MISTREATMENT OF OLDER ADULTS INTERVENTION, IN HAND: AN ETHICAL DECISION-MAKING FRAMEWORK
In Hand has been designed to support health and social service practitioners in their ethical reflection leading to decision-making during the intervention process in a mistreatment of older adult situation. This decision-making framework contains three scenarios: suspension of follow-up, support and formal protective interventions. In Hand targets various competing values arising in a mistreatment of older adult situation and introduces various suggestions for practice and facilitates the identification of psychosocial and ethical issues raised in practice situations.
Origin and development
In Hand was developed in the following social context :
- Growing number of older adults aging at home, some with the support of relatives and services
- Absence of legislation to protect older adults in Quebec
- Lack of a clear policy on intervention with mistreated older adults and the people who mistreat them
- No intervention model shared by several agencies
Some regions have round-tables which deal with violence to older adults
Chronology of work effected
Firstly, from 2000 to 2004, in order to understand the intervention process with mistreated older adults and in order to maximise this comprehension, a review of the literature on the ethical and psychosocial issues of the process was conducted. Meanwhile, accounts of practice were gathered from interviews with psychosocial practitioners having experienced intervention in mistreatment of older adult situations.
In 2004-2005, a first version of In Hand, in form of a decisional chart, was developed and followed by a first training program (2006-2007). In collaboration with community organisations, a second version of In Hand was produced (2006-2007) which was then followed by a new training program (2007-2009). During this same period, a validation of the tool (2007-2009) was conducted. Then followed a third version of In Hand, in the form of a practice guideline. This has now been adapted in English (Canada) and reproduced in booklet format in French and English (2009-2010). This having been done, the current training program is the third to have been developed around In Hand.
Review of literature
From the review of the literature (Beaulieu and Leclerc, 2006; Beaulieu, 2007), there emerged the five principal themes surrounding the psychosocial and ethical issues of practice :
- Reflection on our pre-construction (knowledge and stereotypes) and our values
- Capacity of the older adult
- Confidentiality or sharing information among practitioners, among organisations (services)
- Who has the responsibility: social problem or family issue?
Balance between competing values
The practice guideline In Hand falls within the theoretical framework of the principles approach developed by Beauchamp and Childress (2001).
Beauchamp, T.L., & Childress, J.F. (2001). Principles of Biomedical Ethics. NewYork: Oxford University Press. 454 p.
Beaulieu, M. (2007). Maltraitance des personnes âgées, dans Hébert, R. et M. Arcand, Précis pratique de gériatrie, 3e édition. Édisem, Acton Vale, Québec, chapitre 69, p. 1145-1163.
Beaulieu, M., & Leclerc, N. (2006). Ethical and psychosocial issues raised by the practice in cases of older adults. Journal of Gerontological Social Work, 46(3/4), 161-186.
Beaulieu, M., & Neesham-Grenon, F. (2010). Manuel d’accompagnement à la formation- Inventaire dans les situations de maltraitance envers les aînés : Guide de pratique En Mains. Document inédit, Université de Sherbrooke & Centre de recherche sur le vieillissement.