Please note: the following case study contains a graphic description of sexual assault. This content was included after much thought and discussion to illustrate the seriousness of the situation. |
Elsie listens 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 reported the incident right away to Sharon, the nurse manager. Although Sharon assured her that “these things happen” and it would be “taken care of,” Julia hasn’t received any follow-up. She’s concerned that Sharon hasn’t taken any steps to investigate or address the incident. Julia is now turning to Elsie, hoping she will take further action.
- Is this incident reportable?
Elsie knows that sexual expression and intimacy in long-term care is complex. She is concerned about the safety and well-being of Mr. C, Mrs. S, and the other clients.
Elsie also knows that any instance of client abuse is legally reportable under legislation such as the
Community Care and Assisted Living Act and Adult Guardianship Act, and health authority and facility policies. When criminality—or suspected or unclear criminality—is involved,
police must also be notified.
Reporting abuse ensures that:
- Affected persons receive appropriate aftercare and support
- Required notifications are completed
- Steps are taken to prevent further incidents
- All involved receive appropriate care and safety planning
Elsie and Julia agree on the importance of documenting and reporting the observed details.
- A second incident
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 Elsie considers next steps, she witnesses Mr. C cornering another woman in her room. The woman is visibly distressed, and Mr. C is grabbing at her blouse. Elsie immediately calls for assistance, removes Mr. C. from the room, settles him in the quiet lounge, and comforts the woman. Elsie then goes directly to Sharon’s office to report the new incident.
Once again, Sharon downplays the situation stating, “Dementia clients can have sexually inappropriate behaviour” and “There's no need to blow things out of proportion.” Although Elsie restates her concerns, Sharon remains dismissive and leaves for the day.
Elsie is alarmed by her manager’s response. She believes that if the first incident had been properly addressed, protective measures and a revised care plan could have been implemented, preventing further harm. Elsie does not have the authority to initiate an investigation, order one-to-one supervision, or arrange for Mr. C's transfer to a more appropriate care setting.
- What should Elsie do?
Elsie knows she cannot leave other clients at risk from Mr. C's ongoing behaviour. Since her initial report to her manager was ineffective, she considers other options:
- Escalate her concerns to the Director of Care (while informing the manager, if appropriate)
- Notify Mr. C's and Mrs. S's physician or nurse practitioner
- Temporarily implement constant supervision for Mr. C until a revised care plan is in place
- Continue to support Mrs. S and other affected clients
Elsie decides to call the Director of Care. She outlines the two incidents, Sharon’s lack of follow-up, and her ongoing concerns for client safety. The Director of Care acts immediately authorizing all of Elsie’s proposed steps and calling an urgent team meeting to develop and implement appropriate care plans and support.
Reflection
What are your thoughts?
- What would you do in this situation?
- What options do you have in your setting?
- Are you familiar with your employer and reporting procedures for abuse or neglect?
Taking elder abuse seriously
Nurses have a legal and ethical responsibility to prevent foreseeable harm to clients, especially those who are vulnerable due to mental and/or physical conditions.
Minimizing or normalizing sexual assault or any form of abuse is
unacceptable. Elder abuse includes:
- Physical, sexual, or emotional harm
- Neglect or abandonment
Financial exploitation
Signs of abuse may include:
Reporting abuse and making complaints
Abuse may be a criminal offence under the
Criminal Code of Canada.
If a nurse or another regulated professional fails to report abuse or uphold their professional obligations, you can
submit a complaint to BCCNM or the appropriate regulatory college.
If you're unsure who to contact, consult this government resource
Responding to Elder Abuse: Who to call, when and why.
Resources