Caring for vulnerable people
|Authority||Fraser Health Authority|
Bob’s mom had advanced dementia and lived in residential care. Her husband filed her income tax returns. After he passed away, income tax returns were not filed and the health authority increased Bob’s mom’s fees to the maximum rate for three years. Bob’s mom’s income was too low to cover the increased fees so the health authority sent the bill to a law firm which then threatened legal action against Bob’s brother for payment. When Bob learned about this, he obtained a court order to act on behalf of his mother, filed her income tax returns and gave the Notices of Assessment to the health authority. The health authority refused to retroactively adjust his mom’s fees, saying they tried to inform Bob’s brother when his mom failed to supply proof of her income. Bob found the explanation perplexing as throughout the three years, neither Bob nor his brother had legal status to manage their mom’s financial affairs.
When we investigated, the health authority acknowledged their error and agreed to refund the excess fees charged for the three years. But we had more questions. Health authorities provide care to vulnerable people who may not be capable of managing their financial affairs or making health care decisions. When a vulnerable person’s family is not available or willing to assist, health authorities have obligations under the Adult Guardianship Act. Where a vulnerable person is demonstrating self-neglect by failing to manage their financial affairs, health authorities are expected to refer the matter to the Public Guardian and Trustee who, once notified, would make enquiries to determine whether there are family members able to assist. This did not occur for Bob’s mom. We looked at three health authority policies: consenting to health care, resident neglect, and debt, all of which applied to Bob’s mom. We concluded the policies had not been fully applied and taken together, the policy content did not seem to line up with each other and the health authority’s obligations.
We proposed the health authority change the policies by aligning definitions and language, identifying steps to take where self-neglect exists, and cross-referencing the policies to ensure care providers were aware of procedures. We proposed the health authority review with residential care service providers several steps to serve vulnerable adults. These included that identification of self-neglect and steps to address it must be recorded on patients’ Health Record, the mandatory steps to take when caregivers suspect self-neglect, and the requirement to confirm Temporary Substitute DecisionMakers for incapable residents. The health authority agreed with our proposals.