Adult Abuse and Neglect (15:VIII)

A. What is Adult Abuse and Neglect

An adult might be experiencing, or be vulnerable to experiencing, abuse, neglect or self-neglect. In situations where an adult is in need of support or assistance in order to prevent abuse or neglect, the following legislation applies: Part 3 of the AGA; sections 34 and 35 of the PAA; section 31 of the RAA; and sections 17–19 of the PGTA.

The law defines abuse, neglect and self-neglect to include acts and a failure to act. Refer to the Practical Guide to Abuse and Neglect Law in Canada for a summary of the law and practical guidelines on how to identify and respond to situations of abuse or neglect. This guide is produced by the Canadian Centre for Elder Law (CCEL) and is available online at: http://www.bcli.org/ccel/projects/practical-guide-elder-abuse-and-neglect-law-canada.

Section 1 of the RAA defines the terms abuse and neglect broadly as follows:

• "abuse" means the deliberate mistreatment of an adult that causes the adult (a) physical, mental or emotional harm, or (b) damage or loss in respect of the adult's financial affairs, and includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors;
• "neglect" means 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 or loss in respect of the adult's financial affairs, and includes self neglect.

B. Responding to Adult Abuse and Neglect

Sometimes the most appropriate and helpful response to abuse or neglect is not a legal response. In some instances, it may be appropriate to contact a designated agency, or the Public Guardian and Trustee, as discussed below. However, the key response is generally to listen to the older adult’s description of his or her experience, and to help the person get support and assistance, often through identifying an appropriate referral agency. You will want to consider whether there is an urgency to the circumstances that suggests a need for immediate action. For example:

• Is the person in immediate danger of harm?
• Will money be stolen or spent?
• Will property be taken away?
• Does the person appear to lack mental capacity?

The CCEL has published the following guiding principles for responding to concerns about abuse, neglect or self-neglect: (A Practical Guide to Elder Abuse and Neglect Law in Canada (2011))

1. Talk to the older adult
   • Ask questions. Talk to the older person about his or her experience. Help the person to identify resources that could be helpful.
2. Respect personal values
   • Respect the personal values, priorities, goals and lifestyle choices of an older adult. Identify support networks and solutions that suit the older adult’s individuality.
3. Recognize the right to make decisions
   • Mentally capable older adults have the right to make decisions, including choices others might consider risky or unwise.
4. Seek consent or permission
   • In most situations, you should get consent from an older adult before taking action.
5. Respect confidentiality and privacy rights
   • Get consent before sharing another person’s private information, including confidential personal or health information.
6. Avoid ageism
   • Prevent ageist assumptions or discriminatory thinking based on age from affecting your judgment. Avoid stereotypes about older people and show respect for the inherent dignity of all human beings, regardless of age.
7. Recognize the value of independence and autonomy
   • Where this is consistent with the adult’s wishes, assist the adult to identify the least intrusive way to access support or assistance.
8. Know that abuse and neglect can happen anywhere and by anyone
   • Abuse and neglect of older adults can occur in a variety of circumstances from home care to family violence.
9. Respect rights
   • An appropriate response to abuse, neglect, or risk of abuse or neglect should respect the legal rights of the older adult, while addressing the need for support, assistance, or protection in practical ways.
10. Get informed
    • Ignorance of the law is not an excuse for inaction when someone’s safety is at stake. If you work with older adults you need to educate yourself about elder abuse.

Another useful document provided by the Public Guardian and Trustee is called Decision Tree: Assisting an Adult Who is Abused, Neglected or Self Neglecting and the related videos (See Section I.B: Secondary Sources of Law and Practice).

1. Designated Agencies

There is no duty for the general public to report abuse, neglect or risk in BC. However, if an older adult is experiencing, or particularly vulnerable to, abuse, neglect or self-neglect and is unable to access the necessary support or assistance on her own, anyone may notify a Designated Agency (DA). A Representative of the DA will then meet with the adult to decide on what steps can be taken. The DAs are legally required under the AGA to respond to reports of abuse, neglect and self-neglect. The DA process includes involving the adult in decisions about how to seek support and assistance, providing the necessary support and assistance to prevent abuse or neglect, and respecting the right for an adult with capacity to refuse support or assistance.

The DAs are set out in the AGA, and the DAR. They include BC Community Living, Providence Health Care Society, and each of the provincial Health Authorities (i.e. Vancouver Coastal Health, Interior Health, Fraser Health, Vancouver Health Authority and Northern Health Authority). For contact information, refer to section I.D.: Designated Agencies in this chapter.

A DA must determine whether an adult needs support and assistance if the agency receives a report of abuse or neglect, has reasons to believe that an adult is abused or neglected, or receives a report that the adult’s representative, guardian or monitor has been hindered from visiting or speaking with the adult (s 47, AGA). Where an adult is found to be in need of support or assistance, a DA may take any of the following courses of action: (See s 47(3) and s 51 of the AGA).

• investigate whether abuse or neglect is happening;
• provide assistance to obtain care, social support, or legal guidance;
• assist in obtaining an appropriate Representative or guardian;
• inform the Public Guardian and Trustee;
• prepare and implement a support and assistance plan with the adult; and/or
• apply to the court for an order authorizing the provision of services.

Designated Agencies must involve the adult, to the greatest extent possible, in decisions about how to seek support and assistance, and in decisions regarding the provision of support and assistance necessary to prevent abuse or neglect in the future (s 52, AGA). DAs are also legally required to respect the right for an adult with capacity to refuse support or assistance (s 2, AGA).

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