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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 tells Elise that she found Mr. C, a client 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.

Julia states that she reported the incident right away to Sharon, the nurse manager. Although Sharon assured Julia 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. Julia hopes Elsie can do something more. ​​

Is this incident reportable?

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

Elsie also knows that all instances of client abuse are reportable as required by laws such as the Community Care and Assisted Living Act and the Adult Guardianship Act and facility and health authority client abuse policies. In matters of criminality or suspected/undetermined criminality, assaults are reportable to the police.

All abuse must be reported so that:

  • Affected persons receive appropriate aftercare
  • Required notifications are completed
  • Future incidents are prevented
  • Appropriate supports are provided to all involved

Elsie and Julia discuss the importance of documenting and reporting the observed 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 clients.

As she considers what to do, Elsie discovers Mr. C cornering a different, visibly distressed woman 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 woman. Elsie then goes directly to Sharon’s office to report the matter and determine what steps will be taken to appropriately protect the clients, 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 clients can have sexually inappropriate behaviour” and “no need to blow things out of proportion.” Elsie restates 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 clients and believes that if the first incident had been investigated, appropriate protection, care plans and support for all the clients would have been put in place. Elsie does not have the authority to complete an investigation, authorize 1:1 supervision or a transfer to a more supervised care situation.

What should Elsie do?

Elsie knows she must not leave the clients 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 in place
  • Provide ongoing support to Mrs. S and other clients

Elsie decides to call the Director of Care. She outlines the two incidents, the manager's inaction, and her ongoing safety concerns for other clients. 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 in their facilities, and in particular any person who is vulnerable because of 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 making complaints

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, submit a complaint to BCCNM or the appropriate 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.

Resources

The Seniors First BC 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.

900 – 200 Granville St
Vancouver, BC  V6C 1S4
Canada

info@bccnm​.ca
604.742.6200​
​Toll-free 1.866.880.7101 (within Canada only) ​


With great respect, we acknowledge that BCCNM’s office is located on the unceded territories of the hən̓q̓əmin̓əm̓ speaking peoples – xʷməθkʷəy̓əm (Musqueam), and sel̓íl̓witulh (Tsleil-Waututh) Nations, and the Sḵwx̱wú7mesh-ulh Sníchim speaking peoples - Sḵwx̱wú7mesh Úxwumixw (Squamish Nation) whose historical relationships with the land continue to this day.​