Adult Guardianship Act (AGA) (BC)

• The AGA is a law that protects adults who are incapable of managing their personal or financial affairs as a result of self-neglect or neglect or abuse by others.
• The Act states every adult is presumed to be capable of managing his or her own affairs and when an adult does require support, this support must be provided in the least restrictive and intrusive form.

The legislative components of the AGA have been continually refined and clarified over the years, in brief:

• Part 1 (February 2000)
  • Definitions, principles, presumptions
• Part 2.1 (December 2014)
  • Statutory Property Guardian
  • Only the PGT
  • Only about finances
  • Defines criteria for incapability
  • Establishes rights and notifications
  • Defines QHCP & HAD
  • Prescribes process & forms
• Part 3 - (February 2000)
  • Abuse, Neglect and Self-Neglect of Vulnerable Adults
  • Designates Agencies (Health Authorities and CLBC)
  • Provides tools, authority and mandate
  • Establishes statutory obligations
  • Defines vulnerability
  • Defines abuse, neglect, self-neglect

• Designated Responders (DR) are individuals recieve abuse reports and coordinates investigations. DRs are identified by leadership, onboarded, and trained by ReAct Adult Protection Program, and are usually (but not always):
  • Hospital and LTC Social Workers
  • Community Mental Health Clinicians
  • Home Health Case Managers
  • Licensing Officers (investigate complaints under CCAL Act works with DR for other adult protection issues)
  • Care Home Consultants
  • Assisted Living Case Managers

Section 59 (Emergency assistance) of the AGA allows for urgent action by a designated agency (e.g. - a regional health authority) if there is both imminent risk AND the following criteria are met:^[1]

1. The adult is apparently abused or neglected
2. It is necessary, in the opinion of the person from the designated agency, to act without delay in order to:
   • Preserve the adult’s life
   • Prevent serious physical or mental harm
   • Protect the adult’s property from significant loss or damage
3. The adult is apparently incapable of giving or refusing consent

A section 59 requires a signature by a designated responder, NOT a physician. Under these emergency assistance provisions, the designated agency has the authority to enter any premises where the adult is located. The agency may do so without a warrant, use any reasonable force, remove the adult to a safe place, and provide emergency health care. The authority to act under Section 59 can also continue until the circumstances that resulted in the original emergency have been remediated.

• For non-emergent abuse and neglect cases, the Support and Assistance provisions of the Act allows for protection of the individual. The designated agency can prepare a plan and specify any services required by the adult, including health care, accommodation, social, legal, or financial services.
• These plans can be prepared using guidance from publications by the Public Guardian and Trustee of British Columbia
  • The plan requires the consent of the adult for whom it is designed.
  • If the adult is unable to consent to the plan, the agency can apply through a court process for a support and assistance order.
  • The judicial approval of necessary services lasts for 1 year under Section 56 and can be renewed once through an application to the court.

The Statutory Property Guardianship (SPG) (AGA Part 2.1) provides the criteria, conditions, standards, rights notifications of an adult to be certified as incapable of managing finances for when the Public Guardian and Trustee (PGT) will taking over the financial affairs. Physicians may be requested by the PGT to complete the medical component of the SPG.

• Some of the benefits of AGA compared to MHA include:
  • Provides authority to investigate – this includes the right to information – strong concerns must be reported to designated responder
  • Mandates a response to abuse, not just self-neglect
  • May take an adult to a “safe place” not only a designated psychiatric facility
  • Includes provisions to provide emergency health care, not only psychiatric treatment
  • Not reliant on assessment by physician in past 14 days
  • Presumption of capability and principles allow for least intrusive interventions
  • Protection of assets is an important aspect of AGA

• Incidental finding of serious abuse, neglect, or self neglect
  • Contact Designated Responder/PGT Section 59 vs MHA, if imminent
• Patient referred for assessment by Designated Responder (under abuse/neglect) or referral from PGT or ReAct
  • Variable MD role / Liaise with Designated Responder
• Completion of the Medical Component is requested by the PGT (PART 2.1)
  • Complete Medical Component

• There is no mandatory reporting for adult neglect or abuse in BC
  • However, there is a mandatory response by designated agencies to follow up on reports
• Under the AGA, an individual must agree to do an assessment of incapacity.
  • If they do not agree, can ask PGT to assess if they are not capable
• Barriers to the effective implementation of the AGA include a lack of standards to guide investigations into abuse and no funding or infrastructure for formal court processes when the need arises.
  • Thus, applications for a support and assistance order are exceedingly rare.