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Leanne Lange

Clinical Specialist Adult Abuse & Neglect

September 17, 2013

Fraser Health’s Legal Mandate Responding to Adult Abuse &

Neglect

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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

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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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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

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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

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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

Adult’s Home Relative’s 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 The deliberatedeliberate mistreatment of an adult mistreatment of an adult that causes the adult:that causes the adult: Physical, mental or emotional harm, orPhysical, mental or emotional harm, or Damage to or loss of assetsDamage 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 Adult’s report of being abused

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Emotional Abuse

Any act which diminishes an adult’s 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 adult’s 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 Any failure to provide necessary care, assistance guidance or care, assistance guidance or attention to an adult attention to an adult thatthat causes, causes, or is reasonably likely to cause or is reasonably likely to cause within awithin a short period of timeshort period of time, the , the adult serious physical, mental or adult serious physical, mental or emotional harm or substantial emotional harm or substantial damage to or loss of assets, and damage to or loss of assets, and includes self-neglectincludes 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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SITUATION ABUSER

ABUSED ADULT

Understanding the Dynamics

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

SITUATION

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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

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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

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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: 604-777-7393Cell: 604-807-6838Fax: 604-777-7392Email: leanne.lange@fraserhealth.ca