When Internal Advocacy Does Not Solve the Issue in Home Care and Senior Housing

When Internal Advocacy does not Solve the Issue

If you are not able to resolve an issue at the local service level, there are other authorities that have jurisdiction over various aspects of home and community care for older adults and can provide solutions from outside the service or facility. However, taking these routes to resolve a problem may take a longer time than dealing directly with the service provider.

Seniors First BC is a helpful resource that can assist with assessing a problem and identifying who to connect with for help resolving it. They also provide information and resources on senior-specific issues and support services. Call the Seniors Abuse and Information Line (SAIL) at 604-437-1940 or toll-free at 1-866-437-1940.

Home and Community Care Office

If you cannot resolve an issue with caregivers, case managers or care facility managers, the Home and Community Care Office may offer assistance or guidance or refer you to the appropriate external authority, including the Patient Care Quality Office.

Regional health authority (financial & eligibility issues)

Decisions about eligibility for home care services or care facilities, assigned hours of care, service fees or care facility fees, or changes in home care service can be appealed directly to the regional health authority. Ask the caregiver, case manager, or Home and Community Care Office about how to contact the appropriate person within the health authority.

Patient Care Quality Office

In every health authority region, there is a Patient Care Quality Office (PCQO). They receive formal complaints about the quality of care received (including violations of care facility residents’ rights) or care that was expected but not received. Note that their mandate includes all health care, not just seniors care.

The PCQO will work with the resident or their representative to resolve the complaint. If they cannot help with the complaint, they will refer you to someone who can. They will acknowledge the complaint within two business days and aim to address it within 40 business days. Part of their purpose is to gather information about the quality of services to make recommendations to the Ministry of Health about how to improve services.

See Appendix A Resources for a list of PCQOs.

The province-wide First Nations Health Authority (FNHA) also has a Quality Care and Safety Office.(1) They accept complaints from Indigenous adults about any public health service received in BC, in addition to specific services offered by FNHA. They can assist directly or help guide a person through the health authority PCQO complaint process.

If you wish to make a formal complaint to the PCQO, contact the office in your health authority region. See the PCQO’s website for a list of the PCQ offices in BC. Or you can contact the FNHA Quality Care and Safety Office for help with making a complaint.

If you are not satisfied with the actions or decisions of the PCQO, or if they take longer than 40 days to act or make a decision, you can contact the Patient Care Quality Review Board and request a review. PCQ Review Boards are independent from the regional PCQO. For more information, see the PCQ Review Board’s website.

If you are acting on behalf of someone else, you must provide the PCQ Review Board with written authorization from that person. A consent form can be found on the province’s website.

Patient Care Quality Review Boards do not review:

• involuntary admissions under the Mental Health Act;
• decisions by a licensing officer or medical health officer under the Community Care and Assisted Living Act;
• decisions by the Community Care and Assisted Living Act Appeal Board (which deals with licensing issues); or
• matters related to private-pay services, unless provided under contract with a health authority.(2)

Director of Licensing, Medical Health Officer, or Registrar

Assisted living and long-term care facilities must meet certain physical and operational standards under the Community Care and Assisted Living Act and its regulations, to become licensed (long-term care) or registered (assisted living). The rules for licensing and registration apply to any facility with three or more residents not related to the operator by blood or marriage.(3)

You can make a complaint to the Assisted Living Registry or Health Authority Community Care Facility Licensing (for long-term care) if you have concerns about the overall operation of a care facility, such as the quality of care, staff skills and supervision, hygiene and communicable disease control, medication management, nutrition and food services, recreation program, physical facility (equipment and furnishings), policies and procedures, record management and reporting, or any issues that put the health and safety of residents at risk.

A licensing officer is obliged to investigate any complaint about a care facility not meeting operational standards or operating without a license. Complaints may trigger an inspection. If the inspection finds that the facility is violating standards, the operator may be required to remedy outstanding issues within a certain time frame or may have their license or registration suspended or revoked. The Ministry of Health is required to post summaries of complaint and inspection reports for the past five years on publicly accessible websites.

For private hospitals or extended care provided in a hospital, the Hospital Act governs licensing and inspections. The Ministry of Health employs inspectors to oversee standards and revoke licenses where standards are not maintained.(4)

For more information about licensing for long-term care and inspection reports listed by regional health authority, see the province’s website.

For information about assisted living inspections, see the province’s website.

Professional Oversight Bodies

If you have concerns about the competence or conduct of a specific health care worker, such as their level of skill or ability to act professionally, and your concerns have not been addressed by any of the avenues described above, you may file a complaint with the relevant provincial body responsible for overseeing professional standards.

There are also Whistleblower Hotlines for those who wish to remain anonymous to report concerns about a health care employee. Check your regional health authority website for how to contact them. The Provincial Health Services Authority also operates a whistleblower hotline.

For family physicians or other medical specialists, the College of Physicians and Surgeons of BC is the oversight body. If you have concerns about the clinical care or conduct of a physician, or about sexual misconduct, you can file a complaint with the College. If your concern is about a doctor working within a hospital, then file a complaint using the hospital’s complaint process. This may be done through the Patient Care Quality Office.

For nurse practitioners, registered nurses, registered psychiatric nurses and licensed practical nurses, the BC College of Nurses and Midwives receives and investigates complaints. The majority of complaints are resolved through a consensual resolution process. The outcomes of complaint investigations are summarized on their website.

To contest the outcome of a complaint about a health professional to their regulating organization, or the process has taken longer than the stated timeline for resolving complaints, you can request a review by the Health Professions Review Board within 30 days of a decision. The Review Board can review individual decisions, but only to decide whether the regulating body used procedures that were transparent, objective, impartial and fair. The Review Board cannot reinvestigate or change the original decision, they can only refer the matter back to the regulating college if they find the process has been unfair.

For health care assistants (HCAs), the oversight body is the BC Care Aide and Community Health Worker Registry.(5) In BC, HCAs must be registered to work in publicly funded facilities and services. To be registered, they are required to complete an approved BC training program or its equivalent and to submit a work history to the registry.

The registry has oversight only with respect to alleged cases of abuse or neglect of people receiving care. It does not address other competency issues––these are best addressed with the employer, or applicable licensing or registrar’s office. Employers must follow their own procedures for responding to allegations of patient or resident abuse by staff and may suspend the employee until an investigation of the allegation is completed.

Where an HCA has been suspended or terminated due to abuse or neglect, the employer must report it to the registry. While an employee is suspended from work pending investigation, the registry will also suspend the employee from the registry. Once the case has been reviewed or investigated and resolved, the registry may reinstate the employee or remove them permanently from the registry, depending on the investigation outcome.(6)

The registry’s complaint records are not available to the public; they are restricted to employers who are also registered, as the data is used mainly for employment screening purposes.

For more information about the registry investigation process, see the registry’s website.

HCAs working privately or for private care agencies are not legally required to register or to undergo a criminal record check.(7) If you have a complaint about an unregistered HCA working privately, there are few options other than to complain to the private agency that provided the service and discontinue the caregiver’s service. In this situation, it is important to begin searching for a new caregiver as soon as possible to ensure that a replacement is available when needed.

Mental Health Review Board

This section applies to any older adult who has been certified under the Mental Health Act as an involuntary psychiatric patient and is living on extended leave at home, in assisted living, or in long-term care.(8)

Under the Mental Health Act, a person can be detained involuntarily if they have been certified by two physicians. Patients who are certified are generally detained in psychiatric units in hospitals but may also be detained on extended leave in other situations, such as assisted living or long-term care, if they abide by conditions set by a psychiatrist in consultation with the person’s health care team. These conditions often include continuing to take psychiatric medications and regularly attending appointments with a psychiatrist or mental health team. Other conditions may vary based on the person’s situation and could include not driving, or remaining in the province or country, for example.(9)

If the individual on extended leave under the Mental Health Act does not abide by the conditions, they can be arrested and detained in a psychiatric hospital or unit.

For more information on criteria for certification and information about mental patient rights, see BC Mental Health Rights’ website.

If you have questions about patient rights under the BC Mental Health Act, contact Access Pro Bono.

Seniors who are certified under the Mental Health Act and who wish to contest their detention can file an application for a hearing using a Form 7. The Mental Health Review Board reviews the detention of people certified under the Mental Health Act. Its role is to decide whether the person should continue to be held involuntarily. It does not deal with treatment issues or decide whether the initial certification was justified.

Once a hearing is scheduled, adults who cannot afford a lawyer can seek representation through the Mental Health Law Program run by Community Legal Assistance Society (CLAS) at 604-685-3425 in the Lower Mainland and 1-888-685-6222 elsewhere in BC.

References

1. First Nations Health Authority, “Quality Care and Safety Office,” online: <http://www.fnha.ca/about/governance-and-accountability/quality-care-and-safety-office>.
2. “Patient Care Quality Review Board Act,” SBC 2008, c 35, ss 1, 13, online: <http://canlii.ca/t/84pj>.
3. “Assisted Living Regulation,” BC Reg 189/2019, Part 3, online: <http://canlii.ca/t/9lrn>; “Residential Care Regulation,” BC Reg 96/2009, Part 3 & 5, online: <http://canlii.ca/t/89ln>.
4. “Hospital Act,” RSBC 1996, c 200, ss 6-8, 14, online: <http://canlii.ca/t/843c>.
5. British Columbia, BC Care Aide & Community Health Worker Registry, “Home,” online: <http://cachwr.bc.ca>.
6. Krista James & Sara Pon, “Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants, CCEL Study Paper 11” (October 2022: British Columbia Law Institute) at pg 124 to 130, online: “British Columbia Law Institute” <http://www.bcli.org/project/hca-oversight-in-bc/>.
7. Krista James & Sara Pon, “Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants, CCEL Study Paper 11” (October 2022: British Columbia Law Institute), online: “British Columbia Law Institute” <http://www.bcli.org/project/hca-oversight-in-bc/>.
8. “Mental Health Act,” RSBC 1996, c 288, s 22, online: <http://canlii.ca/t/846j>.
9. “Mental Health Act,” RSBC 1996, c 288, s 22, online: <http://canlii.ca/t/846j>.

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

With respect to courts, (1) the authority of the court to hear an action and make orders, (2) the limits of the authority of a particular judicial official, (3) the geographic location of a court, or (4) the territorial limits of a court's authority. With respect to governments, (5) the authority of a government to make legislation as determined by the constitution, or (6) the limits of authority of a particular government agency. See “constitution."

Under the Family Law Act, a term that describes the time a person who is not a guardian of a child, including a parent who is not a guardian, has with that child. Under the Divorce Act, a term that describes the time a person who is not a married spouse has with a child. See "guardian" and "parental responsibilities."

A method of calculating time under which the days for a legal deadline are counted according to the days when the court is open for business, excluding weekends and holidays. See "calendar days" and "clear days."

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

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, the re-examination of a term of an order or agreement, usually to determine whether the term remains fair and appropriate in light of the circumstances prevailing at the time of the review. In family law, particularly the review of an order or agreement provided for the payment of spousal support. See "de novo," "family law agreements," "order" and "spousal support."

A kind of legislation that provides supplemental rules for a particular act. Regulations are created and amended by the government, not by the legislature, and as a result the legislature has no say in how or what regulations are imposed by government. See "act."

A legal relationship between two persons, whether of the same or opposite genders, that is solemnized by a marriage commissioner or licenced religious official and gives rise to certain mutual rights, benefits, and obligations. See also "conjugal rights," "consortium," and "marriage, validity of."

(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.

An officer of the court with the power to make certain decisions, including the settlement of a lawyer’s bill, a party's costs of a court proceeding, and settling the form of an order. An officer of the court charged with the responsibility of reviewing and approving certain documents submitted to the court, such as pleadings. See "jurisdiction" and "pleadings."

A claim that a certain set of facts is true, such as "on Monday, I had soup for lunch" or "Bob drives a blue Camaro." Also called an "allegation of fact" or a "statement of fact."

In law, to formally deliver documents to a person in a manner that complies with the rules of court. Service may be ordinary (mailed or delivered to a litigant's address for service), personal (hand-delivered to a person), or substituted (performed in a way other than the rules normally require). See "address for delivery," "ordinary service," "personal service" and "substituted service."

In law, an order of a court cancelling or changing an earlier order of the court. See "order."

In law, any proceeding before a judicial official to determine questions of law and questions of fact, including the hearing of an application and the hearing of a trial. See "decision."

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

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."