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Papers by Charmaine Spencer
PLOS ONE, 2015
Elder abuse, a universal human rights problem, is associated with many negative consequences. In ... more Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review.
Reuniting immigrant families has been considered an important goal in Canadian policy (Citizen an... more Reuniting immigrant families has been considered an important goal in Canadian policy (Citizen and Immigration Canada (CIC), 2006). When an elderly relative is sponsored under the Family Class immigration category, the sponsor makes an unconditional undertaking of support for a period of ten years to the Minister of Citizenship and Immigration. This is a longer period than for any other Family Class group. In addition to their legal status as dependents, sponsored seniors-the majority from India and China-are left financially and socially vulnerable by a constellation of cultural, situational and structural factors. Based on case studies of the South Asian and Chinese immigrant populations by authors, Koehn and Hwang, and the legal expertise of author Spencer, we conclude that Canada's laws and policies have an important effect on intergenerational tension, the senior's status, social isolation, as well as the risk of abuse and neglect or domestic and workplace exploitation. These factors can influence access to essential services such as housing and health care services. While further evidence is needed, findings from preliminary studies indicate the need for policy-level revisions as well as other approaches to reducing the vulnerability of this significant subpopulation of ethnic minority seniors.
Abstract : Abuse and neglect of older adults (� elder abuse �) has a significant impact on the l... more Abstract : Abuse and neglect of older adults (� elder abuse �) has a significant impact on the lives of the individuals involved. At the same time, it has a broader social and economic cost. Many of these are � hidden costs � in the sense that the cause of the underlying problem is not identified. Abuse and neglect of older adults affects resource allocation in health, community, and justice services, as well as private industry (banking, housing, insurance) and government reveues and transfers. In addition, abuse in later life can lead to substantial intangible costs for the individuals, families and communities. There are a number of significant barriers to fully exploring the costs of abuse in later life, including the lack of basic statistical data on prevalence/ incidence; significant gaps in government and community data; conceptual differences between other forms of domestic violence and elder abuse; and built in age sensitivities in traditional economic analysis.
International Journal of Law and Psychiatry, 2001
papers.ssrn.com
Abstract: A private care agreement involves an older adult's transfer of property, usually r... more Abstract: A private care agreement involves an older adult's transfer of property, usually residential property, to a friend or family member in exchange for a promise of care and support in the home. The arrangement is usually made orally and without legal advice, ...
Canadian Journal on Aging / La Revue canadienne du vieillissement, 2010
Canadian Journal on Aging-revue Canadienne Du Vieillissement, 2010
ABSTRACT The term “living will” (or advance directives, as they are known in Canada) has been use... more ABSTRACT The term “living will” (or advance directives, as they are known in Canada) has been used by the public to refer to a variety of legal documents that take effect when a person becomes mentally incapable of making her or his own health and personal care decisions. A person can provide her or his wishes in instructions or choose an appointee (proxy) to make the decisions. Living Will, Living Well draws upon Godkin’s interviews, with older people who have drawn up an advance directive, to help both the general public and service providers better understand these important legal documents. In this book, the author reviews the literature, summarizes her own qualitative research, and highlights key issues around advance directives. The reader follows the experiences of “Alice”, a fictional older woman, as she considers and then plans her own advance directive. Alice is an amalgam of 15 research subjects. Using italicized typeface as a stylistic technique to highlight Alice’s personal observations, the author artfully incorporates Alice’s thought processes into conversations with her peers and family over an eight-month period to highlight common fears, concerns, and issues related to dying and the use of living wills, making this a very thoughtful approach. Readers can follow that story separately, and it is an interesting way to first read the book. In Living Will, Living Well, the author has undertaken a challenging task: to describe the complex topic of “living wills” in a generalized way. Each Canadian jurisdiction, for instance, uses different language for these documents and has different laws in this area (e.g., advance directives are called personal directives in Alberta, where the original research was undertaken). The author skillfully highlights the strengths of advance directives and helps the audience to see the development of preparing the directive as a personal journey, not merely reaching a destination (i.e., having a signed document). Perhaps the book’s greatest strength is that it promotes the directives as a means of promoting communication within families about future decisions that they may need to make on behalf of a mother, father, or other relative if that person becomes mentally incapable. It is also very encouraging to see that this book clarifies a number of common misconceptions. Potential drawbacks of the book fall into three categories: interpretations, generalizations, and omissions. Some of the illustrations used in the book might leave the reader with erroneous impressions. For example, a person who has had a stroke may have lost the ability to communicate, but that is not the same as loss of his or her mental capacity. Elsewhere in the book, colloquial language such as “tell doctors to pull the plug” (p. 34) is medically inaccurate. Given that the book is intended to promote the use of advance directives, it is not surprising that it tends to overlook or downplay some issues such as health care providers’ lack of understanding (Mirarchi, Kalantzis, Hunter, McCracken, & Kisiel, 2009) and misuse (Meadus, Wahl, & Rosenbaum, 2007) of advance directives. There has also been a less than altruistic push at a policy level in several Canadian and American jurisdictions to encourage the use of advance directives among older adults as a means to reduce health care costs (Alberta Heritage Foundation for Medical Research, 2005). In a health care system that is sometimes ageist, advance directives may be advocated to “correct” for “expensive and futile care” that older adults are incorrectly perceived as receiving (Spencer, 2009). Several important matters are not addressed which a reader might expect to be covered in a book of this nature. For example, there is no mention of the fact that people can regain mental capacity in some situations (thus mental incapacity is not always a permanent status), and there is no mention of various areas or degrees of capacity. The duties of the health care proxy are not discussed, and there is little if any mention of the continued importance of involving the person who made a directive in care discussions even after she or he is deemed “incapable”. Writing is an art of persuasion. Consequently, one might also ask whether the particular images of death that the author has chosen are fair (such...
Dans cet article nous proposons une analyse normative des évaluations économiques, en faisant un ... more Dans cet article nous proposons une analyse normative des évaluations économiques, en faisant un examen critique des valeurs sociales canadiennes dans le domaine de la santé et en les mettant en contraste avec les valeurs inhérentes, les présomptions méthodologiques et les conséquences politiques pratiques des modèles conventionnels de l'évaluation du coût de la maladie. Cette analyse nous permet de révéler des préjugés et les limitations qui en résultent dans les méthodes actuelles d'évaluation, et de proposer un cadre élargi pour une estimation des coûts qui prenne en compte le sexe et la diversité. Ce cadre proposé se fonde sur les changements fondamentaux qui sont apparus dans le discours concernant les valeurs, émanant des sciences économiques, des politiques sociales, de l'éthique et des théories féministes. Nous démontrons en particulier les implications de ces convergences pluridisciplinaires dans l'étude du coût de la maladie. L'analyse et le cadre proposé fournissent des arguments pour expliquer pourquoi et comment les méthodologies traditionnelles d'évaluation des coûts doivent être modifiées afin de réaliser leur plein potentiel pour que les décisions en matière de politiques de santé soient prises en connaissance de cause. Cet article reflète le travail d'un groupe pluridisciplinaire de chercheurs spécialisés en sciences économiques, sciences politiques, sociologie et sciences infirmières.
PLOS ONE, 2015
Elder abuse, a universal human rights problem, is associated with many negative consequences. In ... more Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review.
Reuniting immigrant families has been considered an important goal in Canadian policy (Citizen an... more Reuniting immigrant families has been considered an important goal in Canadian policy (Citizen and Immigration Canada (CIC), 2006). When an elderly relative is sponsored under the Family Class immigration category, the sponsor makes an unconditional undertaking of support for a period of ten years to the Minister of Citizenship and Immigration. This is a longer period than for any other Family Class group. In addition to their legal status as dependents, sponsored seniors-the majority from India and China-are left financially and socially vulnerable by a constellation of cultural, situational and structural factors. Based on case studies of the South Asian and Chinese immigrant populations by authors, Koehn and Hwang, and the legal expertise of author Spencer, we conclude that Canada's laws and policies have an important effect on intergenerational tension, the senior's status, social isolation, as well as the risk of abuse and neglect or domestic and workplace exploitation. These factors can influence access to essential services such as housing and health care services. While further evidence is needed, findings from preliminary studies indicate the need for policy-level revisions as well as other approaches to reducing the vulnerability of this significant subpopulation of ethnic minority seniors.
Abstract : Abuse and neglect of older adults (� elder abuse �) has a significant impact on the l... more Abstract : Abuse and neglect of older adults (� elder abuse �) has a significant impact on the lives of the individuals involved. At the same time, it has a broader social and economic cost. Many of these are � hidden costs � in the sense that the cause of the underlying problem is not identified. Abuse and neglect of older adults affects resource allocation in health, community, and justice services, as well as private industry (banking, housing, insurance) and government reveues and transfers. In addition, abuse in later life can lead to substantial intangible costs for the individuals, families and communities. There are a number of significant barriers to fully exploring the costs of abuse in later life, including the lack of basic statistical data on prevalence/ incidence; significant gaps in government and community data; conceptual differences between other forms of domestic violence and elder abuse; and built in age sensitivities in traditional economic analysis.
International Journal of Law and Psychiatry, 2001
papers.ssrn.com
Abstract: A private care agreement involves an older adult's transfer of property, usually r... more Abstract: A private care agreement involves an older adult's transfer of property, usually residential property, to a friend or family member in exchange for a promise of care and support in the home. The arrangement is usually made orally and without legal advice, ...
Canadian Journal on Aging / La Revue canadienne du vieillissement, 2010
Canadian Journal on Aging-revue Canadienne Du Vieillissement, 2010
ABSTRACT The term “living will” (or advance directives, as they are known in Canada) has been use... more ABSTRACT The term “living will” (or advance directives, as they are known in Canada) has been used by the public to refer to a variety of legal documents that take effect when a person becomes mentally incapable of making her or his own health and personal care decisions. A person can provide her or his wishes in instructions or choose an appointee (proxy) to make the decisions. Living Will, Living Well draws upon Godkin’s interviews, with older people who have drawn up an advance directive, to help both the general public and service providers better understand these important legal documents. In this book, the author reviews the literature, summarizes her own qualitative research, and highlights key issues around advance directives. The reader follows the experiences of “Alice”, a fictional older woman, as she considers and then plans her own advance directive. Alice is an amalgam of 15 research subjects. Using italicized typeface as a stylistic technique to highlight Alice’s personal observations, the author artfully incorporates Alice’s thought processes into conversations with her peers and family over an eight-month period to highlight common fears, concerns, and issues related to dying and the use of living wills, making this a very thoughtful approach. Readers can follow that story separately, and it is an interesting way to first read the book. In Living Will, Living Well, the author has undertaken a challenging task: to describe the complex topic of “living wills” in a generalized way. Each Canadian jurisdiction, for instance, uses different language for these documents and has different laws in this area (e.g., advance directives are called personal directives in Alberta, where the original research was undertaken). The author skillfully highlights the strengths of advance directives and helps the audience to see the development of preparing the directive as a personal journey, not merely reaching a destination (i.e., having a signed document). Perhaps the book’s greatest strength is that it promotes the directives as a means of promoting communication within families about future decisions that they may need to make on behalf of a mother, father, or other relative if that person becomes mentally incapable. It is also very encouraging to see that this book clarifies a number of common misconceptions. Potential drawbacks of the book fall into three categories: interpretations, generalizations, and omissions. Some of the illustrations used in the book might leave the reader with erroneous impressions. For example, a person who has had a stroke may have lost the ability to communicate, but that is not the same as loss of his or her mental capacity. Elsewhere in the book, colloquial language such as “tell doctors to pull the plug” (p. 34) is medically inaccurate. Given that the book is intended to promote the use of advance directives, it is not surprising that it tends to overlook or downplay some issues such as health care providers’ lack of understanding (Mirarchi, Kalantzis, Hunter, McCracken, & Kisiel, 2009) and misuse (Meadus, Wahl, & Rosenbaum, 2007) of advance directives. There has also been a less than altruistic push at a policy level in several Canadian and American jurisdictions to encourage the use of advance directives among older adults as a means to reduce health care costs (Alberta Heritage Foundation for Medical Research, 2005). In a health care system that is sometimes ageist, advance directives may be advocated to “correct” for “expensive and futile care” that older adults are incorrectly perceived as receiving (Spencer, 2009). Several important matters are not addressed which a reader might expect to be covered in a book of this nature. For example, there is no mention of the fact that people can regain mental capacity in some situations (thus mental incapacity is not always a permanent status), and there is no mention of various areas or degrees of capacity. The duties of the health care proxy are not discussed, and there is little if any mention of the continued importance of involving the person who made a directive in care discussions even after she or he is deemed “incapable”. Writing is an art of persuasion. Consequently, one might also ask whether the particular images of death that the author has chosen are fair (such...
Dans cet article nous proposons une analyse normative des évaluations économiques, en faisant un ... more Dans cet article nous proposons une analyse normative des évaluations économiques, en faisant un examen critique des valeurs sociales canadiennes dans le domaine de la santé et en les mettant en contraste avec les valeurs inhérentes, les présomptions méthodologiques et les conséquences politiques pratiques des modèles conventionnels de l'évaluation du coût de la maladie. Cette analyse nous permet de révéler des préjugés et les limitations qui en résultent dans les méthodes actuelles d'évaluation, et de proposer un cadre élargi pour une estimation des coûts qui prenne en compte le sexe et la diversité. Ce cadre proposé se fonde sur les changements fondamentaux qui sont apparus dans le discours concernant les valeurs, émanant des sciences économiques, des politiques sociales, de l'éthique et des théories féministes. Nous démontrons en particulier les implications de ces convergences pluridisciplinaires dans l'étude du coût de la maladie. L'analyse et le cadre proposé fournissent des arguments pour expliquer pourquoi et comment les méthodologies traditionnelles d'évaluation des coûts doivent être modifiées afin de réaliser leur plein potentiel pour que les décisions en matière de politiques de santé soient prises en connaissance de cause. Cet article reflète le travail d'un groupe pluridisciplinaire de chercheurs spécialisés en sciences économiques, sciences politiques, sociologie et sciences infirmières.