Developing Abuse Prevention Policies & Procedures to Investigate Complaints August 2007

Transcription

1 Developing Abuse Prevention Policies & Procedures to Investigate Complaints August 2007 Nova Scotia Association of Health Organizations 2 Dartmouth Road Bedford, NS B4A 2K7

2 Please Note The purpose of this document is to assist organizations in developing their own abuse prevention policy and investigation procedures. The administrator of the health care facility (employer) is responsible for preparing appropriate policies and procedures for their organization. This includes monitoring their effectiveness, reviewing and updating them as required, ensuring that all employees and volunteers are aware of the policy and are provided appropriate training and support August 2007

3 Developing Abuse Prevention Policies & Procedures to Investigate Complaints 1. Introduction In response to the Protection of Persons in Care Act, hereafter referred to as the Act (See Appendix A for a copy of the Act) NSAHO has developed the following information package 1. The Act applies to hospitals under the Hospitals Act; residential care facilities, nursing homes or homes for the aged, regional rehabilitation centres, group homes and developmental residences under the Homes for Special Care Act; or institutions or organizations designated as a health facility by the regulations. The purpose of this document is to assist the above noted organizations to develop policies and procedures to prevent abuse of patients and residents and to investigate allegations of abuse of residents and patients within the workplace. It is suggested that employers develop, or review existing abuse prevention policies and procedures using the following information as a guideline. 2. Why is it Important? Ensuring that sound policies and procedures are in place will first and foremost, assist in safety of the individual resident or patient, but also help employers meet their obligations under the Act. The ultimate goal of the Protection of Persons in Care Act is to keep people in care free from harm. By working together to increase understanding and awareness of abuse, it will happen less often. However, when abuse does occur, it is important that everyone understands how they are expected to respond, not only according to the legislation, but also to facility policies and procedures. 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. 1 This information package has been adapted from the Ontario Human Rights Commission s Developing Procedures to Resolve Human Rights Complaints within your Organization, June 19, 1996 as well as the Canadian Human Rights Commission s Anti-Harassment Policies for the Workplace: An Employer s Guide. See References for a list of other sources August 2007

4 Organizations need to foster an environment in which reporting is not only accepted but required; this holds true not only for employees but also volunteers, family members, residents or patients. This kind of environment is created through clear policies and procedures, consistent and fair application of them, education, training and support as well as discussing issues of abuse openly and regularly such as at staff meetings. All of these things will facilitate disclosure, information sharing and learning among staff and volunteers. According to the Protection for Persons in Care Regulations: 3 (1) Subject to subsection ( 2) (See Appendix B for the Regulations Respecting Persons in Care made pursuant to Section 18 of Chapter 33 of the Acts of 2004, the Protection for Persons in Care Act) in the Act and the regulations abuse means, with respect to adult patients or residents, any of the following: (a) the use of physical force resulting in pain, discomfort or injury, including slapping, hitting, beating, burning, rough handling, tying up or binding; (b) mistreatment causing emotional harm, including threatening, intimidating, humiliating, coercing or restricting from appropriate social contact; (c) the administration, withholding or prescribing of medication for inappropriate purposes; (d) sexual contact, activity or behavior between a service provider and a patient or resident; (e) non-consensual sexual contact, activity or behaviour between patients or residents; (f) the misappropriation or improper or illegal conversion of money or other valuable possessions; (g) failure to provide adequate nutrition, care, medical attention, or necessities of life without valid consent. (2) Abuse does not occur in situations in which a service provider carried out their duties in accordance with professional standards and practices and health facility based policies and procedures Note: According to the PPC Act adult means a person 16 years of age or older. See Appendix C for Additional Definitions of Abuse. Abuse within health facilities is against the law and administrators of health facilities (employers) can be held legally responsible for failing to take action against abuse August 2007

5 It is important to stress to your staff that if they have a reasonable basis to believe that a patient or resident is, or is likely to be, abused that they must promptly report the belief, and the information on which it is based, to the Minister or the Minister's delegate. In determining whether an employer is liable or not, courts will look for evidence of due diligence : o Were all allegations of abuse treated seriously and investigated promptly? o Were instances of abuse resolved as soon as the administrator (employer) became aware of them? o Did the employer do their best to mitigate the effects of abuse? o Was action taken to prevent any further abuse? When combined with education and support for staff, individuals and their families, legislation and policy creates an integrated approach for the prevention of abuse. 3. Responsibilities under the Protection of Persons in Care Act Employer Responsibility The administrator of a health facility under the Act: Has a duty to protect the patients or residents of the facility from abuse and to maintain a reasonable level of safety for the patients or residents. Shall report to the Minister all allegations of abuse against a patient or resident that come to the knowledge of the Administrator. When required to give information or produce a record or other thing shall give the investigator all reasonable assistance and all information that the investigator reasonably requires. Within the time the Minister specifies, shall comply with the Minister s directions 2 and give the Minister a written report describing what action has been taken or will be taken to comply. Shall not take adverse employment action against a service provider of the facility because that person made a report of abuse in good faith under the Act. Shall not alter, interrupt or discontinue, or threaten to alter, disrupt or discontinue, service to a patient or resident or to a person who has made a report of abuse under the Act, or to a relative of either of them who receives services from the facility, because a report of abuse has been under this Act in good faith. Employee Responsibility The service provider (a person who provides services to a patient or resident and is employed by, or provides service on behalf of, a health facility) under the Act: 2 The Minister may give the administrator of the health facility involved any directions the Minister considers necessary to protect the patient or resident from abuse August 2007

6 Who has a reasonable basis to believe that a patient or resident is, or is likely to be, abused shall promptly report the belief, and the information on which it is based, to the Minister or the Minister s delegate. Can be required by the government s investigator to give information about a matter being investigated and produce for examination or copying any record or other thing, including personal health information that is personal information under the Freedom of Information and Protection of Privacy Act or any other enactment that, in the investigator s opinion, relates to the matter being investigated and that may be in the person s possession or control Guidelines for Developing an Abuse Prevention Policy These guidelines should provide a useful framework. The following elements should be part of any complete strategy to prevent abuse and to resolve abuse allegations that may arise in the workplace: an abuse prevention policy; a complaint-resolution procedure; on-going education programs: and ongoing support to staff. Policy A policy statement should make it clear that abuse will not be tolerated. The policy should describe the types of behavior that are unacceptable, and should send the message that management will treat abuse seriously. It should also clearly delineate how the employer expects staff and volunteers to prepare for and respond to certain situations. Policies should include: a declaration by the organization indicating the kind of environment that they are committed to creating and that there will be zero tolerance of abuse; a definition of abuse 4 ; examples of abuse; what the reporting obligations of staff are; and a brief description of both the PPC and the Internal investigation. All employees should be aware of this policy. It should be: distributed to everyone when it is introduced; shared with new employees during orientation; and processes put in place to allow for ongoing communication and dialogue. See Appendix D for a sample abuse prevention policy. 3 This applies not only to service providers but any person who is able, in the investigator s opinion, to give information about a matter being investigated. 4 This definition needs to be consistent with the Act. It is recommended that health care facilities consider adopting the definition of abuse as outlined in the Act August 2007

7 5. Guidelines for Developing Internal Investigation Procedures for Allegations of Abuse According to the NS PPC Act: 8 (1) On receiving a report of abuse under this Act, the Minister shall inquire into the matter and shall consider whether a more extensive investigation is warranted. (2) Where, after inquiry, the Minister finds there are reasonable grounds to believe that a patient or resident is being abused or is likely to be abused, the Minister shall appoint an investigator to carry out a more extensive investigation. In addition to PPC Investigation, the administrator is responsible for completing an internal investigation. Generally, an internal investigation of an abuse allegation will follow the following four steps: 1. Preparing for the Investigation 2. Interviews and Information Gathering 3. Analysis and Report 4. Decision and Implementation Preparing for the Investigation o An allegation of abuse is made. The policy will identify to whom the report should be made. o Determine whether this is an issue that needs to be referred to the police and/or a professional college in addition to the internal investigation process. Appoint an investigator and a decision maker. They should not be the same person. If possible the organization should train several individuals to be investigators and decision makers to ensure there is always someone available who is trained and seen as objective to investigate. The Decision Maker The organization should select someone in authority who is best suited within their organization to serve as decision maker (someone who is seen as having authority) and select an alternative in case that individual is unavailable. It is important to address the issue in advance of who would be the alternate if the decision maker is named in the allegation (for example, who would be the alternate if the administrator is the appointed decision maker and is named in the allegation) August 2007

8 The Investigator The investigator should: be properly trained; be independent; not be a union employee; be seen as objective not in a position of direct authority over anyone involved in the complaint; have no conflict of interest; and not be involved in the allegation of abuse. Investigators must know about abuse in general, the internal policy and procedures, and the Act. The investigator must make all efforts to ensure that the investigation process is confidential and minimizes harm to the resident and patient. The duty to report under the Act applies even if the information on which the person s belief is based is confidential and its disclosure is restricted by legislation or otherwise, but it does not apply to information that is privileged because of a solicitor-client relationship. The investigator should ensure that both the person making the complaint and the person against whom it is made know how the internal procedure works. o The investigator develops a plan to conduct the investigation that outlines all steps to be followed: prepare a summary of the information you need to collect; decide which documents you need to gather and in what order. This includes the resident/client record; decide who you will speak to and in what order; decide when and where you will conduct interviews; and prepare questions in advance. o The investigator compiles a description of the alleged events or situation: when did it happen dates and times of events; where did it happen; who was involved; and who saw it happen witnesses. Interviews and Information Gathering o The investigator maintains accurate records of all the information that is collected. o During interviews the investigator should take detailed notes of information provided. The investigator should not try to summarize during the interview August 2007

9 o Information recorded should include: date, time, location and duration of interview; names of people interviewed; names of anyone present at the interview; information provided during the interview; and descriptive information, i.e. Mary was crying. o Notes should be: read carefully to ensure they are accurate and complete; kept in a safe place; available to the administrator of the health facility (employer); and not discarded. o When interviewing the person who reported the alleged abuse(complainant) or the alleged victim of the abuse: it is critical that the investigator understand the nature of the complaint; and it is not required to have the complaint in writing; however it is critical that the investigator has documented detailed information regarding the complaint. o When interviewing witnesses: interview anyone who may have first hand knowledge of the complaint; interview witnesses identified by the person being investigated; assure witnesses that there is no penalty for participation and that they are expected to cooperate; and encourage witnesses to recount only first hand information. Rumor, innuendo or speculation should be given little weight unless independently confirmed. o When interviewing the person alleged to have committed the abuse : the individual is entitled to procedural fairness: o Right to be heard, to tell his/her story. o Right to have support/representation of his/her choice during all discussions. o Right to know the complaint in sufficient detail to respond. o Right to identify witnesses or evidence. it is important for the investigator to be courteous and professional; the individual may be upset, emotional or angry. It is important to ensure that information is gathered anyway; and the investigator should note not only the details of the response but the circumstances. Analysis and Report o An investigation is complete when the investigator has interviewed everyone with knowledge, when there are no unanswered questions, and when the investigator can report on what happened August 2007

10 o The investigator writes a report and submits it to the decision maker; the report should include a summary of all the above information and the conclusions of the investigator. o Both parties should be given the opportunity to provide comments on the investigation report before it is finalized. Decision and Implementation o An official decision must follow the investigator s report. The decision should include a summary of the investigator s findings and should detail what action will be taken. 6. Other Investigation Considerations Timelines Investigations should start after an investigator is chosen, and finish within a reasonable timeframe, for example, 30 to 60 days. The timelines will depend on the resources of the organization, availability of participants and accessibility of information. Union Rights Ultimate accountability lies with the administrator of the health care facility (employer). The administrator holds the liability under the Act. Always consult your collective agreements to determine what measures are appropriate when working with unionized employees. Other considerations include normal practice" of the organization as well as the preference of the person alleged to have committed the abuse. Protection from Reprisal Persons who make a complaint, as well as anyone else who is involved, should not be penalized for doing so. This is called "reprisal". Protection from reprisal covers: complainants; witnesses; representatives of complainants and witnesses; investigators; and decision makers/management. False Accusations To knowingly accuse someone of abuse falsely, or in bad faith, is a serious offense. If allegations of abuse are found to have been made in bad faith disciplinary action may be taken August 2007

11 7. Education and Training Education is an important part of preventing abuse. Training programs for all staff are essential to ensure that everyone knows what the rules are and how they will be applied. It is critical that employees understand how their employers expect them to handle certain situations. Everyone responsible for enforcing the policy or advising on procedures should be thoroughly educated about the policies and procedures. Investigators and decision makers should receive additional specialized training in order to properly carry out their roles. An organization s abuse prevention education program should be comprehensive and ensure that: employees understand what abuse is, how to prevent abuse, how to respond if they witness or suspect it, who to report it to etc.; there are structures/processes in place to support staff in disclosing and discussing instances of abuse; all new employees and managers attend education sessions; refresher courses are provided; every employee receives a copy of the policy and understands it. Some employers ask their employees to sign a statement that they have read and understand the abuse prevention policy. You may wish to consider this, as it reinforces the fact that your organization takes the problem of abuse seriously; and there is a strong emphasis on prevention of abuse. Effective abuse prevention programs include training and education on things like: signs and symptoms of abuse; practices and strategies to prevent abuse; and reinforcement of the principles of appropriate resident or patient care, sensitivity to residents or patients, communication skills and problem solving strategies. Training increases awareness, builds skills, and promotes greater sensitivity to residents and patients August 2007

12 References Canadian Human Rights Commission. Anti-Harassment Policies for the Workplace: An Employer s Guide. National Clearing House on Family Violence, Public Health Agency of Canada. Abuse of Older Adults in Institutions. National Clearing House on Family Violence, Public Health Agency of Canada. Preventing Abuse and Neglect of Residents in Long-Term Care Settings. National Defence, Canada. Harassment Prevention and Resolution Guidelines. July, National Defence, Canada. Harassment Investigators Training Guide. July, National Centre on Elder Abuse. National Association of State Units on Aging, Washington, D.C, USA Ontario Human Rights Commission. Developing Procedures to Resolve Human Rights Complaints within your Organization. June, 19, Persons with Developmental Disabilities, Alberta Provincial Board. Abuse Prevention and Response Protocol. January, Protection of Persons in Care Act. Bill Number 110. Royal Assent October 18, Seniors Secretariat. Nova Scotia Elder Abuse Strategy: Toward Awareness and Prevention (2005). Tracy McPhee, Human Resource Consultation, NSAHO provided advice and resources for the development of this document. Various policies of NSAHO members were reviewed on abuse, neglect, harassment etc August 2007

13 Appendix A Protection of Persons in Care Act Be it enacted by the Governor and Assembly as follows: 1 This Act may be cited as the Protection for Persons in Care Act. 2 In this Act, (a) "health facility" means (i) a hospital under the Hospitals Act, (ii) a residential care facility, nursing home or home for the aged or disabled persons under the Homes for Special Care Act, or (iii) an institution or organization designated as a health facility by the regulations; (b) "investigator" means an investigator appointed pursuant to this Act; (c) "Minister" means the member of the Executive Council assigned responsibility for the administration of this Act by the Governor in Council; (d) "patient" means a patient as defined in the Hospitals Act; (e) "resident" means a resident under the Homes for Special Care Act or a resident in a health facility designated pursuant to clause (a)(iii); (f) "service provider" means a person who provides services to a patient or resident and is employed by, or provides the services on behalf of, a health facility. 3 This Act binds Her Majesty in right of the Province. 4 (1) The administrator of a health facility has a duty to protect the patients or residents of the facility from abuse and to maintain a reasonable level of safety for the patients or residents. (2) The administrator of a health facility shall report to the Minister all allegations of abuse against a patient or resident that come to the knowledge of the administrator. 5 (1) A service provider who has a reasonable basis to believe that a patient or resident is, or is likely to be, abused shall promptly report the belief, and the information on which it is based, to the Minister or the Minister's delegate August 2007

14 (2) The duty to report applies even if the information on which the person's belief is based is confidential and its disclosure is restricted by legislation or otherwise, but it does not apply to information that is privileged because of a solicitor-client relationship. 6 (1) Any person who has a reasonable basis to believe that a patient or resident is or likely to be, abused may report the belief, and the information on which it is based, to the Minister or the Minister's delegate. (2) A person may report under subsection (1) even if the information on which the person's belief is based is confidential and its disclosure is restricted by legislation or otherwise, but it does not apply to information that is privileged because of a solicitorclient relationship. 7 A patient or resident may report abuse against himself or herself to the Minister or the Minister's delegate. 8 (1) On receiving a report of abuse under this Act, the Minister shall inquire into the matter and shall consider whether a more extensive investigation is warranted. (2) Where, after inquiry, the Minister finds there are reasonable grounds to believe that a patient or resident is being abused or is likely to be abused, the Minister shall appoint an investigator to carry out a more extensive investigation. (3) As soon as practicable after appointing an investigator, the Minister shall notify the patient or resident that a report of abuse has been made and that an investigation is to be conducted. (4) Notwithstanding subsection (3), where the patient or resident has a guardian under the Incompetent Persons Act, a person to whom the patient or resident has given authorization under the Medical Consent Act or an attorney under the Powers of Attorney Act to make decisions on patient's or resident's behalf, the notice referred to in subsection (3) is to be given instead to the guardian, person or attorney, as the case may be, unless the Minister determines it is inappropriate to do so based on the nature of the allegations. 9 (1) For the purpose of investigating a report of abuse under this Act, an investigator may enter a health facility at any reasonable time, on presenting identification when requested to do so. (2) An investigator may require any person who is able, in the investigator's opinion, to give information about a matter being investigated to (a) give the information to the investigator; and (b) produce for examination or copying any record or other thing, including personal health information that is personal information under the Freedom of Information and Protection of Privacy Act or any other enactment that, in the investigator's opinion, August 2007

15 relates to the matter being investigated and that may be in that person's possession or control. (3) The administrator of a health facility and any person required to give information or produce a record or other thing shall give the investigator all reasonable assistance and all information that the investigator reasonably requires. (4) A justice of the peace who is satisfied by information on oath that an investigator has been prevented from exercising the investigator's powers under this Section may at any time issue a warrant authorizing the investigator, and any other person named in the warrant, to exercise those powers. (5) Nothing in this Section abrogates a privilege that may exist because of a solicitorclient relationship. 10 (1) On completing an investigation, the investigator shall set out the investigator's conclusions and the reasons for them in a report and give it to the Minister. (2) When making a report, the investigator shall try, to the fullest practical extent, to involve the patient or resident and to determine and accommodate the patient's or resident's wishes. (3) The Minister shall retain all records related to an investigation. 11 (1) On receiving an investigator's report under Section 9, the Minister may give the administrator of the health facility involved any directions the Minister considers necessary to protect the patient or resident from abuse. (2) The Minister shall give a copy of the directions to (a) the patient or resident about whom the investigation was conducted or, where subsection 8(4) applies, to the guardian, person or attorney referred to in that subsection, as the case may be, unless the Minister determines it is inappropriate to do so based on the nature of the allegations; and (b) any other person the Minister considers should be notified, having regard to the nature of the abuse reported and the need to protect the patient's or resident's privacy. (3) Within the time the Minister specifies, the administrator of the health facility shall comply with the Minister's directions and give the Minister a written report describing what action has been taken or will be taken to comply. 12 (1) Where the Minister believes on reasonable grounds that a person has abused a patient or resident or has failed to comply with the duty to report under Section 5, the Minister may refer the matter to the body or person that governs the person's professional August 2007

16 status or that certifies, licenses or otherwise authorizes or permits the person to carry on the person's work, profession or occupation. (2) A body or person that receives a report under subsection (1) shall (a) investigate the matter to determine whether a professional status review or disciplinary proceedings should be commenced against the person; and (b) on conclusion of the investigation and any review or proceedings, advise the Minister of the determination under clause (a), the reasons for the determination, and, where applicable, the results of any professional status review or disciplinary proceedings. (3) Where a referral is made under this Section to a body or person that the Minister considers can deal appropriately with the matter, the Minister may decide not to appoint an investigator under Section 8, or may defer doing so. 13 No action or other proceeding may be brought against a person for making a report of abuse under this Act in good faith. 14 (1) No administrator of a health facility shall take adverse employment action against a service provider of the facility because that person made a report of abuse in good faith under this Act. (2) No administrator of a health facility or other person shall alter, interrupt or discontinue, or threaten to alter, interrupt or discontinue, service to a patient or resident or to a person who has made a report of abuse under this Act, or to a relative of either of them who receives services from the facility, because a report of abuse has been made under this Act in good faith. 15 The Minister may delegate to any person any power conferred or duty imposed on the Minister by this Act. 16 No action for damages or other proceeding may be brought against the Minister, an investigator or any other person acting under the authority of this Act or engaged in administering it for (a) anything done in good faith in performing or intending to perform a duty or in exercising or intending to exercise a power under this Act; or (b) any neglect or default in performing a duty or exercising a power in good faith under this Act. 17 (1) A person who contravenes this Act is guilty of an offence and is liable on summary conviction to (a) in the case of an individual, a fine of not more than two thousand dollars; and August 2007

17 (b) in the case of a corporation, a fine of not more than thirty thousand dollars. (2) A person who makes a report of abuse under this Act, knowing it to be false, is guilty of an offence and is liable on summary conviction to a fine of not more than two thousand dollars. (3) A prosecution under this Act may not be commenced more than two years after the alleged offence is committed. 18 (1) The Governor in Council may make regulations (a) designating institutions or organizations as health facilities for the purpose of this Act; (b) respecting any other matter the Governor in Council considers necessary or advisable to carry out effectively the purpose of this Act.; (c) defining any word or expression used but not defined in this Act; (d) deemed necessary or advisable by the Governor in Council to carry out effectively the intent and purpose of this Act. (2) The exercise by the Governor in Council of the authority contained in subsection (1) is regulations within the meaning of the Regulations Act. 19 This Act comes into force on such day as the Governor in Council orders and declares by proclamation August 2007

18 Appendix B Protection for Persons in Care Act Regulations Schedule A Regulations Respecting Persons in Care made pursuant to Section 18 of Chapter 33 of the Acts of 2004, The Protection for Persons in Care Act Citation 1 These regulations may be cited as the Protection for Persons in Care Regulations. Definitions 2 (1) In these regulations, (a) (b) Act means the Protection for Persons in Care Act; adult means a person 16 years of age or older. (2) In subsection 8 (2) of the Act, investigation includes a referral of an allegation of abuse to the appropriate police service and receipt of information concerning the disposition of the allegation from the police service. 3 (1) Subject to subsection (2), in the Act, and these regulations, abuse means, with respect to adult patients or residents, any of the following: (a) (b) (c) (d) (e) (f) the use of physical force resulting in pain, discomfort or injury, including slapping, hitting, beating, burning, rough handling, tying up or binding; mistreatment causing emotional harm, including threatening, intimidating, humiliating, harassing, coercing or restricting from appropriate social contact; the administration, withholding or prescribing of medication for inappropriate purposes; sexual contact, activity or behaviour between a service provider and a patient or resident; non-consensual sexual contact, activity or behaviour between patients or residents; the misappropriation or improper or illegal conversion of money or other valuable possessions; August 2007

19 (g) failure to provide adequate nutrition, care medical attention or necessities of life without valid consent. (2) Abuse does not occur in situations in which a service provider carried out their duties in accordance with professional standards and practices and health facility based policies and procedures. Designation of health facilities 4 A group home or residential centre that has adult residents and is approved or licensed under the Children and Family Services Act is hereby designated as a health facility under the Act August 2007

20 Appendix C- Additional Definitions of Abuse The Public Health Agency of Canada: Physical inflicting physical discomfort, pain or injury. Psychological diminishes the identity, dignity and self-worth of the individual. Financial also known as material or property, the misuse of money or property Neglect failure of a care provider to meet the needs of the individual who is unable to meet those needs alone. Other violating the individual s rights. The Nova Scotia Elder Abuse Strategy: Toward Awareness and Prevention (2005): elder abuse is the infliction of harm on an older person. Abuse is any act or failure to act that endangers the health and/or well being of the older person. Such action or inaction is especially harmful when it occurs within a relationship where there is an expectation of trust. Abuse may be: Physical inflicting, or threatening to inflict, physical pain, injury, or discomfort on an older adult. Sexual any form of sexual activity with a person without the consent of that person. Emotional / Psychological inflicting mental pain, anguish, or distress on an older person through verbal or nonverbal acts. Financial the unethical or illegal misuse of the money, property, or other assets of an older adult, including placing inappropriate pressure on an older person in order to gain access to her or his assets. Violation of Human / Civil Rights the unlawful or unreasonable denial of fundamental rights and freedoms normally enjoyed by adults. Neglect the failure to provide the necessities of life such as proper food, fluids, suitable clothing, a safe and sanitary place of shelter, proper medical attention, personal care, and necessary supervision. There are several forms of neglect, including active neglect, passive neglect, self-neglect, and abandonment. U.S National Centre on Elder Abuse: abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. Broadly defined, abuse may be: Physical Abuse - Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need. Emotional Abuse - Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts. Sexual Abuse - Non-consensual sexual contact of any kind. Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder. Neglect - Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder. Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person August 2007

21 Appendix D Sample Abuse Prevention Policy POLICY TITLE: Abuse Prevention and Response POLICY NUMBER: 6 DATE ISSUED: February, 2006 LAST REVIEW: LAST REVISION: [This is the organization s declaration around what kind of environment they are committed to creating and maintaining. It is important to indicate that your organization will not tolerate abuse.] Policy: Health Facility Name will not tolerate any physical or psychological, verbal, financial or sexual abuse of any persons within our facility. Rationale: Health Facility name is committed to respect, maintain and advocate the personal integrity, dignity and safety of all persons within our facility. [This is where the organization defines what it considers to be abuse. It is important to let your staff and volunteers know what your organization considers to be abuse. It is critical to ensure that the definition of abuse in your organizational policy covers all that is defined as abuse in the Regulations under the Protection of Persons in Care Act. Your organization may choose to expand on the definition as provided in the PPCA Regulations. See Appendix C for Additional Definitions of Abuse] According to the Protection for Persons in Care Regulations: 3 (1) Subject to subsection ( 2) (See Appendix B. Regulations Respecting Persons in Care pursuant to Section 18 of the Chapter 33 of the Acts of the Protection for Persons in Care Act) in the Act and the regulations abuse means, with respect to adult patients or residents, any of the following: (h) the use of physical force resulting in pain, discomfort or injury, including slapping, hitting, beating, burning, rough handling, tying up or binding; (i) mistreatment causing emotional harm, including threatening, intimidating, humiliating, coercing or restricting from appropriate social contact; (j) the administration, withholding or prescribing of medication for inappropriate purposes; (k) sexual contact, activity or behavior between a service provider and a patient or resident; (l) non-consensual sexual contact, activity or behavior between patients or residents; (m) the misappropriation or improper or illegal conversion of money or other valuable possessions; (n) failure to provide adequate nutrition, care, medical attention, or necessities of life without valid consent August 2007

22 (2) Abuse does not occur in situations in which a service provider carried out their duties in accordance with professional standards and practices and health facility based policies and procedures Note: According to the PPC Act adult means a person 16 years of age or older. [It is important for an organization to provide examples of actual abuse, it can sometimes be difficult to take the more abstract definition and understand what it means in terms of behaviours.] Examples of abuse include but are not limited to: unnecessary use of physical force inappropriate use of restraints hitting, pinching, shoving, pushing handling roughly speaking to the person harshly and or name calling ignoring the person or restricting social contact sexual advance, sexual touching denial of food, water, medication theft financial-i.e. intentional with holding of funds Other- i.e. involving a resident or patient in research or providing treatment or procedures without his or her consent All staff and volunteers of Health Facility Name have a responsibility to ensure that residents or patients are treated with respect and dignity, live free from harm, and do not experience abuse. All employees, agency workers and volunteers who suspect or witness abuse, must report it to the administrator immediately. Employees and agency workers also have a duty to report abuse under the Protection of Persons in Care Act, which is posted [location of where it is posted in your facility]. [Organizations need to ensure that their service providers are aware what their reporting requirements are both within the facility and under the Protection of Persons in Care Act as well as internally. It is important to note what your expectations are of volunteers and family members within your organization. The policy should note to whom to report the abuse to prevent any confusion or mishandling of complaints.] The Administrator ( employer) is committed to ensuring that all allegations of abuse will be properly and carefully investigated. All interviews and information obtained or recorded shall be dealt with as confidentially as is possible. Investigations and decisions will be made in as timely a manner as possible August 2007

23 [The policy should include a statement that all allegations of abuse will be investigated thoroughly and in a timely manner; the actual steps of the investigation are part of a practice and are better dealt with through procedures.] Reprisal will not be tolerated and will be acted upon. [Need to let staff know that retaliation against the victim, those who report or those who are witnesses will not be tolerated by the organization and will result in disciplinary action.] Allegations made in bad faith will not be tolerated and will be acted upon. Under the Protection of Persons in Care Act a person who makes a report of abuse knowing it to be false, is guilty of an offense and is liable on summary conviction to a fine of not more than two thousand dollars. [Need to ensure staff knows that making false allegations of abuse will result in serious consequences.] Approved by: Date: August 2007