Six Pressing Issues when Living in Residential Care - Revision history

Charmaine Spencer: /* Addressing abuse or neglect when it happens */

2016-05-13T14:14:11Z

Addressing abuse or neglect when it happens

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	The response to the abuse or neglect situation will depend on the type of harm and who was involved. The operator has a responsibility to investigate the allegation or the known situation. Staff if involved may be suspended, with or without pay during the investigation and in some cases may be fired, although if unionized, they may grieve the response. If a matter is a crime, facility operators are expected to call the police.		The response to the abuse or neglect situation will depend on the type of harm and who was involved. The operator has a responsibility to investigate the allegation or the known situation. Staff if involved may be suspended, with or without pay during the investigation and in some cases may be fired, although if unionized, they may grieve the response. If a matter is a crime, facility operators are expected to call the police.

	Abuse or neglect situations involving care aides that the care facility operators find are supported by the evidence, are expected to be reported to the BC Care Aide & Community Health Worker Registry to be further investigated (Note : While operators cannot be compelled to report to the Registry, a duty to report is part of the contractual responsibilities of publicly funded operators to the Ministry of Health or health authority, see: http://www.cachwr.bc.ca/About-the-Registry/Employer-FAQ.aspx). (For more information on the process see Chapter Three “Rights, Remedies and Problem Resolution”).		Abuse or neglect situations involving care aides that the care facility operators find are supported by the evidence, are expected to be reported to the BC Care Aide & Community Health Worker Registry to be further investigated (Note : While operators cannot be compelled to report to the Registry, a duty to report is part of the contractual responsibilities of publicly funded operators to the Ministry of Health or health authority, see: http://www.cachwr.bc.ca/About-the-Registry/Employer-FAQ.aspx). That report to the Registry is to be made with seven days of the suspected staff member being suspended or terminated, pending investigation. (For more information on the process see Chapter Three “Rights, Remedies and Problem Resolution”).

	If the incident is considered well founded, the care aide worker may be de-registered, which ~~prevents~~ him or her from working in publicly funded care facilities in the province. Care aides cannot be de-registered for general competence issues.		If the incident is considered well founded, the care aide worker may be de-registered, which will prevent him or her from working in publicly funded care facilities in the province. Care aides cannot be de-registered for general competence issues.

	===Video-surveillance and abuse or neglect===		===Video-surveillance and abuse or neglect===

Charmaine Spencer: /* Abuse and Neglect */

2016-05-13T14:10:55Z

Abuse and Neglect

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	The response to the abuse or neglect situation will depend on the type of harm and who was involved. The operator has a responsibility to investigate the allegation or the known situation. Staff if involved may be suspended, with or without pay during the investigation and in some cases may be fired, although if unionized, they may grieve the response. If a matter is a crime, facility operators are expected to call the police.		The response to the abuse or neglect situation will depend on the type of harm and who was involved. The operator has a responsibility to investigate the allegation or the known situation. Staff if involved may be suspended, with or without pay during the investigation and in some cases may be fired, although if unionized, they may grieve the response. If a matter is a crime, facility operators are expected to call the police.

	Abuse or neglect situations involving care aides that the care facility operators find are supported by the evidence, are expected to be reported to the BC Care Aide & Community Health Worker Registry to be further investigated (Note : ~~Operators~~ cannot be compelled to report to the Registry). (For more information on the process see Chapter Three “Rights, Remedies and Problem Resolution”). If the incident is considered well founded, the care aide worker may be de-registered, which prevents him or her from working in publicly funded care facilities in the province. Care aides cannot be de-registered for general competence issues.		Abuse or neglect situations involving care aides that the care facility operators find are supported by the evidence, are expected to be reported to the BC Care Aide & Community Health Worker Registry to be further investigated (Note : While operators cannot be compelled to report to the Registry, a duty to report is part of the contractual responsibilities of publicly funded operators to the Ministry of Health or health authority, see: http://www.cachwr.bc.ca/About-the-Registry/Employer-FAQ.aspx). (For more information on the process see Chapter Three “Rights, Remedies and Problem Resolution”).

			If the incident is considered well founded, the care aide worker may be de-registered, which prevents him or her from working in publicly funded care facilities in the province. Care aides cannot be de-registered for general competence issues.

	===Video-surveillance and abuse or neglect===		===Video-surveillance and abuse or neglect===

Charmaine Spencer: /* References */

2016-05-13T13:55:20Z

References

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	#See: WorkSafe BC. Communicate patient information. Prevent violent based injuries to health care and social services workers. Workplace BC notes that s. 22(3) (a) of FIPPA is often misunderstood and misapplied in this area.		#See: WorkSafe BC. Communicate patient information. Prevent violent based injuries to health care and social services workers. Workplace BC notes that s. 22(3) (a) of FIPPA is often misunderstood and misapplied in this area.
	#(April 2002). Guidelines: Code White Response - a component of prevention and management of aggressive behaviour in health care. BC Workers Compensation Board/Health Coalition of BC/OHSAH.		#(April 2002). Guidelines: Code White Response - a component of prevention and management of aggressive behaviour in health care. BC Workers Compensation Board/Health Coalition of BC/OHSAH.
	#Ministry of Health. (2012). Best practice guideline for accommodating and managing behavioural and psychological symptoms of dementia in residential care a person-centered interdisciplinary approach. Online : http://www.health.gov.bc.ca/library/publications/year/2012/bpsd-guideline.pdf [Last accessed ~~April 30~~, ~~2014]~~		#Ministry of Health. (2012). Best practice guideline for accommodating and managing behavioural and psychological symptoms of dementia in residential care a person-centered interdisciplinary approach. Online : http://www.health.gov.bc.ca/library/publications/year/2012/bpsd-guideline.pdf (Last accessed May 10, 2016)
	#RCR, s.77 (1) to (3).		#RCR, s.77 (1) to (3).
	#See Coroner ~~Services,~~ Eldon Mooney.		#See Report of the Coroner into the death of Eldon Mooney. 2011-0278-0032. North Vancouver, July 16, 2011. Online : http://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/reports/investigative/mooney-eldon.pdf (Last accessed May 10, 2016).
	#Vancouver Island Health Authority. Community Care Licensing Program. Reportable and non-reportable incidents – information for caregivers. Online: http://www.viha.ca/NR/rdonlyres/B669541E-FB61-4416-AF73-AE4647534F0C/0/ReportableandNonreportableIncidents.pdf ( Last accessed May 10, 2016).		#Vancouver Island Health Authority. Community Care Licensing Program. Reportable and non-reportable incidents – information for caregivers. Online: http://www.viha.ca/NR/rdonlyres/B669541E-FB61-4416-AF73-AE4647534F0C/0/ReportableandNonreportableIncidents.pdf ( Last accessed May 10, 2016).
	#ACE.		#ACE.

Charmaine Spencer: /* What Do We Mean? */

2016-05-13T13:48:18Z

What Do We Mean?

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	“Abuse” and “neglect “in residential care generally means a deliberate intention to harm a resident, or a high degree of recklessness or indifference to the resident. Any other harms resulting from lack of understanding, poor procedures or documentation, inadequate training, or inadequate staffing are more commonly characterized as “quality of care” concerns or issues related to “non-compliance with standards”. However, the line between neglect and poor quality of care is not always clear in residential care.		“Abuse” and “neglect “in residential care generally means a deliberate intention to harm a resident, or a high degree of recklessness or indifference to the resident. Any other harms resulting from lack of understanding, poor procedures or documentation, inadequate training, or inadequate staffing are more commonly characterized as “quality of care” concerns or issues related to “non-compliance with standards”. However, the line between neglect and poor quality of care is not always clear in residential care.

	The terms “abuse “ and “neglect “ as used in the Residential Care Regulations are also somewhat different than those used by the Adult Guardianship Act, where the definitions are statutory thresholds for action and focus on deliberate harms causing significant loss. See Figure 1.		The terms “abuse “ and “neglect “ as used in the Residential Care Regulations are also somewhat different than those used by the Adult Guardianship Act, where the definitions are statutory thresholds for action and focus on deliberate harms causing significant loss. See Figure 1. The Residential Care Regulations (s. 52 (2))also prohibit the use of food or fluids as a reward; they are considered a type of mistreatment.

	===Figure 1===		===Figure 1===

Charmaine Spencer: /* Resident to Resident Harms */

2016-05-13T08:48:45Z

Resident to Resident Harms

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	Care facility operators have a general responsibility to promote the health and safety of all residents, and to protect them from harm. This includes harms from other residents. Resident to resident conflict or aggression can have a significant effect on the emotional and physical well-being of the residents and others in the facility.		Care facility operators have a general responsibility to promote the health and safety of all residents, and to protect them from harm. This includes harms from other residents. Resident to resident conflict or aggression can have a significant effect on the emotional and physical well-being of the residents and others in the facility.

	It has been estimated that 11 per cent of the care facility residents are “aggressive” at some point. ([[{{PAGENAME}}#References\|29]]) Drawing on available ~~limited~~ data, the Office of the Seniors Advocate ~~estimated~~ there were between 425 and 550 reports of resident to resident aggression in 2014/15 ~~throughout the province~~. ([[{{PAGENAME}}#References\|30]]) In some instances this can lead to serious injury, even death. The geriatric literature now uses the term “responsive behaviour” to recognize the fact that “aggressive“ residents are often responding (inappropriately) to situations that are frightening to them or causing confusion, Residents may be responsive for many reasons, often it is because of confusion caused by dementia, inadequately addressed pain or an underlying medical condition that is not under control. The resident to resident harms can occur in general residential care facilities as well as those with special dementia units.		It has been estimated that 11 per cent of the care facility residents are “aggressive” at some point. ([[{{PAGENAME}}#References\|29]]) Drawing on available data, the Office of the Seniors Advocate concluded there were between 425 and 550 reports throughout the province of resident to resident aggression causing harm in 2014/15. ([[{{PAGENAME}}#References\|30]]) In some instances this can lead to serious injury, even death. The geriatric literature now uses the term “responsive behaviour” to recognize the fact that “aggressive“ residents are often responding (inappropriately) to situations that are frightening to them or causing confusion, Residents may be responsive for many reasons, often it is because of confusion caused by dementia, inadequately addressed pain or an underlying medical condition that is not under control. The resident to resident harms can occur in general residential care facilities as well as those with special dementia units.

	The Residential Care Regulation requires care facility operators to report “aggressive or unusual behaviour”. This is defined as “aggressive or unusual behaviour by a person in care towards other persons, including another person in care, which has not been appropriately assessed in the care plan of the person in care.”([[{{PAGENAME}}#References\|31]])		The Residential Care Regulation requires care facility operators to report “aggressive or unusual behaviour”. This is defined as “aggressive or unusual behaviour by a person in care towards other persons, including another person in care, which has not been appropriately assessed in the care plan of the person in care.”([[{{PAGENAME}}#References\|31]])

Charmaine Spencer: /* References */

2016-05-13T08:46:40Z

References

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	# See, for example, E. Fleury & H. Campbell. Recent legal developments video surveillance in care homes. Online: http://cnpea.ca/en/blog/520‐recent‐legal‐developments‐video‐surveillance‐in‐carehomes?highlight=WyJudXJzaW5nIiwiaG9tZSIsImhvbWUncyIsIm51cnNpbmcgaG9tZSJd&hitcount=0 (Last accessed May 10, 2016).		# See, for example, E. Fleury & H. Campbell. Recent legal developments video surveillance in care homes. Online: http://cnpea.ca/en/blog/520‐recent‐legal‐developments‐video‐surveillance‐in‐carehomes?highlight=WyJudXJzaW5nIiwiaG9tZSIsImhvbWUncyIsIm51cnNpbmcgaG9tZSJd&hitcount=0 (Last accessed May 10, 2016).
	#Perlman, C.M and Hirdes, J.P. (Dec. 2008). The Aggressive Behaviour Scale: A new scale to measure aggression based on the Minimum Data Set. Journal of the American Geriatrics Society. 56 (12).		#Perlman, C.M and Hirdes, J.P. (Dec. 2008). The Aggressive Behaviour Scale: A new scale to measure aggression based on the Minimum Data Set. Journal of the American Geriatrics Society. 56 (12).
	# Office of ~~the~~ Seniors Advocate ~~report~~.		# Office of Seniors Advocate, "Monitoring Seniors' Services", pg.24.
	#RCR, Schedule D, Reportable Incident.		#RCR, Schedule D, Reportable Incident.
	#Drance, E. (May 2013). Resident to resident aggression in residential care. Friesen Conference, Simon Fraser University, Vancouver, BC.		#Drance, E. (May 2013). Resident to resident aggression in residential care. Friesen Conference, Simon Fraser University, Vancouver, BC.

Charmaine Spencer at 08:44, 13 May 2016

2016-05-13T08:44:12Z

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	Care facility operators have a general responsibility to promote the health and safety of all residents, and to protect them from harm. This includes harms from other residents. Resident to resident conflict or aggression can have a significant effect on the emotional and physical well-being of the residents and others in the facility.		Care facility operators have a general responsibility to promote the health and safety of all residents, and to protect them from harm. This includes harms from other residents. Resident to resident conflict or aggression can have a significant effect on the emotional and physical well-being of the residents and others in the facility.

	It has been estimated that 11 per cent of the care facility residents are “aggressive” at some point. ([[{{PAGENAME}}#References\|29]]) ~~The~~ Office of the Seniors Advocate ~~found that~~ there were ~~____~~ reports of resident aggression. ([[{{PAGENAME}}#References\|30]]) In some instances this can lead to serious injury, even death. The geriatric literature now uses the term “responsive behaviour” to recognize the fact that “aggressive“ residents are often responding (inappropriately) to situations that are frightening to them or causing confusion, Residents may be responsive for many reasons, often it is because of confusion caused by dementia, inadequately addressed pain or an underlying medical condition that is not under control. The resident to resident harms can occur in general residential care facilities as well as those with special dementia units.		It has been estimated that 11 per cent of the care facility residents are “aggressive” at some point. ([[{{PAGENAME}}#References\|29]]) Drawing on available limited data, the Office of the Seniors Advocate estimated there were between 425 and 550 reports of resident to resident aggression in 2014/15 throughout the province. ([[{{PAGENAME}}#References\|30]]) In some instances this can lead to serious injury, even death. The geriatric literature now uses the term “responsive behaviour” to recognize the fact that “aggressive“ residents are often responding (inappropriately) to situations that are frightening to them or causing confusion, Residents may be responsive for many reasons, often it is because of confusion caused by dementia, inadequately addressed pain or an underlying medical condition that is not under control. The resident to resident harms can occur in general residential care facilities as well as those with special dementia units.

	The Residential Care Regulation requires care facility operators to report “aggressive or unusual behaviour”. This is defined as “aggressive or unusual behaviour by a person in care towards other persons, including another person in care, which has not been appropriately assessed in the care plan of the person in care.”([[{{PAGENAME}}#References\|31]])		The Residential Care Regulation requires care facility operators to report “aggressive or unusual behaviour”. This is defined as “aggressive or unusual behaviour by a person in care towards other persons, including another person in care, which has not been appropriately assessed in the care plan of the person in care.”([[{{PAGENAME}}#References\|31]])

Charmaine Spencer: /* Can the facility control “visiting hours”? */

2016-05-13T08:40:54Z

Can the facility control “visiting hours”?

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	===Can the facility control “visiting hours”?===		===Can the facility control “visiting hours”?===

	In some cases a care facility may try to limit access to certain hours, such as a hospital might. The regulations clearly permit visiting “at any time”. This reflects the fact that residents can have different preferences or “good times of the day”, and that family’s ability to visit may be circumscribed by their employment and other responsibilities. In some instances, staff may try to restrict visiting to daytime when there is more staff. In other instances, staff or administration may try to restrict visiting to certain times, because the facility locks its doors at night as safety matter. However, the facility is expected to take an individualized approach to residents’ rights and care planning. Failure to do so may be discriminatory and violate the regulations.		In some cases care facility administration or staff may try to limit access to certain hours, such as a hospital might. The regulations clearly permit visiting “at any time”. This reflects the fact that residents can have different preferences or “good times of the day”, and that family’s ability to visit may be circumscribed by their employment and other responsibilities. In some instances, staff may try to restrict visiting to daytime when there is more staff. In other instances, staff or administration may try to restrict visiting to certain times, because the facility locks its doors at night as safety matter. However, the facility is expected to take an individualized approach to residents’ rights and care planning. Failure to do so may be discriminatory and violate the regulations.

	===Can the facility control people from visiting others than “your resident”?===		===Can the facility control people from visiting others than “your resident”?===

Charmaine Spencer: /* Can the facility control “visiting hours”? */

2016-05-13T08:09:27Z

Can the facility control “visiting hours”?

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	===Can the facility control “visiting hours”?===		===Can the facility control “visiting hours”?===

	In some cases a care facility may try to limit access to certain hours, such as a hospital might. The regulations clearly permit visiting “at any time”. This reflects the fact that residents can have different preferences or “good times of the day”, and that family’s ability to visit may be circumscribed by their employment and other responsibilities. In some instances, staff may try to restrict visiting to daytime when there is more staff. In other instances, staff may try to restrict visiting to certain times, because the facility locks its doors at night as safety matter. However, the facility is expected to take an individualized approach to residents’ rights and care planning. Failure to do so may be discriminatory and violate the regulations.		In some cases a care facility may try to limit access to certain hours, such as a hospital might. The regulations clearly permit visiting “at any time”. This reflects the fact that residents can have different preferences or “good times of the day”, and that family’s ability to visit may be circumscribed by their employment and other responsibilities. In some instances, staff may try to restrict visiting to daytime when there is more staff. In other instances, staff or administration may try to restrict visiting to certain times, because the facility locks its doors at night as safety matter. However, the facility is expected to take an individualized approach to residents’ rights and care planning. Failure to do so may be discriminatory and violate the regulations.

	===Can the facility control people from visiting others than “your resident”?===		===Can the facility control people from visiting others than “your resident”?===

Charmaine Spencer: /* What Do We Mean? */

2016-05-13T08:08:35Z

What Do We Mean?

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	===What Do We Mean?===		===What Do We Mean?===

	In everyday language, the terms such as “abuse” and “neglect “ or “mistreatment” loosely refer to a wide range of negative behaviours, actions or inactions in residential care by staff, administration or others that can undermine the residents’ dignity, or cause them physical, emotional or financial harm. “Neglect of a resident” as the public often thinks of the term may also refer to substandard care, including poor housekeeping, hygiene concerns, delay of treatment, ignoring or slow response to call bells, lack of help with to the washroom, being forced to use incontinence products, inadequate pain treatment, insufficient staffing, poor nutrition, and residents going without a bath for weeks. It can sometimes take extreme forms as well, e.g. a resident lying in urine and feces for extended periods of time, a resident who is malnourished or who develops pressure ulcers due to lack of appropriate care.		In everyday language, the terms such as “abuse” and “neglect “ or “mistreatment” loosely refer to a wide range of negative behaviours, actions or inactions in residential care by staff, administration or others that can undermine the residents’ dignity, or cause them physical, emotional or financial harm. “Neglect of a resident” as the public often thinks of the term may also refer to substandard care, including poor housekeeping, hygiene concerns, delay of treatment, ignoring or slow response to call bells, lack of help with to the washroom, being forced to use incontinence products, inadequate pain treatment, insufficient staffing, poor nutrition, and residents going without a bath for weeks. It can sometimes take extreme forms as well, e.g., a resident lying in urine and feces for extended periods of time, a resident who is malnourished or who develops pressure ulcers due to lack of appropriate care.

	Emotional abuse can show up as the usual forms seen in the community, such as yelling and threatening the person. However, there are special forms that show up in residential care ~~that~~ are either intended to personalize, humiliate or degrade the person, or use power and control over the resident. These forms of emotional abuse include, for example if a staff member, operator or other person working in the facility		Emotional abuse can show up as the usual forms seen in the community, such as yelling and threatening the person. However, there are special forms of inappropriate treatment or mistreatment that show up in residential care. These are either intended to personalize, humiliate or degrade the person, or use power and control over the resident. These forms of emotional abuse include, for example if a staff member, operator or other person working in the facility

	* belittles the resident when the person’s clothing or incontinence brief is wet or soiled;		* belittles the resident when the person’s clothing or incontinence brief is wet or soiled;
	* makes fun of the resident’s mental or physical disability;		* makes fun of the resident’s mental or physical disability;
	* makes racial, cultural or sexual orientation slurs;		* makes racial, cultural or sexual orientation slurs;
	* threatens to kick out (“discharge”) the resident if she or he does not “cooperate.”		* threatens to kick out (“discharge”) the resident if she or he does not “cooperate.”

	In the residential care regulations, the terms “abuse” and “neglect“ have very specific meanings. These focus exclusively on harms to “persons in care “ (residents) by people who are “not persons in care“ (staff, administration, volunteers, family, strangers).		Within the residential care regulations, the terms “abuse” and “neglect“ have very specific meanings. These focus exclusively on harms to “persons in care “ (residents) by people who are “not persons in care“ (staff, administration, volunteers, family, strangers).

	The abuse definitions specifically exclude harms by residents to other residents. These resident to resident harms are also considered important care issues and are “reportable” to Licensing~~; they~~ are simply recognized as having different causes and needing different responses than do abuse or neglect situations. ([[{{PAGENAME}}#References\|25]])		The abuse definitions specifically exclude harms by residents to other residents. These resident to resident harms are also considered important care issues and they are “reportable” to Licensing. They are simply recognized as having different causes and needing different responses than do the abuse or neglect situations. ([[{{PAGENAME}}#References\|25]])

	“Abuse” and “neglect “in residential care generally means a deliberate intention to harm a resident, or a high degree of recklessness or indifference to the resident. Any other harms resulting from lack of understanding, poor procedures or documentation, inadequate training, or inadequate staffing are more commonly characterized as “quality of care” concerns or issues related to “non-compliance with standards”. However, the line between neglect and poor quality of care is not always clear in residential care.		“Abuse” and “neglect “in residential care generally means a deliberate intention to harm a resident, or a high degree of recklessness or indifference to the resident. Any other harms resulting from lack of understanding, poor procedures or documentation, inadequate training, or inadequate staffing are more commonly characterized as “quality of care” concerns or issues related to “non-compliance with standards”. However, the line between neglect and poor quality of care is not always clear in residential care.