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Leanne Lange

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Title: 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

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
BCs 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
  • Adults Home
  • Relatives 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
  • Adults report of being abused

14
Emotional Abuse
  • Any act which diminishes an adults 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
    adults 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 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
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
SITUATION
  • Poverty
  • History of violence
  • Cultural behaviour
  • Social isolation
  • Marital conflict
  • Overcrowding
  • Lack of family support
  • Lack of social support

20
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

21
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

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_at_fraserhealth.ca
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