Fraser Health’s Legal Mandate Responding to Adult Abuse & Neglect Leanne Lange Clinical Specialist Adult Abuse & Neglect September 17, 2013 1 Overview Prevalence Fraser Health is a Designated Agency - The Designated Responders What is abuse, neglect, & self-neglect? Why are these situations so complex? How to make a report Adult Guardianship Act 2 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 3 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 4 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 5 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 6 Guiding Principles Self Determination & Choice Most Effective but Least Intrusive Support, Assistance, or Protection Adults are Presumed Capable Court as the Last Resort 7 Who are the Designated Agencies? All Health Authorities Community Living BC (for adults with developmental disabilities) 8 Location of the Adult Adult’s Home Relative’s Home Private Care Facility First Nations Communities Other than a correctional facility 9 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 10 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 11 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 12 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 13 Emotional Abuse Any act which diminishes an adult’s sense of identity, dignity and self-worth Confinement Isolation Verbal assault Humiliation Intimidation Infantilization 14 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 15 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 16 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 17 Understanding the Dynamics SITUATION ABUSER ABUSED ADULT 18 SITUATION Poverty History of violence Cultural behaviour Social isolation Marital conflict Overcrowding Lack of family support Lack of social support 19 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 20 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 21 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 22 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 23 Our Investigation Answers 2 Pivotal Questions Is the adult being abused, neglected, or self-neglecting? Is the adult able to get help on their own? 24 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 25 Legal Tools Protecting 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) 26 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 27 How to Make a Referral to Fraser Health Home Health Referral Line 1-855-412-2121 28 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 29