Fraser Health ’ s Legal Mandate Responding to Adult Abuse & Neglect

1. Fraser Health’s 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

4. 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

5. BC’s Adult Guardianship Legislation • Adult Guardianship Act (Part 3) • Health Care (Consent) and Care Facility (Admission) Act • Representation Agreement Act • Public Guardian & Trustee Act

6. 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

8. Who are the Designated Agencies? • All Health Authorities • Community Living BC (for adults with developmental disabilities)

9. Location of the Adult • Adult’s Home • Relative’s Home • Private Care Facility • First Nations Communities • Other than a correctional facility

10. 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

11. 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

12. 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

13. 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 • Adult’s report of being abused

14. Emotional Abuse • Any act which diminishes an adult’s sense of identity, dignity and self-worth • Confinement • Isolation • Verbal assault • Humiliation • Intimidation • Infantilization

15. 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 adult’s behalf • Power of Attorney granted under unusual circumstances • Sudden changes in types and amounts of withdrawals

16. Definition of Neglect & Self-Neglect • Any failure to provide necessary care, assistance guidance or attention to an adult thatcauses, or is reasonably likely to cause within ashort period of time, the adult serious physical, mental or emotional harm or substantial damage to or loss of assets, and includes self-neglect

17. 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

18. Understanding the Dynamics ABUSER SITUATION ABUSED ADULT

19. Poverty History of violence Cultural behaviour Social isolation Marital conflict Overcrowding Lack of family support Lack of social support SITUATION

20. 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 ABUSED ADULT

21. 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 ABUSER

22. 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

23. 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

24. Our Investigation Answers2 Pivotal Questions • Is the adult being abused, neglected, or self-neglecting? • Is the adult able to get help on their own?

25. 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

26. 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)

27. 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

28. How to Make a Referral to Fraser Health • Home Health Referral Line 1-855-412-2121

29. Contact Information Leanne Lange, Clinical Specialist, Adult Abuse & Neglect Tel: 604-777-7393 Cell: 604-807-6838 Fax: 604-777-7392 Email: leanne.lange@fraserhealth.ca