Training to raise awareness and develop prevention, detection and intervention measures - PowerPoint Presentation

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Training to raise awareness and develop prevention, detection and intervention measures - PPT Presentation

Adaptation of training offered by Ligne Aide Abus Aînés elder mistreatment help line Prepared by WestCentral Montreal HealthLigne AAA and FNQLHSSC 1 Objective of the training By the end of this training participants will be able to ID: 631929

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Slide1

Training to raise awareness and develop prevention, detection and intervention measures to counter older adult mistreatment

Adaptation of training offered by: Ligne Aide Abus Aînés (eldermistreatment help line)Prepared by: West-Central Montreal Health/Ligne AAA and FNQLHSSC

1Slide2

Objective of the trainingBy the end of this training, participants will be able to

transmit knowledge and skills related to older adult mistreatment

prevention,

detection and

intervention measures

to people

who have relationships with elders in their community.

2Slide3
Structure of the training

Module 1: Context and definition of mistreatment

Module 2:

Types of mistreatment

Module 3:

Detecting mistreatment

Module 4:

Intervening in situations of mistreatment

Module 5:

Key points

Preparing to become a trainer

Module 6:

Facilitation skillsSlide4

This training is an adaptation of the training offered by West-Central Montreal Health, Ligne Aide Abus Aînés (elder mistreatment help line).Governmental action plan to counter elder mistreatment (2010-2015, MFA)Awareness campaignResearch chair (Sherbrooke University)Regional

coordinators Ligne Aide Abus Aînés (provincial helpline)4

History of the trainingSlide5

Project: Québec Ami D

es Aînés (QADA) Projects with a direct impact on elders (Quebec gov’t.)

Opportunity to adapt and provide this training for trainersThis training promotes active participation, which reflects the approach of the FNQLHSSC

Context of the training for the first nationsSlide6

It is important

not to give names or details

making it possible to

identify

who is being discussed.

For this training and also for interventions in the community,

confidentiality is essential

6Slide7

Introductory activity7

Myths and realitiesSlide8

Myths and realitiesElders are mistreated by people they don’t know.

8Adapted from: Maltraitance envers les aînés, Gouvernement du QuébecSlide9

Myths and realitiesElders will quickly tell someone about their situation of mistreatment.9

Adapted from: Maltraitance envers les aînés, Gouvernement du QuébecSlide10

Myths and realitiesThe risk of being mistreated varies according to the elder’s level of income.

10Adapted from: Maltraitance envers les aînés, Gouvernement du QuébecSlide11

The four needs of first nations’ elders11

1. S __ __ U __ __ T Y

2. S U __ P __ __ T A N D C __ __ E

3. R E __ O __ N I T I __ __

4. I N __ O __ V __ M __ __ T

Source: Brief: Our Elders… Our Identity

(2007)

Slide12

Module 112

Context and definition of older adult mistreatmentSlide13

Objective of the moduleBy the end of this module, participants will

know the basic concepts related to older adult mistreatment.

Module 1: Context and definition of mistreatmentSlide14

Components of module 1Unit 1.1: ContextUnit 1.2: Main theoriesUnit 1.3: What is older adult mistreatment?

14Module 1: Context and definition of mistreatmentSlide15

Unit 1.1Context15Slide16

Some statisticsWhich percentage do you think represents the population aged 65 and older?16

Unit 1.1 Context

Source: Statistics Canada 2011

Canada

first NationsSlide17

Some statisticsWhich percentage do you think is the estimated percentage of the population aged 65 and older in 2031?

17Unit 1.1 Context

Canada

first

Nations

Source:

Statistics

CanadaSlide18

Prevalence of mistreatmentIn your opinion what is the proportion of elders who report being victims of mistreatment in Canada?

18Unit 1.1 Context

Source:

Government action plan to counter elder abuse (2010)Slide19

% of reported mistreatment: according to international studies19

Unit 1.1 Context

Spain (2009)

England (2009)

Israel

(2009) Slide20

Unit 1.2: Main theories regarding older adult mistreatment20Slide21

Unit 1.2: Main theories

The story of the houseplantSlide22

Theories allow us to establish some foundations for understanding the origin of older adult mistreatment.But no theory by itself accounts for all aspects; practitioners thus need:More than one theoretical framework

More than one intervention approachCollaborative action with partners22

Unit 1.2: Main theories

Why more than one theory

?Slide23

Main theories regarding mistreatment1

st statement:This theory is based on the fact that a caregiver can become burned out, and from there become inadequate in the role of caregiver while finding it difficult to carry out all the responsibilities related to that role.…………………..

Unit 1.2: Main theoriesSlide24

Caregiver stress

IMPORTANT: A caregiver can experience a great deal of stress without becoming inadequate.A caregiver can also be the one who is being mistreated.24

Unit 1.2: Main theoriesSlide25

Main theories regarding mistreatment2nd statement:

This theory assumes that a dynamic of conjugal violence in a couple’s relationship will generally be maintained as the couple gets older.………………………

Unit 1.2: Main theoriesSlide26

Conjugal violence

IMPORTANT:The women are not always the ‘victims’ and the men are not always the ‘abusers.’26

Unit 1.2: Main theoriesSlide27

Main theories regarding mistreatment3rd

statement:According to this theory, relationships are built on a principle of balance between the ‘costs’ and ‘benefits’ of the relationship for each of the individuals involved. An unbalanced relationship may lead to the vulnerability of one individual.…………………………….

Unit 1.2: Main theoriesSlide28

InterdependenceIMPORTANT:

It may be difficult for an outside person to evaluate the ‘costs’ and ‘benefits’, which are very subjective (assumptions must be validated with the person concerned).28

Unit 1.2: Main theoriesSlide29

Main theories regarding mistreatment4th

statement:According to this theory, it is necessary to identify the personal characteristics, among the elder and the person who mistreats, which may put the elder at greater risk of being in a situation where mistreatment is present. ……………………..

Unit 1.2: Main theoriesSlide30

PathologyIMPORTANT:If improperly used, this theory can lead practitioners to hasty and possibly wrong conclusions, and result in the labelling of individuals

.30

Unit 1.2: Main theoriesSlide31

Victim

Labelling

Any generalization concerning

mistreatment

is dangerous. Be careful not to jump to conclusions and label people; this can be very

harmful

Unit 1.2: Main theories

AbuserSlide32

Unit 1.3: What is older adult mistreatment?32Slide33

How do we define mistreatment?“Older adult mistreatment is a single or repeated

act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm

or distress to an older person

.”

(Adapted from World Health Organization, 2002)

Unit 1.3: What is

mistreatment?Slide34

Two main forms of mistreatmentViolence

Treat an older adult badly or force an older adult to act against his/her will, through the use of force and/or intimidationNeglect

Fail to show concern for an older adult, in particular due to a lack of appropriate action for meeting his/her needs.

Unit 1.3: What is

mistreatment?Slide35

intentional mistreatment vs. unintentional mistreatmentUnintentional

The person does not want to harm the older adult or does not understand the harm being caused.

IntentionalThe person who is mistreating an older adult

wants to harm him/her.

Unit 1.3: What is mistreatment?

Difference

in the intentions

of the person presumed to be mistreating the elderSlide36

Module 236

Types of mistreatmentSlide37

Objective of the module37Module 2: Types of mistreatment

By the end of this module, participants will be able to

recognize

and

distinguish between

the various types of mistreatment and to

know

their

harmful effects

on the elder

.Slide38

Components of module 2Unit 2.1: Psychological mistreatmentUnit 2.2: Physical and sexual mistreatmentUnit 2.3: Material or financial mistreatment

Unit 2.4: Violation of rights and organizational mistreatmentUnit 2.5: Ageism38

Module 2: Types of mistreatmentSlide39
For any type of mistreatment

Regardless of the type of mistreatment, the consequences for the elder must never be under-estimated.The types of mistreatment are not all exclusive

and may be superimposed on one another.We need to be aware of signs of mistreatment, but without being tempted to jump too quickly to conclusion.

39Slide40

Distinguish between signs and indicators40

Signs

Indicators

Observable facts requiring evaluation to know if they are linked to a situation of mistreatment.

Observable facts that have been evaluated and confirm the existence of a situation of mistreatment

.Slide41

41Types of mistreatment

Module 2: Types of mistreatmentSlide42
Unit 2.1: Psychological mistreatment

Gestures, words or attitudes which harm psychological well-being or integrity

.Violence: Emotional blackmail, manipulation, humiliation, insults, infantilization, belittlement verbal and non-verbal threats, disempowerment, excessive monitoring of activities, etc.

Neglect: Rejection, indifference, social isolation, etc.

42Slide43
Examples of possible signs of

psychological mistreatment signsFear;Apathy;

Anxiety;Symptoms of depression;Withdrawal into oneself;Hesitation to speak openly;

Mistrust;Interacts fearfully with one or more persons;

Rapid decline of cognitive capacities;

Suicidal ideas;Suicide;

Etc.

43Slide44

Psychological mistreatment – what to keep in mind:

Psychological mistreatment is probably the most frequent type of mistreatment. It very often accompanies the other types of mistreatment.44Slide45

Unit 2.2: Physical mistreatment45

Inappropriate gestures or actions, or absence of appropriate actions, which harm physical well-being or integrityViolence: shoving, bullying, hitting, burning, force-feeding, inadequate administration of medications, inappropriate use of restraints (physical or chemical), etc.

Neglect: Deprivation of reasonable conditions for ensuring comfort or safety; no support provided for eating, getting dressed, hygiene or taking medications when one is responsible for another person in a situation of dependency, etc. Slide46
Examples of possible signs of

physical mistreatment signs:Bruises;Injuries;

Weight loss;Deteriorating health;Poor hygiene;Undue delay in changing of incontinence pads;

Skin conditions;

Unsanitary living environment;Atrophy;

Use of contraints;Premature or suspicious death;

Etc

46Slide47

Physical mistreatment – what to keep in mind:

We may at times, and wrongly, believe that older people’s capacity for being aggressive diminishes with age. Indications of physical violence may be interpreted as symptoms of certain medical conditions. 47Slide48

Sexual mistreatmentGratuitous gestures, actions, words or attitudes with sexual connotations, which are harmful to sexual well-being, integrity or identity.

Violence: Suggestive comments or attitudes, jokes or insults with sexual connotations, promiscuity, exhibitionist behaviours, aggressive actions of a sexual nature (unwanted touching or caresses, non-consensual sex), etc.Neglect: Deprivation of privacy, non-recognition or denial of sexuality and sexual orientation,

etc.

48Slide49

Examples of possible signs of sexual mistreatmentInfections; Genital and/or wounds;Anxiety when being examined or given care;Mistrust;Withdrawal into oneself;

Depression;Sexual disinhibition;Sudden onset of highly sexualised language;Denial of the older adult sex life;Etc. 49Slide50

Sexual mistreatment – what to keep in mind:

Not recognizing an elder’s sexuality prevents the observing and reporting of sexual mistreatment

Cognitive impairment may lead to disinhibition, in turn leading to inappropriate sexual behaviours.

Sexual aggression is above all an act of domination.Slide51

Unit 2.3: Material or financial mistreatmentFraudulent, illegal, unauthorized or dishonest acquisition or use of the person’s property or legal documents; absence of information or misinformation on financial or legal matters.

Violence: Pressure exerted to change a will, bank card used without consent, excessive price demanded for services provided, misappropriation of money or assets, identity theft, etc.Neglect: Failure to manage the person’s assets in his/her best interest or to provide for those under one’s responsibility, failure to evaluate the person’s capacities, understanding and literacy in financial matters,

etc.

51Slide52

Is it exploitation?It is acceptable if:The parent is competent and is in agreement;The needs of the parent are met;The amount is fair in terms of the help provided and in terms of the parent’s financial resources

.52Is it

acceptable to receive money from a parent whom you are helping out?Slide53

Examples of possible signs of mistreatment signsUnusual banking transactions;

Disappearance of valuable objects;Lack of money for ongoing expenses;Limited access to information about management of the person’s assets;Etc.

53Slide54

Financial mistreatment: organized fraudFraud is a form of exploitation that is occurring more and more often.An individual relies on the trust that the elder has in him or an institution in order to trick the elder out of his money

.54Slide55

Financial mistreatment – what to keep in mind:

Financial mistreatment can influence elders’ ability to carry out their daily responsibilities.Elders who present a form of dependency on someone else (physical, emotional, social, etc.) are more at risk of being victims of this type of mistreatment.55Slide56

Unit 2.4 Violation of rightsNot recognizing the fundamental rights of an older adult

(any infringement of individual & social rights and freedoms).Violence: Imposed medical treatment, denial of the right to: choose, vote, enjoy one’s privacy, take risks, receive telephone calls or visitors, practice one’s religion, live one’s sexual orientation, etc.

Neglect: Non-information or misinformation concerning the older adult’s rights, failure to provide assistance in exercising his/her rights, non-recognition of his/her capacities

, etc.

56Slide57

Examples of possible signs of violations of right

Preventing the older adult from participating in the choices and decisions affecting him/her, Non-respect of the decisions made by the older adult,

Answers given by a family member to questions addressed to the older adult,

Restriction of visits or access to information,Isolation,

Complaints,Etc.

57Slide58

Violation of rights- what to keep in mind:

All persons fully retain their rights as they grow older.

Only a judge can declare a person incompetent and appoint a legal representative.

Persons declared incompetent still retain their rights, which they may exercise according to their capacities

.Slide59

Organizational mistreatment (care and services)Any harmful situation created or tolerated by the procedures of institutions responsible for providing care and services, and which compromise users’ exercise of their rights and freedoms.

Violence: Organizational conditions or practices leading to non-respect of user’s choices or rights, lack of personalized care, failure to adapt the institution and services to the individual, etc.

Neglect: Lack of resources (budget, time, staff) and services, inadequate training of staff, etc.

59Slide60

Examples of possible signs of organizational mistreatment

Treating the person as a number;Largely inflexible care schedule;

Needs not met;

Failure to provide assistance for meals or hygiene care;Undue delay in changing of incontinence pads;

Wounds;

Deteriorating health;

Inadequate care;

Etc.

60Slide61

Organizational mistreatment – what to keep in mind:

We need to look critically at the shortcomings of the system, which could harm elders’ rights.It may be necessary to advocate for the rights of older adults. Each organizational structure has a complaints procedure.61Slide62

Unit 2.5 AgeismDiscrimination due to age, resulting in hostile or negative attitudes, harmful actions or social exclusion.

Violence: Imposition of restrictions or social standards due to age, reduction of access to certain resources, prejudice, infantilization, scorn, etc.Neglect: Indifference shown when witnessing ageist practices or comments, etc.

62Slide63

Examples of signs of ageism

Non-recognition of rights;Non-recognition of competencies or knowledge;Condescension;

Etc.

63Slide64

Ageism – what to keep in mind:

We are all influenced, to varying degrees, by negative stereotypes held concerning elders. These are ‘ready to use’ reactions which lead to wrong and hasty conclusions about various social realities.We can combat ageism by being aware that these ‘ready to use’ reactions exist and by identifying them when they appear.64Slide65

Regardless of the type of mistreatment, the consequences for the elder must never be under-estimated.

Shame, humiliation, sadness, angerFear, psychological distressIsolation, marginalization

Poverty, diminished quality of lifeInjuries, illnesses, overall deterioration in health

Depression, suicide, premature death

For all types of mistreatmentSlide66

Module 366

Detecting mistreatmentSlide67

Objective of the moduleBy the end of this module, the participants will be aware of the importance of knowing the risk factors for mistreatment and the tools that are available to detect it

.67Module 3: Detecting mistreatmentSlide68

Components of module 3Unit 3.1: Why detect?Unit 3.2: Risk factorsUnit 3.3: Screening tools

68Module 3: Detecting mistreatmentSlide69

Unit 3.1Why detect mistreatment?69Slide70

True or false?

70Slide71

Acts of mistreatment are often committed in public.

True or false

True or False

Slide72

Elders who are being mistreated are comfortable with the idea of disclosing the name of the person who is mistreating them.

True or false

True or False

Slide73

Mistreatment is a taboo form of violence.

True or false

True or False

Slide74

The severity and frequency of acts of mistreatment committed against an elder tend to diminish with time.

True or false

True or False

Slide75

Early and adequate intervention can prevent the violence from escalating and limit the consequences for the elder.

True or false

True or False Slide76

Advantages of detection

Allows identification of the risks or presence of mistreatmentAllows preventive interventionsAllows evaluation of the risk levelAllows prioritization of future interventions

Unit 3.1: Why detect?

Challenges of detection

dvantages and challenges of detection

With age, people are more likely to undergo loss of autonomy, which can increase their vulnerability to mistreatment

One must check to see whether

signs

of mistreatment may be linked to other problemsSlide77

Unit 3.2Risk factors77Slide78

Risk factor, sign or indicator?78

Risk factors

Signs

Indicators

Observable facts requiring evaluation to determine if they are linked to a situation of mistreatment

Attributes, characteristics or exposure of a person, which increases the probability of developing a disease or undergoing trauma

Observable and evaluated factsSlide79

Risk factors“A risk factor is an element belonging to an individual or within the environment

that is likely to cause a disease, trauma or any other disruption to a person’s integrity or development.”

Source: Fougeyrollas et al., 1998:34

79Slide80

Risk factorsRisk factors for the elder and/or the person who (allegedly) mistreats:

80Unit 3.2: Risk factors

History of violenceStrained or difficult

family tiesPresence of

cognitive lossesMental health

problems

Addictions

(drugs, alcohol, gambling, etc.)

Social isolation

Insufficient financial resources

Relation of

dependency

on another person

The elder and the abuser

live together

Crisis situation or intense stress

Minority status

Disruptive behavioursSlide81

Risk factorsSpecific to the elderAdvanced age

Problems of mobility or communicationHesitancy to disclose the mistreatment, fear of the public system

Lack of knowledge of one’s rights and what mistreatment isSpecific to the

person who (allegedly) mistreatsBeing in an imposed helping relationship

, not being comfortable with certain forms of care to give Having

little knowledge

about the care to give

Unit 3.2: Risk factorsSlide82

Risk factors specific to the first nations’ contextLinguistic barrierDifferent perception of public services

Generation gapRupture of social linksPovertyHousing shortage and overcrowded housingContext of geographical isolation

Diminishing of traditional ways of lifeDiminishing of the traditional role of elders

Residential school experienceComplicated government jurisdictions

Unit 3.2: Risk

factorsSlide83

Protective factorsIntrinsic to the person

Self-esteemAbility to ask for helpUnderstanding of one’s emotions

Social participation

Ability to learn about self and societyMaintain good lifestyle habits

Unit 3.2: Risk

factorsSlide84

Protection factorsExtrinsic to the personNetwork

Environment Financial capacity84

Unit 3.2: Risk factorsSlide85

85Unit 3.3: Screening toolsSlide86

Some analysis and screening tools86Slide87

Some analysis and screening tools

Risk factors checklist for older adult mistreatment with additional factors of vulnerability for First Nations communities. (West-Central Montreal Health

/AAA Help Line/FNQLHSSC

, 2014).

Tool based on risk factors, applicable to all involved persons

Risk

Assessment of Persons Living at Home: A Decisional Aid

(CLSC Métro and

Public Curator

2004)

Risk analysis grid

: used by workers to situate the risk factors in the context of an intervention plan

Caregiver Abuse Screen (CASE

)

(Namiash and Shrier,1992)

Screening and intervention tool used by caregivers for self-evaluation purposes

Elder

Abuse Suspicion Index

(EASI)

(Yaffe, Lithwick et al., 2006)

Tool

created to allow general practitioners to identify any need for a more in-depth

psychosocial evaluation

87Slide88

Tool for recognizing risk factors concerning all persons involved in a situation of mistreatment

(Training by West-Central Montreal Health, Aide Abus Aînés Help Line, 2014)

Risk factors

hecklist for older adult mistreatment with additional factors of vulnerability for First Nations CommunitiesSlide89

89Risk Assessment of Persons Living at Home: A Decisional Aid

Excerpt from a more generalized tool which includes: checklist, risk analysis grid, criteria from Hospitals Act of Nova Scotia, and elements for looking at ethical issuesSlide90
Identifying risk factors

Clinical exercise

90Unit 3.3: Risk factorsSlide91

CASETool made up of 8 questions 1. Do you sometimes have trouble making [… ] control his/her temper or aggression?2. Do you often feel you are being forced to act out of character or do things you feel badly about?

3. Do you find it difficult to manage [… ] ‘s behaviour?91

Self-evaluation tool developed for

caregiversSlide92
CASE (suite)

4. Do you sometimes feel that you are forced to be rough with [… ]? 5. Do you sometimes feel that you can’t do what is really necessary or what should be done for [… ]?

6. Do you often feel you have to reject or ignore [… ]?7. Do you often feel so tired and exhausted that you cannot meet [… ] ‘s needs?8. Do you often feel you have to yell at [… ]?

92Slide93
CASE: advantages

Shows caregivers that it is normal to experience difficultiesHelps caregivers gain awareness concerning mistreatmentCreates openness (non-judgemental) in order to look at the possible support interventions that a caregiver can engage in

93Unit 3.3: Screening toolsSlide94

EASITool created for family doctors, in order to quickly identify elder at risk of being mistreated.

94Unité 3.3: Screening toolsSlide95
EASI

Question 1 to Q 5: asked of older adult and Q 6 answered by doctor1. Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?

2. Has anyone prevented you from getting food, clothes, medication, glasses, hearing aides or medical care, or from being with people you wanted to be with? 3. Have you been upset because someone talked to you in a way that made you feel shamed or threatened? 95Slide96
Easi (suite)

4. Has anyone tried to force you to sign papers or to use your money against your will?5. Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically? Question 6: answered by doctor.6. Doctor: Elder mistreatment may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months?

96Slide97
EASI: Advantages

Covers the main types of mistreatment in just a few questionsProvides words or ways to address mistreatment, directly but in a respectful manner.Very useful for psychosocial intervention and evaluation teams

97Unit 3:3: Screening toolsSlide98

Module 498

Mistreatment interventionSlide99

Objective of the moduleBy the end of this module, participants will be able to integrate the principles

and the approach involved in mistreatment intervention in order to assist elders in making their choices and in taking any necessary related steps.Module 4: M

istreatment intervention

99Slide100

Components of module 4Unit 4.1: Values, principles and attitudesUnit 4.2: Professional responsibilities and approachUnit 4.3: Intervention sectorsUnit 4.4: Specialized resources

Unit 4.5: Specific resourcesModule 4: Mistreatment intervention

100Slide101

Unit 4.1Values, principles and attitudes105Slide102

102Slide103
Intervention principles

103

To provide guidance to practitioners

Respect choices

and promote the dignity of the person;Encourage the

maintenance or improvement

family ties (when possible);

Seek

human solutions

, supported by the law and ethics;

Reduce social

isolation

;

Promote

collaboration

with your team’s members and with community partners

.Slide104
attitude of mutual support to adopt

Avoid being a judge or …

104Slide105
attitude of mutual support to adopt

…a saviour

105Slide106

Unit 4.2Professional responsibilities and approach106Slide107

In Quebec, there is no legislation requiring mandatory reporting of situations involving older adult mistreatment. All professionals are bound by adherence to confidentiality and professional secrecy.

Professional responsibilities107Slide108
Professional responsibilities by order of priority

Evaluate the risk and ensure the immediate safety

of the personEvaluate the ability of the person to give his/her consent

to our interventionRespect

protocols, procedures and professional

obligations

108Slide109

Contact emergency services (consent should be sought but it is not mandatory)Develop the instinct of thinking about our own safety as well

Immediate risk to safety or integrity109

109Slide110
Person’s decision-making ability

Evaluate the person’s ability to give his/her consent to our interventionAbility to give consent: respect the person’s choices

Inability to give consent: obtain substitute consent and ensure response to the basic needs of the person110Slide111

Respect protocols, procedures and professional obligationsAs established for our workplace

As part of our professional order or association, if applicable

111Slide112
Intervention objectives

Ensure the immediate safety of the personRespect the principle of self-determinationOffer assistance and protection to the elder Offer assistance to the presumed mistreating person, when possible

Avoid doing harm112Slide113

Three profiles of elders113

Acknowledges the existence of the mistreatment and accepts the

intervention:

Provide assistance for an emergency and establish an emergency plan.Help the person find solutions.

Provide the required services or direct the person to the appropriate resources

Stay in touch and continue to monitor the situation;

Reduce the elder’s isolation and create a safety net;

Provide the required services or direct the person to the appropriate services;

Provide assistance in a crisis situation

Acknowledges the existence of the mistreatment

but

REFUSES

the intervention

Does not

acknowledge

the existence of the mistreatmentSlide114

The approachAn intervention should be:

MultidisciplinaryMulti-sectorial

Coordinated

114Slide115

Allows you to explore different intervention strategiesAllows for contributions by all intervention sectors involved (medical, legal, social)Ensures better understanding of the practitioner’s limitations and responsibilities vis-à-vis the elder’s rights. Advantages of a collaborative and coordinated intervention

115Slide116

As a practitioner, you are responsible for the means, not the ends.

116Slide117

Unit 4.3Intervention sectors117Slide118

The different intervention sectors

118Slide119

Family and friends’ network

The family nucleus, including the immediate family, the extended family, friends and even close neighbours

119Slide120

Health sector

Refers to the services offered by the

ealth centre or nursing station, according to the reality of each community

120Slide121

Community

Refers to the available community activities, services and/or resources, with or without the support of the Council or health

entre (or other organization).

121Slide122

Medical sector

Refers to medical services in or away from the community

122Slide123

Secteur hébergement

Housing sector

Refers, for example, to the living environment in which care is given, when it is no longer possible to maintain the elder at home.

123Slide124

Social

services sector

Refers to the available social services offered in the community

124Slide125

Legal sector, including the Band Council

Refers to such services as police, peacekeepers, lawyers, notary, etc

125Slide126

Mistreatment may include acts of a criminal nature.Depending on the case, legal intervention may be considered in order to:Protect the elderBring the act in question to an end

Provide compensation for an elder who has been subjected to a criminal actEnsure that the elder learns about the possible consequences of legal intervention (criminal record, ban on contact) and that the elder is directed to the right resourceLegal sector: criminal acts

126

126Slide127

Distinction between criminal and non-criminal actions127Slide128

Unit 4.4Specialized resources128Slide129
List of specialized resources

Quebec Public Curator and consent for care in a context of legal incompetence;CDPDJ (Commission des droits de la personne et des droits de la jeunesse / human rights and youth rights commission);CAVAC (Centre d’aide aux victimes d’actes criminels /crime victims’ assistance centre);

CALACS (Centre d’aide et de lutte contre les agressions à caractère sexuel / centre for relief of sexual assault);Complaints procedure.

129Slide130

Quebec public curatorwww.curateur.gouv.qc.ca1-800-363-9020

(Practitioners must consult the «pivot» (primary contact) appointed for the Public Curator in their CSSS before contacting the Public Curator directly)130Slide131

Quebec public curatorMission:The public Curator is responsible for protecting incapacitated individuals.To ensure that decisions are made in the best interest of the represented individual, taking into consideration the protection of their rights

and the safeguard of their autonomy.131Slide132

IncapacityIncapacity is evaluated medically and socially:Incapacity to person or to property;Partial or total incapacity; Temporary or permanent incapacity.

An individual is considered apt until they are legally declared inapt or incapacitated (by a judge).An individual has a right to refuse a competency evaluation (except in cases of immediate danger to self or others, or when court ordered).132Slide133

Opening of a protective regimeTwo conditions necessary (Article 145)

Determination of incapacity (inability to make decisions related to their person or property);Need for protection (need of assistance to exercise their rights) .

133Slide134

Measures of ProtectionPrivate: the legal representative is a close family member or concerned partyHomologated incapacity mandatePrivate tutorship

(partial) Private curatorship (total to person, to finance) Public: if no family or significant other available or not appropriate, the PC will represent the individual

Public tutorship Public curatorship

134Slide135

Public curatorPossible interventions … Signalement is possible to PC in order to ensure

the safety and well-being of an individual if:The person is under a protective regime (tutorship or curatorship public or private; homologated mandate)

ORA medical and psychosocial evaluation stating the incapacity of the individual have been completed (the PC will invoke urgent interim measures if necessary while awaiting a final court decision)

135Slide136

«Audi partem Alteram»:The right to be heard Every decision relating to the institution of protective supervision or concerning a protected person of full age shall be in his interest, respect his rights and safeguard his autonomy.

(art. 257)The legal representative should always consult the person they represent and encourage respect for their choices to the extend of their capabilities. 136Slide137
According to Quebec law:

A person can not be subjected to treatment without consent (even if such care is necessary to sustain life), unless there is a court order;The medical team must always obtain the consent of the person before providing treatment (unless consent is impossible to obtain within the context of a life threatening emergency).

Consent to care under the law137Slide138

Regardless of the degree of incapacity (total or partial), the person retains his/her fundamental right to consent or to refuse treatment (exams, tests, treatments, placement, etc.) Distinction between general incapacity «in a sphere» (to property or to person) and the ability to consent to a particular treatment.

Even if a person is incapacitated, under a protective regime or not, we have to evaluate his or her capacity to consent to any new treatment being proposed .Consent for treatment according to the law

138Slide139

Five-pronged Test set out in the Hospitals Act of Nova ScotiaDoes the person understand:Their illness and condition?

The nature and purpose of proposed treatment?The risks associated with the proposed treatment?The risks associated with the refusal of the treatment?

Is the person’s current state or illness effecting their capacity to consent to care?

Evaluation of one’s capacity to consent to care

139Slide140

Civil Code of Quebec (article 16)«The authorization of the court is necessary (… ) where a person of full age who is incapable of giving his consent

categorically refuses to receive care, except in the case of hygienic care or emergency.» Categorical refusal (Kouri et Philips-Nootens, 2003): Firm ‘No’ without ambiguity;

No doubt as to the refusal expressed; Not a result of a biological reflexive response.

Categorical Refusal

140Slide141

Procedure for consent to care (for incapacitated adults)RP = represented personLR = legal representative

Adapted from the Public Curator (2009)by Ligne Aide Abus Aînés

Able to consent according to the Nova Scotia criteria

RP accepts treatment

Under protective regime

RP refuses treatment

Advise LR and provide treatment

Advise LR do not give treatment

Under protective regime

Consult LR

LR and RP accepts treatment

LR and/or RP refuses categorically

Give the treatment

Treating team must obtain court order if they want to give the treatment

Not under protective regime

Consult person who can provide substitute consent

Person who gives consent and RP accepts treatment

Person who gives consent refuses or RP refuses categorically

Treating team must obtain court order if they want to give the treatment

Give the treatment

Incapacitated person requiring treatment

Not able to consent according to the Nova Scotia criteriaSlide142

Procedure for consent to care (for incapacitated adults)Adapted from the Public Curator (2009)by Ligne Aide Abus Aînés

RP = represented personLR = legal representative142

Able to consent according to the Nova Scotia criteria

RP accepts treatment

Under protective regime

RP refuses treatment

Advise LR and give treatment

Advise LR Do not give treatment

Incapacitated person requiring treatmentSlide143

procedure for consent to care (for incapacitated adults) – cont.RP = represented personLR = legal representative

Adapted from the Public Curator (2009)By Ligne Aide Abus Aînés

143

Under protective regime

Consult the LR

LR and RP accepts treatment

LR and/or RP refuses categorically

Give the treatment

Treating team must obtain court order if they want to give the treatment

Incapacitated person requiring treatment

Not able to consent according to the Nova Scotia criteriaSlide144

Procedure for consent to care (for incapacitated adults) – cont.RP = represented personLR = legal representative

Adapted from the Public Curator (2009)By Ligne Aide Abus Aînés

144

Not under protective regime

Consult person who can provide substitute consent

Person who gives consent accepts and RP accepts treatment

Person who gives consent refuses or RP refuses categorically

Treating team must obtain court order if they want to give the treatment

Give treatment

Incapacitated person requiring treatment

Not able to consent according to the Nova Scotia criteriaSlide145

Conflicting perceptions regarding the person’s capacity to consent; Family members’ comprehension of the law;

Disputes between family members regarding «best interests» of the incapacitated person;Challenges and conflicts among the members of the treatment teams…… Clinical challenges in supporting the rights of incapacitated persons

145Slide146

Commission des droits de la personne et des droits de la jeunesse

www.cdpdj.qc.ca1-800-361-6477

146Slide147

Quebec Charter of Human Rights and Freedoms

ARTICLE 48«Every aged person and every handicapped person has a right to protection against any form of exploitation.Such a person also has a right to the protection and security that must be provided to him by his family or the persons acting in their stead.»

147Slide148

Sees to the respect of the principles in the Charter of Human Rights and FreedomsMinistry of Seniors Action Plan (2010):Setting up of a specialized team for treatment of exploitation of seniors cases (article 48)

Free services Role of the Commission148Slide149

The Commission only gets involved in situations of exploitation.“Profit from the state of vulnerability and dependence of the person to satisfy one’s own interests and, by acting this way, causing harm

” All situations of mistreatment are not situations of exploitation in the sense of the Charter of Human Rights.exploitation

149Slide150

Vulnerability of the senior ‘victim’(physical, economic, psychological dependence, etc.)Profit of taking advantage of a situation by a person in a position of strength, of power(monetary benefit or other)Prejudice for the ‘victim’

Exploitation: elements to document150Slide151
Investigation

Following a complaint or on the initiative of the CommissionConsent of the ‘victim’ strongly desired, but not mandatory(e.g., concern for other potential victims)

Expanded legal powers (Act respecting public inquiry commissions)Intervention by the Commission

151Slide152
As needed, submit request to the emergency measures court

Mediation process, amicable agreement Formulation of normal requests by the Commission to: Cease a behaviourProvide financial compensation

Request by the Commission of the Court, to obtain measures that it deems adequate.Possible interventions

152Slide153

Specialized resources

Centre d’aide aux victimes d’actes criminels (CAVAC – crime victims assistance centre)Centre d’aide et de lutte contre les agressions à caractère sexuel (CALACS – centre for relief of sexual assault)

153Slide154

Specialized resources Complaints procedure

Complaints commissionerCentre d’aide et d’assistance aux plaintes (CAAP – complaints assistance centre)Users’ committee

154Slide155

Unit 4.5Specific resources155Slide156

Specific resources concerning older adult mistreatment:- Guide de référence pour contrer la maltraitance envers les personnes aînées (Reference guide to counter older adult mistreatment)- Ligne AAA (elder mistreatment help line)

156Slide157

Guide de rérérence pour contrer la maltraitance envers les personnes aînées (Reference guide to counter older adult mistreatment)https://www.mfa.gouv.qc.ca/fr/publication/Documents/13-830-10F.pdf

To listen to the Web talk on the presentation of the Guide by its creators:http://caringvoicenetwork.adobeconnect.com/p6349p3pbd6/

157Slide158
Table of contents (p.

XXV)158

Recognize mistreatment

Prevent

Identify

Intervene

Coordinate organizations

Coordinate interveners

Know legal measures

Present solutionsSlide159
Services continuum (

p.4)159Slide160

Ligne Aide Abus Aînés – elder mistreatment help linewww.aideabusaines.ca1-888-489-2287

(514-489-2287)

160Slide161
Services provided by Ligne Aide Abus Aînés

Province-wide telephone service (free and confidential)7 days a week (8 a.m. to 8 p.m.)Services provided by professionalsInformation, listening, support

One-time intervention (crisis intervention if necessary)Guidance/referral to other resourcesClientsElders or other people concerned by a possible situation of mistreatment

161Slide162
Services provided by Ligne Aide Abus Aînés

Professional consultation service(practitioners involved in mistreatment issues/cases)Clinical and ethical discussions

Identification of the elements to evaluateSuggested avenues for action and intervention priorities (to be validated with your team)

162Slide163
Each call for professional consultation is discussed with the clinical supervisor for Ligne AAA

Where necessary, the professionals with Ligne AAA may refer to the Provincial multisectorial consultation team for intervention in older adult mistreatment of West-Central Montreal HealthLinks with West-Central Montreal Health

163163Slide164

The provincial multisectorial consultation team of West-Central Montreal Health

Social worker

Public curator

Notary

Medical representative

Police officers

(City police

)

Hospital and long-term care facility managers

istreatment prevention regional coordinator

Lawyers in civil law and criminal law