Leanne Lange

1
Fraser Healths Legal Mandate Responding to
Adult Abuse Neglect

• Leanne Lange
• Clinical Specialist
• Adult Abuse Neglect
• September 17, 2013

2
Overview

• Prevalence
• Fraser Health is a Designated Agency - The Adult
  Guardianship Act
• Designated Responders
• What is abuse, neglect, self-neglect?
• Why are these situations so complex?
• How to make a report

3
Prevalence

• 4 of Canadian seniors suffer from one or more
  serious forms of abuse by a spouse, relative or
  other close contact
• 1 out of 12 seniors in BC have been financially
  abused in amounts that average over 20,000
• Almost half of all violence against seniors
  occurs in spousal relationships

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Prevalence

• Older women are the victims in about
• 2/3 of the cases that come to the attention of
  community agencies
• Only about 1 in 5 cases of abuse come to the
  attention of community agencies or authorities

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BCs Adult Guardianship Legislation

• Adult Guardianship Act (Part 3)
• Health Care (Consent) and Care Facility
  (Admission) Act
• Representation Agreement Act
• Public Guardian Trustee Act

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Adult Guardianship Act- Part 3 The Purpose

• Abused, neglected self-neglected and unable to
  seek support and assistance due to
• Physical restraint
• A physical handicap that limits their ability to
  seek help or
• An illness, disease, injury or other condition
  that affects their ability to make decisions
  about the abuse or neglect

7
Guiding Principles

• Self Determination Choice
• Most Effective but Least Intrusive Support,
  Assistance, or Protection
• Adults are Presumed Capable
• Court as the Last Resort

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Who are the Designated Agencies?

• All Health Authorities
• Community Living BC (for adults with
  developmental disabilities)

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Location of the Adult

• Adults Home
• Relatives Home
• Private Care Facility
• First Nations Communities
• Other than a correctional facility

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The Designated Responders in Fraser Health

• Acute Care
• Home Health
• Mental Health Substance Use
• Acquired Brain Injury Program
• Palliative Care End of Life
• Owned Residential Care Facilities
• Contracted Residential Care Facilities

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Definition of Abuse

• The deliberate mistreatment of an adult that
  causes the adult
• Physical, mental or emotional harm, or
• Damage to or loss of assets

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Examples of Abuse

• Intimidation
• Humiliation
• Physical assault
• Sexual assault
• Over/Under medication
• Withholding needed medication
• Censoring mail
• Invasion or denial of privacy
• Denial of access to visitors
• Theft

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Indicators of Sexual Physical Abuse

• Bruises, black eyes
• Welts, rope marks
• Broken assistive devices
• Lacerations
• Fractures, sprains, dislocations
• Burns
• Repeated falls
• Explanation does not match the injury
• Adults report of being abused

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Emotional Abuse

• Any act which diminishes an adults sense of
  identity, dignity and self-worth
• Confinement
• Isolation
• Verbal assault
• Humiliation
• Intimidation
• Infantilization

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Indicators of Financial Abuse

• Unpaid Bills
• No money for basic necessities
• Sudden sale or change in property ownership
• Adult complains about not knowing where money has
  gone
• Decision maker refuses to spend money on the
  adults behalf
• Power of Attorney granted under unusual
  circumstances
• Sudden changes in types and amounts of withdrawals

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Definition of Neglect Self-Neglect

• Any failure to provide necessary care, assistance
  guidance or attention to an adult that causes, or
  is reasonably likely to cause within a short
  period of time, the adult serious physical,
  mental or emotional harm or substantial damage to
  or loss of assets, and includes self-neglect

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Indicators of Neglect/Self-Neglect

• Malnourished
• Emaciated
• Dehydrated
• Confused
• Inappropriate Clothing
• Squalor
• Over/Under medicated
• Absence of required hearing, visual, mobility
  aids
• Skin sores
• Malodorous
• No follow through on medical services

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Understanding the Dynamics
ABUSER
SITUATION
ABUSED ADULT
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SITUATION

• Poverty
• History of violence
• Cultural behaviour
• Social isolation
• Marital conflict
• Overcrowding
• Lack of family support
• Lack of social support

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ABUSED ADULT

• Functional dependence
• Poor health/impairment
• Age gender
• Economic dependency
• Intergenerational conflict
• Substance Abuse
• History of abuse or abuser
• Stoicism/Internalizes blame
• Presence of problem behaviours
• Impaired judgment/insight

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ABUSER

• Alcohol/drug user
• Mental/emotional problems
• Lack of caregiving experience
• Abused as child/adult
• Stressed
• Confused/demented
• Financially dependent
• Poor social connections
• Need for control
• Unsympathetic

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Hallmarks of Abuse

• Control of finances
• Control of access
• Isolation
• Alienation of previous support network
• Ingratiation to the victim of abuse
• Threats intimidation to those trying to help

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Barriers to Disclosure

• Hopelessness and isolation, may blame self
• Values and beliefs (personal, cultural, familial)
  
• Hope the abuser will stop without intervention
• Fear of reprisals
• Fear of abandonment
• Functional or communication challenges
• Lack of awareness and information re personal
  and legal rights

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Our Investigation Answers2 Pivotal Questions

• Is the adult being abused, neglected, or
  self-neglecting?
• Is the adult able to get help on their own?

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What Fraser Health Must Do During the
Investigation

• Look into the situation
• Involve the adult as much as possible
• Determine if the adult needs support assistance
• Report criminal offences to the police
• Keep the identity of the person who made the
  report confidential

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Legal ToolsProtecting the Adult

• Warrant to enter to conduct an interview
• Access Order to enter (health care provider)
• Interim Restraining Order (up to 90 days)
• Support Assistance Order (may include a long
  term restraining order)

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Legal Tools Emergency Assistance Section 59

• Enter the premises where adult is located use
  any reasonable force necessary
• Provide emergency health care
• Remove an adult and take to a safe place
• Protect assets by informing the Public Guardian
  Trustee
• Protect the adult from harm using any other
  measure necessary

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How to Make a Referral to Fraser Health

• Home Health Referral Line
• 1-855-412-2121

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Contact Information

• Leanne Lange, Clinical Specialist, Adult Abuse
  Neglect
• Tel [phone]
• Cell 604-807-6838
• Fax [phone]
• Email leanne.lange_at_fraserhealth.ca