PEACYR Workshop January 22, 2015 Putting Practices into Action through Policy, Procedures, and Protocols

Susan Steels, MSW, RSW, Southlake Regional Health Centre

Cassandra Rassinger, MSW, RSWCHATS (Community & Home Assistance to Seniors)

Objectives To build knowledge to evaluate existing policies

and procedures or create new policies and procedures that are reflective of best practices.

To establish an action plan for a policy and procedure that integrates hospital and community care.

RNAO Best Practice Guidelines – January 2015Recommendation 1.2: Ensure privacy and confidentiality when discussing issues

of abuse and neglect unless legal obligations require disclosure of information.

Recommendation 2.1: Collect information and resources needed to respond appropriately to alleged or suspected abuse and neglect in ways that are compatible with the law, organizational policies and procedures, and professional practice standards.

Recommendation 3.1: Respond to alleged or suspected abuse and neglect according to legal requirements and organizational policies or procedures

Recommendation 6.2: Organizations/institutions establish policies, procedures and supports that enable nurses and other health-care providers to recognize, respond to, and where appropriate, report abuse and neglect of older adults.

Recommendation 6.8: Nurses, other health-care providers, and key stakeholders (e.g., professional associations, health service organizations, advocacy groups) advocate for policy/organization/system level changes, including the availability of necessary resources, to effectively prevent and address abuse and neglect of older adults.

The Right Honourable Chief Justice of Canada

“…every person in our society, regardless of age, is entitled to three things: [to] live with dignity; to live with security; and to live as an autonomous human being”

Right Honourable Chief Justice of Canada Beverley McLachlin, P.C, Keynote Address, 3rd Annual Canadian Conference on

Elder Law, November 10, 2007

ELDER ABUSE ‘THE HIDDEN CRIME OF THE CENTURY’

Senior dies on porch after hospital discharge on frigid night; 2nd case in Winnipeg

Policy vs Guideline Policies are found in manuals, there is a

process for review, they are formally recognized as being connected to the organizations operations.

Guidelines are suggested practices, promote best practices, allow flexibility in application across programs/services, not found in the manuals, no formal process for review.

The Organization is responsible for monitoring their effectiveness, reviewing and updating, and providing training and support.

Why Abuse Prevention Policy and Procedures?

“Ensuring that sound policies and procedures are in place will first and foremost, assist in the safety of the individual resident or patient, but also help employers meet their obligations under the Protection of Persons in Care Act.”

Policies are an important message to employees, patients and residents on what is expected of them. Policies tell them what to report and to whom; it reassures them that they can report without fear of reprisal and that they can trust that an investigation will occur. Policies also guide individuals on how to prepare for or respond to certain situations.

Nova Scotia Association of Health Organizations “Developing Abuse Prevention Policies and Procedures to Investigate Complaints (August 2007)

Motivating Factors to Establish P & P Responsive to the health and safety of the patients/clients in our care.

Employees need to know what the expectation is from their organization!

Employees need to know what is required by law – No legal duty to report Elder Abuse unless patient/client is a

resident of LTC and Retirement Home.

Awareness has been established - It is not okay to do nothing! Support from system improvement initiatives that give weight to internal champions.

Although there is no specific “elder abuse” crime, many forms of elder abuse may be a crime (i.e. fraud, theft, assault, stopping mail with intent, failure to provide a dependent person with the necessities of life, forcible confinement, uttering threats, etc.)

Bill C-36, An Act to amend the Criminal Code (elder abuse) (short title: Protecting Canada’s Seniors Act) - March 2012.

The bill specifies that “evidence that the offence had a significant impact on the victim, considering their age and other personal circumstances, including their health and financial situation” as factor to be taken into account during sentencing for a crime.

Motivating Factors (con’t) Recognition from our leaders of the social

determinant of health that impact resources.

Abuse has an impact on all systems: quality of life, psychological distress,

loss of property and security.

Associated with increased

mortality and morbidity.

Drafting a P & P: Necessary Components A declaration/policy statement indicating zero tolerance of abuse A definition of abuse and examples of abuse Statement of Confidentiality for the capable patient. Statement addressing consent and the sharing of information. Integrating college standards/professional standards or code of

ethics from multiple disciplines. Statement of duty to report for LTC and RH residences and how

to do this. Statement of how to access the PG and T for incapable patients. Cross reference to PP that overlaps. Exclusion criteria. Linking to protocol to guide practice of staff (and others) and

enhance knowledge of resources available, reflective of care setting.

LTCHA – 24. (1) A person who has reasonable grounds to suspect that any of the

following has occurred or may occur shall immediately report the suspicion and the information upon which it is based to the Director:

1. Improper or incompetent treatment or care of a resident that resulted in harm or a risk of harm to the resident.

2. Abuse of a resident by anyone or neglect of a resident by the licensee or staff that resulted in harm or a risk of harm to the resident.

3. Unlawful conduct that resulted in harm or a risk of harm to a resident.

4. Misuse or misappropriation of a resident’s money.

5. Misuse or misappropriation of funding provided to a licensee under this Act or the Local Health System Integration Act, 2006.

(Advocacy Centre for the Elderly [ACE]: Duty to Report, 2012; ACE, Elder Abuse Response: Things you NEED to know for Effective Intervention, 2014) Full legislation: www.e-laws.gov.on.ca

RHAs. 75(1)A person who has reasonable grounds to suspect that any of the

following has occurred or may occur shall immediately report the suspicion and the information upon which it is based to the Registrar:

1. Improper or incompetent treatment or care of a resident that resulted in harm or a risk of harm to the resident.

2. Abuse of a resident by anyone or neglect of a resident by the licensee or the staff of the retirement home of the resident if the result in harm or a risk of harm to the resident.

3. Unlawful conduct that resulted in harm or a risk of harm to a resident

4. Misuse or misappropriation of a resident’s money

(Advocacy Centre for the Elderly [ACE]: Duty to Report, 2012; ACE, Elder Abuse Response: Things you NEED to know for Effective Intervention, 2014) Full legislation: www.e-laws.gov.on.ca

RHPA 85. (1) – 85. (3) Requires that any health care professional

who has reasonable grounds to believe that a client has been sexually abused by another health care professional must report this to the College of the alleged abuser within 30 days or sooner if the client is at risk.

Legislation: PGT The Public Guardian and Trustee shall investigate any allegation that a

person is incapable of managing property (or personal care) and that serious adverse effects are occurring or may occur as a result. (SDA 27(2).

“serious adverse effects” includes, “loss of a significant part of one’s property or failure to provide the necessities of life for oneself or dependents” (finances)

“serious illness or injury, or deprivation of liberty and personal security” (personal welfare)

(Office of the Public Guardian and Trustee. Guardianship Investigations, 2013)

Police Notification There is no duty to report crime to the police.

Unless there is an imminent risk it is a breach of confidentiality to report a crime to police that has been learned through providing healthcare.

RHA - When reporting abuse to the Registrar at the Retirement Home Regulatory Authority. The Regulatory Authority could request police involvement in investigations if they believe that alleged abuse may be a Criminal offense.

LTCHA S. 98.  Every licensee of a long-term care home shall ensure that the appropriate police force is immediately notified of any alleged, suspected or witnessed incident of abuse or neglect of a resident that the licensee suspects may constitute a criminal offence.

Community Story Despite barriers, reports are common. Potential for ongoing monitoring and in-

home assessment to determine risk Able to identify & respond to the various

types of abuse – financial & psychological abuse identified

Capacity to work closely with community partners - Leverage community resources/develop a support mechanism, reflective of available services.

Elder Abuse requires a collaborative approach to support and ensure the safety of older adults.

Community Story

Despite no mandatory reporting law, some community organizations have policies or guidelines.

Implementing P & P demonstrates stance against abuse. P & P identifies purpose, mandatory reporting by all, and

indicates each person’s responsibility, with corresponding action(s) required.

P & P are effective in clarifying roles and ensuring action. Reflects the importance of client consent (i.e. information

sharing with partner agencies, conducting investigation and pursuing intervention) and relevant/overlapping P & P.

Hospital Story As a safe place, disclosure is common. Reason for admission seldom related to Elder Abuse,

and masked by other health condition. Health impacts mental capacity Ethical remorse around patient experiences. Elder Abuse requires a collaborative response from

hospital and community.

Hospital Story Survey done by PPNO in 2011 to hospital – 9

respondents – 3 had Policy and Procedure specific to Elder Abuse.

Review of known Policy and Procedures demonstrate inconsistency in practice. Few focus on specific action, and focus more on defining elder abuse.

Navigating the road to becoming a Policy and Procedure in a large organization is complex.

Exercise: Taking Action Draft P & P using Template Provided Reflect on Guiding Principles:

Collaboration Diversity Accessibility Social Inclusiveness Respect and Dignity Independence/Self-determination Fairness and Equity Security Advocacy

(Prevention of Elder Abuse Policy and Program Lens. www.ontarioseniors.ca)

Exercise: Re-Group1. Present P & P

2. Which principles did you use to guide the development of your P & P?

3. How will you integrate this P & P into your organizational culture?

4. What do you feel would be the implementation challenges?

Some Useful Resources Elder Abuse Ontario:

www.elderabuseontario.com

NICE Network: www.nicenet.ca

Prevention of Elder Abuse Policy and Program Lens:

http://www.seniors.gov.on.ca/en/elderabuse/docs/ElderAbuse_Engl_web.pdf

Nova Scotia Association of Health Organizations: Developing Abuse Prevention Policies & Procedures to Investigate Complaints (Aug 2007) www.nsaho.ns.ca

PEACYR: What to do if you see or suspect Elder Abuse

www.elderabuse-yorkregion.ca

Canadian Network for the Prevention of Elder Abuse

www.cnpea.ca

Susan Steels: 905-895-4521 ext. 2941 or ssteels@southlakeregional.org

Cassandra Rassinger: 905-713-3373 ext. 6527 or crassinger@chats.on.ca