The Tribune

EDITOR, The Tribune

I have read the Bill in full. As a doctor who has sat at the bedside in Princess Margaret Hospital and in clinics in New Providence and the Family Islands, I welcome it. We need this law.

Our population is ageing. We have seen a 28.2% increase in persons 65 and older since 2010. In my practice, I see what the Bill is trying to stop every week.

I see the 78-year-old woman with pressure injuries — bed sores — because no one taught the family how to turn her every 2 hours or check for early skin breakdown.

I see the man with dementia, now 1,920 Bahamians and counting, who is given the wrong medication, or no medication, because the caregiver does not understand dementia awareness and competency standards — the very training Clause 50(c) finally calls for.

I see the older man whose NIB pension is collected on the first of the month and finished by the 3rd by a family member — economic abuse as defined in Clause 2.

I see the elderly patient medically fit for discharge, left in a hospital bed for 30, 60, 90 days, not because the family does not love them, but because there is no residential care bed, no community nursing service as promised in Clause 48, no home-based service as promised in Clause 49.

So yes — I support the core rights in Part III: general human rights, protection from physical, psychological, sexual and economic abuse (Clauses 17-18), the right to financial self-management (Clause 19), access to healthcare including dementia support and palliative care (Clause 14), and access to places and services (Clause 12-13).

But as a Bahamian physician, I must tell the Government: You cannot legislate the family to do what the system has failed to do.

My concerns from the wards:

1. The 72-hour rule will punish poverty, not abuse.

The Bill criminalizes failure to collect a relative and failure to provide food, water, clothing and safe environment. The penalty is up to $50,000 and 5 years. In my experience, abandonment is rarely malice — it is burnout, poverty, and lack of support. A single mother working at Atlantis, a son fishing in Andros with no private nurse, cannot provide 24-hour care alone. If you make them criminals, families will hide patients, not bring them for care.

2. We need infrastructure before enforcement.

Clauses 42-57 promise a lot that does not yet exist: a digital portal for social assistance, day-care services (Clause 47), community nursing (Clause 48), home-based services (Clause 49), caregiver support and development (Clause 50), a designated liaison officer to coordinate Family Island travel for appointments (Clause 51), priority access, wheelchair ramps and grab bars (Clause 52), and transport services.

As a doctor, I ask: Where are they? Who will staff them? The Bill says the Minister shall promote and facilitate — but my patients need a nurse who will show up on Tuesday to change a catheter, teach wound care, and check for early sepsis. Without funding and manpower in Social Services and Public Health, this Bill is a paper promise.

3. We need prevention, not just protection orders.

Clauses 64-66 provide for general and emergency care and protection orders — to remove an older person to a place of safety, with or without consent. That is necessary for real abuse. But in medicine, we prevent admission. We need Clause 44 — public education on abuse, financial literacy, online safety, dementia risk reduction — to be in every clinic, every church hall, on every ZNS program, in plain language.

And we need Clause 50(3) — training for caregivers via workshops, brochures, TV — to actually reach the auntie in Bain Town who is now the sole caregiver for her mother with Alzheimer's.

What I recommend as a physician:

1. Fund care, not just courts. Pair every protection officer (Clause 61) with a community health nurse. Establish the liaison service in Clause 51 immediately — my Family Island patients miss chemotherapy and eye clinic because no one verified their appointment before they spent $300 to fly to Nassau.

2. Create a clear, non-punitive pathway for help. Before a family is charged under the 72-hour rule, let them have a single phone number, a 24-hour helpline, and a documented assessment of financial and physical incapacity.

3. Protect autonomy while protecting from exploitation. As a doctor I see both sides of Clause 19. Let us allow supported decision-making — a trusted child can help manage money — while criminalizing true exploitation. Require banks and NIB to flag unusual withdrawals for persons over 80.

4. Publish and cost the National Older Persons Policy and the National Dementia Strategy within 6 months, not 12. We already know 2,000 Bahamians live with dementia. They cannot wait.

I want to grow old in The Bahamas. I want my patients to grow old with dignity.

This Bill can be the foundation for that — if it is more than a list of offences. Let it be a guarantee of services.

Protect our elders, yes. But let us also support the families and health workers who carry them every day.

Respectfully,

Dr Jacqueline Penn-Knowles

A Bahamian Physician

Nassau, Bahamas