Is this workshop for you?

Is this workshop for you?
Ask yourself: Are you a volunteer? Do you volunteer for an organization that has members or clients who are older adults? This is an introductory workshop for volunteers who work with older adults. The goal of the presentation is to help you understand: What elder abuse is; The laws that apply to elder abuse and neglect; and What you can do if you have concerns that an older person is being abused or neglected. Volunteers come into contact with older adults in all sorts of ways, for example: Members of volunteer board of directors for an organization that serves older adults; Front line volunteers who provide hands-on assistance to seniors, like delivering food, offering companionship; Volunteers who provide other assistance to older adults.

Federal Elder Abuse Initiative
NEWFOUNDLAND AND LABRADOR PRESENTATION FUNDING Human Resources and Skills Development Canada – New Horizons for Seniors Program Federal Elder Abuse Initiative Funding for this workshop was provided by the federal government, through the Ministry for Human Resources and Skills Development Canada. The Funding program is called the New Horizons for Seniors Program, Federal Elder Abuse Initiative. The purpose of the program is to raise awareness about elder abuse and what people can do about it.

CANADIAN CENTRE FOR ELDER LAW
NEWFOUNDLAND AND LABRADOR CANADIAN CENTRE FOR ELDER LAW National non-profit Studies legal issues that concern older adults Legal research Law reform Outreach Legal education This presentation was created by the Canadian Centre for Elder Law. The CCEL is located in Vancouver. The CCEL studies how the laws impact older adults. Its work falls into 4 areas: Legal research: what does the law say? Law reform: how can the laws be changed so that they are more responsive to the needs of older people? Outreach: means connecting with the public on elder law issues, such as through communicating with community organizations or speaking to the media. Legal education: means creating teaching tools and workshops, like this presentation. Legal education covers issues like: What are your rights as an older adult? How can you conduct your work in a manner that better serves older people? How can volunteers respond to elder abuse concerns?

Information about resources and options
NEWFOUNDLAND AND LABRADOR NOT LEGAL ADVICE Information about resources and options Presenters are not necessarily lawyers If you need more information see the Resources Handout The information in this presentation is not legal advice. On the Resources Handout you will find the name of organizations that can provide legal advice or information.

What is elder abuse and neglect? When and how should you respond?
NEWFOUNDLAND AND LABRADOR LEARNING GOALS What is elder abuse and neglect? When and how should you respond? How do you identify the best response? Who to call for more information or to report abuse? There are 4 parts to this presentation. In Section 1 we explain what elder abuse is and provide examples. In Section 2 we tell you what the law in your province or territory says about when and how you must or can respond to abuse. In Section 3 we outline some guidelines to frame your thinking about whether and how to respond in each case. In Section 4 we highlight key resources that you can call to help you figure out what to do and places that you can refer an older adult who is being abused or is at risk of abuse.

What is Elder Abuse and Neglect?
1 What is Elder Abuse and Neglect? In this section we will discuss abuse and neglect generally without commenting on the law. In Section 2 we discuss the law in your province or territory, including what kinds of abuse are covered by the law where you live and how elder abuse is defined in that law.

NEWFOUNDLAND AND LABRADOR
ELDER ABUSE 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. World Health Organization, 2002 What is elder abuse? This is the definition of elder abuse used by many organizations. This definition excludes mistreatment caused by a stranger.

Action: harming a person - ABUSE
NEWFOUNDLAND AND LABRADOR ELDER ABUSE Action: harming a person - ABUSE Not acting: not providing care or helping a person when a person should have - NEGLECT Here is another way of looking at the definition of elder abuse. This broader definition includes abuse by any person, including strangers. Action: harming a person or their property or assets – ABUSE; Not acting: not providing care or assistance when a person should have – also called NEGLECT. Mistreatment can be a single one-time action or continuing and repeated acts of mistreatment over a period of time. The issue is always the impact on the older person. Ask yourself, was the older adult hurt in some way?

MANY KINDS OF MISTREATMENT
NEWFOUNDLAND AND LABRADOR MANY KINDS OF MISTREATMENT Physical Sexual Psychological Spiritual Chemical Forced Confinement Neglect Financial Elder abuse comes in all shapes and sizes. Here is a list of the most common categories or types of mistreatment. We will go through each type briefly because elder abuse is best understood through types of behaviour or examples. Also, many provincial laws that cover elder abuse acknowledge some, but not all, of these types of abuse. The laws are different in each province and territory. More on the law in Section 2. Here we identify the types to help paint a picture of abuse, help you recognize it in your day to day volunteering.

Hitting, slapping, punching, pushing Being rough Throwing objects
NEWFOUNDLAND AND LABRADOR PHYSICAL Hitting, slapping, punching, pushing Being rough Throwing objects You will not often see a person get hit. What you will more likely notice is the injury (bruises, broken bones, physical pain) or an older adult’s fear of an abusive person. In a caregiving context, being unnecessarily rough or forceful is physical abuse. For example: Shoving or pulling a person into a room, Dressing a person by yanking her limbs into clothing, or Roughly transferring a person from bed to chair or toilet. In each of these instances the caregiver could be gentle with the person.

Pressuring someone into giving money or property
NEWFOUNDLAND AND LABRADOR FINANCIAL Frauds and scams Pressuring someone into giving money or property Improper use of power of attorney Identity theft Older adults who are socially isolated and have acquired assets or property through lifelong saving for retirement are often targeted for theft or scams. Abusers also sometimes see older people as easy targets because of a perception that older people are more trusting. An attorney is someone legally appointed (through a document called a power of attorney) to make financial transactions or decisions for another person. But the attorney must still make financial decisions consistent with the older person’s wishes. Identity theft is when a crook uses personal or confidential information to access someone else’s accounts and credits cards without permission. Another common form of financial abuse is when an older adult opens a joint account with a person they trust on the understanding that this person will only access those funds to help the older adult pay bills and run errands. Then this trusted person spends some or all of the money on herself. That is financial abuse. Financial abuse is a very complex topic that we can’t cover in detail today. Financial abuse is one of the most common forms of mistreatment of older people.

PSYCHOLOGICAL OR EMOTIONAL Causing mental suffering
NEWFOUNDLAND AND LABRADOR PSYCHOLOGICAL OR EMOTIONAL Causing mental suffering Yelling, intimidating Making threats Belittling, criticizing a person Harassment Doing things to frighten a person Threatening to put an older person in a retirement home or to not let the older person see the grandchildren or other family unless he or she does what you want can be psychological abuse. Some kinds of mistreatment can fall into more than one category: for example, a caregiver who is unnecessarily rough when lifting a patient in and out of bed and belittles the patient by talking down to him like he is a child is being physically and psychologically abusive.

Any non-consensual sexual action Making unwanted sexual comments
NEWFOUNDLAND AND LABRADOR SEXUAL Any non-consensual sexual action Making unwanted sexual comments Doing anything sexual without permission Lewd gestures The key is consent or permission. If a person, regardless of age, doesn’t clearly agree or say yes, the comments or actions are a form of abuse or mistreatment. Even if the other person is a girlfriend, boyfriend, husband, wife or spouse, there is always a right to say no to sexual behaviour or attention or any form of intimate contact or touch. If a person lacks mental capacity due to something like advanced dementia then he or she cannot give consent to sexual activity and so doing things to him or her is a violation of personal dignity and also possibly a criminal act.

Overmedicating a person Denying needed medication
NEWFOUNDLAND AND LABRADOR CHEMICAL Overmedicating a person Denying needed medication Substituting over-the-counter medication Making medication decisions without consulting the older person or the correct substitute decision-maker Chemical abuse is medication abuse. Too much or not enough medication can cause harm. When medication decisions are motivated by things other than the older person’s well being or when medication decisions are made without the agreement of the person who needs the medicine or the legal substitute-decision-maker, that’s abuse. Medications abuse is most common when older adults have health problems that make it impossible or difficult for them to take care of themselves, fill prescriptions, or understand medical information. For example, denying your mum expensive medication to save money for your inheritance could be mistreatment. On the flip side, giving your mum a higher dose of her medicine so she is more docile and makes fewer demands on you is also abuse.

Preventing a person from practicing her or his faith
NEWFOUNDLAND AND LABRADOR SPIRITUAL Preventing a person from practicing her or his faith Forcing a person to participate in a spiritual ritual or to practice a religion Our faith is an important part of who we are as people. When someone prevents an older person from practicing his or her faith and seeing people in a chosen faith community, this is mistreatment. Consider actions that stop a person from going to church, mosque, or any other place of worship, or from being involved in spiritual or religious practices of choice. Forcing a person to practice a different religion or forcing a non-believer to attend a faith institution can also be abusive. Forcing a person to participate in any religious or spiritual ceremony, event or ritual could be elder abuse. Requiring a person to receive any form of spiritual-based healing would be abuse. Spiritual abuse is mentioned in very few laws, but it can go hand-in-hand with psychological abuse, and can have a devastating effect on an older person.

Locking a person in a room Restraining a person
NEWFOUNDLAND AND LABRADOR FORCED CONFINEMENT Locking a person in a room Restraining a person Denying a person access to the phone or visitors Again, forced confinement is not mentioned in most laws but involves elements of both physical and psychological mistreatment. We call the abusive actions we have been discussing “elder abuse” when the victim is an older person. Of course, these behaviours are abusive regardless of the age of the victim and almost any person can be victimized. Sometimes the negative consequences can be more extreme if the victim is older. It can be harder to heal when you are older. It can be harder to get help. Some older people are very strong. Others have a lot of health problems and a hard time getting around.

NEGLECT Denying food or care
NEWFOUNDLAND AND LABRADOR NEGLECT Denying food or care Not giving proper care or assistance to someone who is dependent on you Neglect is a complex idea. Basically, if a person depends on another person for care or assistance, and that person does not take proper care of the older person, that could be neglect. Assistance could be with food and nutrition, mobility, medication and medical appointments, intimate activities like bathing and toileting. In some cases, assistance can mean finding a different helper if providing help is too difficult or time-consuming for an individual.

ELDER ABUSE AND NEGLECT
NEWFOUNDLAND AND LABRADOR ELDER ABUSE AND NEGLECT Often the abuser is a loved one or person the older adult trusts Occurs at home and in care facilities – can happen anywhere Can be one incident or ongoing Although older adults are mistreated by strangers and con artists, older adults are often abused by people they care about or rely on for assistance, services or companionship. Family Friend Spouse, boyfriend, girlfriend Neighbour Volunteer caregiver Legal guardian Care facility staff Professionals - doctor, lawyer, nurse Elder abuse can happen anywhere: Home Care facility or hospital Doctor office or bank or other office Elder abuse can be one incident of mistreatment but more often one harmful action is part of a larger pattern of hurting the older person, spending the older person’s money, or ignoring the person’s needs and preferences.

When and How are you Required to Respond to Elder Abuse?
2 When and How are you Required to Respond to Elder Abuse? It can be difficult to decide if you should talk to an adult when you think the person might be being mistreated, and it can be challenging to decide what to do in response to your concerns. Responding to abuse involves both ethical and legal considerations. What is the right thing to do? This is an ethical or moral question. What does the law require me or my organization to do, or allow me to do? This is a legal question. Sections 3 will provide more assistance in answering the ethical question. Section 2 discusses the law.

RESPONDING TO ABUSE AND NEGLECT
NEWFOUNDLAND AND LABRADOR RESPONDING TO ABUSE AND NEGLECT Talk to the older person Help the person get support and assistance, refer to helpful agencies Reporting abuse or neglect What is the right response depends on the circumstances. But usually you will want to talk to the older person to find out what is going on, if the person would like assistance, and what kind of support or assistance they would like. In some provinces, certain people will have a legal duty to respond to abuse and neglect that occurs in specific circumstances by reporting abuse to a government or other agency. In comparison, in some provinces and territories there is no duty to report abuse and no agency designated to receive reports and respond to abuse. Reporting abuse and neglect is only one possible way to respond to abuse concerns, and it is often not the most helpful response. However, it is important to be aware of your legal obligations. This section highlights any legal duty to respond to abuse or neglect in your province or territory. In every instance it is ideal to talk to the older person about his or her own experience and then help connect the person with resources and services. The Resources Handout contains a lengthy list of agencies in each province and territory. Section 4 highlights some resource organizations that can help you decide what to do and services that you can refer an older person to if you think someone is hurting them or their property.

Is the person in danger of harm?
NEWFOUNDLAND AND LABRADOR QUESTIONS TO CONSIDER Is the person in danger of harm? Will money be stolen or spent? Property taken away? Does the person appear to lack mental capacity? How to respond to concerns of abuse is a very delicate question that is difficult to answer and depends on the specifics of each case. Here are some things to consider. These questions can help you to assess if there is a need for urgent action to protect the person or his or her belongings, or if you can take more time to help the adult to identify support or assistance that may protect the person from abuse or neglect.

ELDER ABUSE AND NEGLECT AND THE CRIMINAL LAW
NEWFOUNDLAND AND LABRADOR ELDER ABUSE AND NEGLECT AND THE CRIMINAL LAW Some abusive acts are crimes Some acts might not be criminal even if very harmful Crimes can be reported to the police Although there is no crime called “elder abuse”, sometimes acts of elder abuse can be crimes listed in the Criminal Code, which is the federal law that lists most crimes in Canada and applies across the country. Some examples: Assault Sexual Assault Uttering Threats Unlawful Confinement Theft Fraud Failing to provide the necessaries of life (criminal neglect) Theft by a person holding a power of attorney Often an abusive act is not a crime. For example, emotional abuse, isolating the older person from friends, spending funds in a joint account – these actions are not crimes. Even if an act is possibly criminal, it may be difficult to prosecute the crime, for example, due to a lack of witnesses. Also, an older person victim may not want to see someone they love go to court or get reported to the police - even if this person did things that were very hurtful. If a crime has occurred you may call the police. There is no general legal duty to report crimes involving older adult victims. Reporting a crime sometimes helps adult victims, especially victims who want a court order to keep an abusive person away from them. You might also want to consider reporting a crime to protect your organization from liability. It may look badly on your organization if you or another volunteer or employee was aware of a crime and did nothing. It is not always appropriate to call the police, especially if the older person is not able to access other support and assistance. In some instances a report to the police can increase the likelihood of further abuse.

NEGLECTED ADULTS WELFARE ACT
NEWFOUNDLAND AND LABRADOR NEGLECTED ADULTS WELFARE ACT Every person must report information regarding neglected adults Report to the Director of Neglected Adults Duty to report applies to confidential information Failure to report is an offence A person can be fined for not reporting concerns Newfoundland has a law called the Neglected Adults Welfare Act. Here are some key points about the law.

LEGAL DEFINITION OF NEGLECT
NEWFOUNDLAND AND LABRADOR LEGAL DEFINITION OF NEGLECT A person “who: is incapable of caring properly for self because of physical or mental infirmity, is not receiving proper care and attention, and who refuses, delays or is unable to make provision for proper care and attention for himself or herself.” The law excludes people covered by mental health law. In most basic terms, the law covers people who are not able to take care of themselves, are not receiving care and need some kind of care they are not receiving.

ELDER ABUSE Newfoundland and Labrador does not have a law that requires people to respond to abuse or neglect of adults under other circumstances or that deals with services to abused older adults. Still, there are a number of agencies discussed in section 4 that you can contact if you have concerns.

How do you Identify the Best Response?
3 How do you Identify the Best Response? It can be difficult sometimes to decide when you should do something if you are concerned about an older person who has been mistreated, may be being hurt or taken advantage of by someone, or seems to be at risk of being harmed by someone. Here is a list of guidelines to help you figure out if you should do something and what you should do. There is rarely an easy answer. The overarching goal is always to find the right balance between Protection, and Independence. How can you support an older person to get the support or assistance they need and live free from abuse (protection), while at the same respecting a person’s inherent right to freedom, independence, and privacy (independence)? In other words, how do you assist a vulnerable or mistreated person without undermining their autonomy or increasing their risk of harm?

GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT
NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 1. Talk to the older adult Ask questions. Talk to the older person about his or her experience. Help the person to identify resources that could be helpful. Ask questions and avoid assumptions. The best response is one that an older person identifies as being helpful.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 2. Respect personal values Respect the personal values, priorities, goals and lifestyle choices of an older adult. Identify support networks and solutions that suit the older adult’s individuality. Asking questions will help you to identify appropriate resources and responses. The same response and resources will not work for everyone. Appreciate that some forms of elder abuse are rooted in a lack of respect for the older person’s values and choices.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 3. Recognize the right to make decisions Mentally capable older adults have the right to make decisions, including choices others might consider risky or unwise. Mental capability refers to an adult’s ability to make a reasoned decision. In general, a mentally capable adult is able to understand information and appreciate the consequences of a decision. Some adults will be capable of making some decisions and not others. The issue is not whether the decision the adult makes is reasonable to YOU, but rather whether the adult went through his or her own reasoning process, weighed the options, and came to his or her own reasoned conclusion. Mental capacity is a legal concept that is generally decision-specific and a different standard or test applies depending on the nature of the decision at issue. Getting older doesn’t mean you lose the right to make your own decisions. You can lose the right to make decisions as a result of a court decision or other legal non-court process, based on medical findings, once a medical or other condition takes away your ability to make reasoned decisions.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 4. Seek consent or permission In most situations, you should get consent from an older adult before taking action. Ask for consent FIRST unless it is an emergency. The best form of help is almost always something the older person identifies as helpful. Abuse takes away an older person’s sense of power and control. Be conscious that your response serves to empower the older person rather than take more personal power away.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 5. Respect confidentiality and privacy rights Get consent before sharing another person’s private information, including confidential personal or health information. In general it is against the law to disclose a person’s personal or health information without first getting consent from the person. Violating privacy rights may also be against your professional code of conduct or your organization’s internal policies. Sharing confidential information can also harm an older adult’s sense of dignity, stop an older adult from trusting you to help them, and do damage to other efforts to get assistance and support to a person who is vulnerable to abuse and neglect. In some exceptional situations it is legal and appropriate to disclose information without prior consent. Your organization’s policies may also permit volunteers to share private information in order to consult with staff and supervisors. Some organizations require volunteers and staff to explain confidentiality policies to all clients. Privacy law is complex. If you a volunteer, you should always consult a supervisor before disclosing someone’s personal information to an outside agency. Organizations should have policies in place to help staff and volunteers to know when and to whom to disclose personal information without consent.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 6. Avoid ageism Prevent ageist assumptions or discriminatory thinking based on age from affecting your judgment. Avoid stereotypes about older people and show respect for the inherent dignity of all human beings, regardless of age. Recognize the human dignity of all people. Make sure assumptions about older people – especially negative ones – are not affecting your judgment about how to respond to abuse.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 7. Recognize the value of independence and autonomy Where this is consistent with the adult’s wishes, assist the adult to identify the least intrusive way to access support or assistance. The idea is to honour and safeguard the adult’s independence as much as possible while at the same time helping the person to get the right assistance. Abuse can rob a person of freedom and independence. Be conscious that your response does not further undermine personal freedom.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 8. Know that abuse and neglect can happen anywhere and by anyone Abuse and neglect of older adults can occur in a variety of circumstances from home care to family violence.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 9. Respect rights An appropriate response to abuse, neglect, or risk of abuse or neglect should respect the legal rights of the older adult, while addressing the need for support, assistance, or protection in practical ways. Respecting rights such as the right to confidentiality of private and personal information unless it is an emergency.

NEWFOUNDLAND AND LABRADOR GUIDELINES FOR RESPONDING TO ABUSE AND NEGLECT 10. Get informed Ignorance of the law is not an excuse for inaction when someone’s safety is at stake. If you volunteer with older adults you need to educate yourself about elder abuse. Even with education and awareness, responding to elder abuse is complex and challenging. But education about the law, an awareness of ethical considerations, and knowledge of key resources and services can make it easier to decide what to do, to identify who you can seek guidance from in your agency or to whom you should refer an issue, as well as make you feel more confident that you did the best you could under the circumstances.

4 Who to call for more Information or to Respond to Concerns about Abuse?

Reporting abuse and neglect Legal advice
NEWFOUNDLAND AND LABRADOR RESOURCES Urgent assistance Reporting abuse and neglect Legal advice Counseling and victim assistance More information about elder abuse This presentation highlights 5 key types of resources. See the Resources Handout for information and assistance not covered by these categories and for contact numbers and websites. This section outlines options and agencies. You will not want to contact every single agency in each instance of abuse. The appropriate agencies to contact will depend on the specific circumstances of the older adult.

Call 9-1-1 if an older person is in danger and it is an emergency
NEWFOUNDLAND AND LABRADOR URGENT ASSISTANCE Call if an older person is in danger and it is an emergency Call the police to report a crime The police can require an abusive person to stay away from a victim It may be appropriate to call the police if there is an urgent need to get an abusive person to stay away from the adult who has been abused. It is not always appropriate to call the police. In some instances a report to the police can increase the likelihood of further abuse.

REPORTING NEGLECT Call the Director of Neglected Adults or a social worker, who will report to the Director. Contact number in the Resources Handout.

LEGAL ADVICE Refer older adults to the Public Legal Information Association of Newfoundland and Labrador for legal advice, assistance or referral. Contact numbers are listed in the Resources Handout.

There are a number of agencies that offer crisis counseling
NEWFOUNDLAND AND LABRADOR VICTIM ASSISTANCE There are a number of agencies that offer crisis counseling It can be helpful to give a person a number they can call for free confidential support Contact numbers are listed in the Resources Handout.

A Practical Guide to Elder Abuse and Neglect Law in Canada (2010)
NEWFOUNDLAND AND LABRADOR MORE INFORMATION A Practical Guide to Elder Abuse and Neglect Law in Canada (2010) By the Canadian Centre for Elder Law Available online for free in English and French This Guide provides more details on the law in relation to elder abuse and neglect in Canada. The Guide contains a summary of the law in each province or territory so you can focus on the areas of Canada in which you are volunteering or delivering services.

Be aware of reporting obligations.
NEWFOUNDLAND AND LABRADOR REVIEW Know the organizations in your community where you can refer adults for further support or assistance. Be aware of reporting obligations. Respect privacy and confidentiality. Consult a supervisor when you are not sure how to respond. Here are key things you need to remember from this workshop.

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