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Protecting vulnerable seniors in your care

Case study about taking action

Please note: the following case study contains a graphic description of sexual assault. This content was included after much thought and discussion in order to illustrate the seriousness of the situation.

Elsie listens closely as Julia, a care aide, shares her concerns about an incident that occurred the previous week, while Elsie was away.

Julia found Mr. C, a resident with dementia, in Mrs. S’s room. His pants were undone and he was on top of Mrs. S with his hands down her pants. Mrs. C was weeping and agitated but because of her own dementia, was unable to express herself, call for help or stop Mr. C’s actions.

Julia reported the situation right away to Sharon, the resident care nurse manager. Although Sharon assured her that “these things happen” and it would be “taken care of,” Julia hasn’t heard anything from her since. She’s concerned that Sharon hasn’t taken any steps to collect more information or address the incident in any way. She hopes Elsie can do something more. ​​

Is this incident reportable?

Elsie knows that sexual expression and social/sexual intimacy in lont-term care is complex, and is concerned about Mr. C, Mrs. S and the other residents under their care.

Elsie also knows that all instances of resident abuse are reportable circumstances. This is required  under multiple enactments such as the Community Care and Assisted Living Act (and possibly the Adult Guardianship Act), and policies, including facility and health authority patient abuse policies. In matters of criminality or suspected/undetermined criminality, assaults are reportable to the police.

All abuse must be reported so that:

  • Affected individuals receive appropriate aftercare,
  • Required notifications are completed,
  • Future incidents are prevented, and
  • Appropriate supports are provided to all involved.

Elsie and Julia discuss the importance of documenting and reporting the observed, factual details.

What should Elsie consider?

Elsie knows Mr. C cannot regulate his behaviour because of his dementia and requires a plan of care that assesses and meets his care needs and sensitively addresses his behaviours. Elsie is aware, given the recent changes in Mr. C's behaviours, an assessment and plan is urgently required to protect all residents. For example, Mr. C's behaviour may put him and others at risk for defensive or reactive physical assault and the facility has a duty of care to support him in preventing this behaviour. ​

As she considers what to do, Elsie discovers Mr. C cornering a different, visibly distressed resident in her room, grabbing at her blouse. Elsie immediately calls for assistance to remove Mr. C. from the room and settle him in the quiet lounge, while she comforts the female resident. Elsie then goes directly to Sharon’s office to report the matter and determine what steps will be taken to appropriately protect the residents, investigate the incident and ensure that Mr. C’s care plan supports his needs.

Elsie is dismayed when Sharon again minimizes the incident, saying “dementia residents can have sexually inappropriate behaviour” and “no need to blow things out of proportion.” Elsie reiterates her concerns but Sharon does not agree and a few minutes later leaves for the day.

Elsie is not comfortable with her manager’s dismissal of the situation. She worries that Mr. C will continue to endanger other residents and believes that if the first incident had been investigated, appropriate protection, care plans and support for all the residents would have been put in place. Elsie does not have the authority to complete an investigation nor authorize one to one supervision or a transfer to a more supervised care situation.

What should Elsie do?

​Elsie knows she must not leave the residents at risk from Mr. C's behaviour. She considers her options and available resources.

Her first responsibility—to report it to her manager—was not successful, so she considers some of the other available options:

  • Escalate her concerns to the Director of Care (inform the manager of the decision to take this step, if possible or appropriate).
  • Notify Mr. C's and Mrs. S's physician/nurse practitioner
  • Temporarily put Mr. C under constant supervision until an appropriate plan of care is put into place
  • Provide ongoing support to Mrs. S and other residents

As Elsie is not comfortable doing anything else without some kind of approval from her employer, she decides to call the Director of Care. She outlines the two incidents, the manager's inaction, and her ongoing safety concerns for other residents. The Director of Care authorizes the implementation of all the above options and calls an urgent team meeting to put appropriate supports and care plans into place.

What are your thoughts?

  • What would you do in this situation?
  • What options are available to you for dealing with a similar situation?
  • Are you familiar with your employer policies that would provide direction in a similar situation?

Taking elder abuse seriously

Nurses are reminded they have a legal duty to prevent foreseeable risk of harm to any client or resident in their facilities, and in particular any person who is vulnerable because of a mental and/or physical disabilities. 

Normalizing sexual assaults or other types of abuse and looking the other way is completely unacceptable. Elder abuse includes actions that cause physical, mental or sexual harm, as well as financial exploitation. Potential signs of abuse include unexplained injuries, fear, anxiety, and unusual financial activity.

Reporting abuse and lodging complaint​​s​

Abuse may be a crime and fall under the Criminal Code. Call your local police ​station for information or to report abuse. If you or someone is in immediate danger, call 9-1-1.

If you observe a nurse or other health professional failing to report abuse or not meeting their professional obligations, consider submitting a complaint to CRNBC or their respective regulatory college.  

If you're not sure who to contact consult the B.C. government's resource:  Responding to Elder Abuse: Who to call, when and why

​Getting informa​tion and help

The newly named Seniors First BC, formerly the BC Centre for Elder Advocacy and Support, offers a toll-free helpline for older adults, and those who care about them, to talk to someone about situations where they feel they are being abused or mistreated, or to receive information about elder abuse prevention.

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