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Abuse in Institutions

Table of Contents (click to jump to section)

1. What Percentage of Seniors Live in Institutions

2. What Are the Rights of People Living in Long Term Care Facilities

3. Does Abuse or Neglect of Older Adults Ever Occur in Long Term Care Facilities

4. What Types of Abuses May Occur in Long Term Facilities

5. What is Systemic Abuse

6. Does the Staff or Other Person Have to Intend to Harm the Person for their Action to be Considered "Abusive" or "Neglectful"

7. How Common is Abuse in Institutional Settings

8. Who Is Likely to Be Abused in Institutional Settings

9. Why Might Abuse or Neglect Occur Here

10. Who Might be an Abuser

11. What Is Being Done in Canada to Prevent or Address Abuse Institutional Settings

12. Are There Laws Against Abuse Occurring in Institutions

13. What Happens When Abuse or Neglect Occurs or Is Witnessed in Facilities

14. Is It Mandatory to Report Abuse in an Institution? If So, Who Must Report

15. Is There Protection for Staff Who Report

16. Is There Protection for the Resident When an Abuse Report is Made

17. What Happens When Facility Staff or Administration Suspect Abuse Has Occurred

18. Are Protection Laws Adequate

19. What Are Some Roles for Family and Friends in Abuse Prevention

20. What Are Some of the Other Ways of Encouraging Abuse Prevention and Improving Quality of Care?

References

Resources

Provincial Advocacy Groups

Abuse in Institutions

FAQs about Abuse in Institutions

Across Canada, there are many different kinds of institutions where older adults may live together to receive health care, supportive services or assistance. These include "board and care homes", "care facilities", "care homes", "personal care homes", "seniors' lodges", "assisted living", "retirement homes", "campus of care", or "nursing homes". Some will provide skilled nursing care (e.g., registered nurses) and others will rely on staff with other types of skills and experience.

1. What Percentage of Seniors Live in Institutions?

According to the Statistics Canada 2001 Census, 9.2% of senior women and 4.9% of senior men, or approximately 287,000 seniors aged 65 and over lived in health care institutions (long term care facilities).(1) This includes a wide range of institutions, for example, personal care homes, nursing homes, homes for the aged, and complex care facilities.

Most older adults living in long term care institutions are elderly; the majority is in their late 80s or 90s. Approximately 20-30% of all seniors will spend their last years in some form of care facility.(2)

2. What Are the Rights of People Living in Long Term Care Facilities?

Residents of nursing homes and other institutional settings have all the rights of other adults. They do not "leave their rights at the front door".

Just as in the community, there can be some limits to their rights. For example, people live together in long term care facilities, so some of their rights may be affected by the rights of others living there.

Many residents are unaware that they have the same rights as people in the community, and should not have to experience, abuse, neglect or violation of their rights.

Clearly Identified Rights:

Ontario developed a "Nursing Home Bill of Rights" in the 1980s as part of its Nursing Home Act. Saskatchewan has a similar type of "bill of rights" incorporated into the regulations which cover its personal care homes.  Laws and regulations may list some of the specific rights and freedoms that residents have. They are not extensive lists of those rights.

For example, the regulations of Nova Scotia's Homes for Special Care Act identify that residents continue to have religious freedom, the right to have visitors; freedom to work and freedom from being forced to work; the right to choose a doctor; and the right to not be locked in a room.

In March, 2005, the government of Manitoba announced the development of a bill of rights for residents of private and not-for-profit personal care homes. Among other things, it specifically identifies that residents have the right to

The law also sets out limits on how residents can be physically restrained if they are in danger of harming themselves or others.

Even where provinces' or territories' legislations are silent around rights or freedoms, people living in institutions can expect to have

They can also expect to have

Their rights are only limited if they do not have the necessary mental capability to make decisions in those specific areas, or if they are shown to substantially infringe on the safety or rights of other people. Even then, any restriction on the individual's rights should be as narrow as possible ("less restrictive") and those putting forward the restriction should be able to show how it addresses those other concerns ("most appropriate").

Although the percentage of people who have some degree of mental impairment is higher in long term care facilities than in it is the community, in many facilities the majority of the residents are mentally capable of making many types of decisions. Even where some residents may have difficulty or may be incapable of making some kinds of decisions, they are often still mentally able to make other kinds of decisions.

An abuse free environment recognizes that many rights will have limits, and that residents may have specific responsibilities as well.

3. Does Abuse or Neglect of Older Adults Ever Occur in Long Term Care Facilities?

Yes. Abuse or neglect of older adults can occur in a community setting or an institutional setting. See question #7 below, "How common is abuse in institutional settings?"

4. What Types of Abuses May Occur in Long Term Facilities?

Any type of abuse or neglect of older adults that occurs in the community may happen in institutional settings too. This includes:

In institutions, the specific forms of abuse may be somewhat different than in the community. See What is Abuse? for information and examples of different types of abuse.

5. What is Systemic Abuse?

In institutional settings, some forms of abuse are not always obvious. Subtle emotional harms may occur such as treating older people like children (infantilization) and disregarding their wishes. (3)

"Systemic abuse" refers to practices that take away a person's independence and dignity. Systemic abuse happens in settings where other people are making decisions for the person who has a disability. Government bodies and bureaucrats can also be involved in systemic abuse.

In facilities, everyday practices ("the way things are done here") and lack of sensitivity may create abusive or neglectful situations for older adults. Systemic forms of abuse or neglect may occur in these settings (e.g., "routine use" of incontinence briefs instead of helping the senior to the washroom because the facility does not have enough staff, or for staff convenience).(4)

In some institutional settings, systemic neglect may occur where there is not sufficient number of staff to meet the residents’ needs. There are other types of abuse or neglect that may occur in institutions, such as

Some forms of institutional abuse violate people's rights to accept or decline treatment. Some examples may include requiring that all seniors sign advance directives before being admitted to a long term care facility; placing a "do not resuscitate" order on medical records without consulting with the senior or family, (8) and overriding a mentally capable senior’s personal health decisions.

6. Does the Staff or Other Person Have to Intend to Harm the Person for their Action to be Considered "Abusive" or "Neglectful"?

No, the focus should be on the effect on the older adult (i.e., Does it harm or degrade the person? Does it violate the person's rights?) and addressing the harm.

A staff member or other person's intention can be important in determining the appropriate response to the abuse or neglect, but not for determining whether the situation is abuse or neglect.

Alberta's Protection for Persons in Care law only covers "intentional" harms.

7. How Common is Abuse in Institutional Settings?

There has been virtually no Canadian systematic research on how common abuse or neglect of older adults is in institutional settings (that is, its "prevalence"). However, an increasing number of sources suggest abuse and neglect in institutions is not isolated.

In a Quebec survey in the early 1980s, professionals were asked about violence that they knew about in institutional or home settings (9):

The Ontario College of Nurses  in the early 1990s surveyed 804 nurses and 804 nursing assistants. That study found that

Two American researchers (11) surveyed 577 nurses and nursing aides from 31 New Hampshire nursing homes. The staff reported that in the year before the study took place, the following behaviours were observed:

Abuse and neglect situations are often identified by advocacy groups and by concerned family members, as well as people making reports to facility licensing bodies or other authorities. (12)

8. Who Is Likely to Be Abused in Institutional Settings?

Increasingly, the oldest seniors in Canadian society are the ones most likely to live in a long term care institution; the majority of those seniors are women. Women on average tend  to live longer than men, and women are more likely to be widowed so they do may not have support to live in the community.

In 1996, nearly forty percent (38%) of all women aged 85 and over lived in an institution, compared to one quarter (24%) of men aged 85 and over. Even at younger ages, there are many more older women than older men in long term care facilities.

More older women may experience abuse or neglect in institutional settings, in part because more older women live there.

Some studies suggest that seniors who are the most impaired are the most vulnerable to being abused in this setting. They display greater capacity for dependence and it may be harder for staff to relate to them. Other studies conclude the opposite- that the seniors in care who are the most active (and therefore, the least "compliant") run a greater risk of harm.(13)

9. Why Might Abuse or Neglect Occur Here?

There are many factors:

A. Isolation/ Hidden: Many care facilities are separate from the community. Other than family members who may visits, few outsiders may have contact with seniors who are living in care facilities. That may make it easier for abuse or neglect to remain hidden or go undetected.

B. Mismatch of Skills: Seniors in care today are much more physically frail and much more likely to be cognitively impaired than seniors who moved into long term care facilities 10-15 years ago. Staff members giving care today need considerable skills in assisting seniors who are physically or cognitively impaired. Without these staff skills, the risk of abuse or neglect of the residents in care can increase.

C. Ageism and Ablebodied-ism:  Sometimes a society places considerable value on being young and active. When people grow older or develop conditions that impair their abilities, they may become devalued. Their preferences and wishes are given less weight than other (usually younger) people's needs or interests.

For example, it has been suggested that some financial abuse of people in institutions, such as theft of a resident's personal property occurs because a person views the resident as "less deserving" (e.g., "because they really won’t miss it" , "Oh, they don't need it anymore, they are in a home" or "Oh, they really don’t need nice things"). (4).

Because people in institutions are often physically disabled and dependent on others to help them, they may be treated as if they are mentally incapable, and may be treated as if they are children. They lose their ability to have their opinions listened to and respected.

Many people consider institutional care as the last place people will live before they die. Being infirm and being much closer to "the end of life", residents' lives may be valued less by some people.

D.  Systemic Problems: "It's just the way things are here" (14) This is an aspect of an unsupportive environment.

F. Personality traits of staff, volunteers, administration or other persons in the environment may lead to abuse or neglect. Like any other setting, some people working or volunteering in a nursing home, personal care home, assisted living or other institutional setting may not have the personality best suited for helping frail older adults. For example, some people may be authoritarian or punitive in their approach, and some may not like being around older people. In many cases, the way that a person is trained affects the way they respond to others.

Some may be experiencing personal problems, including family pressures, mental health problems, or substance use problems that affect they act on the job. This may be a factor in only a small percentage of the abuse cases in institutional settings, and these problems can often be addressed by having appropriate workplace support and resources for staff and volunteers.

10. Who Might be an Abuser?

Abuse or neglect occurring in institutional settings may be perpetrated by people who work or visit in that setting. This may include: nursing or care staff, volunteers, doctors, support staff, family, or other residents. (15)  In some cases, abuse by family which had been occurring in the community will continue after the older adult moves into a facility.

11. What Is Being Done in Canada to Prevent or Address Abuse Institutional Settings (16)

Abuse in institutional settings is dealt within a variety of ways across Canada. Gradually, a growing number of facilities have focussed their efforts on

1. prevention and education (training staff to identify and recognize abuse; training staff so they have proper skills to avoid becoming abusive)

2. intervention (steps to deal with the problem).

One of the major Canadian prevention initiatives is the "Abuse Prevention in Long Term Care" training program (See Resources) developed in the late 1990s. It focuses on fostering a respectful environment for residents and staff.

The process of proper care and abuse prevention through training, assessment, investigation, and response is part of assuring that seniors in care are protected from harm and that they can live in a safe and respectful environment.

Increasingly, Canada is recognizing that abuse and neglect issues cannot be considered separate from quality of care. Also, external advocacy and health care coalition groups are increasingly becoming involved by identifying the situations they see, bringing these to the attention of authorities and the public.

In most Canadian jurisdictions, there is a legal responsibility to report accidental or "unexplained" deaths to coroners or medical examiners. This includes the deaths of persons residing in nursing homes that may have occurred as a result of negligence or actions of the staff or administration. The coroner or medical examiner, in turn, has a legal responsibility to determine the causes and circumstances of the death, and in some cases may request a public inquiry.

12. Are There Laws Against Abuse Occurring in Institutions?

Yes, there are. Harmful and abusive situations that would be considered crimes in the community, are also crimes if they occur in an institution. They should be treated as such. Some examples of crimes that may occur in institutions include theft, assault (including sexual assault), and neglect.

Beyond the criminal law, there are other laws as well that prohibit harming residents and can be used to prevent or address against abuse or neglect in institutions. These include special protection laws, general "vulnerability" laws, and laws specifically covering long term institutions, such as a nursing home act. In addition, a health ministry may have specific policies regarding abuse or neglect in long term care facilities.* [See endnote]

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A. Examples of General Laws that Protect People in Institutions from Abuse

In some jurisdictions, laws designed to protect "vulnerable" people who are being abused or neglected may cover adults living in the community and those in institutions.

For example, in British Columbia, Part 3 of the Adult Guardianship Act provides support and assistance to people who are unable to seek support and assistance because of a condition or circumstance that limits their ability to seek help, or affects their ability to make decisions about the abuse or neglect. This section of the British Columbia law covers abuse and neglect occurring in the community and in institutions.

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B. Examples of Abuse Protections in Institutional Laws

Some jurisdictions include abuse protections in their nursing home or care home laws. In Ontario the Nursing Home Act identifies the right of every nursing home resident to be free of physical and mental abuse.

The regulations to Saskatchewan's Personal Care Home Act identify abuse and neglect as "serious incidents" that must be reported to the resident's "supporter" or family member; physician; the department responsible for personal care homes and the health authority.

The laws in some jurisdictions will require that all staff being hired must have criminal records checks. (See Saskatchewan, www.qp.gov.sk.ca/documents/English/Regulations/Regulations/P6-01R2.pdf)

In some cases, a nursing home law will also prohibit operators or staff from engaging in specific kinds of behavior. For example, in Ontario the Nursing Home Act prohibits the licensed operators from persuading a resident to

(i) make or alter a will,

(ii) make a gift,

(iii) provide a benefit for the licensee, the licensee's spouse, relative or friend.

These may be seen as ways of reducing the likelihood of specific kinds of exploitation from occurring.

 ~~~

C. Examples of Special Protection Laws

Alberta has a 1-888 telephone line for reporting abuse of people in certain types of housing or care residences (Phone: 1-888-357-9339). These places include publicly funded hospitals, nursing homes, seniors' lodges and nursing homes. This protection law has a mandatory investigation process.

Alberta’s legislation for the protection of adults in care covers physical, emotional, sexual and financial abuse, as well as abuse by inappropriate use of medication, and intentionally neglecting to provide adequate nutrition or medical attention. (17) Protection of Person in Care consultant investigates reports of abuse or safety concerns for adults in these care facilities in Alberta.

The focus of the Alberta legislation is on "intentional abuse", however a 2003 review recommended removing this requirement.(18) See: www.cd.gov.ab.ca/helping_albertans/persons_in_care/index.asp The focus of the legislation is prevention and education, not punishing offenders.(18)

Criminal cases are required to be diverted to the police. The remaining cases are vetted through the legal department for interpretation and then investigated by existing staff from whichever department is responsible for that particular facility (Community Development, Health or Municipal Affairs). After investigation and if it is considered "substantiated", the situation  is addressed.

The Alberta legislation has mandatory reporting and requires staff to report abuses that come to their attention. There are fines for not reporting. At the beginning of the PPCA program, Alberta initiated an education program for informing seniors, their families and service providers about the Act. Approximately 900 people were trained about the new legislation in workshops in 1998.

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Bill No. 100, is a private Member's bill which received Royal Assent on October 18, 2004. It is expected to come into effect in 2006. It provides special protections for residents under the Homes for Special Care Act or residents in a health facility.

The law places a responsibility on the administrator and service providers providing services in the facility to report abuse. It includes an investigation process, protections for persons making reports (including residents and family),  and fines for contravening the Act (e.g., not reporting).  "Abuse" is not defined in the Act, but may be identified in the regulations that develop.

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A private member's bill with legislation similar to Alberta's was drafted in Saskatchewan in 2002, but it has not been enacted. (17) It would have applied to public and private facilities, including hospitals, personal care homes and special care homes, as well as facilities operated by district health boards.

13. What Happens When Abuse or Neglect Occurs or Is Witnessed in Facilities?

All facilities should have a specific process (a "protocol") for dealing with abuse or neglect situations if they occur.

Abuse Protocols:

These protocols help staff and administration know how to recognize abuse and instruct them on what to do when they encounter it.

Protocols typically set out a number of steps for investigating the situation internally, and reporting to external authorities such as licensing. They also identify reporting other persons who should be informed of the situation, which may include family, or a person with legal authority to speak on the resident's behalf.

The resident is assessed for safety. The incident should be reported to the police where it involves a criminal matter. The response needed in the institution will depend on the type of abuse and who the perpetrator is.

Protocols tend to be incident focussed. They are based on the assumption that the abuse or neglect is the result of an individual staff member. Protocols may not deal with systemic problems such as inadequate staffing or policies that violate senior’s rights.

Intervention:

The immediate intervention in a suspected abuse case is typically left to the facility's operator and the care team.

Some jurisdictions (for example, Ontario, Alberta and Manitoba) have mandatory reporting, where abuse in an institution must be reported to an outside authority.

In British Columbia, the adult care regulations include "abuse" and "neglect" as a "reportable incident" that must be reported to licensing authority. There is a similar requirement in the law governing Saskatchewan's personal care homes. (19)

In many cases, the circumstances may look like abuse or neglect, but the facts of the situation may not have been determined. It is very important that the intervention process supports the resident, and is fair to the staff.

14. Is It Mandatory to Report Abuse in an Institution? If So, Who Must Report?

Most Canadian jurisdictions have some form of mandatory reporting. This requirement recognizes the special vulnerability of the people living there and the responsibility of the operators to provide proper care. See Mandatory Reporting.

When a problem arises, residents may be reluctant to say anything out of fear that the situation may worsen, e.g., abuser may retaliate or the staff may not provide good care. Sometimes, because of vision loss or memory impairment, a resident may be unable to identify the abuser. Sometimes residents are unable to tell someone about the situation because they have a condition that affects their ability to communicate (such as a stroke or Parkinson’s disease).

Family members note that even if they do report abuse, older adults in care may have their credibility or reliability questioned. Many times people may erroneously assume that because the residents are physically disabled, that they are also mentally incapable. That is not accurate.

If a person dies in an institution and there is reason to believe the death occurred as a result of accident, violence or negligence, there is also a legal responsibility on people (including the staff or administration) to inform the local coroner or medical examiner. See Death in the Community or Long Term Care Institutions. This responsibility to report is identified in provincial and territorial coroner or fatalities laws.

15. Is There Protection for Staff Who Report?

Some Canadian jurisdictions provide legal protection for staff or others who report suspected abuse or neglect in an institution, as long as they are making the report in "good faith". For example, in British Columbia, the reporting protections for anyone reporting abuse and neglect are identified in Part 3 of the Adult Guardianship Act . There is a similar protection under the Community Care and Assisted Living Act offering protections for staff who report abuse of people residing in licensed complex care facilities.

Having legal protection and internal supports for staff and others reporting abuse or neglect in institutional settings is very important. Staff may be reluctant to speak up about a problem or concern if they feel it will jeopardize their job. Some may view reporting abuse or neglect as a futile effort, because the problem is systemic. Others may feel intimidated, have divided loyalties, or want to protect their co-workers.

The legal protection for reporting recognizes the importance of addressing the harm early, and helps to encourage people to raise their concerns without fear of retaliation.

16. Is There Protection for the Resident When an Abuse Report is Made?

Many residents and their families are concerned that if they report abuse, neglect or other serious matter, that this will negatively affect the care that the resident receives.

In better run facilities, operators and staff will work hard to make sure this does not happen. They understand and try to reduce any concerns the residents or family members may have about possible retaliation or negative changes in services.

At present, most Canadian jurisdictions do not have a specific law or regulation prohibiting retaliation or threats of retaliation, although it would obviously be a standard of quality care.  Manitoba's Protection for Persons in Care Act prohibits any interruption in the care and services provided to patients and residents.

As of 2004, British Columbia's Community Care and Assisted Living Act expressly prohibits a residential care operator from

This protection does not extend to residents living in assisted living facilities.

17. What Happens When Facility Staff or Administration Suspect Abuse Has Occurred?

During the process of investigation, if a staff member is suspected of abuse or neglect, he or she may be asked to go home or may be suspended (with or without pay). In serious cases, the staff member may be dismissed.

If the accused staff person is a union member, he or she may contest the facility’s "punishment", leading to arbitration of the case. If the abuse involves a family member, the facility may have to take extra steps to assure the resident’s safety. This might include asking the resident if he or she wants to have the person visit, and in the case of resident who wants continued contact with the person, making sure the resident and perpetrator visit in more visible locations.

18. Are Protection Laws Adequate?

Nursing home, personal care home legislation and the protection laws for people in care have come under criticism in several jurisdictions. Among the criticisms:

The special person in care protection laws have also come under special scrutiny. These are some of the concerns that have been expressed:

19. What Are Some Roles for Family and Friends in Abuse Prevention?

In several Canadian jurisdictions (Ontario, Alberta and British Columbia in particular), families and friends of people in institutional settings are becoming actively involved in abuse prevention and early intervention. In some instances, they may be an advocate for the person, helping to identify problems and sometimes aiding staff and administration to find solutions to individual or systemic problems. Others work together through family councils to achieve these same goals. (23)

Recently, Ontario initiated a long term care strategy that would include requiring long term care facilities to have resident councils and family councils. (24)

20. What Are Some of the Other Ways of Encouraging Abuse Prevention and Improving Quality of Care?

There are many ways.

For example, in Quebec, each year the Quebec Network for the Prevention of Elder Abuse recognizes initiatives that reflect promising practices in preventing abuse or neglect. In 2003, they awarded "Honourable Mention" to Maimonides Geriatric Centre in Montreal for the most innovative project concerning the prevention/intervention of elder abuse. The restraint-reduction program at Maimonides also won an Honourable Mention from the Prix d'excellence de l'administration publique Québécoise that same year.

In 2004, Maimonides Geriatric Centre also received an Honourable Mention for its encouragement and support of nurses wanting to receive Gerontology Certification. The award is given by the Canadian Nurses Association.

A Supportive Environment

An abuse-free environment is seldom created by simply having a no-abuse or zero tolerance policy. It is created by developing an entire living environment that is supportive of the rights of residents, promotes quality of care, and addresses the residents' needs. It is also created by having a positive working environment for people who work there, which includes having sufficient staff to meet the residents' needs, so that the staff can provide the residents with needed physical, emotional, social, and spiritual support, care and assistance.

In a supportive environment, creating an abuse free environment becomes an integral component of all the training, policies and practices of the facility.

Endnote

Ontario has recently developed a new draft policy on abuse and neglect in long term care facilities, which among many other things includes provisions for screening and criminal record checks. The draft policy is currently under consultation.

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Interestingly, a recent discussion paper on adult protection in Nova Scotia states that it would be cumbersome to apply the adult protection law to special care homes. It also suggests that "While cases of abuse/neglect may occur in these homes, they are the exception." (pg. 23) It should be noted that placement in special care homes is one of the commonly used interventions in Nova Scotia for abuse or neglect of older adults.

Nova Scotia Dept. of Health. (September, 2004) Adult Protection Act: A Discussion Paper. www.gov.ns.ca/health/ccs/discussion_paper.pdf

References

(1) Statistics Canada. (2002) 2001 Census Analysis Series - Profile of Canadian Families and Households: Diversification Continues Catalogue no. 96F0030XIE2001003 p. 6.

As reported in J. Brzozowski. "Family violence against older adults" in Family Violence in Canada: A Statistical Profile 2004, pg. 30.  Canadian Centre for Justice Statistics. Catalogue no. 85-224-XIE.

Online at: www.statcan.ca/cgi-bin/downpub/listpub.cgi?catno=85-224-XIE2004000

(2) Murtaugh, C.M., Kemper, P.M., Spillman, B. (October, 1990)."The risk of nursing home use in later life". Medical Care, 28 (10), 952-962.

(3) Nebocat, S.A. (1990). "Elder abuse and neglect: borderline situations" in Ronald Roesch, Donald G. Dutton & Vincent F. Sacco (eds.) Family Violence Perspectives on Treatment, Research and Policy. Burnaby, BC, British Columbia Institute on Family Violence, 151-160.

(4) See for example, Protection for Persons in Care Act, 1st Quarterly Report (2003-4), April- June, page 6. Where service providers told residents to use incontinence products (diapers) instead of assisting them to the toilet. Online: www.cd.gov.ab.ca/helping_albertans/persons_in_care/quarterly_reports/QRAprilJune2003.pdf

(5) Spencer, C. (June, 1994). Abuse of Older Adults in Institutional Settings (Ottawa: Health Canada, Mental Health Division)

http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/archives/html/1oldsetenglish.htm#GuidingPrinciples4

(6) Kogut, A.S. (January, 1993). "Assisting nursing home residents who have suffered theft or damage to their personal property" Michigan Bar Journal,72 (1), 50-53.

(7) Brower, H.T. (1992). "Physical restraints: a potential form of abuse" Journal of Elder Abuse and Neglect 4 (4) 47-58.

(8) For example, see the facility policy in Sawatsky v. Riverview Health Centre, [1998] M.J. No. 506 Manitoba Court of Queen's Bench, November 13, 1998.

(9) Belanger, L., Darche, T., de Ravinel, H., & Grenier, P. (1981) Violence et personnes âgées. Montréal: Les cahiers de l’Association québécoise de gérontologie.

(10) College of Nurses of Ontario (1993). Abuse of Clients by RNs and RNAs: Report to Council on Result of Canada Health Monitor Survey of Registrants. Toronto, p. 1-11

(11) Pillemer, K. & Moore, D.W. (1989). Abuse of Patients in Nursing Homes: Findings from a Survey of Staff. Gerontologist, 29(3), 314-320.

(12) Findings of the March 15th 2000, Community Consultation on the Protection of Persons in Care Act,  (Fair ElderCare, Alberta)

(13) Spencer, C. (June, 1994). Abuse of Older Adults in Institutional Settings (Ottawa: Health Canada, Mental Health Division) p. 21. http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/archives/html/1oldsetenglish.htm#GuidingPrinciples4

(14) Macdonald, L. & Collins, A. (2000). Abuse and Neglect of Older adults : A Discussion Paper.

www.hc-sc.gc.ca/hppb/familyviolence/pdfs/Abuse%20and%20Neglect.pdf

(15) Spencer, C. (June, 1994). Abuse of Older Adults in Institutional Settings. (Ottawa: Health Canada, Mental Health Division) p. 21. http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/archives/html/1oldsetenglish.htm#GuidingPrinciples4

(16) Ibid. p. 54.

(17) Protection of Persons in Care Act, Bill 205. See: www.qp.gov.sk.ca/documents/english/Opposition/2002/bill-205.pdf

(18) Alberta Legislative Review Committee. (March 2003) Report on the Review of the Protection of Persons in Care Act. Online at : www.cd.gov.ab.ca/helping_albertans/persons_in_care/Leg_review/CommitteeReport_March2003.pdf

(19) BC Adult Care Regulations. Online at: www.qp.gov.bc.ca/statreg/reg/C/CommuCareAssisted/536_80.htm

(20) Protection for Persons in Care, 2nd Quarterly Report, 2003-4, July- September, p. 7. www.cd.gov.ab.ca/helping_albertans/persons_in_care/quarterly_reports/PPC_2nd_Q_Report%202003-2004.pdf

(21) In Ontario, for example, the nursing home law only talks about the residents' rights to be free from physical or emotional abuse. It does not include neglect.

(22) For example, in 1998, there were 939 reports to the Alberta system. Only approximately 20% were interpreted as being covered by the legislation, and considered founded ("substantiated"). In 2002, 68% of the reports involving allegations of abuse in seniors’ lodges were dismissed due to insufficient evidence of intent or harm.

Protection for Persons in Care, 2002-3 Annual Report. p. 10. www.cd.gov.ab.ca/helping_albertans/persons_in_care/quarterly_reports/annual_report_2002-2003.pdf

Protection for Persons in Care, Fourth Quarterly Report. 1998.

(23) See for example, Dent, L. & Matresky, E.  Family Council Project Panel Presentation Ontario Elder Abuse Conference Proceedings.

(24) "McGuinty government launches comprehensive strategy to protect seniors in long-term care" May 11, 2004 press release. www.newswire.ca/en/releases/archive/May2004/11/c1603.html.

In the Fall, 2003,  Ontario undertook a top-to-bottom review of the long-term care system in the province and to recommend needed reforms. To download a copy of Monique Smith's report "A Commitment to Care: A Plan for Long Term Care in Ontario", go to: www.health.gov.on.ca/english/public/pub/ministry_reports/ltc_04/mohltc_rep04.html

Resources (Click on titles)

Publications

Respecting Your Rights: A Guide to the Rights of People Living in British Columbia's Long Term Care Facilities 

(Gerontology Research Centre, Simon Fraser University)

Every Resident — Bill of Rights for People Who Live in Ontario Long Term Care Facilities (1180KB)
March 2004 ( www.cleo.on.ca/english/pub/onpub/PDF/apr04/everyres.pdf (Advocacy Centre for the Elderly & Community Legal Education Ontario)

Nursing Homes and Homes for the Aged (Advocacy Centre for the Elderly)

Abuse of Older Adults in Institutions — Overview Paper (1999). A Health Canada publication written by I. Enns. Available at the National Clearinghouse on Family Violence Website:

www.hc-sc.gc.ca/hppb/familyviolence/age_e.html

www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/archives/html/1oldsetenglish.htm#GuidingPrinciples4

Returning Home: Fostering a Supportive and Respectful Environment in the Long-Term Care Setting. (2001). A Health Canada publication written by J. Kozak & T. Lukawiecki. Available at the National Clearinghouse on Family Violence Website: www.hc-sc.gc.ca/hppb/familyviolence/age_e.html
 

Stand by Me: Preventing Abuse and Neglect of Residents in Long-Term Care Settings. (2001). A Health Canada publication written by J. Kozak & T. Lukawiecki. Available at the National Clearinghouse on Family Violence Website: www.hc-sc.gc.ca/hppb/familyviolence/age_e.html
 

When Home is Not a Home: Abuse and Neglect in Long-Term Care - A Resident's Perspective. (2001). A Health Canada publication written by J. Kozak & T. Lukawiecki. Available at the National Clearinghouse on Family Violence Website: www.hc-sc.gc.ca/hppb/familyviolence/age_e.html
 

Nursing Home Abuse Risk Prevention Profile and Checklist (November 2005), National Association of State Units on Aging (NASUA). Available at: www.elderabusecenter.org/pdf/publication/NursingHomeRisk.pdf

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Canadian Research

Report on the implementation of the recommendations made in the report Towards a Tightened Safety Net.  [January, 2005]  See pages 10-13.

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Saskatchewan Personal Care Home Act C. 6.01 Reg. 2

www.qp.gov.sk.ca/documents/English/Regulations/Regulations/P6-01R2.pdf

Saskatchewan Special Care Homes, Information provide by Public Legal Education Association of Saskatchewan (2002). www.plea.org/freepubs/sch/schpdf.pdf

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More Specific Information for Manitoba

Parkland Regional Health Authority Policy, Protection for Persons in Care from Abuse

www.prha.mb.ca/regpolicies_files/protection.pdf

The Protection for Persons in Care Act, C.C.C.M. 114. http://web2.gov.mb.ca/laws/statutes/ccsm/p144e.php

Support for Staff During an Investigation (Manitoba) www.gov.mb.ca/health/protection/staffsupport.html

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French Language Resources (Presentations at the 2003 Quebec Elder Abuse Conference)

Provincial Advocacy Groups

Concerned Friends of Ontario Citizens in Care Facilities

140 Merton St, 2nd Floor
Toronto, ON
M4S 1A1

Phone: (416) 489-0146 (Please leave a message)

Website: www.concernedfriends.ca

The website carries a useful checklist to help seniors and families choose a facility that meets their needs.

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Advocates for Care Reform

3348 West Broadway

Vancouver BC

V6R 2B2

Phone: (604) 732-7734 (Please leave a message)

Website: www.vcn.bc.ca/acr/

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