The Commission recognizes that persons may experience disadvantage in unique ways based on the intersection of age with other aspects of their identity. During the consultations, the Commission heard about certain groups of older persons who face particular barriers arising from the intersection of age with gender, disability, sexual orientation, race, ethnicity, religion, culture and language.
“Women particularly suffer because of past customs, practices and traditions.” (Canadian Pensioners Concerned)
Age & Gender
While older men do experience particular concerns, many submissions emphasized the unique and often compounded disadvantage experienced by older women.
One of the most pressing concerns for older women relates to their socio-economic
status. Owing to a number of factors including longer life expectancy, labour force participation patterns, wage inequality, social programs and systems designed primarily from a male-centred or gender-neutral perspective, older women are more likely to experience poverty. [5]
In addition, as noted by one organization “most elderly persons are women and the prevalence of women in the population increases with age. Among people over 65, 58 percent are women, while among those over 85, 75 percent are women” (Ontario Association of Social Workers). Therefore, women are disproportionately represented in the group of older persons who tend to be most vulnerable and in need of services and supports.
“There are particular problems for elderly women. In Ottawa-Carleton there are some 33,000 seniors aged 75 and older, according to the 1996 census, nearly two-thirds of which [sic] are women. Of these women, half had annual incomes of $16,000 or less, and half live alone. This, in our view, creates a vulnerable population to the problems of abuse and discrimination, and requires a more proactive response by government.” (Council on Aging – Ottawa-Carleton)
As a result of these factors, the issues that have been raised as a concern for older persons throughout the Report may be more acute for older women. The following areas tend to be of particular concern.
Health care, Home care and Institutions: Health care has been noted as one of the most pressing needs of older women. Older women are less likely than their male counterparts to rate their health as good, very good or excellent and more likely to rate their health status as fair or poor. Older women also average the longest hospital stays and with increasing age, more females than males need help with daily activities.[6] These and other statistics suggest that the concerns related to health care and home care identified in this Report may disproportionately affect women.
The majority of older persons live at home. However, among those who do live in institutions such as nursing homes, retirement homes and long-term care facilities, a larger number are older women. In 1996, 38% of all women age 85 and older lived in an institution compared to 24% of all men age 85 or more.[7] This means that issues concerning regulation of such facilities are of particular concern to older women.
“There is a growing risk of homelessness amongst older women”
(Older Women’s Network)
Housing and Community: The Commission was told that older women suffer due to a lack of affordable, suitable housing. Concerns were expressed with respect to the lack of rent control in the rental housing market, the physical inaccessibility of housing for older persons, the inadequacy of social housing and the need for options that allow for “aging in place”. Given that women have longer life expectancies, and are more likely to be widowed, many of the identified issues affect older women in a disproportionate manner.
Transportation: In order to access the services and supports they need and to participate in community life, affordable accessible public transportation is an important issue for older women.
Caregiving: Women make up the vast majority of paid and unpaid caregivers. The Commission was told that wives, sisters, daughters and daughters-in-law are providing most of the unpaid eldercare in the province. The devaluing and lack of societal support for the role of caregiver has a disproportionate impact on women of all ages.
Elder abuse: Freedom from abusive behaviour, including physical abuse, sexual abuse, emotional abuse, neglect or financial abuse, by family or professionals has also been identified as a significant concern. Both men and women are at risk for elder abuse and neglect. Because older women make up a higher proportion of the frail elderly, they are more likely to experience certain kinds of abuse. Older women are also more likely to experience abuse by their spouse than are older men. Women 65 years of age or more are more frequently the victims of violence at the hands of family members than are men.[8] Accordingly, issues regarding elder abuse are a concern for both male and female victims, although the particular vulnerability of women in the context of elder abuse must be recognised.
Employment: In the context of employment and pension benefits, many of the current systems were designed on the basis of a workforce that was primarily male and on the assumption that women were supported by male wage earners. As a result, women face unique and compounded disadvantage in the context of employment related-discrimination. In turn, mandatory retirement has a particularly harsh impact upon women. The section on Employment provides a thorough discussion of these issues.
Older Men
Many of the issues raised in this Report also concern men, and older men face their own unique issues.
Consultees said that the gendered division of labour experienced by many older persons means that older men may not be able to cope with their own personal needs upon the death of a partner or a family member who was responsible for household tasks such as cooking, laundry etc. In addition, the Commission heard that single older men who have lost their family caregiver seem to have difficulty in accessing community services. As the Commission heard:
“Single older men, who have lived most of their lives with a partner and are now living on their own are also a group needing specific support as most have never cooked, shopped, done laundry or managed other household chores.” (Dieticians of Canada)
“A gentleman who was receiving a lot of care at home by his wife...his wife had a fall in her home. She fell and ended up in a coma going to the hospital. He could not make his own meals, had an addiction problem and was basically isolated and alone in his home...He had no avenue to access services.” (Senior Link)
As well, high suicide rates exist among older men, particularly over the age of 85.[9]
Given what the Commission heard regarding the intersection of age and gender, the Commission recommends the following:
Recommendations for Government & Community Action
6. THAT government, the public and private sectors consider the ‘intersectional effect’ of age and gender in policies and programs, especially with respect to the compounded disadvantage experienced by older women.
Age & Disability
Many older persons are active, healthy and physically fit. Perceptions that older persons are weak and frail do not reflect the fact that the majority of persons over 65 consider themselves in good health.[10] Moreover, many older persons, who do have a chronic health condition or a disability, continue to lead fulfilling lives.
Nevertheless, it is important to acknowledge that with increasing age, the prevalence of disabilities and chronic conditions also increases. Recognition of this fact is necessary to ensure that appropriate supports and services will be put in place to meet the needs of an aging population. As discussed elsewhere in this Report, it also underscores the need for appropriate training in geriatrics, psycho-geriatrics and geriatric nursing for health care professionals and other service providers.
For persons with disabilities, aging can result in a disproportionate impact or unique experiences of discrimination. Moreover, multiple disabilities can create a ‘domino effect’.
For persons with disabilities, aging aggravates chronic patterns of poverty and social discrimination. When disabilities develop later in life, individuals can experience sudden and devastating changes in lifestyle and living standards. Aging can result in a disproportionate impact or unique experiences of discrimination. Moreover, multiple disabilities can create additional barriers and limitations on the ability to fully-participate in society. The Commission learned that where older adults are already experiencing isolation, for example, because they live in rural or northern areas, having a disability can compound the effect of the isolation. The following is a brief summary of some of the most important issues that relate to aging and disability.
Health care, Home care and Institutions: As discussed in the section on Health Care, Institutions and Services, there is a need to ensure that health care and home care services respond to disabilities associated with aging. Funding community-based care and long-term care at sufficient levels is one way to address this need. Health care providers also require appropriate training in disabilities associated with aging such as hearing loss and cognitive disabilities. Health care facilities and institutions should be designed to maximize safety, integration and comfort. They should be physically accessible (i.e. ramps, TTYs etc.) and services must be provided in a manner that accommodates disability related needs (i.e. sign-language interpretation).
Up-front barrier-free design promotes “aging in place” and is more cost effective than retrofitting inaccessible dwellings when a disability develops.
Housing: Housing should address disability-related needs associated with aging. Consultees told the Commission that housing design should address current needs and be flexible enough to accommodate future disabilities. This type of up-front, barrier-free design promotes “aging in place” and is more cost effective than retrofitting inaccessible dwellings when disability develops. Suggestions for design features that would respond appropriately to the needs of older persons with disabilities are discussed in section on Housing.
The Commission also learned that more specialized housing for Deaf, deafened and hard of hearing older persons and for others with particular disabilities is needed. As well, government involvement in the development of social housing for older persons with disabilities is required. Consultees told the Commission that Ontario requires housing that provides a continuum of care with the capacity to support the disability-related needs of older persons throughout the aging process. Finally, the Commission heard that the concept of “aging in place” is a critical housing principle for older persons with disabilities.
Transportation: Public transportation is critical for the independence and participation of older persons. In February 2000, the Commission released its Discussion Paper on Accessible Transit Services in Ontario.[11] The paper emphasizes that conventional transit systems must ensure maximum accessibility and that parallel para-transit services should be available for those who cannot access even the most integrated conventional system. During the consultation, consultees echoed the same concerns. Concerns were raised about narrow criteria for determining eligibility for para-transit services. Consultees offered suggestions for ways in which the accessibility of transit systems can be improved. A more detailed discussion of transportation issues appears in the section on Health Care, Institutions and Services.
“In the last number of years, there have been many governments and companies who have been down-sizing, and many deaf employees who are 45 years of age and older have been laid off their jobs. They may have been and often have been working in the same job for 10 or 20 years right after high school, and suddenly they are laid off. They haven't had an opportunity to upgrade their skills. They aren't prepared for today's job market.”
(Canadian Hearing Society – Ottawa)
Employment: A 1998 survey of approximately one thousand Deaf Canadians illustrates in statistical terms the particular disadvantages faced by older persons with disabilities in the employment context. The Employment and Employability of Deaf Canadians study reported that for the 52-64 age group, only 30% are employed while 27% are underemployed[12] and 43% are unemployed. Between ages 52-64, Deaf individuals experience an enormous 17% shift from employment to unemployment, a rate much higher than the national average of all Canadians.[13] This has been attributed to an obsolescence of skills rather than voluntary early retirement.[14]
In the context of employment, the Commission was told that older workers with disabilities may be more likely to lose their jobs in a workplace reorganization as a result of having had fewer opportunities to upgrade their skills or because of a perception that their disability makes them harder to place in a different job.
In addition, both age and disability are barriers for individuals when trying to get a job. Therefore, in the context of a labour market that favours youth, an older person with a disability may face additional hurdles to finding employment. As one group explained, prejudice based on age and disability amounts to “double-edged sword” for older persons (Canadian Hearing Society – London).
Additional Concern: The Building Code Act: The Commission was very concerned to learn that the standards for barrier-free design that are already contained in the Building Code Act, 1992[15] are often not met by builders or enforced by inspectors. For example, the Commission was told that the requirement in section 3.8.3.7 of O. Reg. 403/97 under the Building Code Act, 1992 that classrooms, auditoria, meeting rooms and theatres “shall be equipped with assistive listening systems” is rarely adhered to. The Building Code Act, 1992 itself could be improved by addressing additional elements of barrier-free design.
The Commission recently released its new Policy and Guidelines on Disability and the Duty to Accommodate.[16] The Policy sends a clear message that employers, landlords, service providers, and those who deliver programs are expected to take proactive measures to ensure that persons with disabilities can be equal participants in society. It emphasizes that the duty to accommodate is not optional and meeting the needs of persons with disabilities is a legal obligation up to the point of undue hardship. The Commission has confirmed that the undue hardship standard is a high one. As the Discussion Paper noted, these principles apply equally to older persons with disabilities.
Recommendations for Government & Community Action
7. THAT the provincial government enact legislation that will set minimum standards for accessibility for persons with disabilities, including older persons..
8.THAT government, the public and private sectors consider the ‘intersectional effect’ of age and disability in policies and programs, especially with respect to the compounded disadvantage experienced by older persons with disabilities.
“Older Gay and bisexual men and lesbians experience ageism within traditional gay spaces and homophobia within traditional ‘senior’ spaces.”
(AIDS Committee of Toronto)
Age & Sexual Orientation
The Commission heard about the exclusion of older gay men, lesbians and bisexual persons in the context of the gay community and broader society. As well, a number of concerns were identified regarding homophobia and discrimination in the context of employment and community-based care and long-term care facilities. The concerns regarding the intersection of homophobia and ageism that were emphasized, illustrated that in any future work in the area of elder abuse, an intersectional analysis that also takes into account sexual orientation will be critical.
“We have lesbian great-grandmothers, gay uncles, and bi-sexual cousins! Principally what has changed is the number of people prepared to come out and be publicly identified.”
(The Coalition of Lesbian and Gay Rights in Ontario)
The Commission heard that there is great emphasis placed on youth within the gay community, which can result in the marginalization of older gay men. The Commission was told that “most spaces and organizations are geared toward younger people” (AIDS Committee of Toronto (ACT)). There is a stereotype that gay, lesbian and bisexual persons are all young in age and it is often assumed that there were few or no gay men, lesbians and bisexuals in previous generations. This can translate into a failure to recognize the existence of older gay men, lesbian and bisexual persons and their partners and has serious implications for their experience in social areas such as services, health care and institutions. The Coalition of Lesbian and Gay Rights in Ontario (CLGRO) noted that “there are older lesbians, gays and bisexuals moving through the system now – in residential homes, using the healthcare system and social services available...many of them will not come out and the willful [sic] ignoring of their needs [and] the homophobia they witness can convince them that they were right not to.” Clearly these issues adversely impact an older person’s rights to dignity, full-participation in society, fairness and security.
Employment: One group noted that older gay men, lesbians and bisexual persons face the same barriers faced by other older workers, yet this burden is compounded by homophobia. The Commission was told, “older lesbians, gays and bisexuals are particularly prone to pressure to take early retirement schemes where employers do not want them in the workforce” (CLGRO). Homophobia in the workplace can make the option to leave, even if not favourable, attractive. Lesbian and bisexual women face the same economic disadvantage as heterosexual women given that women in general continue to earn less than men in the workforce. Where homophobic work environments create barriers to advancement, however the disadvantage experienced by lesbian and bisexual older women is intensified.
Elder Care: The increasing reliance upon family and friends to provide care for aging relatives may not be possible for some older gay men, lesbians and bisexual persons. ACT told the Commission that, “many older gays and lesbians do not enjoy the familial support that many heterosexual seniors can turn to in later life. They may have no family at all to turn to for emotional, financial or practical assistance and support.” Additionally, due to the impact of AIDS in the gay community, many older gay men have lost entire circles of friends, so the relationships they had developed to facilitate their older years are also gone. Our system of health and social services is based on traditional assumptions about family and social relationships that in fact may pose barriers for gay, lesbian and bisexual older persons.
Health Care, Institutions and Services: Homophobia in the health care system was identified as a prominent concern. The Commission was told by CLGRO that studies of systemic barriers to provincial health and social service systems have identified pervasive homophobia on all levels, resulting in situations from mild neglect to faulty medical treatment. ACT told the Commission that the homophobia that is directed at gay, lesbian and bisexual persons by the staff of care facilities, “is a frightening and realistic one for many older gays and lesbians...they fear homophobic violence, both physical and verbal/emotional.” In addition, health care professionals need to be more knowledgeable and sensitive to lesbian, gay and bisexual issues. In the area of community-based care, where volunteers may be relied on to provide care, education and regulation is particularly challenging yet needed.
“Older gay men are very concerned about where they will go when they can no longer be self-sufficient. They fear seniors’ residences and homes where their sexual identity and history will not be present, respected or validated. Older gay couples fear being split up at the end of their lives because there really is no space they can go that will respect them as a couple.”
(ACT)
In the context of residential homes for older persons, the Commission heard that gay, lesbian and bisexual partners are not always recognized. As one group stated, “we still have a struggle to get doctors, caregivers and other professionals to accept our partners as our spouses...something as simple as placing a photo of a spouse on the bedside table can bring about repercussions” (CLGRO). Older gay couples fear being split up at the end of their lives because of this prejudice. In addition, gay, lesbian and bisexual persons fear that their sexual identity and history will not be respected or validated in residential facilities.
Recommendations for Government & Community Action
9. THAT government, the public and private sectors consider the ‘intersectional effect’ of age and sexual orientation in policies and programs, especially with respect to the compounded disadvantage experienced by older gay, lesbian and bisexual persons.
10. THAT health care and social service providers receive training to enable them to appropriately address the needs of older gay, lesbian, bisexual and transgendered persons.
11. THAT residential facilities ensure that gay, lesbian, bisexual and transgendered residents are protected from homophobia, and afforded the same rights and recognition of their relationships as other residents.
Age & Citizenship Status, Religion, Language, Ethnicity, and Race
The intersection of age and citizenship status, religion, language and ethnicity has implications for health care, services and institutions:
Health Care, Institutions and Services: The Commission heard that there is little recognition of the diversity within the population of older persons in Ontario. The Commission was told that a person’s immigration status in Canada can limit access to health care services. Participants noted that the provision of health care information in only French and English means that those who speak other languages may not receive critical information. Others noted that there is a shortage of French language services thereby further limiting access. In 1999, the largest percentage of immigrants to Ontario, age 65 and older, were not conversant either in English nor French:[17]
Additionally, 1996 Census Canada statistics note that of older Aboriginal persons in Ontario, 57.7% were conversant in English, 7.4% in French and 34.8% were conversant in non-official/aboriginal languages.[18] Together, these statistics illustrate the need for health care and other service providers to ensure that their services can be accessed by the variety of linguistic groups represented in this growing population older persons in Ontario.
Concerns were also expressed about the manner in which service providers currently address the needs of various groups of seniors within long-term care facilities. The provision of food, social and recreational activities in such institutions may not respond to the particular cultural and religious needs of some older persons. Service providers in all sectors must respect the identity and dignity of all persons and be sensitive to the diverse cultural and religious needs of older persons. This is equally important on the basis of race and ethnicity.
The Commission heard that there is a need for further consultation with older persons to discover the barriers faced on the basis of the intersection between age and ethnicity, citizenship, religion, race, and language.
Recommendations for Government & Community Action
12. THAT health care and other service providers should seek to find ways to deliver services to a range of ethnic, cultural, racial, linguistic and religious groups.
[5] Statistics Canada, Percentage of Seniors with Low Income, Ontario, 1996/97 from Third Age Ontario Intranet, online: <www.mczcr.gov.on.ca/thirdage/>.
[6] Ibid. and Health Canada, Division of Aging and Seniors, Statistical Snapshot No. 47: Hospitalization of Seniors supra, note 3.
[7] Health Canada, Division of Aging and Seniors, Statistical Snapshot No. 12: Institutional Living, supra, note 3.
[8] Statistics Canada, Family Violence in Canada: A Statistical Profile (Ottawa: Minster of Industry, June 1999) at 23-4.
[9] From Third Age Ontario Intranet Web site, supra note 5.
[10] Statistics Canada, Self-Rated Health of People 65+ and 75+, by Gender, Ontario from Third Age Ontario Intranet Web site, supra note 5.
[11] Ontario Human Rights Commission, Discussion Paper on Accessible Transit Services in Ontario (February 2001) available online at www.ohrc.on.ca.
[12] The term “underemployed” is used to describe people who may not be satisfied with their current job, may have experienced job insecurity, or may face a lack of accessibility; from Root & Kerr, infra note 13 at 15.
[13] From C. Kenopic, Keeping Hands in Motion (Canadian Association of the Deaf, 2000) citing J. Root & D. Kerr, The Employment and Employability of Deaf Canadians (Canadian Association of the Deaf, 1998) at 6.
[14] Root & Kerr, ibid. at 36.
[15] Ontario Building Code Act, S.O. 1992, c. 23.
[16] Ontario Human Rights Commission, Policy and Guidelines on Disability and the Duty to Accommodate (March 2001) available online at www.ohrc.on.ca.
[17] Citizenship and Immigration Canada, Senior Immigrants (65+) Landing in Ontario in 1999, by Official Language Ability, found in Aging Quiz, Third Age Ontario Intranet Web site, supra note 5.
[18] Statistics Canada, Mother Tongue of Aboriginal Seniors, Ontario, 1996, online: Third Age Ontario Intranet Web site, supra note 5.