A record of complaints,
an underestimated reality
(Quebec) Complaints and reports of elder abuse or vulnerable adults jumped by 50% in one year. They have even tripled in four years. However, we are far from having seen everything: the phenomenon is even more widespread and cases are under-reported despite the obligations provided for in a law.
What we receive as complaints is the
snowflake on Everest!The number of complaints and reports of elder abuse and vulnerable adults has exploded in Quebec in recent years,
both in the public and private networks.
In total, 2870 cases of mistreatment were reported to health network authorities in 2021-2022, especially in CHSLDs. There were 866 in 2018-2019, the first full year of application of the Act to combat maltreatment of seniors and other persons of full age in vulnerable situations. Adopted in 2017, it was improved in 2020 and then in 2022.
What we receive as complaints is the
snowflake on Everest!The number of complaints and reports of elder abuse and vulnerable adults has exploded in Quebec in recent years,
both in the public and private networks.
In total, 2870 cases of mistreatment were reported to health network authorities in 2021-2022, especially in CHSLDs. There were 866 in 2018-2019, the first full year of application of the Act to combat maltreatment of seniors and other persons of full age in vulnerable situations. Adopted in 2017, it was improved in 2020 and then in 2022.
In addition, the law requires health network workers and professionals to report "without delay" any situation of abuse they witness or suspect against a senior or vulnerable adult housed in a private or public CHSLD, a seniors' residence, an intermediate resource (IR) or a family-type resource (RTF). They are also asked to report the abuse they see during a visit to a patient's home. They must report it to the local service quality and complaints commissioner of their CISSS or CIUSSS.
Abuse has many faces. It is an employee who bullies an elder or a person with a mental health problem. A resident who sexually assaults another. A son who is financially abusing a parent.
Abuse can be "organizational": residents' incontinence briefs are not regularly changed, they are deprived of basic hygiene care, they are left bedridden for hours, excessive restraints are imposed. Lack of staff or inadequate training of employees
are sometimes at the root of these practices.
Commissioners are responsible for dealing with these reports – just like complaints from a user, family member or third party. They report on it annually. The data gathered by La Presse are drawn from a compilation of their reports and a brief analysis of the implementation of the law produced by the Ministère de la Santé et des Services sociaux (MSSS).
"Under-reporting"
"What we receive [in terms of complaints and reports] is not the tip of the iceberg, it's the snowflake on Everest!" says Jean-Philippe Payment, president of the Regroupement des commissaires locales aux plaintes et à la qualité des services.
He and other commissioners say cases are under-reported. He concludes that "we are collectively far from achieving the real goal of ending abuse in our communities."
At the CIUSSS West-Central Montreal, where Mr. Payment is a commissioner, 134 complaints and reports were filed last year. This is an increase of 150% in one year, but it is far from being the real portrait of the magnitude of the phenomenon according to him.
He cites as proof a vast survey published in 2020 by the Institut de la statistique du Québec (ISQ) according to which 6% of seniors living at home are victims of abuse.
When you cross-check the data, [...] I should be, I think, at more than 2000 files per year [and not 134].
Jean-Philippe Payment, President of the Regroupement des commissaires locales aux plaintes et à la qualité des services
"There are people who don't denounce for all sorts of reasons. [...] Employees fear that it will backfire," he said, recalling that the law prohibits retaliatory measures. It recalls that reports are treated confidentially and that they can be made anonymously. The law also lifts solicitor-client privilege in certain situations, which he says professionals are unaware of.
His predecessor Maude Laliberté attached the bell on the "under-reporting" of abuse in a report a year ago. Different factors can explain it, she writes. "Seniors may not want to come forward or seek help, for fear of repercussions, addiction to abuse, feelings of shame or guilt, or resignation. Second, staff may be unaware of available resources and settlement policies,
or may even trivialize the phenomenon of maltreatment. »
"Will staff members report systemic [organizational] abuse? No, absolutely not, "deplores Jean-Philippe Payment.
"With the scarcity of labour that we're seeing right now, there's normalization going on in people's heads.
There were before, but there are even more," he adds.
"Not having half the staff that we should have according to the minimum ratios and that it becomes recurring [...], it does not work. "
If you are in a public institution and you are overdrawn on all the night figures for three months, for me, I am sorry, if there are no actions taken to solve the problem, it can constitute [organizational] abuse.
Jean-Philippe Payment, President of the Regroupement des commissaires locales aux plaintes et à la qualité des services
"Do the commissioners have all the latitude to be able to open this type of file? It will depend from one institution to another [...], on the agreement between the commissioner and senior management, "he reveals.
Jean-Philippe Payment also points out that cases of abuse are not reported to the Commissioner, but rather reported to managers. These "administratively filtered" cases therefore escape the Commissioner's attention. However, he does not believe that management is trying to cover up abuse because they are taking steps to stop it. However, these records are not accounted for. They fly under the radar of the commissioners and, therefore, the general public.
The CISSS and CIUSSS act quickly against an employee who, for example, mistreats a senior housed in a CHSLD. "There is no silliness" and "there is no forgiveness," insists Mr. Payment. He pointed out that commissioners make recommendations to management, but that they do not have the power to apply sanctions themselves.
The affected employee is promptly suspended and, at the conclusion of the investigation, is dismissed if there is sufficient evidence. "It exists for real and it is a common reality," he argues, which is confirmed by the commissioners' reports, which do not go into details. Mr. Payment adds that employees who have witnessed abuse but have not reported it are suspended by the employer.
"In seniors' residences, it's another world," says CIUSSS de la Capitale-Nationale Commissioner Jacques Beaulieu.
They are private developers. The commissioner does not have as much control at that level. They manage their staff according to their management policy. Sometimes there is a little more recurrence: we find the same [abusive] people a little more often.
Jacques Beaulieu, Complaints Commissioner of the CIUSSS de la Capitale-Nationale, on RPPs
"I wouldn't want to generalize either," he adds.
It was on its territory that there were the most complaints and reports, 367. "There is a much greater awareness among employees and there is an interest on the part of the institution to train employees," he explains. It's a law, an obligation, so it's not "I can report", it's "I have to report". »
In his report, the commissioner of the CISSS du Bas-Saint-Laurent, Éric Parent, said he had received "many worrying situations where RPA owners were out of breath, making it difficult to provide services." Cases of abuse have been reported and the necessary measures have been taken to resolve them, he adds.
"Nevertheless, we remain concerned about the context of community housing, particularly with regard to RPA, RI, RAC [residences with continuous assistance, editor's note] and RTF," he wrote. The psychological effects of COVID-19 are being perceived, staff are more fragile, and resource managers have fewer and fewer means to provide for [residents]. »
900 unreported storiesDespite the increase in complaints and reports, "we are really in a situation of under-reporting of abuse," confirms Marie-Josée Boulianne, commissioner of the CISSS des Laurentides. She has noticed over the past year that many cases go unreported to her. Rather, many are listed in other databases to which it did not have access, such as that of CLSC home care workers. She discovered 419 situations of abuse that had been treated by these workers in 2021-2022.
That's not all. The accident and incident log contained cases of abuse that the institutions had dealt with but had not been reported to her, she found. In total, "504 situations were reported involving a user who was injured during an assault with another user,
either by a care or service provider."
"We are far from the 64 situations that have been officially declared to me!" says the Commissioner. According to her, stakeholders did not report these cases to her "either for lack of time or lack of knowledge of the Anti-Maltreatment Policy."
But the result is obvious: the extent of abuse is underestimated. However, the objective of the law is not only to fight against abuse, but also "to have the most accurate portrait of what is happening,"insists Ms. Boulianne. "We need to increase knowledge of the law, give more training and support to remind people of the importance of reporting."
Commissioners in an "uncomfortable position"Local service quality and complaints commissioners are in an "uncomfortable position" vis-à-vis the boards of directors of CISSS and CIUSSS. And the fines provided for in the law to combat abuse are still not in force.
Decried underfundingLocal service quality and complaints commissioners are in "an uncomfortable position" by being employees of the boards of directors of CISSS and CIUSSS, according to the president of their group. "From the moment I am on a board of directors whose members have interests opposed to mine, where they can be the target of complaints and decide on my budget, I am in an uncomfortable position," says Jean-Philippe Payment. He goes on to say that they are in an "ejection seat". Commissioners should report to the Ministry instead, he said. They also lack resources. "I believe, like many of my fellow commissioners in the province, that the addition of missions without additional funding by successive ministerial decisions and the chronic underfunding of activities by the boards of directors of health institutions across the province have made the complaints system more precarious," he wrote in his report.
Fines are long overdueA law passed last year provides for fines for perpetrators of abuse: from $5000,125 to $000,10 in the case of a natural person, from $000,250 to $000,2500 for an institution or legal person. For staff members who fail to report abuse they witness or suspect, fines range from $25 to $000,45. However, these sanctions are still not in force. The Department of Health and Social Services says it is "currently working on the implementation of these provisions." "A procedure to make a request to conduct an inspection or an investigation to issue a possible criminal sanction will be available shortly," he said. About <> inspectors and investigators have been hired, but are still not trained. They will deal with cases of maltreatment, but will also analyze violations of other laws and regulations under the responsibility of the Ministry (on smoking, cannabis and the certification of private seniors' residences, for example).
Progress, according to QuebecFor Dominique Charland, the advisory commissioner for the complaint examination system of the Ministry of Health and Social Services, "a lot of progress has been made to raise awareness of the provisions of the law." "This is one of the factors contributing to the increase observed in the majority of integrated centres" in the number of complaints and reports. She anticipates another significant increase in 2022-2023 because the mandatory reporting of abuse in private seniors' residences, intermediate resources or family-type resources came into effect last spring, after an improvement to the law. She sees the increase in complaints and reports "positively" because it is proof that "we are taking action to eradicate abuse," she says.
Dismissals of employees, forced closuresComplaints and reports lead in some cases to employee dismissals, complaints to the police and closures of shelter resources. Overview of the situation in the three regions with the most files in 2021-2022.
Capitale-Nationale: 157% increase in complaintsOf the 367 complaints and reports, up 157% year-on-year, about half are for physical abuse. The other files mainly involve psychological or organizational abuse.
Employees have been dismissed for physically or psychologically abusing users. Two shelter facilities
were also ordered to close for the same reasons.
In cases involving acts of violence, employees of a private personnel agency have been banned from CIUSSS facilities. Reports were made to the Ordre des infirmières et infirmiers du Québec.
Commissioner Jacques Beaulieu gave examples of measures taken following the handling of various reports of sexual abuse: users were placed elsewhere, a police complaint was filed, an administrative investigation led to a dismissal and a letter was sent to the board of directors of a community organization concerning the behaviour of the executive director.
Saguenay–Lac-Saint-Jean: twice as many reportsThere were 280 complaints and reports in the region.
A total of 96% of reports were made by staff members, 3% by third parties and 1% by users or their legal representatives.
The relocation of users elsewhere, the initiation of administrative investigations and the imposition of "supervisory measures" on employees are part of the means put in place to stop abuse.
65% increase in Montérégie-OuestThere were 228 complaints and reports in the region.
In total, 47% of reports were made by staff members, 38% by another user and 15% by a relative or a third party.
A total of 159 "corrective or improvement" measures were taken, including the relocation of users, support in filing a police complaint or the implementation of protective supervision for vulnerable persons (which is often done with the Curateur public).
Abuse has many faces. It is an employee who bullies an elder or a person with a mental health problem. A resident who sexually assaults another. A son who is financially abusing a parent.
Abuse can be "organizational": residents' incontinence briefs are not regularly changed, they are deprived of basic hygiene care, they are left bedridden for hours, excessive restraints are imposed. Lack of staff or inadequate training of employees
are sometimes at the root of these practices.
Commissioners are responsible for dealing with these reports – just like complaints from a user, family member or third party. They report on it annually. The data gathered by La Presse are drawn from a compilation of their reports and a brief analysis of the implementation of the law produced by the Ministère de la Santé et des Services sociaux (MSSS).
"Under-reporting"
"What we receive [in terms of complaints and reports] is not the tip of the iceberg, it's the snowflake on Everest!" says Jean-Philippe Payment, president of the Regroupement des commissaires locales aux plaintes et à la qualité des services.
He and other commissioners say cases are under-reported. He concludes that "we are collectively far from achieving the real goal of ending abuse in our communities."
At the CIUSSS West-Central Montreal, where Mr. Payment is a commissioner, 134 complaints and reports were filed last year. This is an increase of 150% in one year, but it is far from being the real portrait of the magnitude of the phenomenon according to him.
He cites as proof a vast survey published in 2020 by the Institut de la statistique du Québec (ISQ) according to which 6% of seniors living at home are victims of abuse.
When you cross-check the data, [...] I should be, I think, at more than 2000 files per year [and not 134].
Jean-Philippe Payment, President of the Regroupement des commissaires locales aux plaintes et à la qualité des services
"There are people who don't denounce for all sorts of reasons. [...] Employees fear that it will backfire," he said, recalling that the law prohibits retaliatory measures. It recalls that reports are treated confidentially and that they can be made anonymously. The law also lifts solicitor-client privilege in certain situations, which he says professionals are unaware of.
His predecessor Maude Laliberté attached the bell on the "under-reporting" of abuse in a report a year ago. Different factors can explain it, she writes. "Seniors may not want to come forward or seek help, for fear of repercussions, addiction to abuse, feelings of shame or guilt, or resignation. Second, staff may be unaware of available resources and settlement policies,
or may even trivialize the phenomenon of maltreatment. »
"Will staff members report systemic [organizational] abuse? No, absolutely not, "deplores Jean-Philippe Payment.
"With the scarcity of labour that we're seeing right now, there's normalization going on in people's heads.
There were before, but there are even more," he adds.
"Not having half the staff that we should have according to the minimum ratios and that it becomes recurring [...], it does not work. "
If you are in a public institution and you are overdrawn on all the night figures for three months, for me, I am sorry, if there are no actions taken to solve the problem, it can constitute [organizational] abuse.
Jean-Philippe Payment, President of the Regroupement des commissaires locales aux plaintes et à la qualité des services
"Do the commissioners have all the latitude to be able to open this type of file? It will depend from one institution to another [...], on the agreement between the commissioner and senior management, "he reveals.
Jean-Philippe Payment also points out that cases of abuse are not reported to the Commissioner, but rather reported to managers. These "administratively filtered" cases therefore escape the Commissioner's attention. However, he does not believe that management is trying to cover up abuse because they are taking steps to stop it. However, these records are not accounted for. They fly under the radar of the commissioners and, therefore, the general public.
The CISSS and CIUSSS act quickly against an employee who, for example, mistreats a senior housed in a CHSLD. "There is no silliness" and "there is no forgiveness," insists Mr. Payment. He pointed out that commissioners make recommendations to management, but that they do not have the power to apply sanctions themselves.
The affected employee is promptly suspended and, at the conclusion of the investigation, is dismissed if there is sufficient evidence. "It exists for real and it is a common reality," he argues, which is confirmed by the commissioners' reports, which do not go into details. Mr. Payment adds that employees who have witnessed abuse but have not reported it are suspended by the employer.
"In seniors' residences, it's another world," says CIUSSS de la Capitale-Nationale Commissioner Jacques Beaulieu.
They are private developers. The commissioner does not have as much control at that level. They manage their staff according to their management policy. Sometimes there is a little more recurrence: we find the same [abusive] people a little more often.
Jacques Beaulieu, Complaints Commissioner of the CIUSSS de la Capitale-Nationale, on RPPs
"I wouldn't want to generalize either," he adds.
It was on its territory that there were the most complaints and reports, 367. "There is a much greater awareness among employees and there is an interest on the part of the institution to train employees," he explains. It's a law, an obligation, so it's not "I can report", it's "I have to report". »
In his report, the commissioner of the CISSS du Bas-Saint-Laurent, Éric Parent, said he had received "many worrying situations where RPA owners were out of breath, making it difficult to provide services." Cases of abuse have been reported and the necessary measures have been taken to resolve them, he adds.
"Nevertheless, we remain concerned about the context of community housing, particularly with regard to RPA, RI, RAC [residences with continuous assistance, editor's note] and RTF," he wrote. The psychological effects of COVID-19 are being perceived, staff are more fragile, and resource managers have fewer and fewer means to provide for [residents]. »
900 unreported storiesDespite the increase in complaints and reports, "we are really in a situation of under-reporting of abuse," confirms Marie-Josée Boulianne, commissioner of the CISSS des Laurentides. She has noticed over the past year that many cases go unreported to her. Rather, many are listed in other databases to which it did not have access, such as that of CLSC home care workers. She discovered 419 situations of abuse that had been treated by these workers in 2021-2022.
That's not all. The accident and incident log contained cases of abuse that the institutions had dealt with but had not been reported to her, she found. In total, "504 situations were reported involving a user who was injured during an assault with another user,
either by a care or service provider."
"We are far from the 64 situations that have been officially declared to me!" says the Commissioner. According to her, stakeholders did not report these cases to her "either for lack of time or lack of knowledge of the Anti-Maltreatment Policy."
But the result is obvious: the extent of abuse is underestimated. However, the objective of the law is not only to fight against abuse, but also "to have the most accurate portrait of what is happening,"insists Ms. Boulianne. "We need to increase knowledge of the law, give more training and support to remind people of the importance of reporting."
Commissioners in an "uncomfortable position"Local service quality and complaints commissioners are in an "uncomfortable position" vis-à-vis the boards of directors of CISSS and CIUSSS. And the fines provided for in the law to combat abuse are still not in force.
Decried underfundingLocal service quality and complaints commissioners are in "an uncomfortable position" by being employees of the boards of directors of CISSS and CIUSSS, according to the president of their group. "From the moment I am on a board of directors whose members have interests opposed to mine, where they can be the target of complaints and decide on my budget, I am in an uncomfortable position," says Jean-Philippe Payment. He goes on to say that they are in an "ejection seat". Commissioners should report to the Ministry instead, he said. They also lack resources. "I believe, like many of my fellow commissioners in the province, that the addition of missions without additional funding by successive ministerial decisions and the chronic underfunding of activities by the boards of directors of health institutions across the province have made the complaints system more precarious," he wrote in his report.
Fines are long overdueA law passed last year provides for fines for perpetrators of abuse: from $5000,125 to $000,10 in the case of a natural person, from $000,250 to $000,2500 for an institution or legal person. For staff members who fail to report abuse they witness or suspect, fines range from $25 to $000,45. However, these sanctions are still not in force. The Department of Health and Social Services says it is "currently working on the implementation of these provisions." "A procedure to make a request to conduct an inspection or an investigation to issue a possible criminal sanction will be available shortly," he said. About <> inspectors and investigators have been hired, but are still not trained. They will deal with cases of maltreatment, but will also analyze violations of other laws and regulations under the responsibility of the Ministry (on smoking, cannabis and the certification of private seniors' residences, for example).
Progress, according to QuebecFor Dominique Charland, the advisory commissioner for the complaint examination system of the Ministry of Health and Social Services, "a lot of progress has been made to raise awareness of the provisions of the law." "This is one of the factors contributing to the increase observed in the majority of integrated centres" in the number of complaints and reports. She anticipates another significant increase in 2022-2023 because the mandatory reporting of abuse in private seniors' residences, intermediate resources or family-type resources came into effect last spring, after an improvement to the law. She sees the increase in complaints and reports "positively" because it is proof that "we are taking action to eradicate abuse," she says.
Dismissals of employees, forced closuresComplaints and reports lead in some cases to employee dismissals, complaints to the police and closures of shelter resources. Overview of the situation in the three regions with the most files in 2021-2022.
Capitale-Nationale: 157% increase in complaintsOf the 367 complaints and reports, up 157% year-on-year, about half are for physical abuse. The other files mainly involve psychological or organizational abuse.
Employees have been dismissed for physically or psychologically abusing users. Two shelter facilities
were also ordered to close for the same reasons.
In cases involving acts of violence, employees of a private personnel agency have been banned from CIUSSS facilities. Reports were made to the Ordre des infirmières et infirmiers du Québec.
Commissioner Jacques Beaulieu gave examples of measures taken following the handling of various reports of sexual abuse: users were placed elsewhere, a police complaint was filed, an administrative investigation led to a dismissal and a letter was sent to the board of directors of a community organization concerning the behaviour of the executive director.
Saguenay–Lac-Saint-Jean: twice as many reportsThere were 280 complaints and reports in the region.
A total of 96% of reports were made by staff members, 3% by third parties and 1% by users or their legal representatives.
The relocation of users elsewhere, the initiation of administrative investigations and the imposition of "supervisory measures" on employees are part of the means put in place to stop abuse.
65% increase in Montérégie-OuestThere were 228 complaints and reports in the region.
In total, 47% of reports were made by staff members, 38% by another user and 15% by a relative or a third party.
A total of 159 "corrective or improvement" measures were taken, including the relocation of users, support in filing a police complaint or the implementation of protective supervision for vulnerable persons (which is often done with the Curateur public).
