Abuse Policy

VALUES AND BELIEFS:

The Leamington Mennonite Home values and respects the dignity and unique gifts of each resident, staff, volunteer, resident family member, and community caregivers. The Home strives to promote a home-like environment which nurtures respect between and among all individuals who contribute to the quality of life at the Leamington Mennonite Home.

The Home seeks to provide a safe and secure facility of care, free from any threat, abuse, neglect, or harsh behaviours and/or conduct.

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POLICY:

The Leamington Mennonite Home has a policy of zero tolerance for any type of abuse that may occur at the Home. The Home will be proactive and responsive in its ongoing management of abuse prevention, intervention, and education.

The Home shall treat every reported incident and allegation of abuse, witnessed or suspected, as a serious matter and will investigate such allegation(s) immediately with consequent Ministry of Health/RHRA reporting, disciplinary, education and prevention measure(s) as required.  The Home, and/or any person who has reasonable grounds to suspect abuse, shall immediately report to the Director any:

• improper or incompetent treatment or care of a resident that resulted in harm or a risk of harm to the resident.

• abuse of a resident by anyone or neglect of a resident by the Home staff, volunteers, resident family members, contractors and/or any visitor that resulted in harm or a risk of harm to the resident.

• unlawful conduct that resulted in harm or a risk of harm to a resident.

• misuse or misappropriation of a resident’s money.

• misuse or misappropriation of funding provided to the Home under the Long Term Care Homes Act or the Social Health System Integration Act.

The following definitions shall guide the interpretation, enforcement and evaluation of the LMH Abuse Policy and Procedure.

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Definition: Abuse

Abuse of a resident means any action or inaction, misuse of power and/or betrayal of trust or respect by a person against a resident, that the person knew or ought to have known, would cause (or could reasonably be expected to cause) harm to the resident’s health, safety or well-being.

Abuse includes, but is not limited to:

• Physical Abuse

• Sexual Abuse

• Emotional Abuse

• Verbal Abuse

• Financial Abuse

• Exploitation of a Resident’s Property or Person

• Neglect

Definition: Physical Abuse

Physical Abuse means:

• The use of physical force by anyone other than a resident that causes physical injury, pain, or discomfort.

• Administering or withholding a drug for an inappropriate purpose.

• The use of physical force by a resident that causes physical injury to another resident.

Physical abuse includes, but is not limited to:

• Assault

• Forced confinement

• Biting

• Slapping

• Pushing

• Pinching

• Beating

• Twisting

• Shaking

• Burning

• Forced feeding

• Rough handling, for example attempting to provide care to residents who are actively resisting.

• Overmedication, withholding medication, or medicating a resident when it is not medically necessary to do so.

Definition: Sexual Abuse

Sexual Abuse means:

• Any non-consensual sexual intercourse, or other form of non-consensual physical sexual relations, with a resident.

• Any non-consensual touching of a resident that is of a sexual nature.  This does not include touching, remarks or behaviour of a clinical nature that is appropriate to the provision of care.

• Behaviour or remarks of a sexual nature towards the resident that are unwanted by the resident, including remarks that are sexually demeaning, humiliating, exploitative or derogatory.

• Any situation in which a staff member begins a sexual relationship with a resident.

• Sexual assault of the resident.

Definition: Emotional Abuse

Emotional Abuse means:

• Any action or behaviour that may diminish the sense of identity, dignity, and self-worth of a resident.

• Threatening or insulting gestures, behaviour, or language.

• Imposed social isolation including ‘shunning’, ignoring, or lack of acknowledgement.

• The denial or deprivation of any of a resident’s rights as set out in the Residents’ Bill of Rights.

• Any threatening or intimidating gestures, actions, behaviour, or remarks by a resident that causes alarm or fear to another resident where the resident performing the gestures, actions, behaviour, or remarks understands and appreciates their consequences.

Definition: Verbal Abuse

Verbal Abuse means:

• Any forms of communication, which demonstrate disrespect for the resident.

• Any form of verbal communication of a threatening or intimidating nature or any form of verbal communication of a belittling or degrading nature which diminishes a resident’s sense of well-being, dignity, or self-worth, that is made by anyone other than a resident.

• Any form of verbal communication of a threatening or intimidating nature made by a resident that leads another resident to fear for his or her safety where the resident making the communication understands and appreciates its consequences.

Verbal Abuse includes, but is not limited to:

• Swearing

• Name-calling, cultural or racial slurs

• Threats or insults

• Shouting

• Belittling, degradation, infantilization

• Sarcasm, taunting

• Intimidation

• Inappropriate tone of voice and manner of speaking which is upsetting and/or frightening to the resident

Definition: Financial Abuse

Financial Abuse means:

• Any misappropriation or misuse of a resident’s finances.

• Providing any financial information which is misleading, erroneous or of malicious intent.

Financial abuse includes, but is not limited to:

• Theft or unlawfully withholding a resident’s money, pension, securities, etc.

• Fraud, forgery, and extortion.

• Using Power of Attorney, Substitute Decision-Making authority, or a family relationship in a manner that is detrimental to the resident or the resident’s care and/or personal well being.

Note: The definitions of physical, sexual, emotional, verbal, and financial abuse are also applicable to all staff, volunteers, resident family members, and community care givers.

Definition: Exploitation of a Resident’s Property

Exploitation of a Resident’s Property means:

• Theft of or unlawfully withholding a resident’s property or possessions (including the resident’s food, and items of little monetary value).

• “Borrowing” of a resident’s personal belongings by staff (in which there is removal of the item).

• Using the property or the personal image/voice of a resident for personal, commercial, or other purposes in a manner that is detrimental to the resident’s well-being.

• Using any of the following, without the resident’s consent, and in a manner that is detrimental to the resident or the resident’s care:

• Power of Attorney

• Substitute decision-making authority

• A family relationship

Definition: Neglect

Neglect is a form of abuse and means:

• The failure to provide the care and assistance required for the health, safety or well being of a resident.

• A pattern of inaction that jeopardizes the health or safety of one or more residents.

• The term” neglect” includes, but is not limited to, the failure to:

• Provide the ongoing care set out in a resident’s plan of care.

• Provide access to a physician’s services, when required.

• Reduce and manage health and safety hazards in the Home on an ongoing basis.

• Implement programs to identify and mitigate risks, so as to prevent and minimize health-care problems in the home, including, but not limited to the following:

  • Pressure ulcers

  • Dehydration

  • Unplanned weight loss

• Summon or provide assistance, when required.

• Respond to a resident’s request for assistance.

Definition: Assault

Assault is a form of abuse and means:

• Attempting to apply force to a resident, or threatening (by act or gesture) to apply force to a resident, in such a way that the resident can ”reasonably” expect the threat or action to be carried out.

• Intentionally applying force to the resident, directly or indirectly, without the resident’s consent.

• A physical attack on the resident.

Definition: Staff

Staff of the Leamington Mennonite Home includes, for the purposes of this policy, except where otherwise indicated, any permanent and contract, full-time and part-time:

• Employees

• Physicians

• Agency staff

• Contracted health-care professionals

• Paid trainees

• Students under clinical placements

• Paid companions (paid by the resident, family member or substitute decision-maker)

• Contracted workers

This definition does not imply or create an employer/employee relationship where none exists, and it is used solely in the context of this policy to clarify that abuse will not be tolerated from any source.

Definition: Substitute Decision-Maker

Substitute Decision-Maker (SDM), in relation to a resident, means depending on the context, one or more of the following:

• The person who would be authorized under the Health Care Consent Act, to give or refuse consent to a treatment on behalf of the resident, if the resident were incapable of making decisions with respect to the treatment under that Act.

• The person who would be authorized under the Health Care Consent Act, to make a decision concerning a personal assistance service on behalf of the resident, if the resident were incapable of making decisions with respect to the personal assistance service under that Act,

• The person who is authorized under the Substitute Decisions Act to make decisions concerning the resident’s property, or

• The person who is authorized under the Substitute Decision Act to make a decision concerning the resident’s personal care, if the resident is incapable of making the decision.

Definition: Zero Tolerance Policy

The Leamington Mennonite Home maintains a Zero Tolerance Policy with regard to any form of abuse as defined in the Abuse Policy and Procedure.  The Zero Tolerance Policy ensures that:

• Prevention, education and awareness of abuse remain the foundation of the Abuse Policy.

• No exceptions occur.

• No abuse, assault, neglect or any threat or intimidation as defined in the Policy is tolerated.

• The Abuse Policy is always enforced and is applied to all individuals present at the Leamington Mennonite Home.

Zero Tolerance further means that the Leamington Mennonite Home shall:

• Build awareness of, and educate, to achieve the goal of elimination of abuse.

• Allow no exceptions.

• Tolerate no abusive behaviour, and

• Require strict compliance and enforcement.

Zero Tolerance means, within this policy, that the Leamington Mennonite Home shall:

• Uphold the right of the residents of our Home to be treated with dignity and respect within the Home, and to live free from any abuse, neglect, and/or threat, intimidation and assault.

• Not tolerate any form of abuse by anyone working, residing, visiting or volunteering at the Leamington Mennonite Home.

• Provide information and education regarding abuse and the prevention of abuse.

• Treat every allegation of abuse as a serious matter.

• Investigate every allegation of abuse.

• Take corrective action, including sanctions or penalties, against those who have committed abuse against a resident.

• Report to the Ministry of Health and Long-Term Care every incident of abuse, improper or incompetent treatment and unlawful conduct that resulted in harm or a risk of harm to a resident.  Any misuse or misappropriation of the resident’s money or the misuse or misappropriation of funding to the Home shall be reported immediately upon becoming aware of the incident.

• Make every effort to eliminate abuse through the Quality Improvement Program(s) of the Leamington Mennonite Home.

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Abuse Prevention Program

The Leamington Mennonite Home seeks to be not only responsive but also proactive in the prevention of any form of abuse, neglect, assault or threat.  An Abuse Prevention Program shall be maintained by the Home whereby the following measures are facilitated:

• All new staff shall receive an extensive information/education package on the LMH: Abuse Policy & Procedure and obligation to report any witnessed or suspected incidents of abuse.

• Volunteers will receive an information package outlining the LMH: Abuse Policy & Procedure with an accompanying signed acknowledgement that the policy has been read and understood.

• A monthly interdisciplinary review of residents with difficult behaviours creating risks for resident and/or staff abuse.  The review to be undertaken by the Home’s Leadership Team representing all Departments at their monthly meetings.

• A quarterly review of abuse/resident care incidents by the Dementia: Best Practice Working Group and Quality Improvement Committee with the development of education, promotion, awareness, and prevention strategies.

• A quarterly review of resident health and safety incidents by the Occupational Health and Safety Committee of the Home.

• Annual mandatory education regarding the LMH Abuse Policy and Procedure.

• Information Package on the LMH Abuse Policy and Procedure provided to each new employee, volunteer, and contract worker at the Home.

• Completion of criminal reference checks for all hired staff and volunteers in accordance with the Home’s Criminal Reference Check Policy and Procedure.  Such Criminal Reference Checks shall assist the Home in preventing unsuitable staff and volunteers from assuming positions of trust within the Home.

Policy Evaluation

The Home shall ensure that:

• An analysis of every incident of abuse or neglect of a resident is undertaken immediately of receiving information/knowledge of an incident.

• At least annually an evaluation is facilitated by the Administrator in co-operation and consultation with the Leadership Team to determine the effectiveness of the policy to promote Zero Tolerance of abuse and neglect of residents and to promptly implement changes and improvements to prevent further occurrences. The results of the analysis of incidents reviewed are considered in the evaluation.

A written record of the annual evaluation and implemented changes/improvements to the policy shall be generated by the Administrator, including date, names of persons who participated in the evaluation as well as the implementation date of policy revisions/changes.

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Abuse Policy Compendium

INTERACTIONS SUBJECT TO ABUSE:

1. Staff to Resident Abuse – Can include, but is not limited to, the following:

   1. Slapping, pushing, rough interaction/care

   2. Forced confinement in bed, chair, room (unauthorized or unnecessary restraints)

   3. Failure to provide reasonable supervision to an impaired person to prevent injury

   4. Misuse of medications

   5. Stealing money, cheques, or possessions

   6. Remarks that are humiliating, insulting, frightening, mimicking, taunting, or any form of speech with intent to annoy or cause discomfort

   7. Shouting, swearing, curt response

   8. Sexual fondling or relations

   9. Knowingly allowing resident abuse to occur

   10. Failure to report observed, suggested, or alleged incidents of resident abuse

   11. Failure to attend to basic needs in a timely fashion (grooming, food, clothing, and incontinence)

   12. Failure to provide proper medical care

   13. Any unwarranted action which strips resident of dignity

2. Staff to Staff Abuse – Can include, but is not limited to, the following:

   1. Harassment by employer, supervisor, or co-worker with intent to cause offense or humiliation

   2. Behaviour which is intimidating, annoying, hurtful or malicious

   3. Slurs, gestures, name calling, innuendoes, or taunts that are insulting

   4. Displays of demeaning or derogatory material

   5. Unwelcome physical contact or remarks of a sexual nature

   6. Harassment aimed at disability, gender, sexual orientation, race or ethnic background

   7. Any physical abuse

Note: LMH Staff, by definition includes all employees (union and non-union) professionals with Home privileges (such as Physicians, Occupational and Physiotherapists, Dieticians), contracted service providers, salespersons, students, volunteers.

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1. Resident to Staff – Can include, but is not limited to, the following:

   1. Aggression: physical, verbal

   2. Inappropriate language and/or body gestures

   3. Unwillingness to follow instructions and care routines

   4. Spitting, biting and other unacceptable forms of behaviour

2. Resident to Resident – Can include, but is not limited to, the following:

   1. Aggression: physical, verbal

   2. Inappropriate Language and/or body gestures

   3. Use of elevated voice

   4. Unconsensual sexual relations

   5. Any form of harassment

3. Visitor/Family to Resident – Can include, but is not limited to, the following:

   1. Unwanted visits and conversation

   2. Neglect

   3. Financial mismanagement and fraud

   4. Withholding of important information

   5. Inappropriate language use

Abuse Committed by a Staff Member or Volunteer

In the event of abuse committed by a staff member or volunteer at the Home, the Home shall:

• Make all staff and volunteers aware of the Home’s policy on abuse and the expectation that both staff and volunteers will comply with this policy.

• Make all residents of the Home, resident families and Substitute Decision Makers aware of:

  • The Home’s policy on abuse

  • The expectation that the policy will be held in compliance

  • The Home’s expectation that residents or their SDM’s report all suspected alleged and confirmed instances of abuse to the Registered Staff, Department Leader or Administrator.

• Resources made available to residents or their SDM’s in the event that an incident of abuse occurs include access to:

  • Home Chaplain

  • Shalom Counseling Services

  • Canadian Mental Health Association:  Counseling Services

• When a member of the staff or volunteer fails to comply with the Home’s policy on abuse the following measures shall be taken:

  • An investigation shall commence immediately following the Investigation Protocol included in the Abuse Policy & Procedure.

  • The staff member shall be automatically suspended with consequent disciplinary measures, pending the outcome of the investigation.

  • The volunteer shall have their volunteer rights to the Home suspended and/or terminated, pending the outcome of the investigation.

  • The Ministry of Health and Long Term Care shall be notified of the alleged abuse and action plan taken.

Abuse Committed by a Resident’s Family Member, Substitute Decision Maker, or Visitor

The Home shall:

• Communicate to all family members, substitute decision makers and visitors to the Home that the Home has and enforces a policy on abuse, that all family members, substitute decision-maker and visitors to the Home are expected to comply with. Action will be taken against those who do not comply. The Ministry of Health and Long Term Care shall be notified of the alleged abuse and action plan taken.

Communication to family members, substitute decision makers and volunteers shall include, but not be limited to the following:

• Inclusion of the Abuse Policy in the Admission Package distributed to family members and others upon a resident’s admission.

• Articles in the Resident Family Newsletter

• Facilitation of Information Sessions for Resident Families

When a resident’s family member, substitute decision maker or visitor does not comply with the Abuse Policy & Procedure, that individual shall automatically be suspended from visiting the home with consequent further corrective and punitive measures taken, pending the outcome of the Investigation.

• An investigation shall commence immediately following the Investigation protocols included in the Abuse Policy & Procedure.

• The Ministry of Health and Long Term Care shall be notified of the alleged abuse and action plan taken.

Abuse Committed by Another Resident

The Home shall:

• Communicate to each mentally capable resident and substitute decision maker, upon admission, the contents of the Home’s policy on abuse and the expectation that the resident will comply with the policy. The Home shall ensure that the consequences of not adhering to the policy are explained to the resident and substitute decision maker.

The communication to the resident shall include, but is not limited to:

• Education/Information at Residents Council Meetings.

• Posting the policy in locations that are easily accessible to the resident and/or public.

• When a resident fails to comply with the Abuse Policy & Procedure, the following measures will be taken:

• The resident will be re-educated/informed of the Abuse Policy and Procedure.

• The resident will be isolated from other residents until the completion of the investigation with further measures taken, pending the outcome of the investigation.

• An investigation shall commence immediately following the Investigation Protocols included in the Abuse Policy & Procedure.

• The Ministry of Health and Long Term Care shall be notified of the alleged abuse and action plan taken.

Abuse Committed by Cognitively Impaired Resident

The Home shall:

• Provide, at least annually, and as required, education/information on Dealing with Difficult Resident Behaviours. The Quality Improvement Committee shall provide advisement on resource materials and educational inservicing for all staff, residents, and their families as well as volunteers.

• Provide information to Substitute Decision Makers regarding the zero tolerance Abuse Policy and Procedure maintained by the Home.

• Review the special needs, behaviours and risks of cognitively challenged residents with identifiable, abusive behaviours on a monthly basis. An interdisciplinary team shall assess the needs of a cognitively incapable resident upon a reported or suspected incident of abuse and recommend an action plan. The Substitute Decision Maker will be notified of the assessment and involved in the formulation of a responsive action plan.

Abuse Committed by Others

The Home shall:

• Communicate to all persons entering the Home, including independent contractors, maintenance staff, etc., that the Home has, and enforces, a policy on abuse and that action will be taken against anyone who does not comply with that policy.

The communication to persons entering the Home may include, but is not limited to, the following:

• Posting the policy in a prominent location within the Home

• Distributing a brochure on the Home’s policy and other issues related to abuse.