Gap Analysis – Preventing and Addressing Abuse and Neglect of Older Adults

Gap Analysis:

Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches, July 2014

Work Sheet

This guideline can be downloaded for free at:

The RNAO Toolkit: Implementation of Best Practice Guidelines, Second Edition is also available at:

Date Completed:
Team Members participating in the Gap Analysis:

Completion of this gap analysis allows for the annual comparison of your current practice to evidence-based practices as regulated by the MOHLTC. See Appendix A for this and other regulations that apply to prevention and management of abuse and neglect program in your home.

RNAO Best Practice Guideline Recommendations / Met / Partially Met / Unmet / Notes
(Examples of what to include: is this a priority to our home, information on current practice, possible overlap with other programs or partners)
Practice Recommendation: Assessment
1.1 Establish and maintain a therapeutic relationship with older adults, and families as appropriate, when discussing issues of abuse and neglect.
(Level of Evidence = IV)
1.2 Ensure privacy and confidentiality when discussing issues of abuse and neglect unless legal obligations require disclosure of information.
(Level of Evidence = V)
1.3 Be alert for risk factors and signs of abuse and neglect during assessments and encounters with the older adult.
(Level of Evidence = V)
1.4 Carry out a detailed assessment in collaboration with the older adult, interprofessional team, and family, as appropriate, when abuse or neglect is alleged or suspected.
(Level of Evidence = V)
1.5 Identify the rights, priorities, needs and preferences of the older adult with regard to lifestyle and care decisions before determining interventions and supports.
(Level of Evidence = IV)
Practice Recommendation: Planning
2.1 Collect information and resources needed to respond appropriately to alleged or suspected abuse and neglect in ways that are compatible with the law, organizational policies and procedures, and professional practice standards.
(Level of Evidence = V)
2.2 Collaborate with the older adult, family and interprofessional team, as appropriate, to develop an individualized plan of care to prevent or address harm.
(Level of Evidence = IV)
Practice Recommendation: Implementation
3.1 Respond to alleged or suspected abuse and neglect according to legal requirements and organizational policies or procedures.
(Level of Evidence = V)
3.2 Implement an individualized plan of care that incorporates multiple strategies to prevent or address harm, including:
  • Education and support for older adults and family members,
  • Interventions and supports for those who abuse or neglect,
  • Providing resources/referrals, and
  • Development of a safety plan.
(Level of Evidence = IV - V)
Practice Recommendation: Evaluation
4.1 Collaborate with the older adult, family and interprofessional team, as appropriate, to evaluate and revise the plan of care, recognizing that some instances of abuse and neglect will not resolve easily.
(Level of Evidence = V)
Education Recommendation: Education
5.1 All employees across all health-care organizations that serve older adults participate in mandatory education that raises awareness about:
  • ageism;
  • the rights of older adults;
  • the types, prevalence and signs of abuse and neglect of older adults;
  • factors that may contribute to abuse and neglect; and
  • individual roles and responsibilities with regard to responding or reporting abuse or neglect;
(Level of Evidence = V)
5.2 Nurses, other health-care providers, and supervisors who work in health-care organizations that provide care and services to older adults participate in mandatory and continuing education opportunities that include:
  • understanding issues of abuse and neglect;
  • assessing and responding to abuse and neglect;
  • roles and responsibilities and laws;
  • positive approaches to working with older adults;
  • effective strategies for challenging/responsive behaviours; and
  • fostering a safe and healthy work environment and personal well being.
(Level of Evidence = V)
5.3 Educational institutions incorporate the RNAO Best Practice Guideline, Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches into curriculum for nurses and, as appropriate, for other health-care providers.
(Level of Evidence = V)
5.4 To help nurses and other health-care providers build competence in preventing, identifying, and responding to abuse and neglect of older adults, education programs are designed to:
  • address attitudes, knowledge and skills;
  • include multimodal and interactive/participatory strategies; and
  • promote an interprofessional approach.
(Level of Evidence = IV- V)
Policy, Organization and System Recommendation
6.1 Organizations/institutions establish and support collaborative teams to assist with preventing and addressing abuse and neglect of older adults.
(Level of Evidence = V)
6.2 Organizations/institutions establish policies, procedures and supports that enable nurses and other health-care providers to recognize, respond to, and where appropriate, report abuse and neglect of older adults.
(Level of Evidence = V)
6.3 Institutions* adopt a combination of approaches to prevent abuse and neglect of older adults, including:
  • screening potential employees, hiring the most qualified employees, and providing proper supervision and monitoring in the workplace;
  • securing appropriate staffing;
  • providing mandatory training to all employees;
  • supporting the needs of individuals with cognitive impairment, including those with responsive behaviours;
  • upholding resident rights;
  • establishing and maintaining person-centred care and a healthy work environment; and
  • educating older adults and families on abuse and neglect and their rights, and establishing routes for complaints and quality improvement.
*Note: may apply to other health-care settings.
(Level of Evidence = V)
6.4 Organizations/institutions with prevention and health promotion mandates (such as community and public health organizations) lead or participate in initiatives to prevent abuse and neglect of older adults.
(Level of Evidence = V)
6.5 Organizations/institutions identify and eliminate barriers that older adults and families may experience when accessing information and services related to abuse and neglect.
(Level of Evidence = IV)
6.6 Provincial and territorial nursing regulatory bodies provide accurate information on jurisdictional laws and obligations relevant to abuse and neglect of older adults across the continuum of care.
(Level of Evidence = V)
6.7 Governments dedicate resources to effectively prevent and address abuse and neglect of older adults.
(Level of Evidence = V)
6.8 Nurses, other health-care providers, and key stakeholders (e.g., professional associations, health service organizations, advocacy groups) advocate for policy/organizational/system level changes, including the availability of necessary resources, to effectively prevent and address abuse and neglect of older adults.
(Level of Evidence = V)

Appendix A

Applicable Ministry of Health and Long-Term Care Regulations for Prevention of Abuse and Neglect

“Abuse” — definition
2.(1)For the purposes of the definition of “abuse” in subsection 2 (1) of the Act,
“emotional abuse” means,
(a) any threatening, insulting, intimidating or humiliating gestures, actions, behaviour or remarks, including imposed social isolation, shunning, ignoring, lack of acknowledgement or infantilization that are performed by anyone other than a resident, or
(b) any threatening or intimidating gestures, actions, behaviour or remarks by a resident that causes alarm or fear to another resident where the resident performing the gestures, actions, behaviour or remarks understands and appreciates their consequences; (“mauvais traitement d’ordre affectif”)
“financial abuse” means any misappropriation or misuse of a resident’s money or property; (“exploitation financière”)
“physical abuse” means, subject to subsection (2),
(a) the use of physical force by anyone other than a resident that causes physical injury or pain,
(b) administering or withholding a drug for an inappropriate purpose, or
(c) the use of physical force by a resident that causes physical injury to another resident; (“mauvais traitement d’ordre physique”)
“sexual abuse” means,
(a) subject to subsection (3), any consensual or non-consensual touching, behaviour or remarks of a sexual nature or sexual exploitation that is directed towards a resident by a licensee or staff member, or
(b) any non-consensual touching, behaviour or remarks of a sexual nature or sexual exploitation directed towards a resident by a person other than a licensee or staff member; (“mauvais traitement d’ordre sexuel”)
“verbal abuse” means,
(a) any form of verbal communication of a threatening or intimidating nature or any form of verbal communication of a belittling or degrading nature which diminishes a resident’s sense of well-being, dignity or self-worth, that is made by anyone other than a resident, or
(b) any form of verbal communication of a threatening or intimidating nature made by a resident that leads another resident to fear for his or her safety where the resident making the communication understands and appreciates its consequences. (“mauvais traitement d’ordre verbal”)
(2)For the purposes of clause (a) of the definition of “physical abuse” in subsection (1), physical abuse does not include the use of force that is appropriate to the provision of care or assisting a resident with activities of daily living, unless the force used is excessive in the circumstances.
(3)For the purposes of the definition of “sexual abuse” in subsection (1), sexual abuse does not include,
(a) touching, behaviour or remarks of a clinical nature that are appropriate to the provision of care or assisting a resident with activities of daily living, or
(b) consensual touching, behaviour or remarks of a sexual nature between a resident and a licensee or staff member that is in the course of a sexual relationship that began before the resident was admitted to the long-term care home or before the licensee or staff member became a licensee or staff member. O. Reg. 79/10, s.2.
Policy to promote zero tolerance
96.Every licensee of a long-term care home shall ensure that the licensee’s written policy under section 20 of the Act to promote zero tolerance of abuse and neglect of residents,
(a) contains procedures and interventions to assist and support residents who have been abused or neglected or allegedly abused or neglected;
(b) contains procedures and interventions to deal with persons who have abused or neglected or allegedly abused or neglected residents, as appropriate;
(c) identifies measures and strategies to prevent abuse and neglect;
(d) identifies the manner in which allegations of abuse and neglect will be investigated, including who will undertake
the investigation and who will be informed of the investigation; and
(e) identifies the training and retraining requirements for all staff, including,
(i) training on the relationship between power imbalances between staff and residents and the potential for abuse and neglect by those in a position of trust, power and responsibility for resident care, and
(ii) situations that may lead to abuse and neglect and how to avoid such situations. O. Reg. 79/10, s.96.
Notification re incidents
97.(1)Every licensee of a long-term care home shall ensure that the resident’s substitute decision-maker, if any, and any other person specified by the resident,
(a) are notified immediately upon the licensee becoming aware of an alleged, suspected or witnessed incident of abuse or neglect of the resident that has resulted in a physical injury or pain to the resident or that causes distress to the resident that could potentially be detrimental to the resident’s health or well-being; and
(b) are notified within 12 hours upon the licensee becoming aware of any other alleged, suspected or witnessed incident of abuse or neglect of the resident.
(2)The licensee shall ensure that the resident and the resident’s substitute decision-maker, if any, are notified of the results of the investigation required under subsection 23 (1) of the Act, immediately upon the completion of the investigation.O. Reg. 79/10, s.97.
Police notification
98.Every licensee of a long-term care home shall ensure that the appropriate police force is immediately notified of any alleged, suspected or witnessed incident of abuse or neglect of a resident that the licensee suspects may constitute a criminal offence. O. Reg. 79/10, s.98.
Evaluation
99.Every licensee of a long-term care home shall ensure,
(a) that an analysis of every incident of abuse or neglect of a resident at the home is undertaken promptly after the licensee becomes aware of it;
(b) that at least once in every calendar year, an evaluation is made to determine the effectiveness of the licensee’s policy under section 20 of the Act to promote zero tolerance of abuse and neglect of residents, and what changes and improvements are required to prevent further occurrences;
(c) that the results of the analysis undertaken under clause (a) are considered in the evaluation;
(d) that the changes and improvements under clause (b) are promptly implemented; and
(e) that a written record of everything provided for in clauses (b) and (d) and the date of the evaluation, the names of the persons who participated in the evaluation and the date that the changes and improvements were implemented is promptly prepared. O. Reg. 79/10, s. 99.

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