Preventing Harm to Vulnerable Older Adults: A Social Justice Perspective

Abstract

This article presents the results from a qualitative study that explored how legislation in British Columbia, intended to protect vulnerable adults from harm, is implemented in practice. The legislation contains guiding principles that require the least restrictive and minimally intrusive form of support or intervention be used and that the adult’s wishes be respected. Sixteen professionals who work as elder abuse responders in British Columba participated in this study through interviews and a focus group. Fifteen of the study participants were social workers. Grounded theory method was used, and themes were identified. The first theme reveals that responders prefer to obtain older adult consent to service provider involvement, rather than forcing compliance by using statutory authority. The second theme reveals that responders may not be able to intervene in a minimally intrusive manner because of resource shortages and organizational structural issues. These findings have human rights and social justice implications.

Elder abuse is a social problem with profound policy and practice implications. On the policy front, governments must decide what type of legislation to enact to respond to elder abuse. In Canada, different approaches have been taken in different provinces. This article presents the results of a recent study on elder abuse response under British Columbia’s Adult Guardianship Act (1996).

In British Columbia, social workers working for the health authorities are mandated responders under this legislation, which requires them to apply this legislation to practice. The purpose of this study is to understand how social workers interpret the Adult Guardianship Act and the decisions they make upon receiving a report of elder abuse. The results of this study have social justice and human rights implications, which are discussed in the final section of this article. This article presents preliminary findings from the study and analyzes the results from a social justice perspective.

Legal Responses to Elder Abuse

Elder abuse is a pernicious problem, with profound negative impacts on the recipient of the abuse. Elder abuse refers to abuse of adults who are older in age and may be physical, sexual, psychological, or financial. ¹ A recent Canadian national survey by MacDonald found the prevalence of these four types of elder abuse in the previous year to be 7.5% (National Initiative for the Care of the Elderly, 2015). An earlier Canadian study found that 4% of the elderly population recently experienced some serious form of maltreatment in their own home at the hands of a partner, relative, or significant others (Podeneiks, 1993). The most common perpetrator of all types of elder abuse, other than sexual, is immediate family members (National Initiative for the Care of the Elderly, 2015). Unfortunately, older adults are often reluctant to report abuse when the perpetrator is a family member (Groh & Linden, 2011; Ha & Code, 2013), which makes it more difficult for governments to tailor legal interventions that are effective.

Governments have implemented a range of different legislative and programming responses to elder abuse. Programs, services, and legislation may target abuse prevention or intervention. Specifics vary from jurisdiction to jurisdiction and from model to model. Legislation provides remedies for some types of elder abuse. For example, where the abuse constitutes a crime, then police or other government agents can intervene. In some jurisdictions, governments have passed civil laws that offer protection to populations believed to be at heightened risk of harm. These laws do not necessarily apply exclusively to older adults and may apply to any group that the government believes to require protection and assistance to remain safe.

In Canada, criminal law is under federal jurisdiction and criminal laws apply universally throughout the country. Some provinces have passed civil laws intended to provide protection from abuse for specific groups in specific situations. The scope of these laws varies from province to province. In British Columbia, Part 3 of the Adult Guardianship Act ² authorizes agencies designated by government regulation (“designated agencies”) to intervene when adults are experiencing abuse or neglect and are unable to seek support and assistance on their own. Although the statute applies to adults of any age, most investigations carried out under this mandate involve older adults (I. McKenzie, 2016). The majority of cases are older adults who are experiencing early dementia and don’t have family around to help them (BCPLS Central, 2015).

British Columbia’s legislation is unique in Canada. The only other Canadian province or territory with similar legislation is the Yukon (Canadian Centre on Elder Law, 2007). British Columbia’s legislation resembles the adult protection laws that exist in the United States. Those laws enable government intervention to protect populations deemed to be vulnerable. These laws are fairly broad in scope. In contrast, the Adult Guardianship Act only permits intervention in very narrow circumstances. This is discussed further below.

Given persistent stereotypes that older adults are frail and forgetful, it is not surprising that older adults are often identified as one of the vulnerable populations who need protection. In many American states, adult protection laws apply to all adults above a certain age and authorize intervention regardless of whether the older adult is competent or wishes protection. Scholars have argued that these age-based laws violate the civil rights of older adults (Kohn, 2009). Given that these laws allow the government to override the wishes of competent adults based solely on age, it seems obvious that discrimination is occurring.

British Columbia’s Adult Guardianship Act is much less intrusive. The legislation only authorizes government intervention in cases where adults are unable to seek support and assistance on their own. From a policy perspective, the intention is to protect vulnerable adults. Although the Adult Guardianship Act does not contain the word “vulnerable,” mandated responders use the term to refer to adults that fall within the statutory mandate (BCPLS Central, 2015).

The concept of vulnerability has been criticized by scholars for fostering paternalism and providing a rationale for intrusive protective measures. Legal scholar Margaret Hall (2012) explains that the justification for intrusion is often justified based on the perceived incapability of vulnerable persons. The perception of incapability is used to “justify interference without a formal finding of incapability” (p. 63). Clough (2017) highlights dangers that arise when policies are based on the conception of vulnerability associated with specific groups:

Given concerns about the way in which vulnerability discourse may be used to create dangerous new categorizations and binaries, and to effect social control and paternalistic intervention in the lives of those classed as vulnerable, it is important that we do not valorize vulnerability as a guide for new modes of legal and policy reform. This is perhaps most salient in contexts such as disability and adult social care, where the concept of vulnerability is eyed with suspicion due to its perceived synonymous relationship with weakness and powerlessness, and its traditional ascription to disabled people to enable controlling interventions. (p. 269)

The complicated question of how to define vulnerability cannot be answered by turning to moral philosophers or theorists, as there is no agreement on the meaning. Theories of vulnerability generally fall into two distinct categories: The etiology of vulnerability is ontology, or the etiology of vulnerability is linked to particularized harms certain groups are subject to (C. McKenzie et al., 2014). The latter view provides a rationale for adult protection laws. These laws protect the groups that are subject to particularized harms. However, offering protection based on perceived vulnerability has a downside. In society, negative stereotypes of victimhood and dependency are often associated with vulnerability. These stereotypes may influence legislators to draft laws that are highly paternalistic.

Regardless of the existing ambiguity over the meaning of vulnerability, governments must grapple with the question of how to protect members of society who cannot protect themselves and the related question of how to respond to victims of elder abuse who are not able to protect themselves. For governments, this area is fraught with challenges. When governments legislate in this area, they must balance considerations of protection with considerations of preserving the autonomy of adults who may not want protection. In some jurisdictions, adult protection laws favor protection and in others autonomy (Canadian Centre on Elder Law, 2007). Where protection is favored, there is the potential for violating rights by overriding the wishes of those who do not want help. On the other hand, in jurisdictions that favor autonomy, the government may abandon elder abuse victims, leaving them to find assistance on their own regardless of whether they have the ability or resources. In some cases, the government’s neglect of these issues may violate human rights principles.

Even when adult protection laws are well crafted and not overtly discriminatory, there is the potential for these laws to negatively impact older adults since discrimination may occur at the implementation stage. For example, a law may only permit the government to override an adult’s wishes when an older adult is legally incompetent. This written law might appear to protect older adult rights. However, if the professional investigating a report of elder abuse has a personal belief that most older adults have dementia and treats a cognitively capable older adult paternalistically on that basis, then that older adult experiences discrimination in the implementation of the law.

In sum, creating an effective response to elder abuse presents challenges. Governments must first decide what role they should play in protecting vulnerable members of society. This is a difficult policy question, because vulnerability is an undefined term, with no agreement on its specific meaning. Even if a moral argument can be made that the government has a duty to protect vulnerable members of society, translating that into a specific policy or law is extremely difficult. This requires defining who is vulnerable and determining what form of protection is needed.

Adult Guardianship Act

British Columbia’s Adult Guardianship Act has been described by one law reform agency as an example of a modern approach to protecting vulnerable adults (Canadian Centre on Elder Law, 2007). In keeping with law reform trends around the world, this statute emphasizes providing support to those who require it in contrast to approaches that utilize more intrusive and paternalistic means of protection. The statute has narrow criteria that limit who this mandate applies to. The mandate is set out in s. 44 of the Adult Guardianship Act, which states:

The purpose of this Part is to provide for support and assistance for adults who are abused or neglected and who are unable to seek support and assistance because of

• physical restraint,

• a physical handicap that limits their ability to seek help, or

• an illness, disease, injury or other condition that affects their ability to make decisions about the abuse or neglect.

When the Adult Guardianship Act came into force in 2000, British Columbia’s five health authorities were designated as the agencies responsible for carrying out this mandate (Designated Agencies Regulation, 2002). ³ Staff at the designated agencies investigate and respond to reports of abuse of vulnerable adults in accordance with the requirements and authorities set out in s. 44–60.1 of the Adult Guardianship Act. Although all staff are considered to be mandated responders, social workers carry out the primary role of investigating and responding to reports of abuse.

Mandated responders must follow guiding principles when carrying out this work. The guiding principles can be found in section 2 of the Adult Guardianship Act, which reads:

This Act is to be administered and interpreted in accordance with the following principles:

• all adults are entitled to live in the manner they wish and to accept or refuse support, assistance, or protection as long as they do not harm others and they are capable of making decisions about those matters;

• all adults should receive the most effective, but the least restrictive and intrusive, form of support, assistance, or protection when they are unable to care for themselves or their financial affairs;

• the court should not be asked to appoint, and should not appoint, guardians unless alternatives, such as the provision of support and assistance, have been tried or carefully considered.

The guiding principles align with the government’s intention when creating this legislation. As explained by Colin Gabelman, the attorney general at the time:

While we envision a system of support and assistance where an adult’s right to self-determination will not be interfered with unnecessarily, the bill does set out specific steps which must be taken to protect an adult who is unable to prevent or resolve a situation of abuse or neglect because of diminished mental capacity or a severe physical handicap. These steps include the offer of services which, if accepted, would address the situation. However, should the adult refuse such assistance, there is provision for the community response network to seek a court order to require the incapable adult to avail himself or herself of services that have been designed to resolve the abuse or neglectful situation. (British Columbia Government, 1993)

In accordance with the Adult Guardianship Act, when the designated agency receives a report of abuse or neglect of adults not able to seek support and assistance on their own, it is required to investigate. If the adult is abused or neglected and unable to seek support and assistance, the next step is to offer support and assistance. If that support is accepted and the risk is mitigated, the matter ends there. If the adult refuses assistance then, under the authority of the Adult Guardianship Act, the designated agency may investigate further and may intervene using a variety of different legal remedies, such as a court order that requires the adult to comply with a support and assistance plan. The statute sets out criteria stipulating reasons why adults may be unable to seek support and assistance. One of the included criteria is cognitive deficit.

Although this law applies to adults of any age, the statute has a greater impact on older adults. Statistics show that the majority of cases where there is an investigation of abuse or government intervention under the provisions of this statute involve older adults (I. McKenzie, 2016). There are two likely reasons for this. First, as adults age, there is an increased prevalence of health issues, which may require the support of a caregiver. If the caregiver also is the abuser, it can greatly complicate the older adult’s ability to seek support and assistance. This can bring the case into the purview of the designated agencies.

Second, the statute lists cognitive deficit as one of the criteria that can render an adult unable to seek support and assistance. There is an increased prevalence of dementia in the older adult population. For example, the prevalence of dementia for women aged 75–84 increases to 11.6% and men with the same age increases to 10.4%. The prevalence for women over age 85 is 37.1% and men 28.7% (Alzheimer’s Society of Canada, 2016, p. 22). Even when older adults do not have dementia, the responder may perceive that they do. There are stigma and discrimination associated with dementia (Milne, 2010). A common stereotype is that older adults are forgetful and have diminished cognition. As a consequence of this, the responder may assume that older adult abuse victims who choose not to leave abusive situations have cognitive difficulties that prevent them from doing so.

As discussed above, the British Columbia government introduced the Adult Guardianship Act with the intention of protecting vulnerable adults in a minimally intrusive manner and to focus on support and respect for individual autonomy. However, it is not known whether the legislator’s intentions are being met in practice. This study examines the question from the perspective of social workers, who are mandatory responders under the Adult Guardianship Act. It examines how they understand their statutory responsibilities and interpret concepts such as autonomy and support within the context of that mandate.

Rationale for the Study

This study fills an important gap. Scholars have examined issues of autonomy and aging including in the context of adult protection legislation (e.g., Beaulieu & Leclerc, 2006; Hall, 2012). However, there is a paucity of empirical research that has examined how civil or criminal legislation is implemented in cases of elder abuse. A search for previous studies on this topic in Canada only revealed four previous empirical studies published in English. It is possible that additional studies in French may exist.

Two of the four studies are qualitative studies based on the survey method. Both are more than 20 years old. The 1992 study compared adult protection laws in two Canadian jurisdictions and found that responders interpreted identical laws differently depending on the professional background (Poirer, 1992). In the other study, Spencer (1996) examined how older adults understood and experienced financial abuse using qualitative interviews. She provided scenarios of situations of elder abuse based on criminal law offenses to study participants and discussed these. She found that one in 12 of the study participants had experienced financial exploitation in amounts of over $20,000 (Canadian).

The other two empirical studies used the case review method. One was a review of court cases involving sexual assault of older adults. Grant and Benedet (2016) examined the treatment of sexual assault by the criminal justice system by reviewing social science literature and sexual assault court cases. The authors contrast depictions of older adult women and sexual assault in the literature and in court cases. In the other study, Ha and Code (2013) reviewed police files at the Ottawa police elder abuse unit, examining 531 cases, and identifying trends and characteristics.

Although these studies provide useful information about elder abuse and the justice system, two of these studies are very old and none involved the same issues as this study, which examines how social workers respond to elder abuse under the provisions of a particular adult protection law.

There are also two recent British Columbia studies relevant to this study. These pertain to the Adult Guardianship Act but do not focus on the legal aspects. Storey and Prashad (2018) examined the effectiveness of training for mandated responders. Holland (2011) interviewed social workers who are mandated responders to understand how they apply the ethic of justice and the ethic of care to practice. In addition, the Canadian Centre on Elder Law wrote a report based on a legal analysis of the Adult Guardianship Act comparing it to legislation from other provinces (BC Abuse and Neglect Collaborative, 2009).

The Adult Guardianship Act has been in force for more than 20 years. However, there has been very little research on how it is being implemented. This study fills that gap.

Implications for Social Workers

Fifteen of the 16 responders who volunteered to participate in this study were social workers. Ten of the participants work for the designated agencies. The designated agencies are large quasi-governmental bodies with strict policies, procedures, and reporting structures that must be followed. One of the questions asked participants was how these policies and procedures affect social workers’ interpretation of the Adult Guardianship Act and decisions made when responding to reports of elder abuse.

This study reveals issues highly relevant to social work practice. Questions of how to respect the autonomy of vulnerable older adult clients are central to social work practice. Empowerment and respect for the individual are important values spelled out in social work ethical codes and are foundational to advancing social justice another core value of the social work field. As explained by Twomey (2015), social justice includes a respect for human dignity, empowerment, and remaining cognizant of the “social and political actions that need to be taken in order to enable people to develop the capacity for autonomy, and to enable the exercise of autonomy” (p. 164).

A social worker must consider how to apply social work ethics to their work with clients and how to advance social justice to the greatest degree possible. When that client is an older adult, the importance of supporting an older adult’s autonomy is particularly important. Older adults are often treated in an ageist fashion by service providers, which unfortunately may undermine the older adult’s ability to act autonomously (McLeod & Sherwin, 2000).

Social workers must also determine how to practice ethically when social work values are not supported by the agency where they work or where client autonomy is undermined by policies and procedures established by their employer. For example, a social worker working in a seniors’ agency may encounter situations where agency practices have a discriminatory impact. In this situation, social workers “need a critical analysis and response to the way that organizations, policies and rules and norms operate to produce discriminatory effects, such as reproducing truths and knowledge that continue the cycle of prejudice, stereotyping and discrimination” (Watts & Hodgson, 2019, p. 17).

Scope of Study

Although the response to abuse set out in the Adult Guardianship Act applies to vulnerable adults of any age, this study more narrowly focuses on older adults. The older adult social context differs from the younger adult social context. A recent study found that 63% of seniors aged 66 years of age and older believe they have been treated unfairly or differently because of their age and 35% of Canadians admit treating someone differently because of their age (International Federation on Ageing, 2012). By focusing solely on response to elder abuse, it was possible to consider issues such as whether the participants’ attitudes about age affected their response. Rather than providing participants with a definition of these terms, during interviews, participants were asked to describe their personal understanding of “older adult” and “elder abuse.” Although the Adult Guardianship Act also provides authority for the designated agencies to respond to reports of neglect and self-neglect, but this study focused more narrowly on the response to elder abuse.

Method

The purpose of this study was to develop an understanding of how social workers who are mandatory responders under the Adult Guardianship Act (“responders”) interpret the legislation and decide how to respond to reports of elder abuse. This includes how they balance competing values in their decision making. The study involved interviews and a focus group. Ethics approval from the Behavioral Research Ethics Board was obtained before commencing the study. In keeping with ethics board requirements, participants signed a consent form in advance of the interviews and focus group.

Theoretical Perspective

This study falls under the umbrella of socio-legal research, which is concerned with the interaction between social processes and the law. In the words of Schiff (1976),

[a]ccording to a socio-legal approach, analysis of law is directly linked to the analysis of the social situation to which the law applies and should be put into the perspective of that situation by seeing the part the law plays in the creation, maintenance and/or change of the situation. (p. 187)

Grounded theory methodology has been used in previous socio-legal research. For example, Outhwaite et al. (2007) used grounded theory in a study on biosecurity law and Bentzon et al. (1998) used grounded theory in a study of women’s law in Zimbabwe. The second example has a closer affinity to this study. That study examined the experience of women in relationship to the law, whereas the current study examines the experience of responders in relationship to the law.

With the grounded theory approach, the researcher does not impose a theory on the data, but rather the theory arises out of the data. For this reason, some grounded theorists delay literature review until after data collection and analysis is complete (e.g., Charmaz, 2006; Reager, 2018). I conducted a literature review that was limited in scope, searching for previous empirical research on elder abuse and the law and about response to abuse under the Adult Guardianship Act.

I chose grounded theory because it is well suited to studies where very little is known or where the purpose is to explain a particular process or practice (Cresswell, 2013). As noted, there is a paucity of previous relevant empirical research. There are a number of different grounded theory approaches, and I chose to rely on Charmaz’s constructivist approach. This approach aligns with the purpose of the study, which was to explore how responders understand the law and apply it in their work. Charmaz’s constructivist perspective emphasizes the importance of capturing the views, values, and ideologies of the participants (Charmaz, 2006).

According to Charmaz (2006), there are seven defining components of grounded theory practice, all of which I incorporated into my research design:

Simultaneous involvement in data collection and analysis.

Constructing analytic codes and categories from data, not from preconceived logically induced hypothesis.

Using the constant comparison method, which involves making comparisons during each stage of the analysis.

Advancing theory development during each step of data collection and analysis.

Memo writing to elaborate categories, specify their properties, define relationships between categories, and identify gaps.

Sampling is aimed toward theory construction, not for population representation.

Conducting the literature review after developing an independent analysis.

Research Questions

At the outset of the study, the following research questions were adopted:

Research Question 1: How do elder abuse responders interpret and implement the Adult Guardianship Act?

Research Question 2: How do they balance providing protection and preserving independence (autonomy) in their decision making?

As interviews and data analysis progressed, it became evident that responders’ decisions were constrained by structural and systematic issues in the workplace. In order to capture this additional component, the research questions were modified. The revised research questions were:

Research Question 1: How do responders interpret and implement the Adult Guardianship Act?

Research Question 2: How do considerations of autonomy and protection guide their work?

Research Question 3: How is the response to individual reports of elder abuse affected by the structure and workplace culture of the designated agency?

Study Participants

There were 16 study participants, with eight focus group participants and 13 interview participants. Five participated in both. Participants came from different regions of the province with at least one participant from each of the five designated agencies.

The first phase in the research project involved a focus group with responders from the designated agencies and agencies that work in close collaboration. Participants in the focus group were responders in policy, supervisory, or leadership positions in their respective agencies. There were eight participants in the focus group. The rationale for conducting a focus group first was to gather background information about regional differences and a historical perspective.

The second phase consisted of interviews with responders who (1) are employed by the designated agencies or an agency that has a collaborative relationship with the designated agencies and (2) have responded to at least one case of elder abuse in the past year. The requirement that participants must have personally responded to at least one case of elder abuse in the past year was waived for the focus group, since some of these work in roles where they no longer personally respond to elder abuse reports but have extensive earlier experience.

All participants in the focus group had several years’ experience working with older adults or on elder abuse issues. The participants in the interviews had a wide range of experience, from newly qualified social workers to those with several years’ experience.

Recruitment

Participants for the focus group were recruited through an advertisement distributed by a multisectoral working group in the vulnerable adult response field. Participants for the interviews were recruited through advertisements distributed by professional organizations whose membership includes social workers and professionals in the older adult field and by study participants who forwarded the advertisement to other responders.

Although the study was open to professions other than social work, 15 of the 16 participants were social workers. This is a reflection of the fact that it is primarily social workers who take the lead as responders under the Adult Guardianship Act in British Columbia.

Data Collection

During the data collection and data analysis, I relied on conventional grounded theory methods as described by Morse (2007), Holton (2007), and Cresswell (2013). Data were collected through one 2-hr focus group and thirteen 1-hr interviews. The author of this article conducted the interviews and focus group. The focus group was held in Vancouver British Columbia. The interviews were conducted on the phone or in person in various British Columbia locations.

Five social workers participated in both the focus group and an interview. These social workers had dual responsibilities, working in senior-level roles and also providing direct response to reports of elder abuse. Similar questions were asked throughout the study with additional questions asked of focus group participants to gather information about gaps between legislation and practice, policies related to the legislative mandate, and regional differences. Following are examples of interview questions:

Describe laws and policies relevant to elder abuse response in British Columbia.

What is your understanding of s. 44 of the Adult Guardianship Act?

What principles do you apply when interpreting elder abuse laws and policies?

What are the most common circumstances under which an older adult is unable to seek support and assistance on his or her own?

Can you describe a recent case where you responded to elder abuse?

How could laws, policies be improved to make elder abuse response in British Columbia more effective?

The focus group and interviews were recorded and transcribed. The data were coded, and themes were identified.

Data Analysis

In accordance with grounded theory method, data were coded and analyzed concurrently with data collection. Initial themes were identified and as data analysis continued, the original themes were modified, new themes were identified, and some themes were dropped or combined as the properties of the themes were identified. In the later stages of coding the data, theoretical sampling was used, where participants were chosen who had knowledge to confirm or contradict the emerging categories (Morse, 2007). At the end of the data analysis, four major themes were confirmed. These are societal influence, agency constraints, understanding concepts, and acting to respond. Data collection and analysis continued until these themes were saturated (Morse, 2007).

Results

Two of the four themes had subthemes. The subthemes related to the theme of understanding concepts are autonomy, capacity, law, vulnerability, and elder abuse. The subthemes related to the theme acting to respond are investigate and assess, collaboration and consultation, creative approaches, use legislative tools, and importance of support.

Through the process of creating memos (Holton, 2007) and examining the qualities of the themes, it became clear that these four themes fall into two very distinct categories or conceptual themes. These conceptual themes are (1) social beliefs and agency context and (2) taking action and avoiding intrusion. The first describes how responders’ decision making is constrained by the health authority structure, policies, and organizational beliefs. It reveals how the decisions made by these social workers are impacted by the environment that they work in.

The second describes the steps responders take upon receiving a report of abuse and suggests a preference for supporting older adult wishes instead of using intrusive intervention methods. It also relates to how they interpret their mandate. These two juxtaposed themes reveal how social workers carry out their role as responders.

The intent of a grounded theory study is to “move beyond description and to generate or discover a theory or…[an explanation] for a process or action” (Cresswell, 2013, p. 83). In conventional grounded theory methods, the objective is to identify one core concept that links all categories (Reager, 2018). In contrast to traditional methods, Charmaz’s constructivist grounded theory approach does not require the emergence of one core category (Charmaz, 2006). More than one unifying theme may be identified (Reager, 2018), which is true of this study.

The themes social beliefs and agency context and taking action and avoiding intrusion reveal a very interesting dynamic. Individual responders who participated in the study described being guided by the desire to keep vulnerable older adults safe and to use the least intrusive means possible. This finding is reflected by the first theme. However, they also described not always able to achieve this objective because of circumstances beyond their control. This includes a shortage of resources and reporting structures in the agencies where they work. This is reflected in the second theme, social beliefs and agency context. I discuss each of these themes in turn.

Taking Action and Avoiding Intrusion

Participants in the study expressed support for the Adult Guardianship Act and the philosophy behind it. Several commented that this statute represents a positive move away from paternalism. In the words of one participant:

I like the fact that it is about balance of autonomy and safety. We already have a legislation for extreme protection when needed with the Mental Health Act, even though it doesn’t apply to all situations. But if you look at them as legislative tools, I look at them as one’s a hammer, one’s a mallet, they both have similar jobs. But one’s more [flexible] and then the other is more for kind of a Black and White.

Participants described steps that they take to align their work with the guiding principles and the intent of the legislation. This includes preventing further harm to abused older adults through offering support and assistance and, where intervention is necessary, gaining the cooperation of the older adult and using the least intrusive measures necessary. They also expressed a desire to avoid intervening against the wishes of the older adult.

Responders participating in this study also explained steps they take to mitigate risk of future harm to older adult victims of elder abuse, while respecting the wishes of the older adult. One way that they do this is to investigate the abuse and provide support with the cooperation of the older adult. This enables the responder to avoid using the legal authority of the Adult Guardianship Act to investigate or intervene without older adult cooperation. Responders view taking actions without the agreement of the older adult as intrusive.

For example, even though the Adult Guardianship Act gives the designated agencies the authority to obtain financial records from a bank without consent, study participants stated a strong preference for avoiding this by obtaining the older adult’s consent. In order to get consent, they focus on building a relationship of trust with the older adult. As one participant explained, “that doesn’t mean that the risk isn’t there and it doesn’t mean there’s nothing we can do, it just means that our approach has to be very much client-driven or client, they have to be on board in some way or another.”

Study participants expressed a commitment to protect older adults from harm using the least intrusive measures possible. As one participant explained, “more often than not, the risks can kind of be mitigated by some like, yeah, just smaller interventions, like least intrusive kind of interventions.”

Although they noted that every case is different, participants were able to describe typical steps that they take upon receiving a report of abuse: First, speak to the person making the report, and second, speak to the older adult. They explained that responders consider the older adult’s social and family context during interviews in order to reach an understanding of the older adult’s perspective and wishes. This includes the historical context of the abuse and the adult’s support network. The history is important, especially if the older adult has diminished cognitive ability. If the adult has historically given financial gifts to adult children, a current gift is more likely to reflect the older adult’s wishes and less likely to be a sign of financial abuse. The presence of a support network is also very important. Participants explained that when an older adult has a strong support network of friends and families, this can serve as a protective factor that reduces risk and avoids future abuse.

The presence of a supportive network is an ideal scenario. According to study participants, where that does not exist, and where responders believe that abuse is occurring, the preferred option is to put a support system in place. This reduces risks in a minimally intrusive way. However, according to some participants, the health authority does not have enough resources to make that possible in all instances. This is one of the issues reflected in the next theme.

Social Beliefs and Agency Context

The Adult Guardianship Act mandate was delegated to the health authorities. However, the health authorities also have the responsibility to provide health care. Some participants commented on the tension between these mandates. This tension arises for a number of reasons including limited resources to fulfill both mandates. As one participant explained, “don’t forget we’re not first and foremost an adult protection agency. We’re first and foremost a health agency delivering services to a lot of vulnerable adults.” Some participants expressed concern that the health care mandate sometimes takes precedent over response under the Adult Guardianship Act mandate. In the words of one participant,

I think that people that are working in health care are just completely inundated with so much. They’re asked to do so much and to have so many—like what I think is important which is the AGA response is like, you know, one tick on a manager’s tick list of 15 other priorities…part of the problem is that we don’t have enough people identified to have this as their number one priority and because of that it’s a big diluted, I think, if you look at the organization as a whole.

One consequence of delegating responsibility for the Adult Guardianship Act mandate to the health authorities is that elder abuse victims may be assessed through a medical lens rather than through the guiding principles in the Adult Guardianship Act. Participants commented that social workers, who are trained to respond under the Adult Guardianship Act mandate, may have their views overridden by doctors, nurses, or health care administrators. As explained by one participant,

So that conflict is there, especially in the health care setting, because sometimes as a social worker, it is within our code of ethics that we want to be able to support people, give them the right to self-determination within their setting. And so, when you’re working in a team and there’s one social worker, but also like nurses and doctors and rec therapists and OTs and everybody else, you’re the only one sometimes that’s advocating for the client to let them do what they want, because everybody else can be prescriptive. You know, like you need to do this…you need to live in here so that these people can come and find you when they need to.

When an older adult is abused and also has health care needs, the case may be treated as a health care matter rather than an elder abuse case. Following the mandate or guiding principles in the Adult Guardianship Act may be a lesser priority than treating the health care issue or managing risk related to it.

Some study participants gave examples of times in which their authority was limited by policies, procedures, structures, and resources in the agencies where they work. Although some study participants work in more senior-level positions and have sufficient authority to influence decisions, other participants work in more junior roles and described limitations to their decision-making authority about how to provide support and assistance to adults who are being abused or are at risk of abuse. They described instances where they were unable to respond in an optimal manner and where older adult abuse victims did not receive adequate protection or were subjected to interventions that were overly intrusive.

Another issue identified by study participants is related to scarce resources. According to study participants, even though the health authorities were given responsibility for the Adult Guardianship Act mandate, insufficient resources have been made available to support this initiative. One participant noted that it can be hard to access a number of different resources. In his words, “it is not just a housing resource issue…I think it’s also…psychosocial support and personal care support.”

Participants explained that the system prioritizes autonomy for adults who are capable. However, the Black and White dichotomy between capable/not capable does not fit the life experience of older adults. Some older adults may be legally competent but not able to protect themselves without receiving some support services. Some participants expressed concerns about limiting support services for adults who are deemed legally capable and outside the mandate of the Adult Guardianship Act. One responder illustrated the point in the following words:

So, and its older adults that have taught me this, right—that have said to me, “I may not be fully capable some days and sometimes I need someone to help me and to help protect my money, or to help protect my body, or whatever it is, but that doesn’t mean I’m globally incapable. And I don’t want to be abandoned either.

Participants explained that resource shortages may have consequences for elder abuse victims with significantly compromised cognition who need support and assistance to be safe, when the needed resources are not be available. Sometimes the situation may escalate, and designated agency staff may be forced to use interventions that are intrusive to protect the older adult. As one participant explained, “sometimes it seems like we get in situations where we have to go to a higher level of intervention because the supports aren’t available. And that doesn’t sit well with me.”

Participants described other reasons why the designated agency may default to intervention rather than support. According to some participants, this also may occur when the decision about how to intervene is made by a doctor or nurse or other professional not trained in the Adult Guardianship Act mandate and whose personal beliefs prioritize protection over autonomy. One participant explained this in the following words:

I couldn’t imagine going to a surgeon who doesn’t have skills and varied practice and competencies and licensing and training, to perform that function on me. And yet we’re just saying really, anybody who works for a designated agency, with no standards, can intervene and that’s why I think we’re starting to see some of the things like human rights challenges.

A few study participants provided examples of situations with the potential for infringing human rights, such as (1) older adults being admitted to hospital or health care facilities for the purpose of keeping them safe, but sometimes without first obtaining proper consent, and (2) lack of protections for legal rights embedded into in the wording of the Adult Guardianship Act. For example, the statute does not require the designated agency to notify relatives when an older adult is kept in hospital under the emergency intervention provision (s. 59).

Discussion

In this section of the article, I first discuss the guiding principles contained in the Adult Guardianship Act. Then, I discuss the obstacles that prevent the designated agencies from following these in practice as identified by study participants. Finally, I highlight practice implications for social workers. I conclude this section with a discussion of relevant literature including on human rights and social justice.

Guiding Principles Applied in Practice

As mentioned earlier, the Adult Guardianship Act contains guiding principles that apply when implementing this statute, including the section titled as Part 3, which contains the adult protection provisions. The guiding principles can be found in s. 2 and s. 3 and specify that adults are entitled to refuse support and assistance as long as they do not harm others and are capable of making that decision, that adults should receive “the most effective but least restrictive and intrusive, form of support assistance or protection when they are unable to care for themselves or their financial affairs” and that adults are presumed to be capable to make decisions “until the contrary is demonstrated” (s. 3).

In sum, according to the guiding principles, all adults are presumed capable and entitled to refuse support or assistance. When services are offered, those should be minimally intrusive. In situations where an incapable adult refuses services and is at risk of harm, the Adult Guardianship Act specifies that the health authorities can seek a court order (s. 54), but this will not be granted unless least intrusive measures—such as support and assistance—have been tried first.

Resource Shortages and Program Structure Issues

Responders are not always able to align response to abuse with these guiding principles for a number of reasons as explained in the previous section of this article. This includes the fact that the Adult Guardianship Act mandate is delegated to the health authorities who operate under more than one mandate. Other statutes applicable to health care settings do not contain the same guiding principles and may authorize interventions that are more intrusive and are less supportive of older adult autonomy than the Adult Guardianship Act.

For example, study participants explained that if an older adult with cognitive impairment is at risk of harm in their current living environment, the health authority may use the provisions of the Mental Health Act (1996) to intervene rather than proceeding under the Adult Guardianship Act. The Mental Health Act authorizes the health authority to admit an adult to a medical facility against their will based on one doctor’s opinion. In contrast, the Adult Guardianship Act requires the health authorities to first offer support and when further intervention is required to use the least intrusive means of intervention. The Adult Guardianship Act’s guiding principles also state that adults are presumed to be capable and capable adults can refuse services or intervention.

Some study participants also described an absence of guidelines to inform them about how to apply the legislation to practice situations. When asked about the process for investigating elder abuse, participants said that “everyone does it differently.” The lack of clarity is complicated by the fact that cases falling under the Adult Guardianship Act mandate are not overseen by a specialized department with the authority to manage reports of elder abuse. Therefore, when an adult is abused and has a health issue, overlapping mandates apply to the case. These mandates differ and may sometimes be in tension.

The response to elder abuse, as set out in the Adult Guardianship Act, presumes that support and assistance will be provided to adults experiencing abuse who are unable to obtain support and assistance on their own. Participants in this study identified resource shortages. Based on the information they provided, these resource shortages impact their work and their ability to fulfill the mandate set out in the Adult Guardianship Act.

Since this study was based on interviews of a limited number of responders, it cannot be known for certain how widespread the underresourcing problem is. Until further research is done, we can’t know, for example, whether some health authorities or some geographical locations are impacted more than others. However, this theme did appear in the interviews and in the focus group, and it is safe to assume there are circumstances where resource shortages hinder the designated authority’s ability to effectively fulfill its mandate.

Resource shortages, as discussed under the heading Social Beliefs and Agency Context in the Results section above, have the potential to negatively impact older adults at risk of abuse for two reasons. First, older adults who are cognitively capable may not receive support services because incapable older adults are a higher service priority in keeping with the Adult Guardianship Mandate. Although legally capable adults may have the mental capacity to take action to leave situations where they are being abused, they may not be able to do so because of social conditions, such as poverty, lack of housing, lack of family support, or physical disability. Having been left to resolve the situation themselves, they may remain in an unsafe situation or be exposed to further violence or abuse.

Second, support services may not be provided to older adults who have mild cognitive impairments but are still legally capable. Study participants explained that targeted support services can mitigate the risk of further abuse. However, in situations where support services are not provided early on the situation may deteriorate over time due to a decline in the older adult’s cognitive ability or in the circumstances. Eventually, more intrusive interventions may be required. Study participants provided examples, with one participant illustrating this issue with the story of an older adult who was eventually admitted to the hospital due to safety concerns. This occurred even though there was no medical condition, and the older adult did not provide informed consent to the admission.

Social Work Practice Implications

Although all employees of the hospital are considered to be responders under the legislation, it is social workers who take on lead roles responsible for investigating and intervening in situations of abuse under the Adult Guardianship Act mandate. Given the issues discussed above, how do the social workers who participated in this study do their work and what implications are there for social work practice?

Social workers and the Adult Guardianship Act mandate

Study participants described the agreement with the guiding principles set out in s. 2 of the Adult Guardianship Act. One way that they align their practice with the guiding principles is to collaborate with colleagues to learn how to interpret the legislation and understand how it applies to practice situations. This emerged as a theme entitled collaboration and consultation.

Social workers who participated in this study described a preference for providing support informally rather than using their authority under the Adult Guardianship Act to intervene. They described building a relationship of trust to obtain consent for an investigation or offer of services. This avoids the need for a formal assessment of incapacity or a court order.

Study participants also emphasized the importance of using creative approaches to elicit cooperation from older adults to mitigate the risk of harm. This is one area where delegating the Adult Guardianship Act mandate to the health authorities may be beneficial. Older adults regularly come into contact with the health care system and may be more comfortable accepting help from a social worker employed by the health authority than a social worker from a stand-alone agency dedicated to elder abuse. Older adults recognize social workers as health care professionals, and social workers are able to leverage that social capital in creative ways to ensure that the support is accepted by older adults at risk.

For example, one participant described obtaining an older adult’s consent to meet for coffee periodically. These meetings over coffee enabled the social worker to monitor the older adult to make sure he was safe. Another social worker described asking a nurse to do a home visit in a nurse’s uniform because the older adult had a strong respect for nurses. The social worker believed that a uniformed home visit would increase the likelihood that the older adult would agree to have a conversation.

One theme running through interviews was the importance of support for the older adult at risk of harm. According to study participants, when older adults have a good support network of friends and family, it can help protect them from abuse. In cases where older adults lack a support network, responders often work toward creating or strengthening a network. Social workers who participated in the study described how support can enable adults with compromised cognitive ability to function independently.

Applicable Literature

This study examines how responders to elder abuse apply a statutory mandate in practice. As discussed above, there has been limited previous empirical research on this topic. However, the study by Holland (2011) that examined social worker response under the Adult Guardianship Act from an ethics perspective identifies similar themes on a number of points. For example, participants in that study identified inadequate resources, and the dual role of health provider/responder under the Adult Guardianship Act as matters of concern. They also identified social worker preferences for avoiding intrusive interventions and social worker views on the importance or relationship building with the older adult.

Human rights

In this study, social workers explained how support enables adults with compromised cognitive ability to function independently. This aligns with human rights principles. It also is supported by the literature on social justice and on social work ethics.

Article 1 of the Convention on the Rights of Persons with Disabilities (CRPD) reads:

The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. (United Nations, 2006)

The CRPD states that governments, “shall take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity” (Article 12[3]). Applying this to elder abuse response in British Columbia, it supports the argument that the designated agencies should not remove the right of an older adult with cognitive deficits to live independently without first offering support to enable that adult to exercise autonomy. The older adult may not be able to make decisions without assistance and may lack the autonomy to leave a situation where they are at risk. However, they may be completely capable of doing these things with appropriate support.

Even though the health authority may be legally entitled to intervene against the wishes of the older adult when they are legally incapable, that does not justify taking that step. The older adult might have sufficient capacity to make decisions with support. Denying an adult the right to make independent decisions or to exercise self-determination, because support is not offered has an appearance of unfairness. In contrast, an approach founded on human rights principles would presume that support should be provided to adults with compromised cognitive ability.

Although this principle is clearly stated in the CRPD, that document is an international convention and does not extend rights to any individual in any country. Many domestic human rights statutes do not go that far and only require that an adult with disabilities not be adversely impacted in the delivery of existing services. Nonetheless, many scholars have argued that governments should adopt Article 12 of the CRPD into domestic law and that support for persons with cognitive disabilities is a basic human right (e.g., Bach & Kerzner, 2010; Caivano, 2014).

In British Columbia, although the Adult Guardianship Act presumes that support will be given to adult abuse victims who cannot seek support on their own, in actuality, there are insufficient resources to enable the designated agency to extend sufficient support in many cases. This sometimes results in the more intrusive intervention being used, which is clearly contrary to human rights principles. Unfortunately, a government’s failure to provide support does not break any domestic law, and there is no legal remedy to force a government to provide support.

In addition to these human rights issues, participants in the study provided examples of situations where there is the potential for human rights violations because of oversights in how the legislation was drafted. The statute does not include a provision with the legal right for adults to appeal decisions made by the designated agency. Further, it does not require the designated agencies to notify relatives in situations where vulnerable adults have been detained under the emergency provision in s. 59.

One recent court challenge to an action taken by the Fraser Health Authority illustrates the potential for harm because of legislative oversights. S. 59 of the Adult Guardianship Act authorizes the health authorities to detain an adult at risk of harm without a court order in emergency situations. In A. H. v. Fraser Health Authority (2019) , a woman brought a successful challenge under the Canadian Charter of Rights and Freedoms (1982) after being detained in hospital for more than a year without Fraser Health making an application to the court about her case. The court found a violation of her Charter rights. In the judgment, the court stated:

There is no doubt that on October 6, 2016, F.H.A. staff had good reason to believe that A.H. had been abused and that she was at risk of serious harm. However, there is also no doubt that F.H.A. could have promptly applied in Provincial Court for an order authorizing the provision of support and services to her in accordance with whatever plan F.H.A. deemed appropriate. F.H.A.’s failure to take that step and its decision to instead detain A.H. for nearly a year, without providing her with clear and written reasons for the detention or the opportunity to obtain legal advice, under conditions that significantly violated her residual liberty, is inexplicable. (para. 179)

This is the only case where health authority actions have been challenged in court. Study participants did not give examples of similar instances, so it cannot be assumed that other rights violations have occurred.

Social justice

Although Part 3 of the Adult Guardianship Act was enacted with the intention of preventing abuse without impeding rights, it may not meet those objectives in implementation. Study participants described their approach when responding to elder abuse, which includes supporting older adult victims and being minimally intrusive. Study participants provided illustrations of how they build relationships with older adults to encourage them to accept support services, making intrusive intervention unnecessary. However, they also described working in an environment that is short of resources resulting in some older adults being left to deal with an abusive situation on their own and others being subjected to intrusive interventions that would not be necessary if resources were available. As discussed, this violates human rights principles. There also are social justice implications.

Human rights are integral to social justice. Watts and Hodgson (2019) provide terminology to describe the concept that social justice requires the protection of rights and enablement of individual autonomy. The term they use is the autonomy and rights perspective of social justice, which requires supporting “people to act as moral agents with dignity, worth, and in recognition of their rights as human beings with personal and social identities” (p. 181). Nerenberg (2019) argues that “social justice requires fairness in how governments distribute resources, provide services and protect rights” (p. 131). Ensuring the rights of elder abuse victims are protected is an important social justice issue, and this can only be achieved with a fair distribution of the resources needed to protect their rights.

Governments must consider how social context advantages some people and disadvantages others when distributing resources and providing services. A fair distribution must take context and inequities into account. As applied to the issue of elder abuse, research shows that older adults who are disabled or are from ethnic minorities are more likely to experience abuse. Issues such as poverty, lack of social support, or health issues can also be risk factors (Nerenberg, 2019). Government involvement is required to address these disparities as a strategy for providing protection against abuse. This responsibility should not be narrowly construed as a question of how governments can effectively intervene at the point that abuse is occurring. The broader issue is the government’s responsibility to create environments that enable older adults to live safely. This applies to the prevention of abuse as well as intervention after the abuse has occurred. Justice requires developing a strategy to protect the rights of older adults who have experienced abuse and to create supportive environments in society to reduce risk before it occurs.

These issues are important to the social work profession as well. Social justice is a core value of social work. According to Watts and Hodgson, (2019), social justice “has remained a central focus of social work’s mission and focus since its establishment” (p. 23). Social work ethical codes make a strong connection between human rights and social justice. For example, Choi et al. (2017) highlight connections between social work and social justice and explain that a fundamental aspect of social work is based on human rights principles, including empowering people and enhancing their well-being.

Implications

These findings have implications for government and policy makers as well as social workers. These include questions of government responsibility to address elder abuse and questions of social worker responsibility when working in an environment where client autonomy is being undermined—even if only occasionally.

Implications for government

Government responsibility should be understood within the context of human rights principles. A core human rights principle is that individuals should be treated with dignity and respect. This is summed by the United Nations’ Universal Declaration of Human Rights (1948), which states that “all human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood” (Article 1). Elder abuse and mistreatment directly contravene that principle. Scholars have argued that it is a government’s responsibility to protect older adults (e.g., Herring, 2016). This responsibility is not always explicitly stated in domestic statutes. Even so, when this right is not explicitly stated in law, a moral duty exists.

Watts and Hodgson (2019) argue that human rights are based on moral principles. These moral principles are captured in international human rights documents. These documents, treaties, and conventions may be signed by governments, who agree to follow the principles in these documents when creating legislation. The CRPD is an example of this type of document. It clearly articulates human rights principles as applied to persons with disabilities. The CRPD includes an obligation on governments to support individuals with cognitive disabilities so that they can exercise autonomy. However, the CRPD only becomes a domestic law if a country chooses to adopt those requirements into law.

The Adult Guardianship Act mandate appears, on paper, to create a means for protecting vulnerable adults by offering support and assistance to those who cannot protect themselves, while avoiding intruding on individual rights. This approach fits with the human rights principles enshrined in documents such as the CRPD. Where this model may fall short is in its implementation. Since this study only had 16 participants, further research is required to confirm the extent of the resource shortages. However, it is clear that the current response to elder abuse is not adequate. This is a social justice issue and should be addressed.

Implications for social workers

There are two very specific implications for social work practice. The first relates to responders’ role in supporting elder abuse victims. Participants in the study identified the importance of offering support and assistance to enable vulnerable older adults to exercise their autonomy and to reduce the risk of harm. Feminist scholars have reframed the concept of autonomy from defining it as the ability to exercise individual self-government to arguing that autonomy can only be understood and exercised within the context of relationship. This is explained by Twomey (2015) in the following words:

[T]he ability to exercise autonomy is dependent to some extent on the relationships people have with those around them. In order to promote the exercise of autonomy, or the conditions which enable autonomy to be exercised, therefore, practitioners need to work with a concept of autonomy which recognises these relational aspects. Relational autonomy recognises the contribution of others to a person’s capacity to exercise autonomy, and also recognises the importance of the social contexts within which relationships occur. (p. 263)

This perspective on autonomy has been termed relational autonomy.

Social workers who participated in this study acknowledged the importance of positive support networks to enable older adults to live safely and exercise independence. This perspective fits with feminist writings on relational autonomy and illustrates the importance of responding to elder abuse by encouraging and nurturing positive support networks. Support enhances the capacity of those who are having difficulty exercising autonomy and can help mitigate the risk of harm to the older adult.

Empowerment and respect for the individual are important values spelled out in social work ethical codes and also align with the goal of advancing social justice. As explained by Twomey (2015), social justice includes a respect for human dignity, empowerment, and remaining cognizant of the “social and political actions that need to be taken in order to enable people to develop the capacity for autonomy, and to enable the exercise of autonomy” (p. 164).

The second implication for social work practice is the importance of reflection and careful consideration of how to apply social work ethics and social justice principles to client work to the greatest degree possible. Watts and Hodgson (2019) explain that social workers “need a critical analysis and response to the way that organizations, policies and rules and norms operate to produce discriminatory effects, such as reproducing truths and knowledge that continue the cycle of prejudice, stereotyping and discrimination. (p. 17)” Individual responders working for the health authority may not have the ability to change the structural and resourcing issues that were revealed in this study. However, they can advocate for their clients when possible and work toward change incrementally.

Recommendations

I conclude this section of the article by proposing steps to address issues identified in this study.

Structural and social change

The first recommendation is for further study. This study had 16 participants and, therefore, it is not possible to generalize the results too broadly. At the same time, study responses suggest that the response under the Adult Guardianship Act could be improved. A few examples of steps the government could take are the following: All employees of the health authority should be trained on how to interpret the Adult Guardianship Act, including the guiding principles, and staff should be provided with interpretive guidelines. Clearer procedures are warranted to identify situations where the Adult Guardianship Act applies. These changes would improve the response to elder abuse and would enhance the response to elder abuse under the Adult Guardianship Act mandate. As well, the legislation should be updated to add protections such as mandatory notice requirements and right to counsel to the legislation.

Most importantly, additional funding should be given to free up resources so that elder abuse victims are neither left to deal with situations of abuse nor subjected to intrusive interventions because of the absence of resources. These intrusive interventions are most likely to occur to older adults who have a cognitive disability, because those are the adults who will be perceived to be legally incapable of decision making. Placed in context, any denial of the rights of persons with disabilities is particularly unjust. There are higher rates of cognitive disability for adults who already face double disadvantage, such as being disabled and also indigenous. Some ethnic groups have been shown to have higher rates of Alzheimer’s disease, which is presumed to be related to life stress. As well, “…studies have found that poverty, substandard housing, low education rates, and underemployment are correlated with poor cognitive performance” (Nerenberg, 2019, p. 134). These double-disadvantaged groups should be prioritized for support.

There is a strong argument for the view that governments are responsible to provide services and supports to victims of elder abuse based on social justice and human rights principles. An additional argument in favor of government responsibility can be made based on Martha Fineman’s theory of the vulnerable subject. According to Fineman, vulnerability is a part of the human condition. Because of this universal vulnerability, the state has a responsibility to respond. Fineman (2019) explains that,

[i]n defining this collective responsibility, the collective reality of human vulnerability and the physical and social dependency that it inevitably generates must be of central concern. In particular, the social implications of dependency are vitally important in defining state responsibility. (p. 360)

The responsive state is a normative aspect of Fineman’s (2019) theory. The state must respond because humans are universally vulnerable. By defining vulnerability as universal, and by arguing that the state must respond, this theory side steps the problems that arise when the state only intervenes after identifying specific populations that have particularized vulnerability, which were discussed in the earlier part of this article.

Best practices for social workers

As discussed above, social workers who respond to report of elder abuse must do with the understanding that support enhances the capacity of those who are having difficulty exercising autonomy. Empowerment and respect for the individual also align with the goal of advancing social justice. When a social worker is working in an agency that has practices that undermine client autonomy or that reinforce values contrary to social work, the social worker must be consider what ethical standards apply. It often is possible to remain true to values, ethics, and principles, even in the face of difficult resource challenges or agency policies. Social workers who participated in this study illustrated a number of different ways that they remained committed to these values despite obstacles. The social worker must be observant of any instances where older adult autonomy is being undermined and have the self-awareness to ask serious questions about how to respond.

Conclusion

Elder abuse is a social problem with profound policy implications for governments who must determine how to address elder abuse, including what type of government intervention is appropriate. Government response to this area varies from jurisdiction to jurisdiction. This article presents the results of a study carried out in British Columbia Canada that examined response to reports of elder abuse under British Columbia’s Adult Guardianship Act. The results of the study were analyzed from a social justice and human rights perspective.

The study revealed an interesting dynamic. Although individual responders are guided by the desire to keep vulnerable older adults safe and to use the least intrusive means available, they are sometimes unable to meet these objectives because of issues in the service delivery model and resource shortages.

Literature on human rights and social justice is directly applicable to these results. Not only are there social justice implications, but study participants also identified situations where there is the potential for infringement of human rights. In this article, I discussed relevant social justice and human rights issues and implications for social work practice. I also made recommendations about how to address the identified issues.