An Act to strengthen the fight against maltreatment of seniors and other persons of full age in vulnerable situations
Background
In 2017, the Government of Quebec passed the Act. On April 6, 2022, Bill 101 respecting the maltreatment of seniors and other persons of full age in vulnerable situations was assented to, strengthening the initial 2017 Act.
Major changes made by the Act
- Mandatory adoption of a policy to combat maltreatment of persons in vulnerable situations by public or private institutions in the health and social services network (RSSS).
- Addition to the role of local complaints commissioners and improvements to the quality of services offered by RSSS institutions (processing of maltreatment reports).
- Possibility of lifting confidentiality or professional secrecy where there is a serious risk of death or serious bodily injury.
- Establishment of a Quebec-wide framework agreement.
- Establishment a concerted intervention process (CIP).
- Requirement that certain situations of maltreatment be reported and introduction of penal sanctions in cases of breach.
- Encouragement of voluntary reporting by witnesses or victims.
Impact on First Nations in Quebec
Impact on the population
- When a situation of maltreatment is reported, vulnerable persons from First Nations receiving services from the RSSS may face an intervention (even to the point of being relocated outside the community) without the health centre (or nursing station), the community police department, or a person in authority being consulted or even informed. (*)
- The rules of confidentiality may prevent anyone not authorized by the Act and the regulations of Quebec organizations from contacting the person who was reported or obtaining information about them.
(*) To avoid this type of situation, the community and the organizations responsible for the health region should come to an agreement beforehand.
Impact on community decision–makers and resource persons
- In the case of a report, an existing agreement between a community and an RSSS institution cannot be applied if it does not provide for a process to deal with situations of maltreatment.
- Communities might find themselves unable to follow up on files of people reported to the commissioner and therefore be incapable of supporting families in their interactions with the Quebec organizations involved in the intervention.
- To comply with their legal duty and avoid penal and ethical sanctions, community resource persons may be forced to submit a report to a CIP authority in their health region in the following cases:
- If the community has no anti-maltreatment policy or if it is not organized to respond to the report.
- If no person in authority agrees to follow up on the report or is able to do so promptly.
Decision support process
After the Act is implemented, it will be important for community decision–makers to know what their options are so that they can make informed decisions to protect seniors and vulnerable persons in their communities. Here are a few actions to consider to get the process under way.
- Determine the services affected by the application of the Act in the community (health, social services, institutions for seniors and vulnerable persons, income security, public security, etc.).
- Evaluate the impact of the Act on the organization of these services (role of departments, responsibilities of the resource persons concerned, inter-service communication links, etc.).
- Make an inventory of the agreements and processes already in place (within the community and with RSSS partners).
- Review the complaints policy already in place in the community.
- Inform political authorities of the foreseeable effects of the Act on seniors, vulnerable persons, and their families, as well as on the role of services under the authority of the band council.
- Inform and mobilize community resources to get them involved in the protective measures applicable inside and outside the community, depending on the option the community chooses (see options below).
Options proposed
Here are the three options proposed and the benefits of each one.
Status quo
Collaboration agreement
Anti-maltreatment policy and a CIP
The community takes no specific action.
The community adapts an existing agreement or enters into a specific agreement with the health region regarding the application of the Act.
The community adopts its own anti-maltreatment policy
Status quo
The status quo means that the government of Quebec would intervene in the territory, including the communities, to apply the Act. This means that, in a case of maltreatment, only RSSS resources could intervene. It would therefore be possible for people who are reported to be isolated from their environment, culture, and family.
Advantages
- No administrative procedures are required, and there are no changes to current practices.
Disadvantages
- When a report of maltreatment is made, the person is taken in charge by the Quebec network according to the concerted intervention process.
- There is a risk that the person will be placed outside the community, isolating them from their living environment, culture and family and putting them out of reach of community services.
- When the person is taken in charge through the concerted intervention process, the confidentiality policy of Santé Québec regional facilities may limit access to information and communication for community workers, even when there is a service agreement in place.
- It may be difficult for health centres and community services to monitor the case and support the person and his or her family.
Collaboration agreement
Communities could adapt an existing collaboration agreement with an RSSS institution or enter into a specific agreement to apply the Act. Under this type of agreement, communities could, among other things:
- Follow up on reports.
- Exchange information on the files of people who have been reported.
- Propose culturally safe solutions.
- Provide support for families in the communities.
However, this option includes some important aspects that must be considered:
- Before signing such an agreement, the institution could ask the health centre or nursing station to apply its policy. If the institution agrees that the community can develop and implement its own policy on its territory, that policy would probably have to be compliant and consistent with the institution’s policy and the provincial Act.
- Resource persons who belong to professional corporations and work at the community health centre or nursing station would have to submit reports to the Quebec authorities.
- The regional CIP would apply.
- Information exchanges might be limited because of restrictions on information set out in the Act and under the regional CIP.
Advantages
- A communication channel is set up with the Quebec network, allowing for the monitoring of reports and records and information exchange.
- There is the possibility of proposing culturally safe solutions.
- Community workers and Quebec network resource persons can provide support to the individuals and their families.
Disadvantages
- There is an obligation to comply with the Act and apply the anti-maltreatment policy of the relevant Santé Quebec regional facility or to ensure that the community’s policy is compatible and recognized.
- Information sharing may be constrained, limiting the community’s ability to take action.
Step 1: Identify the Santé Quebec regional facility with which the community will collaborate and determine which agreements will be affected.
Step 2: Negotiate the terms of the agreement and include provisions regarding the protection and exchange of confidential information with Santé Québec, respect for the community cultural practices and community participation in the reporting and intervention process.
Step 3: Implement the agreement, while ensuring that clear communication channels are established, and that community workers and Quebec network resource persons receive adequate training.
Key points
- Terms of the agreement: When a report is made, the extent of the community’s involvement should be based on the terms of the agreement, and there needs to be flexibility when it comes to ensuring that the community’s policies are compatible with those of the institutions as well as provincial law.
- Legal terms: Specify the legal terms of the anti-maltreatment legislation that could be adapted to the community’s cultural context and safety concerns and obtain the community’s approval.
- Service corridor: If a service corridor is in place with the health region, evaluate existing measures for sharing information to manage cases of maltreatment.
- Information sharing: Specify in the agreement procedures and measures for sharing information about reports.
- Complaints procedures: If the community already has a procedure for handling maltreatment complaints, see if it can be recognized and adapted by the health region.
- Line of communication for the concerted intervention process: Ensure that there is a line of communication between the community and the institution to support the application of a regional concerted intervention process.
- Reports to the local service quality and complaints commissioner: Professionals working for the health centre or nursing station continue to report cases to Santé Québec, in accordance with the Act. The community may also consider including a waiver of this provision in the agreement if it sets up its own reporting mechanism for professionals working in the community.
- Mandatory reporting: For those living in a residential and long-term care centre or under tutorship or a protection mandate in a First Nations community, establish a line of communication and information exchange with the health region’s concerted intervention process.
- Cases outside the community: For cases of maltreatment occurring outside the community, check whether culturally safe procedures can be applied and recognized by the health region.
- Consent: Clearly define consent, taking into account cultural and linguistic particularities. However, note that consent is not required when a person’s life is in imminent danger. (The First Nations of Quebec and Labrador Health and Social Services Commission [FNQLHSSC] recommends obtaining written or oral consent in the individual’s mother tongue.)
- Primacy of the agreement: Ensure that the agreement takes precedence over other existing agreements.
Anti-maltreatment policy and a CIP
The third option is to develop an anti-maltreatment policy while also adopting and implementing a community CIP through a by-law under the Indian Act to give it legal effect. This would allow for, among other things:
- The designation of resource persons to implement the community’s CIP and to participate in intervention processes triggered by an RSSS organization for members who live outside the community.
- A reporting process by which reports are made to a resource person in the community who is designated to receive complaints and is in charge of mobilizing resources locally.
At the same time, communities would have to draw on their own legal powers to enter into or update one or more agreements with the institutions and organizations taking part in the CIP in their health region, in order to:
- Facilitate the recognition of the anti-maltreatment policy and the community CIP by these organizations.
- Come to agreements with those organizations on the coordination and communication channels to be established between designated resource persons under the community’s CIP and the regional CIP in the event of a report by an RSSS institution.
- Amend any other agreement on service corridors to take into account situations related to reported cases of maltreatment, whether the report was made under a CIP triggered by the community’s services or by an RSSS institution.
Advantages
- Control over the management of maltreatment situations.
- Solutions adapted to the community’s culture and values.
- Strengthening of the community’s autonomy and empowerment.
- Community professionals can legally file a report with a designated worker and mobilize the resources of the consultation mechanism.
Disadvantages
- It is a complex process, requiring human and financial resources.
- Sustained commitment is needed.
- There is a risk of not benefiting from the support of the health care network or the resource persons in the concerted intervention process, as resource persons may refuse to exercise the powers granted to them under the Act.
How should you prepare to implement your policy?
Step 1: Set up a committee or working group tasked with developing the policy and the community consultation mechanism, while involving seniors, vulnerable people, their families and key community workers.
Step 2: Draft the policy. It should clearly define the roles and responsibilities of everyone involved, the procedures for managing reporting and interventions, penalties, sanctions, measures to protect confidential information as well as prevention, awareness-raising and training measures.
Step 3: Adopt the policy through a by-law issued by the band council, in accordance with the Indian Act and the inherent rights enshrined in section 35 of the Constitution Act, 1982.
Step 4: Deploy the human and financial resources to apply the policy.
Step 5: Provide community workers with training on the policy.
Step 6: Consider entering into agreements with relevant Santé Québec regional facilities and organizations to facilitate collaboration and coordination where necessary.
Step 7: Regularly evaluate the effectiveness of the policy and make any necessary adjustments.
How to choose the best option?
Each community is unique and must choose the option that best corresponds to its needs, resources and aspirations. Here are a few suggestions to help you:
- Mobilize community workers.
- Consult community members about their concerns and expectations.
- Evaluate the resources available to implement the chosen option.
- Seek help in developing an appropriate policy or collaborative agreement.
For more information about the Act or for assistance, please contact us at info@cssspnql.com or 418-842-1540.