Dedicated to my Mum, Isabel Sommerville, RN, BN, MPA
By Anne Thompson
Under Canadian law, a corporation is considered to be a legal person who can own property, borrow money, pay taxes, hire employees, and commence or be subject to a lawsuit. They can be guided, but they cannot care, nor have empathy, nor have they the ability to sense anything at all. And, I believe some person should be held to account for the anecdotal reports reported in local media of the physical and psychological damage to persons in care secondary to neglect as a consequence of insufficient time expenditure with the beneficiary or of quality of staff training.
I believe in holding all persons accountable, lest humans become second-class to corporations who otherwise seem allowed to choose behaviour for which a natural person, a human, would be held to account. Holding to task all persons to the same measure of law, whether a natural person or an ‘incorporated person’, is my primary concern on the matter of elder abuse.
I did not find a legal definition for ‘care’ in the Continuing Consolidation of the Statutes of Manitoba, including the Protection of Persons in Care Act. With my major concerns in mind, with respect to current efforts — especially legal efforts — to address the abuse and neglect of older adults receiving care services from some corporations, I composed the following proposed legal definition for care.
Where, “designated caregiver” means an essential partner or partners in care, including family members, actively and regularly participating in providing care, which may include the support of feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity, and assistance in decision-making. “impeccable” means beyond reproach of the code of ethics and the standards governing their job. “individual” means a natural person who is beneficiary of services or a client or a resident or a patient.
Then a legal definition of for care is where “care” means, while simultaneously carrying out impeccable and ongoing assessment of the individual, the application of culturally-appropriate trauma-informed knowledge within the scope of training received, and the performance, as part of a team, of those activities, appropriate for the individual’s age, that contribute to the benefit of the individual’s body, mind and spirit, and that assure;
(a) an effective broad multidisciplinary consultative approach based on beneficiary guidance and active participation, that allows input from family members or designated caregiver, and that makes use of available community resources that offer a support system to help the individual live as actively as possible until death;
(b) support to the family members and the designated caregiver of the individual;
(c) services that ensure the individual is not left alone or is monitored, so as to give a family member/designated caregiver time off for rest or respite, or an opportunity to receive services determined by government regulation, such as support, assistance and training services;
(d) health providers evaluate and alleviate the individual’s physical, psychological, and social distress;
(e) personalized point of care quality-of-life assessment, that is routinely reviewed and updated in response to individual condition;
(f) the cleanliness of the individual, which includes washing, rinsing, and drying of hair, face, trunk, extremities and perineum, and anything that touches the individual, which includes glasses, dentures, clothing, linens, hearing aids, prosthesis, and orthosis;
(g) the grooming of the individual, which includes cleaning of teeth and/or dentures, brushing, combing and maintenance of hair, application of therapeutic moisturizing cream/lotion, application of make-up, shaving, and clipping nails;
(h) the timely obtaining, donning and doffing of the individual’s indoor and outdoor clothing, and when applicable, prosthesis +/or orthosis,+/ or clean, properly fitting glasses in good repair and of the correct prescription, +/or clean, well-maintained, properly fitted dentures, +/or clean and fully-charged properly functioning hearing aids, +/or incontinence products/devices;
(i) the habitual ingestion of a variety of sufficient nutritious, familiar, culture-specific, prepared to the correct consistency, texture and temperature, foods and beverage to improve or to maintain the individual’s best health, including feeding the individual if necessary;
(j) the integration of the psychological and spiritual aspects of individual care;
(k) the exercise of empathetic social behaviours in order to support the emotional and mental health of the individual;
(l) enhancing the quality of life of the individual, and of their families/designated caregiver, facing the problems associated with the individual including bereavement counseling, if indicated;
(m) sufficient repositioning/rotation of the individual on a regular basis to prevent bedbound complications;
(n) the safety and stability of the individual when the individual mobilizes without assistance;
(o) a safe, comfortable, temperature- and humidity-controlled environment for the individual;
(p) engagement of the individual in programs that foster the physical, social, emotional, intellectual and spiritual maintenance or improvement of the individual, and demonstrate an appreciation of their inherent value;
(q) maintenance of good communication with the individual, including attentive listening, smiling, patience, and empathetic and calming actions;
(r) development of strong communications channels that ensure the individual and their families/designated caregiver receive timely, accurate and useful information;
(s) monitoring of the individual’s vital signs, as necessary;
(t) the maintenance of good sleep hygiene;
(u) provision of timely professional medical, dental and/or therapeutic intervention, especially if and as soon as something untoward or unusual is seen or detected;
(v) the timely delivery of medication, assessment of the effective outcome of medication, and periodic assessment using de-prescribing guidelines; provided in non-specific locations in such a manner as would an individual perform unaided if the individual had the necessary strength, will or knowledge.
I believe part of the solution to ending undignified treatment of patients receiving care in any setting (Long-term Institutional Care, Long-term Home Care, Long-term Community Care) is two-pronged. It lies in educating the general public about the menu of services that may be needed, and in passing into legislation a definition of the word ‘care’ for the purpose of instructing an unfeeling incorporated person what is meant whenever the word ‘care’ is used in legislation, instructing them as to what behaviours are obligated to be made available for the choice of natural persons, and for use by any incorporated person to guide its own choices of behaviour as well as the behaviour of those whose work it has an ability to influence.
With a properly implemented management program, corporate culture can be guided to ‘care’ and in doing so avoid a culture that allows the development of the indifference that allows insufficient and second-rate service delivery, as well as for little value placed on the quality of life for sick and older individuals, to be accepted as normal workplace culture anywhere in Canada.