as the emphasis in the school is academic in nature, focussing more on religious contexts than pastoral care. The bulk of any learning in pastoral care comes when clergy meet a problem face to face. However, when they do meet the problem face to face, how will they know what to do? Dr. Lord suggested that on-going training take the form of being able to call on and consult with an outside contact. This contact would have expertise in elder abuse and would be sympathetic to the fact that the caller is a leader in a religious community. This contact could support any written documents that the clergy had at his or her disposal. He also mentioned that it would be very easy to distribute a pamphlet about elder abuse to a graduating class or to students starting their internship.
One of the clergy in the focus group mentioned that a natural dissemination vehicle and opportunity for training may come in the form of seminars in "zones" or ministerial groups where clergy get together to explore and educate one another. Another participant mentioned that post-seminary programs would be a more effective vehicle for training because the "theological programs feel like theyre always being asked to save the world and theyre just trying to make sure that they can train a few people and get them out there." The consensus amongst all of the people interviewed was that more training needed to happen, but that it would be a hard sell if clergy were not personally involved in the issue. If this is true, it explains why clergy may be somewhat hesitant to buy into an education and awareness program that would increase their exposure to the issue without increasing their training. The problem is one of, "What comes first, the chicken or the egg?" They cannot respond without training and they are hesitant to obtain training because of the above barriers, including lack of priority due to a lack of personal involvement in the issue.
Recommendations for Next Steps with Clergy
Access existing groups of clergy where education and awareness activities are taking place, such as "zone" meetings, ministerial groups, Diocesan committee meetings, and clergy appreciation days, in order to facilitate discussion and resolution with regard to the following areas:
the role of the clergy in responding to social concerns such as elder abuse;
how to create a religious culture where people feel comfortable talking about or disclosing elder abuse;
what it would take to put elder abuse on the map as a high priority for individual churches and synagogues, as well as umbrella networks such as Diocesan offices
ideas regarding resources that would be helpful to clergy;
put out a call to clergy, parishioners, researchers and seminary students to uncover anecdotes and religious references to be used in "sermonettes" that can be given by clergy in the pulpit;
access modules on gerontology in theological seminaries so as to determine what could be added to make the section on elder abuse more relevant to the students, i.e. talking about the problems regarding the role of clergy in responding to the issue and/or the "chicken and the egg" scenario.
Aging, Elder Abuse and Faith Communities
Research has been able to document the vital role that faith institutions play in the lives of older adherents. Sheehan (1989) states that faith institutions affirm the dignity of the individual, connect the individual to the group or community, and provide direct services. In examining the relationship between the rural elderly and the church, Rowles (1986) found that congregants had "embarrassingly high levels of faith" in their faith leader and that "the single most important and trusted institution outside of the family, in the lives of the rural elderly, is the Church." Other authors have reported that the faith leader is often the first to be called when a family is having difficulties, that twice as many elderly prefer to seek assistance from their faith leader as from a government agency, and that far more older people seek counselling from faith leaders than from psychologists, psychiatrists, or other professional counsellors (Gulledge, 1992).
At the same time, research pertaining to the relationship between faith leaders and older persons who have experienced abuse and mistreatment suggests that faith leaders may need assistance in improving their abilities to respond to elder abuse. Clergy have been found to be among the leaders in encountering cases of elder abuse and neglect (Crouse et al., 1981). However, a national American study that compared fourteen different occupational groups who work with seniors ranked clergy as among the least effective in addressing elder abuse issues (Blakely and Dolan, 1991). As well, clergy were found to be among the least likely to refer abuse and/or neglect cases to outside agencies (Blakely and Dolan, 1991).
This view seems to be supported by a study of 1,000 battered wives from across the United States, one-third of whom sought help from faith leaders (Bowker, 1988). The women sampled rated the effectiveness of the clergy as lower than most other formal supports. While Bowkers study did not specify ages, this finding may be seen as a general indicator of how effective faith leaders are when it comes to aiding victims of abuse, who choose to turn to their faith community for assistance.
Nason-Clark (1997) describes empirical studies in the U.S. that have examined the involvement of clergy in the lives of abused women and reports that between sixteen percent (Hornung, et al., 1981) and forty percent of women who have been battered sought advice from clergy (Bowker, 1988). Usually they were disappointed. In one sample of 350 battered women, twenty-eight percent sought help from local clergy. The primary responses these women reported having received from clergy were a reminder of their marital responsibilities and the advice to "forgive and forget"; a suggestion that they avoid church involvement; and "useless advice" based on religious doctrine rather than the womens own needs (Pagelow and Johnson, 1988). Gender is an interesting variable in this work because most parishioners are women and most faith leaders are males. The clergy may preach a male-oriented theology and hold certain attitudes about womens place, duty, and vows of commitment that will influence how they respond to reports of abuse (Horton and Williamson, 1988).
In the study by Nason-Clark (1997), ministers were asked to estimate the percentage of married couples first in Canada and secondly within their own congregations who have experienced violence as part of their relationship. Findings indicated that pastors consider that more than one in four married couples (28.8 percent) in Canada are violent, as compared to under one in five (18.8 percent) in their own congregations. In other words, they appear to underestimate violent behaviour within their own pastoral charge. Further research will determine whether these figures can be related to perceptions of elder abuse.
Faith Leaders Knowledge of Aging
The establishment of appropriate programs and services for the abused elderly and their abusers, within a faith institution, may depend on the faith leaders knowledge of aging. In 1989, Levy and West administered Palmores Facts on Aging quiz to faith leaders representing five Protestant denominations, as well as to Catholic and Jewish clergy. All demonstrated a high pro-aging bias. However, their general knowledge level of aging was found to be no better than that of a group of undergraduate Duke University students. Based on these findings, Levy and West (1989) proposed that faith leaders image of older people "lacks a realistic basis without which elders needs and programs cannot be adequately assessed."
Similarly, Gulledge (1992) used Kogans Attitudes Toward Aging scale to measure the attitudes of Baptist, Methodist, and Lutheran faith leaders. The faith leaders were again predisposed towards a general acceptance and approval of elderly people. An interesting finding to come out of this work was the significant difference in attitudes found between the denominations sampled. It is thought that this difference could be attributed to the length of pastorates which varied greatly between the denominations. Over three-fourths of the Lutherans studied had been in their office for three years or more, whereas fewer than half of the Methodists and Baptists had been in their positions for that same length of time. The quality of the Baptist and Methodist ministers contact with older people were reportedly less meaningful and their attitudes less positive than that of the Lutherans (Gulledge, 1992).
With respect to elder abuse and neglect, differences have also been documented by Tatara (1998) who found significant differences between racial/ethnic groups in their responses to statements describing situations concerning treatment and attitudes toward older people. These findings have implications for this project in that the development of generalized materials and strategies may not meet the needs of all groups. Pieper and Garrison (1992) used the Social Facts on Aging quiz to question 160 pastors about their knowledge of key aspects of social aging. Their results showed an average score of 55 out of 100, indicating that there are "some significant gaps in the knowledge base about aging among many pastors" and that "a high priority should be placed on assisting pastors in becoming more age literate."
While faith leaders seem to demonstrate a positive attitude regarding aging, pre-conceived notions of old age might prevent them from truly seeing the realities of the lives of their older followers. Shepard and Webber (1992) have noted that ageism is almost as prevalent in local church congregations as it is in the general population. Ageism has been identified as one cause of the abuse of older adults. Negative stereotypical attitudes affect how older people view themselves and can lead to their being more vulnerable to abuse. Ageism also perpetuates the creation of environments in which abuse is more acceptable. Filial morality and the cultural concept of the family may make it difficult for faith leaders to accept that older persons within their faith community are being abused. For instance Jane Boyajian (1991) stated, "In our own congregations, we expect love and charity and can believe that elder abuse may possibly happen elsewhere. So we cannot reach out to victims. Indeed, we do not even see them."
Training and Education of Faith Leaders
Self-education, participation in seminars, and the development of resources and strategies for the faith community as a whole are all ways to assist faith leaders to increase their knowledge of aging. Some training projects in the past that targeted faith leaders have resulted in improved knowledge about particular issues, such as care giving to the elderly, and have stimulated the development of programs aimed at helping with that issue (Sheehan, 1989).
Faith leaders are extremely busy people due to their dynamic role. As a result, some educators have reported faith leaders signalling their interest in training programs by sending church-affiliated designees rather than attending themselves (Sheehan, 1989). This can make faith leaders a difficult group to target for training, particularly if the goal is to increase the faith leaders knowledge about a particular topic such as aging or elder abuse and neglect.
Youngman (1989) reports that significant differences have been found between faith leaders and lay religious when it comes to increasing their knowledge about older persons within the context of a Planned Learning Experience (PLE). The PLE that Youngman examined was a one-day activity called "Workshops for Religious Leadership on Aging" that included such topics as "Becoming Aware of the Aging Process," "Realities of Aging," "Aging and the Religious Community," and "Program Building in Your Congregation." After the PLE was conducted, it was found that clergys knowledge had increased significantly, while that of the lay leaders did not. Youngman (1989) hypothesized that the difference may have been due to several factors, such as the clergys greater motivation to learn, the greater extent of the clergys prior formal education, and the clergys greater need to learn (Youngman, 1989). On the other hand, clergys positive and negative beliefs were not changed by the PLE, whereas lay leaders positive beliefs rose significantly. The nature of the PLE is thought to have been responsible for this difference. For example, the information was presented to groups as opposed to single persons. Youngman (1989) points out that group listening has been found to be more effective at changing beliefs than solitary listening if the majority of the group favours the position taken by the communicator. As well, one-sided presentations have been found to be more effective at changing the beliefs of less well-educated people, which in this case were the lay leaders (Youngman, 1989). Finally, characteristics of the presenter, such as being seen as credible and as a member of the group, were thought to play an important role in the findings.
Educational sessions such as PLEs may be more effective in changing faith leaders knowledge and beliefs if they are sponsored by specific denominations. For the project "Raising Awareness of Elder Abuse in Faith Communities," this observation supports the importance attached to the involvement and participation of faith leaders in all aspects of the study, particularly in the development of educational resources and strategies. A second point to consider is discussed by Pieper and Garrison (1992). That is, due to realities of pastoral life, educational initiatives targeting faith institutions are perhaps better structured when there is a minimal time investment involved, and when such initiatives occur as part of the regular ongoing professional activities of the faith leader.
In some instances, written materials arriving on the doorsteps of faith leaders could prove to be a practical and cost-effective way of getting the maximum amount of information to the maximum number of faith leaders. This strategy would also eliminate the dependence on their felt sense to become more knowledgeable about elder abuse, motivating them to seek out information on their own (Pieper and Garrison, 1992). These materials could take the form of elder abuse information columns in newsletters and journals regularly delivered to faith leaders, or separate monthly newsletters devoted exclusively to the issue of elder abuse.
Nichols (1995) highlights an additional component of successfully targeting faith leaders for training collaboration with community agencies. One of the three most important factors that leads to the development of more aging programs within a faith institution is their collaboration with community agencies (Sheehan et al, 1988). It was with this in mind that the "Churches in Rural Aging Networks: Education and Collaborative Efforts" (CRANCE) project was developed. CRANCE is a continuing education project involving West Virginia University Center on Aging , the West Virginia Council of Churches and the West Virginia Commission on Aging. The program was created in order to respond to rural area clergy who were being faced with an increasingly larger group of older parishioners, but reported inadequate training in ministry to the elderly. Congregations with high percentages of elderly tend to be in the inner city, central city, or rural areas (Nichols, 1995). The large-scale collaboration described by Nichols (1995) is perhaps beyond the scope of the Ontario project, however, the content of the workshops and educational materials merit further investigation. Workshops were held on such topics as "Social Issues of Aging," "Health/Physical Issues of Aging," "Myths about Aging." and "Church Ministries for Older Adults." Elder abuse education could be easily integrated into all of these topics. In the end, CRANCE was successful in motivating the development of even more collaborative projects between local faith institutions and community agencies.
Taking the Dialogue Forward
In reviewing the literature, other areas of discussion have emerged and are worthy of examination. These include the length of time since a faith leader has graduated from seminary, and the location of the faith institution. Researchers have documented conflict within faith institutions centred around an age gap between new faith leaders and the oldest members of the congregation, who are very aware of both its history and traditions (Underwood, 1991).
One of the participants in the study identified the age of her faith leader as a barrier to the disclosure of elder abuse: he was too young. This conflict often arises when the faith leader joins the faith community and begins to promote new programs, encouraging change before becoming a part of the long-established system. Reasoning for the new programs may only be based on the faith leaders perceptions and not the actual needs of the older congregants in the faith community. Underwood (1991) explains that the ensuing conflict can cause positions to become rigid, and this process may reinforce stereotypes. On the one hand, the faith leader may see older members as "uncreative, self-satisfied and uninteresting as people" (Underwood, 1991). On the other hand, older congregants may see the young faith leader as someone who cannot be trusted, especially when it comes to disclosing information such as elder abuse.
Rural faith institutions also merit special consideration. Rural faith communities tend to be comprised of high percentages of older persons (Nichols 1995). However, rural ministers are often recent seminary graduates and commonly leave the rural setting once a more urban location can be found (Rowles, 1986). As we have seen from the earlier research presented involving Baptist, Methodist, and Lutheran faith leaders, length of pastorate is thought to be related to the faith leaders attitudes toward aging, as well as the quality of contact with older congregants (Gulledge, 1992). In other words, rural faith leaders expectation of a short pastorate may prevent them from investing time in the development of meaningful relationships with older followers. Also, people in rural areas tend to be extremely reluctant to be identified as needing support (Rowles, 1986). This suggests that rural faith leaders may need to be even more aware of elder abuse indicators and risk factors than their urban counterparts if they are to respond effectively to the issue.
Battered Women and Elder Abuse
Although we have cited the lack of current scholarship regarding elder abuse and faith communities, we can borrow from other fields of inquiry, particularly family violence. Clarke (1986), writing in Pastoral Care of Battered Women, offers very specific advice to pastors on the need to listen to battered women and to provide help in the form of resources and referral. She speaks of the need for shelters and support groups. Pastors are urged to exert their influence on followers by speaking about the problem of abuse, in addition to staying in contact with the battered women and helping to find or maintain a connection for them somewhere in the church.
Are these initiatives being used, or advocated for, in working with abused older adults? In the article The Role of the Church in Aging: Implications for Policy and Action, Hendrickson (1986) argues that there must be a systematic exploration of the major issues and problems facing the elderly today and in the near future. Leaders of the faith community must be active participants in shaping national policy related to aging. Elder abuse is a health issue and should fall under health policy.
In Counseling for Family Violence and Abuse (1987), Martin includes a chapter on elder abuse in which he identifies teaching of nonviolent coping behaviours early in life as a fundamental prevention strategy. This supports the activities of the "Raising Awareness of Elder Abuse in Faith Communities" project that seeks to include youth in elder abuse awareness through the development of nonviolent conflict-resolution alternatives.
As those of us in the field of elder abuse look to the researchers in spouse/partner abuse we find much to adapt from the work of Nason-Clark. Her book, The Battered Wife: How Christians Confront Family Violence (1997), invites many comparisons with elder abuse. She refers to the religious victims of abuse who have little help other than their faith perspective to make sense of the mistreatment they are enduring. This was also a finding in a study conducted by OWN in Toronto.
Sadly, the response of faith leaders to the disclosure of elder abuse has been ineffective, at best. Nason-Clark discusses the need for faith leaders to be more aware of secular resources such as the police, shelters/transition houses, social services, and health services. She also refers to the lack of training of religious leaders a situation that was clearly revealed in the OWN study on elder abuse cited above.
This paper concludes with a brief message on the power of parish nurses to link the vision of the church as a historic facilitator of healing with modern health promotion goals (Shank, Weis, and Mathews, 1996). Parish nurses provide holistic nursing services to members of church congregations.
Parish nursing is not just about putting a nurse in a church. The nurse is part of a broad concept of Health Ministry, which is about restoring the healing aspects of Christian heritage. Many of the gospel stories are about healing. Throughout the ages, Christian orders have provided sanctuaries for the sick and the poor. The concept of shalom wholeness, or whole health, including the help of nurses, may be a useful concept for all faith traditions. Health ministry has four main parts: the faith/health connection, the church as a healing community, the health cabinet, and the parish nurse. The nurse is part of the team.
People must be able to be open about their neediness, brokenness, and failure, and in doing so, to find acceptance and reconciliation. Intercessory prayer, ritual, and laying-on-of-hands all promote health and healing. Sermons, support groups, and workshops can empower people to take responsibility for their relationships and their health. The church can be an inspiration for volunteering and social action for the health of the congregation, as indeed for the wider community. It can be especially helpful to seniors at a time of depleted community services. This is especially true in rural communities and in ethnic groups where cultural and language barriers affect seniors.
The focus of a parish nurse is to promote health and wellness in the body, mind, and spirit of those they serve (Ebersole, 2000). The potential for parish nurses to work with the clergy and intervene in cases of elder abuse is enormous. They are welcomed into the homes of their clients, they are able to observe signs and symptoms of neglect and, most importantly, they are trusted by both older persons and their families. There is a growing body of literature on parish nurses which now needs to examine the role of the parish nurse in working with other members of the faith community to prevent elder abuse and neglect.
Older people who suffer abuse and neglect are often reluctant to seek help. However, a trusting relationship between faithful older persons and their faith leaders may make disclosure of mistreatment more bearable. "Whereas an older person can lie to another outsider for the greater good of protecting a loved one, a lifetime of cherished values prevents that person from fabrication to the clergy" (Pagelow, 1988). It is thought that faith leaders may in fact encounter cases of elder abuse more often than other service providers. Older persons are likely to share their experiences of abuse with someone they deem trustworthy and feel safe with namely, a faith leader. And rightly so. Abuse damages the body, mind, and spirit. Perhaps more than any other single resource, faith leaders are in the special position of being able to offer spiritual and emotional help and guidance to victims. Seniors should be able to view their faith community as a safe haven and place for spiritual renewal. At no other point in time is the service of the church, temple, or synagogue potentially more valuable or restorative than when a crime has been perpetuated against an elderly person. The power of a higher spirit, and the religious tradition of unconditional love and care are unique aspects of victim assistance that only the faith community can provide.
Canadian population demographics will result in a rapid rise in both the number of older persons who belong to a faith community and cases of elder abuse. It has been reported that faith institutions may not be prepared to meet the needs of senior congregants, particularly their oldest members who, due to advancing age, are at higher risk of being abused. Research indicates that education with appropriate materials and participation in educational sessions may help faith leaders better respond to this growing population. The most effective means of identifying and combatting elder abuse may well be a thorough understanding of the actual aging process. To this end, schools of theology and/or seminaries must seriously consider incorporating gerontology courses as part of their core curriculum for future faith leaders.
Faith leaders and community agencies must partner together to ensure that spiritually sensitive social services are available to abused older adults. The study discussed in this paper is a step in that direction. The information collected and disseminated through the project will inform and enlighten faith leaders, their communities, researchers and policy makers of the role that faith institutions are, and should be, playing with respect to elder abuse. Most importantly, however, the valuable findings of the project will go a long way to helping older, abused churchgoers by working with faith leaders in improving and extending their abilities to respond to the abuse and neglect of older persons.
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