This article reviews the legal, ethical and practical challenges of complying with the Ontario Personal Health Information Protection Act (PHIPA) within the context of a Canadian mental health system that is overburdened and under resourced. The advent of deinstitutionalization has placed significantly increased responsibilities on the families of mentally ill individuals. While research evidences that involving family members in the care of their mentally ill relatives improves treatment outcomes, mental health practitioners constantly face the challenge of engaging family caregivers while also complying with privacy laws. The authors propose an Ontario Caregiver Recognition Act (OCRA) to formally recognize family caregivers as informal health information custodians based on the practice of other jurisdictions which incorporate the rights of family members actively engaged in providing care to their mentally ill relatives.
When parents try to assume responsibility for an ill adult-child with schizophrenia, the law, mental health practitioners, and often the ill person reject their right to do so. Consequently, these parents regard themselves as disenfranchised, i.e., lacking the rights required to care properly for their loved ones. Redefining Parental Identity, a grounded theory of caregiving and schizophrenia, traces changes in a parent's identity and caregiving during the erratic course of the child's mental illness. Participants were a purposive sample of 29 parent caregivers from 19 families in British Columbia, Canada, caring for 20 adult children. This understanding of their experience will be helpful to parents of people with schizophrenia, professional practitioners, and those involved in mental health care reform.
Comment In: Evid Based Nurs. 2003 Oct;6(4):126-714577410
The aim of this investigation was to undertake an exploratory analysis of child care providers who sexually offend against children and adolescents and the circumstances related to these offences. Archival Violent Crime Linkage Analysis System (ViCLAS) reports were obtained from the Royal Canadian Mounted Police (RCMP), and demographic and criminal characteristics for the offender, as well as information about the victim and offence, were selected for analyses. A descriptive approach was used to analyze the qualitative reports for a group of 305 Canadian sexual offenders between 1995 and 2002. Adult male (N = 163) and female ( N = 14), along with juvenile male (N = 100) and female (N = 28) child care providers who were involved in a sexual offence against a child or adolescent are described. This article provides unique information about the crimes committed by child care providers in that it is focused on crime characteristics, rather than on personality or treatment variables. Furthermore, it represents a comprehensive examination of this type of offender by including understudied groups, namely juvenile and female offenders.
In early welfare states, social rights predominantly derived from formal employment relations. Within the past two decades, however, some European countries have opened these social institutions to care work also. Cash-for-care and social entitlements for periods of at-home family caregiving have changed the characteristics of informal care work that family members traditionally provide to older relatives. Formerly based on unpaid kinship relations, it has changed towards new paid and more formalized forms of care work by family members. But it can be assumed that long-term care work by family members is constructed differently across welfare states. The paper is guided by the following research question: How do welfare-state policies differ in the degree to which their policies towards family care for senior citizens create social risks for the caring family members? We use the conceptual framework of "family care regimes" as our analytical framework for the comparative research. To do this, we compare care policies towards older care-needy people in the welfare states of the Netherlands, Germany and Denmark. The findings show that a common feature in all three countries is that the situation of family carers is to some degree being formalized: in all three countries a frail senior citizen can chose a family member as the care provider, and the welfare states support the family care providers. Still, the legal situation as well as the quality and level of social rights for family caregivers differ considerably among the three countries. It is shown that the institutional framework for senior care by family members in Germany and the Netherlands represents a family care regime that supports semi-formal family care, and that in Denmark it can be classified as a family care regime that supports formal family care. We show that these different types of family care regimes differ considerably in the social risks they pose to family carers.
Occasionally, ambulatory surgical patients present without an escort for their procedure. This creates a dilemma for caregivers, and allowing patients to drive may have an impact on their safety. The Canadian Medical Protective Association is a mutual defense organization for 95% of Canadian physicians. The national database is a unique and extensive repository of medico-legal data. We scanned this database for malpractice patients who were discharged after an ambulatory surgery procedure and allowed to drive home with a poor outcome. From this database, two malpractice cases of patients who were discharged without an escort after an ambulatory surgical procedure were reported. Both had a car accident and sustained serious injuries. Based on this we do not recommend discharge without an escort after general anesthesia, regional anesthesia, monitored anesthesia or sedation. Driving after ambulatory surgery cannot be considered safe and caregivers need to verify a safe ride home.
The Community Care Access Centre (CCAC) of Waterloo Region, in partnership with a number of other social service agencies, designed and implemented a restorative justice model applicable to older adults who have been abused by an individual in a position of trust. The project was very successful in building partnerships, as many community agencies came together to deal with the problem of elder abuse. The program also raised the profile of elder abuse in the community. However, despite intensive efforts, referrals to the restorative justice program were quite low. Because of this, the program moved to a new organizational model, the Elder Abuse Response Team (EART), which has retained the guiding philosophy of restorative justice but has broadened the mandate. The team has evolved into a conflict management system that has multiple points of entry for cases and multiple options for dealing with elder abuse. The team has developed a broad range of community partners who can facilitate referrals to the EART and also can help to provide an individualized response to each case. The transition to the EART has been successful, and the number of referrals has increased significantly.