Prevention of Abuse and Neglect
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This best practice guideline is focused on preventing and addressing abuse and neglect of older adults throughout various health-care institutions and community settings in Canada. It outlines recommendations for nurses and other health-care providers, educators, health-care organizations, advocacy groups, nursing regulatory bodies and governments. Implementation resources in development include an e-learning course, a health education fact sheet, and a personal digital assistant (PDA) version of the guideline.
This guideline is part of an initiative funded by the Government of Canada’s New Horizons for Seniors Program and builds on a collaborative project between the Canadian Nurses Association (CNA) and RNAO, titled Promoting the Awareness of Elder Abuse in Long-Term Care.
Registered Nurses’ Association of Ontario. (2014). Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, ON: Registered Nurses’ Association of Ontario. Retrieved from https://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults_English_WEB.pdf -
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A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.
Registered Nurses Association of Ontario (2022) Gap Analysis Preventing and Addressing Abuse and Neglect of Older Adults. Toronto, ON
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This handout features promising practices to help move long-term care homes towards becoming safe, welcoming and inclusive spaces for the 2SLGBTQI+ community. It was developed as a supplement to the presentation delivered at the AdvantAge Ontario Convention on “A Home for All: Making Long-Term Care Welcoming for 2SLGBTQI+ People” in May 2019. This work stems from the Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI)’s Supporting Diversity and Inclusion Advisory Group.
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Toolkit contains easy to use resources to support uptake of the guideline at practice, education, policy, organizational and systems levels. The toolkit includes a E-Learning course (4 modules) on Elder Abuse for leadership and staff with various knowledge-based activities and supplementary resources.
Reference: Registered Nurses' Association of Ontario. (2015). Addressing Abuse of Older Adults: An RNAO Initiative-Best Practice Success Kit. Toronto, ON: Author. Retrieved from http://rnao.ca/bpg/initiatives/abuse-and-neglect-older-adults-pan-canadian-best-practice-guideline-initiative
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This document contains a sample policy and procedures to support compliance and meet the requirements of s. 20(1) and (2) of the Long-Term Care Homes Act, 2007 and its Regulation.
AdvantAge Ontario Long-Term Care Homes Act (LTCHA) Implementation Member Support Project resources are confidential documents for AdvantAge members only. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information, by persons or entities other than the intended recipients is prohibited without the approval of AdvantAge.
Reference: Ontario Association of Non-Profit Homes and Services for Seniors. (2012). Zero tolerance for abuse and neglect: Sample policies and procedures. Retrieved from http://www.oanhss.org/MediaCentre2/LTCHomesActCentralseeSiteNavigation/LTCHA_Resources.aspx?WebsiteKey=112387af-5c3c-42f5-bfce-85c542bee396
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The ACE Website provides materials for public education on prevention of elder abuse. Materials include information on powers of attorney, consumer protection and legal issues affecting older persons.
Advocacy Centre for the Elderly (ACE) (2013) Retrieved from http://acelaw.ca
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This site describes elder abuse and provides a number of downloadable publications related to addressing and preventing elder abuse.
Any use of information in the web site should be accompanied by an acknowledgment of WHO as the source, citing the uniform resource locator (URL) of the article.
Reference: World Health Organization. Ageing and Life Course Elder Abuse. Retrieved from http://www.who.int/ageing/projects/elder_abuse/en/
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An extensive list of validated assessment and screening tools. Tools not only assess for history of abuse but also assess for possibility of future abuse, and quality of care being given.
Registered Nurses’ Association of Ontario. (2014). Appendix G of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. pp 105-110. http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults.pdf
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This site provides information on recognizing scams, frauds and identity theft and how to address and report them.
Reference: Canadian Anti-Fraud Centre, Government of Canada, 2015. This site provides information on recognizing scams, frauds and identity theft and how to address and report them. http://www.antifraudcentre-centreantifraude.ca/index-eng.htm
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A short, easy guide to help keep ageism out of your writing. These guidelines for age-inclusive communications address: what is ageism and why should we care; terminology to avoid and preferable terms; ageist imagery vs age-positive images; and avoiding ageist storylines
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Cinq mesures à adopter pour vous protéger Fiche de renseignements pour la sensibilisation en matière de santé. Association des infirmières et infirmiers autorisés de l’Ontario (2014, juillet).
Cinq mesures à adopter pour vous protéger . Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/guidelines/fact-sheets/cinq-mesures-%C3%A0-adopter-pour-vous-prot%C3%A9ger
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This document was written by nurses for nurses to help them understand their own ethical beliefs and practice ethically when working with clients, families and within the confines of the public health system.
All rights reserved, no part of this document may be reproduced, transcribed or stored in a retrieval system in any forms or by any means. Electronical, mechanical, photocopying, recording or otherwise without written permission of the publisher. ©Canadian Nurses Association
Reference: Canadian Nurses Association (2008). Code of Ethics for Registered Nurses. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-fr/code-of-ethics-for-registered-nurses.pdf?la=en
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This appendix outlines considerations, tips and resources to support effective communication when addressing issues of abuse and neglect of older adults.
Registered Nurses’ Association of Ontario. (2014). Appendix F of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. pp 103-104. http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults.pdf
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The Comprehensive Geriatric Assessment (CGA) Toolkit is comprised of multiple resources for the personalized and person-centred care of the elderly. This link will take you to the page where you will find descriptions and possible signs and symptoms of the different types of abuse. A description and link for the Elder Assessment Instrument (EAI): Screening tool for elder mistreatment is provided as well as interventions that should be carried out based on the findings of the conducting clinician. Resources for the comprehensive geriatric assessment based on proactive and personalized primary care of the Elderly. Resources are provided on such geriatric syndromes such as falls, pressure injuries, incontinence, and sleep disorders. Hand-outs, videos and other tools are also available on this toolkit.
Reference: http://www.cgakit.com/elder-abuse
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This resource describes the variety of abuse and neglect that can occur and will assist homes in planning a comprehensive education program.
Registered Nurses’ Association of Ontario. (2014). Appendix D of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. Pp 97-99.rnao.ca/sites/rnao-ca/fi..._Adults_English_WEB.pdf
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Les présentes lignes directrices sur les pratiques exemplaires, Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système sont conçues pour favoriser des milieux de travail sains. L’objectif de l’élaboration de ces lignes directrices était de déterminer les attributs des soins interprofessionnels qui permettront d’optimiser les résultats de qualité pour les patients/clients, les fournisseurs, les équipes, l’organisation et le système. Les présentes lignes directrices déterminent les pratiques exemplaires pour faciliter, améliorer et maintenir le travail d’équipe ainsi que la collaboration interprofessionnelle, et pour accroître les résultats positifs pour les patients/clients, les systèmes et les organisations. Elles sont fondées sur les meilleures données probantes existantes; lorsque ces données étaient limitées, les recommandations ont été fondées sur un consensus basé sur des opinions d’experts.
Association des infirmières et infirmiers autorisés de l’Ontario. (2013). Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système. Toronto, Canada: Autheur. Récupéré: http://rnao.ca/bpg/language/d%C3%A9veloppement-et-maintien-des-soins-de-sant%C3%A9-interprofessionnels-optimisation-des-r%C3%A9sul Ce travail est financé par le Ministère de la Santé et des Soins de longue durée d'Ontario.
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Practice standards are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the regulatory and legislative requirements for documentation.
College of Nurses of Ontario. (2008). Documentation, Revised 2008. Toronto, ON: Author. Retrieved from http://www.cno.org/globalassets/docs/prac/41001_documentation.pdf
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Elder Abuse Ontario (EAO)) (formerly known as ONPEA, The Ontario Network for the Prevention of Elder Abuse) is a provincial, charitable, non-profit organization focused on supporting the implementation of The Ontario Strategy to Combat Elder Abuse and has been doing so since 2002. EAO has resources that are useful for LTC homes under the ‘Help for Seniors’ section of their website.
Reference: Elder Abuse Ontario (EAO). 2017. Help for Seniors. Accessed Feb. 6, 2017 https://eapon.ca/
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This is a series of animated learning resources that have been created to enhance the capacity of those working with seniors and to adopt a common approach to identify and respond to elder abuse. As you move through each training module, you will be prompted by a coach who will act as your guide to make sure you maximize your learning.
Reference: Elder Abuse Ontario. (n.d.). Elder Abuse Training Tools: Interactive Animated Learning Resources_Recognizing Financial and Emotional Abuse. Retrieved from Training Tools - Elder Abuse Prevention Ontario (eapon.ca)
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This reference guide is a tool considered to be a promising approach for professionals, family and friends to use when working with seniors who may be experiencing abuse.
Reference: National Initiative for Care of the Elderly. (n.d.).Elder abuse: Assessment and intervention reference guide. Retrieved from http://www.nicenet.ca/tools-elder-abuse-assessment-and-intervention-reference-guide
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Practice standard are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the ethical values and practice standards that the nursing profession in Ontario must uphold. It also provides scenarios of ethical situations in which there is a conflict of values.
College of Nurses of Ontario. (2019). Ethics [PDF file]. Retrieved from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf -
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This booklet can help understand your rights as a resident of a long-term care home. These rights are yours by law. Advocacy Centre for the Elderly & Community Legal Education Ontario. (2008).
Every resident: Bill of rights for people who live in Ontario long term care homes. Retrieved from: http://www.advocacycentreelderly.org/appimages/file/everyresEN%20-%20Dec%202011.pdf
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The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector.
The Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force. The new Act also includes a new regulation.Government of Ontario (2021) Fixing Long-Term Care Act, 2021. Toronto ( ON) retrieved from Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 (ontario.ca)
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This collaboration between LGBT and mainstream organizations examines why the LGBT population face additional obstacles to successful aging. It also looks at what groundwork needs to be in place for these obstacles to be overcome . Copyright © 2015 Movement Advancement Project ©
Reference: LGBT Movement Advancement Project (MAP), & Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE). (2010). Improving Lives of the LGBT older adults. Retrieved from https://lgbtmap.org/improving-the-lives-of-lgbt-older-adults
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Video of recognizing the warning signs/attitudes present in elder abuse situations.
©2015 Centre For Research & Education On Violence Against Women & Children
Reference: Centre for research & education on violence against women & children. (n.d.). It's not right: Neighbours, friends & family for older adults. Retrieved from http://itsnotright.ca.
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The expert panel for the BPG Facilitating Client Centred Learning (2012) developed the L.E.A.R.N.S. Model, which describes how to support effective learning. LEARNS stands for Listen, Establish, Adopt, Reinforce, Name, Strengthen and refers to the nurse/client interaction.
Reference: Registered Nurses’ Association of Ontario (2012). Facilitating Client Centred Learning. Toronto, Canada: Registered Nurses’ Association of Ontario. pp. 19-20. http://rnao.ca/bpg/guidelines/facilitating-client-centred-learning
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The link will take you to the document that the Law Commission of Ontario released October 2015 it is entitled Legal Capacity, Decision-Making and Guardianship, this report provides a number of recommendations designed to reduce opportunities for elder abuse.
Law Commission of Ontario (2017) Legal Capacity, Decision-making and Guardianship. Toronto, On. Retrieved from: http://www.lco-cdo.org/wp-content/uploads/2017/03/CG-Final-Report-EN-online.pdf
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Cette ligne directrice sur les pratiques exemplaires en soins infirmières et infirmiers est un document détaillé comportant les ressources nécessaires au soutien de la pratique basée sur des données probantes. Un milieu de travail sain, c’est un milieu de pratique qui maximise la santé et le bien-être des infirmières, des résultats de qualité chez le patient ou client, le rendement de l’organisation et du système, et les retombées sociales, y compris des collectivités en meilleure santé.
Association des infirmières et infirmiers autorisés de l’Ontario (2013). Lignes directrices sur le développement et le maintien du leadership infirmier, (2em Ed.). Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/language/lignes-directrices-sur-le-d%C3%A9veloppement-et-le-maintien-du-leadership-infirmier Ce travail est financé par le Ministère de la Santé et Ministère des Soins de longue durée d'Ontario
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Pauktuutit Inuit Women of Canada is the national organization that represents all Inuit women in Canada. Pauktuutit has been active in abuse prevention and building capacity to address abuse issues since its inception in 1984. Pauktuutit brought together individuals, agencies and groups who share a common interest in preventing abuse in Inuit communities, to collaborate on the development and implementation of this unique national,community-based strategy.
Reference: Pauktuutit Inuit Women of Canada. (2006). National Strategy to Prevent Abuse in Inuit Communities and Sharing Knowledge, Sharing Wisdom: A Guide to the National Strategy. Ottawa, ON: Author. Retrieved from http://pauktuutit.ca/wp-content/blogs.dir/1/assets/InuitStrategy_e.pdf
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The Privacy Commissioner of Canada is an Agent of Parliament whose mission is to protect and promote privacy rights. The Office of the Privacy Commissioner of Canada (OPC) oversees compliance with the Privacy Act. The OPC carries out its mission by: promoting public awareness; investigating complaints, conducting audits, pursuing court action; publicly reporting; and supporting, undertaking and publishing research
Reference: Office of the Privacy Commissioner of Canada Retrieved from: http://www.priv.gc.ca/resource/prov/index_e.asp
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Bullying (also known as harassment) happens when a person or a group of people repeatedly hurts, threatens, or scares a peer. Bullying awareness and prevention activities have been traditionally aimed at younger generations, even though the behaviours occur across the life course and can affect older adults where they live and socialize. This factsheet summarizes the definition of bullying, causes, impacts on older adults, strategies for prevention, and available services in Ontario.
Adapted from: A&O and CNPEA Info-graph on Older Adults and Bullying 2020
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Ontario Regulation 246/22 was made under The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector April 11, 2022.
Government of Ontario (2022) Ontario Regulation 246/22. Toronto ( ON) retrieved from O. Reg. 246/22: GENERAL (ontario.ca)
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This brochure helps identify several key issues regarding managing the stigma and discrimination in housing, family and social support found in LGBTT population. The resource is available for free download.
Senior Pride Network. (2014). Opening the Closet on Aging: Working with older lesbian, gay, bisexual, transsexual, and transgender people. Retrieved from http://www.rainbowhealthontario.ca/resources/opening-the-closet-on-aging-working-with-older-lesbian-gay-bisexual-transsexual-and-transgender-people/
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The fact sheet is a tool to increase awareness of the regulatory mandate on educating and preventing client abuse and provide further resources to support nurses in the prevention of abuse in practice.
College of Nurses of Ontario. (2011). Preventing client abuse fact sheet. [PDF file]. Retrieved from https://www.cno.org/globalassets/docs/ih/47008_fspreventabuse.pdf -
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Cette ligne directrice sur les pratiques exemplaires en soins infirmiers est axée sur la prévention et résolution des mauvais traitements et de la négligence envers les aînés dans divers établissements de santé et services communautaires à travers le Canada. Ces auditoires comprennent les infirmières, les gestionnaires, les éducateurs, les équipes d'amélioration de la qualité, les administrateurs, les décideurs, les organismes de réglementation des soins infirmiers et les organismes gouvernementaux. Financé par le programme Nouveaux Horizons pour les aînés du gouvernement du Canada.
Association des infirmières et infirmiers autorisés de l’Ontario. (2014). Prévention et résolution des mauvais traitements et de la négligence envers les aînés: approches axées sur la personne, coopératives et à l'échelle du système Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults_Final_French_0.pdf
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This Website provides local, provincial, federal and multicultural links to elder abuse resources. It also provides strategies to minimize the risk of elder abuse.
Reference: http://elderabuse-yorkregion.ca/prevention/Disclaimer: The Prevention of Elder Abuse Committee of York Region has a mission to reduce elder abuse by increasing awareness. The committee does not provide services or assistance.
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This project was designed to identify relevant principles, screening and intervention tools and approaches and prevention strategies being used in First Nations communities to address/prevent abuse of older adults.
April Struthers, Georgina Martin, Alison Leaney Project Team BC Association of Community Response Networks December 2009
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The Website provides excellent resources focussed on the intersection of the LGBTQ community and aging. Some resources are available for download and some resources can be purchased.
Copyright with Rainbow Health Ontario
Reference: Rainbow Health Ontario Website (n.d.). Retrieved from http://www.rainbowhealthontario.ca/resource-search/
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This resource list helps you identify key contacts in addressing elder abuse. Complete the contact details for your local resources.
Reference:Registered Nurses’ Association of Ontario. (2014). Appendix H of Addressing and Preventing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, ON: Registered Nurses’ Association of Ontario. , pp.112-114. http://rnao.ca/bpg/guidelines/abuse-and-neglect-older-adults
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The manual contains a series of clearly written, interactive modules on violence against older persons. Module 3 (page 42) focuses on violence against older persons in residential care facilities. The manual is intended for use in a training program on preventing violence, but could be used for self-learning. References and resources are Newfoundland and Labrador based.
Violence Prevention Initiative - Women’s Policy Office, Government of Newfoundland and Labrador. (2013). Respect Aging: An Education and Training Program for Recognizing, Preventing and Intervening in Violence Against Older Persons Participant Manual [PDF document]. Retrieved from https://www.respectaging.ca/training/Participant_Manual.pdf Copyright, Government of Newfoundland and Labrador
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The BPG assists nurses in exploring how the decision making process can ensure that appropriate structures and supports are in place to maximize the nursing care and outcomes and minimize the potential for abuse of residents/patients/clients.
Registered Nurses’ Association of Ontario. (2017). RNAO Developing and sustaining safe, effective staffing and workload practices. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_Relationships.pdf?_ga=2.88936027.1702348378.1602485970-1685849072.1567072300 This work is funded by the Ontario Ministry of Health and Long-Term Care
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This guideline is to be used to enhance the safety of health service organizations and academic institutions through the adoption of evidence based practices. Safe and healthy work environments are an enabler for nurses and other health workers to optimize clinical outcomes for those receiving care.
Registered Nurses Association of Ontario (2019) Preventing Violence, Harassment and Bullying Against Health Workers. Toronto, ON. retrieved from Preventing Violence, Harassment and Bullying Against Health Workers | Registered Nurses' Association of Ontario (rnao.ca)
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The Relating to Older People Evaluation (ROPE) is a self-report measure of the frequency and type of ageist behaviours. ROPE is a 20-item questionnaire that measures personal discrimination through 14 statements that reflect negative types of ageism, and 6 statements that reflect positive types of ageism.
Reference: Cherry, K., & Palmore, E. (2008)). Relating to Old People Evaluation (ROPE). Retrieved from rope_tool_web_relating_to_old_people_evaluation.pdf (cnpea.ca)
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The Staff Mix Decision-making framework for quality Nursing Care is a comprehensive and evidence informed resource that presents a systematic approach to staff mix decision making. It can be used in all clinical practice settings. It is a Joint Position statement between the CNA, Canadian Council for Practical Nurse Regulators, and the Registered Psychiatric Nurses of Canada.
Reference: Canadian Nurses Association. (2012). Staff Mix Decision Making Framework for Quality Nursing Care. Retrieved from: http://cna-aiic.ca/~/media/cna/files/en/jointps_staff_mix_partnership_e.pdf
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This resource describes the variety of theories as to why elder abuse and neglect can occur and will assist homes in planning a comprehensive education program.
Registered Nurses’ Association of Ontario. (2014). Appendix E of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. Pp 100-102. http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults.pdf
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At the core of nursing is the therapeutic nurse-client relationship. The College's Therapeutic Nurse-Client Relationship, Revised 2006, practice standard describes the expectations for all nurses in establishing, maintaining and terminating a therapeutic relationship.
College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship. [PDF document]. Retrieved from https://www.cno.org/globalassets/4-learnaboutstandardsandguidelines/prac/learn/modules/tncr/pdf/tncr-chapter3.pdf -
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The link takes you to the COllege of Nurses of Ontario webcast on Therapeutic Nurse-Client Relationship – Maintaining Boundaries
College of Nurses of Ontario. (2011). Therapeutic Nurse-Client Relationship – Maintaining Boundaries. [Webcase]. Retrieved from https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/webcasts/therapeutic-nurse-client-relationship/ -
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This is a brightly coloured, one page pamphlet/poster that describes signs of elder abuse and gives resources. This is one of a suite of resources from Elder Abuse Ontario in the Helping Seniors section of their website.
Reference: Elder Abuse Ontario. 2015. Warning Signs of Elder Abuse. Accessed Feb. 2, 2017 from http://www.elderabuseontario.com/what-is-elder-abuse/help-for-seniors/educational-materials-for-seniors/
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This pamphlet has an algorithm to help decide on whether and to whom to report elder abuse, as well as elder abuse resources in Ontario. This is one of a suite of resources from Elder Abuse Ontario in the Helping Seniors section of their website.
Web Source: Elder Abuse Ontario. 2015. What To Do If You Suspect Elder Abuse. http://www.elderabuseontario.com/what-is-elder-abuse/help-for-seniors/educational-materials-for-seniors/
Reference: Elder Abuse Ontario. 2015. What To Do If You Suspect Elder Abuse. Accessed Feb. 2, 2017 at file:///C:/Users/sumani/Downloads/What-To-Do-If-You-Suspect-Elder-Abuse-2016.pdf