Every day, there’s a vulnerable adult living in BC who suffers from abuse, neglect or self-neglect. The Adult Guardianship Act (Act) was enacted in February 2000 – with recent updates and changes that came into force on December 1, 2014 – to give designated agencies the power to investigate situations in which vulnerable adults may be living at risk and tools to intervene.

Vancouver Coastal Health (VCH) is a designated agency under the Act and their ReAct Adult Protection Program ensures frontline care providers know how to identify a vulnerable adult and report a suspected case, where to find resources and help, and what steps to take when preventative action is needed.  

Amanda Brown is the Director of ReAct at VCH and a respected voice on behalf of adults in need. She’s led ReAct for several years and recently visited our office to describe the program and its close ties to BC PSLS. She also shared her views on why protecting vulnerable adults is an important part of BC’s healthcare system.

Q: Let’s begin with the term ‘vulnerable adult’. What does that mean exactly?vulernable adult

AB: A vulnerable adult is anyone 19-years of age or older who is impaired, encumbered or incapacitated in some way, either by mobility, mental illness, cognition, age or frailty. Because of those limitations, they are less able to seek support and assistance if they’re experiencing abuse, neglect or self-neglect.

Vulnerable adults may be surrounded by supportive loving people and living in a safe environment and therefore not likely to experience abuse, neglect or self-neglect. So it is the adults who are less able to protect themselves and who are experiencing abuse, neglect or self-neglect – those are the people we try to help.

Q: And the Adult Guardianship Act gives VCH the ability to help vulnerable adults?

AB: Yes. The Act means we have a duty to respond. Designated agencies like ours have access to legal tools so we can protect adults who meet the criteria of being vulnerable.

But it can be complicated because we provide a multitude of healthcare services. VCH is not a standalone agency for the sole purpose of protecting vulnerable adults – there’s no such agency or ministry in BC like there is for children. So it can be a challenge for clinical staff to identify a vulnerable adult living at risk verses when they are providing everyday healthcare services.

Typically, a vulnerable adult would become known to us either through a social worker, nurse, doctor or case manager, somebody who is already ‘attached’ to that patient for some other health reason. The care provider may see evidence of abuse, neglect or self-neglect, or the patient will report it to them. 

Q: So ReAct was established to educate staff about this highly specialized type of care?

vulernable adult with healthcare workerAB: That’s right. ReAct makes sure our frontline care providers understand their obligations and how to handle situations of abuse, neglect or self-neglect. It’s not easy work, so it’s important for staff to know how to deal with a vulnerable adult, how to report the suspected case, and where to go if they need help.  

When a report of suspected abuse comes in (by referral, phone or letter) we have identified staff throughout VCH called  Designated Responder Coordinators (DRCs) who review the details of the case. They work with Designated Responders (DRs) who are trained to follow-up with the vulnerable adult.

The legislation has been around for 15 years now and I’m quite proud of the work that our responders do. ReAct has a website with resources and tools for staff that we’ve developed and we’re continuing to develop many education supports. We have over 330 clinical professionals at VCH who are trained to receive reports and investigate suspected abuse and neglect of vulnerable adults in need of our support (approximately 35 DRCs and almost 300 DRs).

Q: Is the ReAct Reporting System (in BC PSLS) a way to collect reports of suspected cases?

AB: Yes, but it’s more than that. The ReAct Reporting System is giving us a way to quantify the problem. We haven’t been able to do that until now and that’s where BC PSLS comes in.

Central Office worked with us to develop the report forms for ReAct. We also created a separate database specifically for our reports, which is great because it keeps our system separate from the regular patient safety reports that come in through BC PSLS.

We’ve collected over 600 reports in ReAct since going live in 2011. So now we can start asking some key questions: How big is this problem? What types of abuse are we seeing most? What resources do we need to effectively and efficiently help adults who are suffering?

So that’s where our focus is now – looking at our data, identifying trends, and working with our leadership to improve our programs and services.

Q: What have you learned about this issue?

vulnerable adult with care giverAB: The most common types of concerns are neglect, self-neglect and financial abuse. The majority of cases are older adults who are experiencing early dementia and don’t have family around to help them. We also see cases of people with alcohol and drug addictions who are starting to decline in their functioning and their living arrangements are unsafe. Vulnerable adults are often not aware that they need help and the circumstances have become unmanageable for them.

We’re certainly learning a lot about this issue, but I don’t think our data are at all yet representative of the actual number of cases of vulnerable adults at risk.

Q: How can we learn more?

AB: Unless it becomes a requirement for health authorities to input all suspected cases of abuse and neglect into BC PSLS – or the ReAct Reporting System in our case – we can’t possibly know about every situation where a vulnerable adult is in need of support.

Being able to record and quantify this issue in a systematic way at a provincial level…that’s the place I’d really like to get to.

As an organization, we’ve always done the clinical work, so our patients receive the help they need if they present with failure to thrive, uncontrolled diabetes or fell and broke her hip, for example. But I believe there’s more we can do.

I’m hopeful that our own health authority will become more consistent at logging reports and investigation outcomes, and that other health authorities will start to use BC PSLS to collect this information, so we can improve quality of care and patient safety for vulnerable adults living throughout BC.   

Q: You’re very passionate about this.

AB: I am. I’ve been committed to this for years and it’s a poorly understood and grossly under-reported issue, and it’s not something that will just go away.

elderly womanStudies show that 4% – 10% of older adults will experience abuse of some kind, and that’s quite high when you think about our senior population and the expected growth over the coming years. Our role at ReAct is to educate and support the clinical practice, to make it easier for our clinicians to do their work.

But we have come a long way. There’s new legislation that came out in December 2014 to assist vulnerable adults who are unable to manage their finances. We’re working with Central Office now to update the ReAct Reporting System and meet the new Ministry of Health requirements. So we are taking the right steps forward.

Q: Would you be interested in helping other organizations looking to establish similar programs?

AB: Definitely. We started this work a number of years ago, so I think we have a lot to offer in terms of advice to other organizations who are interested in setting up their own system.

We’ve spent a lot of time tweaking the ReAct Reporting System and making sure it would work for front-line care providers, so we’re very open to sharing our experience.

As healthcare professionals we’re trained to care for vulnerable adults who need our help. But there’s never been a mandate for BC health authorities to create a specific data collection system to track, trend and quantify cases of abuse, neglect and self-neglect. We’re unique in that sense, but we’ve made our system available to others, so it would be great to see it spread to other areas of the province.

Additional Resources:

Amanda Brown is the lead for Adult Guardianship at Vancouver Coastal Health. ReAct is responsible for supporting and educating clinical staff about the ReAct Adult Protection Program at VCH and in addition to Amanda, is comprised of one full-time manager, Alana Prashad, and administrative support, Anita Ford. The ReAct Reporting System will be upgraded in 2015 to integrate new Ministry of Health requirements.

For more information about ReAct and how BC PSLS is helping to support this important work, please contact ReAct at

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