Appendix B - Glossary for Navigating Home Care and Senior Housing: An Advocacy Guide

Abuse

The Adult Guardianship Act defines abuse as the "deliberate mistreatment of an adult that causes the adult (a) physical, mental or emotional harm, or (b) damage or loss in respect of the adult's financial affairs, and includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors”.(1)

Assisted Living

Assisted living(2) is semi-independent housing for adults who are capable of making their own decisions but require assistance with their day-to-day needs due to physical, health, or mental health challenges or while in recovery for substance use. Each adult has their own private lockable suite, and can access meals, activities, hospitality services, and personal care.

Attorney

An attorney is a person appointed under a Power of Attorney document to make financial and legal decisions for the older adult. This person is not a lawyer; it is typically a trusted family or friend. The attorney has a fiduciary duty to act honesty, in good faith, and in the older adult’s best interests.(3)

Capacity

Capacity is the ability to understand and appreciate the nature and consequences of a decision. All adults are presumed to be capable under BC law. Capacity is time, decision, and situation specific. A person may be capable of making some decisions but not other. A person may be more capable at a specific time of day. The context can increase or decrease a person’s capacity. Medication or an illness or disability may lead to capacity fluctuations throughout the day. Temporary stress, anxiety, grief, or depression could impact a person’s capacity for a time. Having a supporter can increase capacity.(4)

Care Aides

See “Health Care Assistants” definition below.

Committee

A committee is a person appointed by the court to make decisions for an adult who the court has found is incapable of making decisions. A committee of the person makes health and personal care decisions. A committee of the estate makes financial and legal decisions.(5)

Community Health Worker

See “Health Care Assistants” definition below.

Designated Agency

Designated agencies(6) receive reports of abuse and neglect of adults who cannot get assistance through either a lack of capacity or a physical limitation. The designated agencies are the health authorities (Fraser, Interior, Northern, Vancouver Coastal, and Island Health) and Community Living BC.

Designated agencies must respond to any reports they receive. Designated agencies can investigate, refer an adult to community services, develop a support and assistance plan, and apply for court orders to help the adult. If an adult is in imminent danger, the designated agencies have emergency powers to remove the adult from the dangerous situation.

Health Care Assistants

Health Care Assistants (HCAs) are known by a variety of names, including care aides, community health workers, personal support workers, nurse aides, and patient service associates. HCAs are frontline care providers working under the direction of a health care professional, typically a registered nurse. HCAs provide personal care and delegated health care tasks in a variety of settings, including home and community care, assisted living, long-term care, acute care hospitals, and group homes.

HCAs are not regulated health professionals, so they do not have a regulated scope of practice. An HCA’s work is based on their employer’s requirements, their job description, and the health care setting. HCAs who work for a publicly funded employer must complete an approved education program and be registered with the BC Care Aide and Community Health Worker Registry. All publicly funded employers must report if they suspend or fire an HCA for suspected abuse or neglect, and the registry investigates these reports.

In acute care or long-term care, HCAs complete personal care tasks such as bathing, dressing, grooming, mobility, and helping with meals. Nurses may delegate health care tasks such as monitoring vital signs, observing patient behaviour and symptoms, incontinence management, and giving medications.

In home care, HCAs also complete personal care and delegated health care tasks. HCAs may also do housekeeping tasks such as laundry and cooking. HCAs may be delegated tasks from other regulated health professionals, such as physiotherapists or occupational therapists.(7)

Home Care

Home care includes a range of services that help clients remain independent and in their own home as long as possible. Home care is provided primarily by HCAs, but may also include nurses, occupational therapists, and physiotherapists. Services include personal care and health care. Home care may also include housekeeping, cooking, nursing care, medication management, and physiotherapy.(8) For a definition of home care worker, see “Health Care Assistants” definition above.

Licensed Practical Nurses (LPN)

LPNs are a type of nurse who has the smallest scope of practice of all types of nurses, primarily helping patients who are medically stable or have predictable courses of illness. LPNs must obtain a practical nursing diploma from a recognized program typically of 1.5 to 2 years in length, and pass a regulatory exam. LPNs are governed by the BC College of Nurses and Midwives. LPNs work in all types of health care settings. LPNs work as part of a team, including doctors, RNs, and HCAs. LPNs can make some nursing decisions on their own. LPNs may do a variety of tasks depending on the care environment, including caring for stable patients, taking vital signs, implementing infection control, administering medication, monitoring patients, managing therapeutic diets, post-operative care, and minor wound care.(9)

Long-Term Care Home

Long-term care is a residence for adults who have complex care needs and require 24-hour care. Long-term care includes accommodations, which in BC is usually an individual room with a bathroom. Residents are provided with care planning, nursing care, medical care, personal care, meals, recreational and social activities, room upkeep, hygiene supplies, wheelchairs, and other services the resident needs.(10)

Neglect

The Adult Guardianship Act defines neglect as “any failure to provide necessary care, assistance, guidance or attention to an adult that causes, or is reasonably likely to cause within a short period of time, the adult serious physical, mental or emotional harm or substantial damage or loss in respect of the adult's financial affairs, and includes self-neglect;”(11)

Palliative Care

Palliative care is an approach to care for patients who are facing life-threatening illnesses, where the focus is on maximizing quality of life. The aim is to relieve suffering by identifying and treating pain. Palliative care also focuses on physical, psychological, social, and spiritual needs of the patient. Palliative care may be provided in many care settings, including at home, in long-term care, in an acute care hospital, or in a palliative care facility.(12)

Power Of Attorney Document (POA)

A power of attorney document (POA)(13) appoints a person to make financial and legal decisions for the adult. The POA can include routine financial decisions such as depositing money and paying bills. The POA can also include major decisions such as investments, selling a home, and managing the adult’s business. It is often used in combination with a Representation Agreement.

Most POAs are enduring, which means they start when signed by the adult, attorney, and witnesses, and continue when the adult loses capacity. A POA can also be springing, which means it starts at a triggering date or event, such as when the adult loses capacity. The POA may limit the authority of the attorney to specific tasks or accounts.

Public Guardian and Trustee (PGT)

The Public Guardian and Trustee is a statutory body who protects people who lack capacity. The PGT has three main areas where they assist:

• Guardianship and trust management for children and youth;
• Estate and personal trust services for people who are incapable, missing, or deceased; and
• Financial management and decision-making services for adults who are incapable and do not have supporters to assist them.

The PGT’s decision-making services include monitoring substitute decision-makers, investigating financial abuse, and substitute decision-making.(14)

Registered Nurse (RN)

Registered nurses are a type of nurse who can work with patients with a variety of medical conditions and can work in any health care setting. RNs must complete an approved Bachelor of Nursing program typically lasting three to four years and pass a regulatory exam. RNs are regulated by the BC College of Nurses and Midwives.

RNs have a wider scope of practice than LPNs. RN’s scope of practice includes assessing patients, giving nursing diagnoses, complex wound care, and planning, implementing, and evaluating interventions. RNs can prescribe, compound, dispense, and administer a wider number of drugs to patients than an LPN. RNs have a larger autonomous scope of practice than LPNs. RNs can specialize in a particular area of medicine and perform a wider array of restricted activities in that area, such as managing labour.

A Registered Psychiatric Nurse (RPN) is a registered nurse who received a psychiatric nursing program and specializes in caring for patients with psychiatric conditions. A Nurse Practitioner (NP) is an RN who obtained a master's degree and has the widest scope of practice. NPs can assess patients, order diagnostic tests, prescribe medications, treat disease, and manage results.(15)

Representation Agreement (RA)

A representation agreement (RA)(16) appoints a person you trust to be your representative. They can help you with medical and personal care decisions. If you are ill, injured, or lose capacity, the representative can make decisions on your behalf. An RA can cover all major and minor health care decisions. This includes end-of-life decisions and refusing medical treatment. The RA may specify wishes for certain medical treatments the person wants or doesn’t want. The RA can cover personal care decisions such as where the adult lives and what visitors they see. It is often used in combination with a Power of Attorney.

Representative

A representative is a person appointed under a representation agreement to support a person or make health care and personal care decisions. The representative can be a family member or friend, but not a person who is paid to care for you.(17)

Resident and Family Councils

Resident and family councils are meetings of residents in long-term care or their family members with the aim of improving quality of life. Residents and family members have a right to create a council. If one is created, the operator must meet with the council at least twice a year and respond to recommendations made by the council.(18)

Residential Care Facilities

Residential care is a facility where care is provided on an in-patient basis. The person lives at the facility, receiving meals, either temporarily or on a long-term basis. Residential care could be as small as three people receiving care in a single-family home, to a large multi-level care building. Residential care can include long-term care, hospice, community living, or care for mental health, substance use, or acquired injury. Residential care could be for a particular age group, such as children or older adults, or be for any adult. The facility may only care for adults with a particular injury or illness, such as dementia.(19)

Self-Neglect

The Adult Guardianship Act defines self-neglect as:(20)

...any failure of an adult to take care of himself or herself that causes, or is reasonably likely to cause within a short period of time, serious physical or mental harm or substantial damage or loss in respect of the adult's financial affairs, and includes:

a) living in grossly unsanitary conditions,

(b) suffering from an untreated illness, disease or injury,

(c) suffering from malnutrition to such an extent that, without intervention, the adult's physical or mental health is likely to be severely impaired,

(d) creating a hazardous situation that will likely cause serious physical harm to the adult or others or cause substantial damage to or loss of property, and

(e) suffering from an illness, disease or injury that results in the adult dealing with his or her financial affairs in a manner that is likely to cause substantial damage or loss in respect of those financial affairs;

Substitute Decision-Making

Substitute decision-making occurs when a person makes decisions for an adult after being granted the authority to do so. See “Committee”, “Power of Attorney”, and “Representation Agreement” definitions above.

Supportive Decision-Making

Supportive decision-making occurs when a person supports an adult who still has some decision-making capacity to make decisions. See “Representation Agreement” definition above.

References

1. Adult Guardianship Act, RSBC 1996, c 6, s 1, online: <https://canlii.ca/t/84gj>.
2. British Columbia, ”Assisted Living in BC”, online: <https://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc>; Interior Health, ”Assisted Living”, online: <https://www.interiorhealth.ca/health-and-wellness/home-and-community-care/assisted-living>; Fraser Health, “Assisted living“, online: <https://www.fraserhealth.ca/health-topics-a-to-z/assisted-living>; Community Care and Assisted Living Act, SBC 2002, c 75, online: <https://canlii.ca/t/84lk>; Assisted Living Regulation, BC Reg 189/2019, online: <https://canlii.ca/t/9lrn>.
3. Power of Attorney Act, RSBC 1996, c 370, online: <https://canlii.ca/t/849l>.
4. Canadian Centre for Elder Law, Practical Guide to Abuse and Neglect Law in Canada, ”Glossary of Terms”, online: <https://ccelderlaw.ca/glossary-of-terms/>.
5. Patients Property Act, RSBC 1996, c 349, online: <https://canlii.ca/t/848s>.
6. Adult Guardianship Act, RSBC 1996, c 6, online: <https://canlii.ca/t/84gj>.
7. Work BC, ”Nurse aides, orderlies and patient service associates (NOC 3413)”, online: <https://www.workbc.ca/career-profiles/nurse-aides-orderlies-and-patient-service-associates>; BC Care Aide & Community Health Worker Registry, “Home“, online: <https://cachwr.bc.ca>.
8. British Columbia, ”Home Care”, online: <https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/health-care-programs-and-services/home-care>.
9. Work BC, ”Licensed practical nurses (NOC 3233)”, online: <https://www.workbc.ca/career-profiles/licensed-practical-nurses>; British Columbia College of Nurses and Midwives, ”LPN Scope of Practice”, online: <https://www.bccnm.ca/LPN/ScopePractice/Pages/Default.aspx>; Nurses (Licensed Practical) Regulations, BC Reg 224/2015, online: <https://canlii.ca/t/8z1p>.
10. British Columbia, Ministry of Health, Home and Community Care Policy Manual, (6 February 2023) at ch 6, online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
11. Adult Guardianship Act, RSBC 1996, c 6, s 1, online: <https://canlii.ca/t/84gj>.
12. BC Centre for Palliative Care, ”About Palliative Care”, online: <https://www.bc-cpc.ca/all-resources/individuals/understanding-palliative-care/>; World Health Organization, ”Palliative Care”, online: <https://www.who.int/news-room/fact-sheets/detail/palliative-care>.
13. Power of Attorney Act, RSBC 1996, c 370, online: <https://canlii.ca/t/849l>.
14. Public Guardian and Trustee of British Columbia, ”Home”, online: <https://www.trustee.bc.ca/Pages/default.aspx>.
15. Work BC, ”Registered nurses and registered psychiatric nurses (NOC 3012), online: <https://www.workbc.ca/career-profiles/registered-nurses-and-registered-psychiatric-nurses>; British Columbia of Nurses and Midwives, ”RN Scope of Practice”, online: <https://www.bccnm.ca/RN/ScopePractice/Pages/Default.aspx>; Nurses (Registered) and Nurse Practitioners Regulation, BC Reg 284/2008, online: <https://canlii.ca/t/859c>.
16. Representation Agreement Act, RSBC 1996, c 405, online: <https://canlii.ca/t/84bw>.
17. Representation Agreement Act, RSBC 1996, c 405, online: <https://canlii.ca/t/84bw>.
18. British Columbia, ”Resident and Family Councils”, online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/family-and-resident-councils>; Residential Care Regulation, BC Reg 96/2009, s 59.1, online: <https://canlii.ca/t/89ln>.
19. British Columbia, ”Residential Care Facilities”, online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/finding-assisted-living-or-residential-care/residential-care-facilities#>.
20. Adult Guardianship Act, RSBC 1996, c 6, s 1, online: <https://canlii.ca/t/84gj>.

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Seniors First BC, February 2024.

In law, defending a claim by denying the truth of a fact supporting the claim; a rejection of the truth of facts alleged.

Under the old Divorce Act, the schedule of a parent's time with their children under an order or agreement, replaced with "parenting time" and "contact" in the new Divorce Act. Access usually referred to the schedule of the parent with the least amount of time with the child. See "contact," "custody" and "parenting time."

A person licensed to practice law in a particular jurisdiction by that jurisdiction's law society. See "barrister and solicitor."

(1) Intentionally doing a thing, or (2) a law passed by a government, also called "legislation" or a "statute." See "regulations."

Acting in an honest, truthful, open, and fair manner, without the intent to deceive or defraud. Also known by the Latin phrase bona fide. See "bad faith."

In law, (1) a judge's conclusions after hearing argument and considering the evidence presented at a trial or an application, (2) a judgment, or (3) the judge's reasons. A judge's written or oral decision will include the judge's conclusions about the relief or remedies claimed as well as their findings of fact and conclusions of law. A written decision is called the judge’s "reasons for judgment." See "common law," "conclusions of law" and "findings of fact."

In law, a legal incapacity to do certain things, like enter into a contract or start a court proceeding. Legal disabilities include insanity and being under the age of majority. See "age of majority."

In law, all of the personal property and real property that a person owns or in which they have an interest, usually in connection with the prospect or event of the person's death.

(1) A central office, located in each judicial district, at which the court files for each court proceeding in that district are maintained, and at which legal documents can be filed, searched, and reviewed, or (2) a courthouse.

A person who is younger than the legal age of majority, 19 in British Columbia. Not to be confused with "miner," which means something else altogether. See "age of majority."

The geographic place where a person permanently lives. This is different from a person's "domicile" in that a person's residence is more fixed and less changeable in nature. A person's residence can also have an impact on a court's authority to hear and decide a legal action. See "domicile" and "jurisdiction."

In law, a form of possession of property in which a "trustee" keeps and manages property for the benefit of another person, the "beneficiary," without owning that property and usually without acquiring an interest in that property other than as payment for their services. The trustee holds the property in trust for the beneficiary. See "constructive trust," "ownership," "possession" and "resulting trust."

In law, in British Columbia a person under the age of 19.

Since January 2024, these provincially-appointed judicial officials of the BC Supreme Court are now called associate judges. They serve a similar role as justices of the BC Supreme Court, but have limited jurisdiction. Associate judges are usually charged with making interim decisions before final judgment in a court proceeding, and certain decisions after final judgment, including the assessment of lawyers' bills and the settling of bills of cost. See "interim application," "judge" and "jurisdiction."

To determine the proper value or worth of something. A lawyer's bill may be assessed by a registrar to determine the actual amount the client should pay. See "appraisal."

A mandatory direction of the court that is binding and enforceable upon the parties to a court proceeding. An "interim order" is a temporary order made following the hearing of an interim application. A "final order" is a permanent order, made following the trial of the court proceeding or the parties' settlement, following which the only recourse open to a dissatisfied party is to appeal. Failing to abide by the terms of an order may constitute contempt of court. See "appeal," "consent order," "contempt of court," "decision" and "declaration."

In contract law, a promise made by someone about a certain state of affairs, like "the plumbing was replaced last year" or "I had a vasectomy two years ago." See "misrepresentation."

In family law, the dwelling occupied by a family as their primary residence. See "family property" and "real property."

Something which can be owned. See "chattels" and "real property."