Abuse in Quebec Twice as many
complaints in one year
A total of 1,667 cases of elder abuse and other adults were reported in the health care system between April 1, 2019 and March 31, 2020- until the very beginning of the pandemic. In 2018-2019, 866 cases had been processed.
The number of complaints and reports of abuse of seniors and other vulnerable adults has doubled in Quebec in one year. This increase does not mean that there is more abuse and neglect, experts say. A recent law would rather shine
a spotlight on problems that are often left in the shadows.
The number of complaints and reports of abuse of seniors and other vulnerable adults has doubled in Quebec in one year. This increase does not mean that there is more abuse and neglect, experts say. A recent law would rather shine
a spotlight on problems that are often left in the shadows.
(Quebec) A law that makes its effects felt
Twice as many complaints and reports were received by health network authorities in one year.
A total of 1,667 cases of maltreatment were reported to the Complaints and Quality of Services Commissioners working in CISSS and CIUSSS between April1, 2019 and March 31, 2020 - until the very beginning of the first wave of the COVID-19 pandemic.
Twice as many complaints and reports were received by health network authorities in one year.
A total of 1,667 cases of maltreatment were reported to the Complaints and Quality of Services Commissioners working in CISSS and CIUSSS between April1, 2019 and March 31, 2020 - until the very beginning of the first wave of the COVID-19 pandemic.
The increase in cases does not mean that older people are being mistreated more today than they were a year ago, according to experts.
This is revealed by a compilation made by La Presse of the data contained in their annual reports filed in recent weeks in the National Assembly.
By 2018-2019, 866 cases had been handled by the commissioners.
Abuse can take many forms. There is no typical portrait. It is sometimes a CHSLD employee who abrupts residents, sometimes an elder who is financially abused by his son. Employees were dismissed, residents were relocated and others were placed under the protection of the Public Curator, as a result of the commissioners' interventions.
The increase in cases does not mean that older people are being mistreated more today than they were a year ago, according to experts. "I don't see it as an increase in the number of situations," says Dominique Charland, former president of the Group of Complaints and Quality of Services Commissioners, who was appointed a few months ago as a consultant commissioner
at the Department of Health and Human Services.
She explains that the network's players are now more aware of the new obligations given to them under a new law,
which has also begun to be phased in in 2018-2019.
The dissemination of policies, procedures and promotional activities was not at the same level in 2018-2019 as in 2019-20. People are now better informed about their obligations, including reporting.
Dominique Charland, Advisory Commissioner at the Ministry of Health and Social Services
Commissioners are responsible for dealing with and reviewing reports and complaints annually following the passage of the Anti-Elder Abuse Act and other vulnerable adultsunder the Couillard government in the spring of 2017.
In addition, the Act requires network staff to report to the Commissioner any situation of abuse that they witness against a person housed in CHSLD or a person under guardianship, guardianship or for whom a protection warrant has been approved, regardless of where they live.
This "mandatory denunciation" was added during the study of the bill in the National Assembly, following an investigation by La Presse - a beneficiary worker had mistreated 11 residents of a CHSLD and her employer had been aware of his actions for a year. The law also encourages staff to report abuse, whether the victim lives in a seniors' residence or lives at home, for example.
Victims can complain to a commissioner themselves, as can their loved ones.
Estrie in the lead
Estrie had the highest complaints and reports: no less than 262 cases of abuse were reported.
"It's all the better if there's more, it's more positive than negative. We are shedding light on something that already exists" and that needs to be fought, argues the local commissioner, Annick Brisson.
According to its report, "organizational abuse is by far the most common type of abuse." "Organizational abuse" refers to "any prejudicial situation created or tolerated by the procedures of organizations (private, public or community) responsible for providing care or services of all types, which jeopardizes the exercise of the rights and freedoms of individuals." Examples include not bathing a week, providing services abruptly, or leaving CHSLD residents with a bed for many hours.
Last year, the Quebec Superior Court authorized a $500 million class action launched by the Council for the Protection of the Sick against the government for the "shameful" treatment of residents in the CHSLD.
"The statistics are partly evidence of a better understanding of the responsibilities in relation to the reporting obligation. But to say that it is appropriate throughout the network, that everyone knows their responsibilities well and is able to handle these situations well, I would not go that far. There's still a lot of work to be done," says Brisson.
The Minister responsible for Elders and Caregivers, Marguerite Blais, intends to reopen the law by the end of the mandate. In particular, it wants to be able to impose criminal sanctions - and therefore fines - on perpetrators of abuse and those who fail to report such acts.
"It's a very personal point of view, but I think we have all the legal mechanisms already to deal with these situations," says Commissioner Brisson. It is already in the Criminal Code that you cannot steal, it is already provided in the Civil Code that you have a base of options against someone who commits negligence or fault that causes harm. And in terms of labour law,
we already have all the mechanisms to punish an employee who has done wrong. »
Complaints and reports
By region and university hospital
Estrie: 262Lanaudière: 152Capitale-Nationale: 137Saguenay-Lac-Saint-Jean: 132Seegergie West: 126Montergie-Centre: 117Bas-Saint-Saint-Laurent: 108Chaudière-Appalachians: 78Centre-South-Island of Montreal: 72 Mauricie-Centre-du-Québec: 72Montergie-Est: 63Laurentides: 57Ou Montreal Island: 44This of Montreal Island: 39Centre-West-of-Montreal Island: 39Laval: 29North Island-de-Montreal: 26Outaouais: 26Se-North: 23Abitibi-Témiscamingue: 23Baie-James: 7Gaspesia: 4les-de-la-Madeleine: 2
CHUM: 17CUSM: 6CHU from Quebec City: 4CHU Sainte-Justine: 2
TOTAL : 1667
Source: 2019-2020 Reports from CISSS and CIUSSS Complaints and Service Quality Commissioners
Under the radar of the authorities
This is revealed by a compilation made by La Presse of the data contained in their annual reports filed in recent weeks in the National Assembly.
By 2018-2019, 866 cases had been handled by the commissioners.
Abuse can take many forms. There is no typical portrait. It is sometimes a CHSLD employee who abrupts residents, sometimes an elder who is financially abused by his son. Employees were dismissed, residents were relocated and others were placed under the protection of the Public Curator, as a result of the commissioners' interventions.
The increase in cases does not mean that older people are being mistreated more today than they were a year ago, according to experts. "I don't see it as an increase in the number of situations," says Dominique Charland, former president of the Group of Complaints and Quality of Services Commissioners, who was appointed a few months ago as a consultant commissioner
at the Department of Health and Human Services.
She explains that the network's players are now more aware of the new obligations given to them under a new law,
which has also begun to be phased in in 2018-2019.
The dissemination of policies, procedures and promotional activities was not at the same level in 2018-2019 as in 2019-20. People are now better informed about their obligations, including reporting.
Dominique Charland, Advisory Commissioner at the Ministry of Health and Social Services
Commissioners are responsible for dealing with and reviewing reports and complaints annually following the passage of the Anti-Elder Abuse Act and other vulnerable adultsunder the Couillard government in the spring of 2017.
In addition, the Act requires network staff to report to the Commissioner any situation of abuse that they witness against a person housed in CHSLD or a person under guardianship, guardianship or for whom a protection warrant has been approved, regardless of where they live.
This "mandatory denunciation" was added during the study of the bill in the National Assembly, following an investigation by La Presse - a beneficiary worker had mistreated 11 residents of a CHSLD and her employer had been aware of his actions for a year. The law also encourages staff to report abuse, whether the victim lives in a seniors' residence or lives at home, for example.
Victims can complain to a commissioner themselves, as can their loved ones.
Estrie in the lead
Estrie had the highest complaints and reports: no less than 262 cases of abuse were reported.
"It's all the better if there's more, it's more positive than negative. We are shedding light on something that already exists" and that needs to be fought, argues the local commissioner, Annick Brisson.
According to its report, "organizational abuse is by far the most common type of abuse." "Organizational abuse" refers to "any prejudicial situation created or tolerated by the procedures of organizations (private, public or community) responsible for providing care or services of all types, which jeopardizes the exercise of the rights and freedoms of individuals." Examples include not bathing a week, providing services abruptly, or leaving CHSLD residents with a bed for many hours.
Last year, the Quebec Superior Court authorized a $500 million class action launched by the Council for the Protection of the Sick against the government for the "shameful" treatment of residents in the CHSLD.
"The statistics are partly evidence of a better understanding of the responsibilities in relation to the reporting obligation. But to say that it is appropriate throughout the network, that everyone knows their responsibilities well and is able to handle these situations well, I would not go that far. There's still a lot of work to be done," says Brisson.
The Minister responsible for Elders and Caregivers, Marguerite Blais, intends to reopen the law by the end of the mandate. In particular, it wants to be able to impose criminal sanctions - and therefore fines - on perpetrators of abuse and those who fail to report such acts.
"It's a very personal point of view, but I think we have all the legal mechanisms already to deal with these situations," says Commissioner Brisson. It is already in the Criminal Code that you cannot steal, it is already provided in the Civil Code that you have a base of options against someone who commits negligence or fault that causes harm. And in terms of labour law,
we already have all the mechanisms to punish an employee who has done wrong. »
Complaints and reports
By region and university hospital
Estrie: 262Lanaudière: 152Capitale-Nationale: 137Saguenay-Lac-Saint-Jean: 132Seegergie West: 126Montergie-Centre: 117Bas-Saint-Saint-Laurent: 108Chaudière-Appalachians: 78Centre-South-Island of Montreal: 72 Mauricie-Centre-du-Québec: 72Montergie-Est: 63Laurentides: 57Ou Montreal Island: 44This of Montreal Island: 39Centre-West-of-Montreal Island: 39Laval: 29North Island-de-Montreal: 26Outaouais: 26Se-North: 23Abitibi-Témiscamingue: 23Baie-James: 7Gaspesia: 4les-de-la-Madeleine: 2
CHUM: 17CUSM: 6CHU from Quebec City: 4CHU Sainte-Justine: 2
TOTAL : 1667
Source: 2019-2020 Reports from CISSS and CIUSSS Complaints and Service Quality Commissioners
Under the radar of the authorities
Some organizations that are not certified and work with people with mental health problems may be outside the controls of health authorities.
Seniors are not the only victims of abuse. Adults with mental health problems are also affected. It is sometimes in a residence where the owner offers them "shelter and cover", as it is said in the jargon of the health community.
Institutions that do not need a permit and are under the radar of the authorities.
"It's appalling!" says Laurentian Complaints Commissioner Marie-Josée Boulianne. "These are non-certified organizations," as opposed to private seniors' residences and intermediate or family-type resources. "And fortunately
we have people who follow patients in these environments!"
This is about, for example, a homeowner who decides to house someone who, because of a "sometimes significant"
mental health problem, cannot live alone, notesMs. Boulianne.
Seniors are not the only victims of abuse. Adults with mental health problems are also affected. It is sometimes in a residence where the owner offers them "shelter and cover", as it is said in the jargon of the health community.
Institutions that do not need a permit and are under the radar of the authorities.
"It's appalling!" says Laurentian Complaints Commissioner Marie-Josée Boulianne. "These are non-certified organizations," as opposed to private seniors' residences and intermediate or family-type resources. "And fortunately
we have people who follow patients in these environments!"
This is about, for example, a homeowner who decides to house someone who, because of a "sometimes significant"
mental health problem, cannot live alone, notesMs. Boulianne.
Marie-Josée Boulianne, Laurentian Complaints Commissioner
Some do this in good faith and good will, but there are others unfortunately where, for example,
it is unsanitary and people do not eat to their hunger.
Marie-Josée Boulianne, Laurentian Complaints Commissioner
The Commissioner has already intervened in such a situation, alerted by CLSC workers providing services at home.
"My general message to all stakeholders is, "If you have any doubts about neglect or abuse, I need to know," saysMs. Boulianne, who is also a member of the Management of the Complaints and Quality of Services Commissioners. She said she was "a little surprised" by her statistics for 2019-20: the Laurentians are one of the few regions where the number of cases of abuse has decreased in a year.
Limited interventions
In the North Island of Montreal, a sharp increase in reporting relates to "situations primarily experienced at home."
"Abuse situations reported by a relative or third party often end without corrective action. This is partly because of the reasons that prove to be unfounded after review, but also because the able person, a victim of abuse, may not consent to the intervention to stop the abuse, says Commissioner Annick Dallaire. In the latter case, actions are still taken by CIUSSS staff to take into account
the situation and protect the person within the limits of his agreement. »
Some do this in good faith and good will, but there are others unfortunately where, for example,
it is unsanitary and people do not eat to their hunger.
Marie-Josée Boulianne, Laurentian Complaints Commissioner
The Commissioner has already intervened in such a situation, alerted by CLSC workers providing services at home.
"My general message to all stakeholders is, "If you have any doubts about neglect or abuse, I need to know," saysMs. Boulianne, who is also a member of the Management of the Complaints and Quality of Services Commissioners. She said she was "a little surprised" by her statistics for 2019-20: the Laurentians are one of the few regions where the number of cases of abuse has decreased in a year.
Limited interventions
In the North Island of Montreal, a sharp increase in reporting relates to "situations primarily experienced at home."
"Abuse situations reported by a relative or third party often end without corrective action. This is partly because of the reasons that prove to be unfounded after review, but also because the able person, a victim of abuse, may not consent to the intervention to stop the abuse, says Commissioner Annick Dallaire. In the latter case, actions are still taken by CIUSSS staff to take into account
the situation and protect the person within the limits of his agreement. »
Annick Dallaire, Northern Montreal CIUSSS Complaints and Service Quality Commissioner
She noted that her intervention following five other reports "resulted in the dismissal of employees whose actions were consistent with the definition of abuse." "This demonstrates CIUSSS' commitment not to tolerate abuse in its living and care settings," she adds.
Ignorance
His colleague from Mauricie-Centre-du-Québec, Lucie Lafrenière, notes that the provisions of the act "remain little known" at CIUSSS and "are not known in the majority of seniors' residences, neither the operator, nor the staff,
nor the residents [...] who know very little about their rights."
She noted that her intervention following five other reports "resulted in the dismissal of employees whose actions were consistent with the definition of abuse." "This demonstrates CIUSSS' commitment not to tolerate abuse in its living and care settings," she adds.
Ignorance
His colleague from Mauricie-Centre-du-Québec, Lucie Lafrenière, notes that the provisions of the act "remain little known" at CIUSSS and "are not known in the majority of seniors' residences, neither the operator, nor the staff,
nor the residents [...] who know very little about their rights."
Lucie Lafrenière, Commissioner for Complaints and Quality of Services for Mauricie and Central Quebec
In this region, 80% of the 72 cases dealt with relate to accommodation settings, especially private residences for seniors and CHSLD. The Commissioner notes that the development of procedures for enforcing the law is delayed, which "contributes to some confusion in the performance of roles and responsibilities and hinders the rapid and efficient handling of reported situations."
Her colleague from Saguenay-Lac-Saint-Jean, Julie Bouchard, points out that the average processing time for the 132 reports was nine days - the time allotted to process a file is rarely specified in the reports. It adds that "the Act and the institution's policy provide for a modulation of the processing period depending on the seriousness of the situation, but this period should not,
unless there is a particular reason, exceed 45 days."
In Montérégie West, of 126 cases, 61% involved abuse by an employee or other user; the rest came from a relative or a third party. This is mainly physical abuse (42% of cases). The report refers to "shoving, rudoing, blow, burning or neglect."
Physical abuse also dominates the sad record in Montérégie-Est. Commissioner Nathalie Deschênes gives examples of sanctions imposed as a result of the handling of the 63 cases of abuse: dismissal of the employee, disciplinary notice on the employee's file, suspension of an employee for three weeks, replacement of an employee in another unit.
At the CHUM, Commissioner Sylvie Fortin recounts in her report that "a passenger was isolated by her granddaughter and kept captive in a cramped studio of a squalid motel, without the vital physical needs of the passenger being met." "The user has proven unfit according to professional evaluations. This resulted in our stakeholders taking care of it and protecting against placement in CHSLD," she continues.
Financial abuse
In Lower St. Lawrence, Commissioner Stephanie Bush noted that "situations denouncing abuse are primarily aimed at financial abuse of vulnerable people, mostly by family members."
The procedure should be performed with skill, delicacy and caution. As a result, it often takes some time for the file to be completed, as the intervention must be well planned and orchestrated with the various partners.
Stephanie Bush, Lower St. Lawrence Complaints and Service Quality Commissioner
In the West Brunswick Centre, Commissioner Maude Laliberté deplores a "significant blurring" on "data capture and mapping of the process of reports of alleged abuse." "While the Act speaks volumes on the basis for it, the reality of poorly prepared organizations and deficient complaints data management systems could now undermine the accountability desired by Parliament."
On the other hand, "it seems clear that not all reports are forwarded to our Office," she said. And "stakeholders have not fully appropriated the ins and outs of CIUSSS's abusive policy," she adds.
Pandemic: Expected increase in complaints
Complaints and Quality Of Service Commissioners note that the COVID-19 pandemic is causing an increase in reporting this year. "It leads to situations of neglect and abuse. For example, owners of private residences for seniors were putting things in place that were completely excessive. They were almost sequestering the residents, so we had to intervene because there was psychological distress in those people. We are talking about places where people are self-reliant and who were forced to stay in their homes, things that don't look good," says Laurentian Commissioner Marie-Josée Boulianne. It says it has received more complaints and reports in eight months than for the whole of 2019-20. The death toll in the LTCH, when many seniors have been neglected and deprived
of care while others have died, is also the source of denunciations.
In this region, 80% of the 72 cases dealt with relate to accommodation settings, especially private residences for seniors and CHSLD. The Commissioner notes that the development of procedures for enforcing the law is delayed, which "contributes to some confusion in the performance of roles and responsibilities and hinders the rapid and efficient handling of reported situations."
Her colleague from Saguenay-Lac-Saint-Jean, Julie Bouchard, points out that the average processing time for the 132 reports was nine days - the time allotted to process a file is rarely specified in the reports. It adds that "the Act and the institution's policy provide for a modulation of the processing period depending on the seriousness of the situation, but this period should not,
unless there is a particular reason, exceed 45 days."
In Montérégie West, of 126 cases, 61% involved abuse by an employee or other user; the rest came from a relative or a third party. This is mainly physical abuse (42% of cases). The report refers to "shoving, rudoing, blow, burning or neglect."
Physical abuse also dominates the sad record in Montérégie-Est. Commissioner Nathalie Deschênes gives examples of sanctions imposed as a result of the handling of the 63 cases of abuse: dismissal of the employee, disciplinary notice on the employee's file, suspension of an employee for three weeks, replacement of an employee in another unit.
At the CHUM, Commissioner Sylvie Fortin recounts in her report that "a passenger was isolated by her granddaughter and kept captive in a cramped studio of a squalid motel, without the vital physical needs of the passenger being met." "The user has proven unfit according to professional evaluations. This resulted in our stakeholders taking care of it and protecting against placement in CHSLD," she continues.
Financial abuse
In Lower St. Lawrence, Commissioner Stephanie Bush noted that "situations denouncing abuse are primarily aimed at financial abuse of vulnerable people, mostly by family members."
The procedure should be performed with skill, delicacy and caution. As a result, it often takes some time for the file to be completed, as the intervention must be well planned and orchestrated with the various partners.
Stephanie Bush, Lower St. Lawrence Complaints and Service Quality Commissioner
In the West Brunswick Centre, Commissioner Maude Laliberté deplores a "significant blurring" on "data capture and mapping of the process of reports of alleged abuse." "While the Act speaks volumes on the basis for it, the reality of poorly prepared organizations and deficient complaints data management systems could now undermine the accountability desired by Parliament."
On the other hand, "it seems clear that not all reports are forwarded to our Office," she said. And "stakeholders have not fully appropriated the ins and outs of CIUSSS's abusive policy," she adds.
Pandemic: Expected increase in complaints
Complaints and Quality Of Service Commissioners note that the COVID-19 pandemic is causing an increase in reporting this year. "It leads to situations of neglect and abuse. For example, owners of private residences for seniors were putting things in place that were completely excessive. They were almost sequestering the residents, so we had to intervene because there was psychological distress in those people. We are talking about places where people are self-reliant and who were forced to stay in their homes, things that don't look good," says Laurentian Commissioner Marie-Josée Boulianne. It says it has received more complaints and reports in eight months than for the whole of 2019-20. The death toll in the LTCH, when many seniors have been neglected and deprived
of care while others have died, is also the source of denunciations.
Tommy Chouinard
The Presse
The Presse