1. 1 Leanne Lange Clinical Specialist Adult Abuse & Neglect September 17, 2013 Fraser Health’s Legal Mandate Responding to Adult Abuse & Neglect

2. 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. 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. 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. 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. 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. 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. 8 Who are the Designated Agencies?  All Health Authorities  Community Living BC (for adults with developmental disabilities)

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

10. 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. 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. 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. 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. 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. 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. 16 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

17. 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. 18 SITUATION ABUSER ABUSED ADULT Understanding the Dynamics

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

20. 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. 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. 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. 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. 24 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?

25. 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. 26 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)

27. 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. 28 How to Make a Referral to Fraser Health  Home Health Referral Line 1-855-412-2121

29. 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