A Saskatchewan patient — unable to care for themselves due to cognitive impairment — was kicked and punched down the stairs at home. Another was left on the floor for several days with no food or medication.

These are real situations described by Saskatchewan health care workers who say they are powerless to help when legal caregivers are abusing or neglecting people with intellectual disabilities.

"People in the community would be highly shocked," said Dr. Lilian Thorpe, a geriatric psychiatrist in Saskatoon.

"Abuse is the far end ... the more common thing is more neglect and a care provider just not being able to respond."

Dr. Thorpe said that although a legal avenue exists for authorities to intervene, those steps are not necessarily being taken.

'Terrible situations'

In 2018 a Joint Ethics Committee for the Saskatchewan Health Authority (SHA) called for better legislated protections for vulnerable adults, such as people with cognitive impairment from brain injury, intellectual impairment and conditions like Alzheimer's Disease.

Under the current system, an individual can appoint a "proxy" person to make healthcare decisions on their behalf when they can no longer do so themselves. If a proxy has not been appointed, that responsibility will lie with a next of kin.

But Dr. Thorpe said that when health care workers see that person making decisions that lead to perceived harm, neglect or abuse, there is no effective mechanism for a public body to take over guardianship of the patient.

"It's really traumatizing for staff because the staff ... there would be social workers and nurses that are seeing somebody coming in and out in really, really terrible situations and they are stuck," said Dr. Thorpe.

Dr. Lilian Thorpe says better protections are becoming increasingly important as more vulnerable people are living at home rather than in care. (Roger Cosman/CBC)

The 2018 report said several incidents of this nature occurred every year.

"It's easy to blame the care provider, the family member, but often those people are in really difficult situations themselves so they might have addictions or mental health issues of their own," said Dr. Thorpe.

"They're trying to do the right thing but they eventually may lose it and do something that's not in that person's interest."

The SHA said the report was a working document.

"This report has not been presented to [SHA] leadership for discussion yet nor have its recommendations been endorsed by SHA. Once SHA leadership has a chance to review the report, a decision will be made whether to pursue its recommendation."

Other provinces, such as Ontario, have independent boards set up to consider complaints about family members caring for vulnerable patients. The board in Ontario has the authority to hold hearings to review a substitute decision maker's compliance with the rules.

Dr. Thorpe said Saskatchewan needs a similar system with an independent board — a system purpose-built to handle these types of situations.

The Office of the Public Guardian and Trustee in Saskatchewan said any interested party, including the Public Trustee, can apply to the Court of Queen's Bench for a new decision maker to be appointed for the patient.

They can't protect themselves, they don't recognize they are being abused, they can't get away from it. - Elliot Paus-Jensen, Saskatoon Council on Aging

CBC requested an interview with the Office of the Public Guardian and Trustee (PGT) but received a written statement.

"Typically, another family member or the health authority are in the best position to bring such a Court application as they have the necessary medical information and/or knowledge of the person's wishes," said the statement.

"The Public Guardian and Trustee could also bring such an application under Section 22 of the Act and may request to be appointed as personal guardian under The Adult Guardianship and Co-decision-making Act with authority to make the health care decision."

Dr. Thorpe said PGT staff told her that although they would like to assist, they do not have the resources to handle non-financial cases.

She said SHA is reluctant to take these matters to court because the process can take years.

"Then if one was to override it, who then looks after that person?" said Dr. Thorpe.

Saskatchewan legislation does allow two health care workers to take over guardianship in cases where there is no next of kin.

Dr. Thorpe said the need for change is becoming more urgent as more people receive care at home rather than in facilities.

She pointed to the closure of the Valley View Centre for people with intellectual disabilities in Moose Jaw, Sask. The province said 36 new group homes were opened to house former residents of the home.

Dr. Thorpe said an increasing number of people are choosing not to have children, adding that dealing with these situations can be more complicated in rural areas.

The 2018 report recommends a new system to facilitate further evaluation of complaints and advocacy for changes to the legislation.

Dr. Lilian Thorpe says the system is failing to protect vulnerable adults in Saskatchewan. (Matthew Garand/CBC News)

Dr. Thorpe said a change in the Saskatchewan legislation should coincide with the creation of an independent board to consider complaints and decide if intervention is really needed.

"The decisions are difficult because oftentimes a person has been living in a difficult situation but may choose to go back there," said Dr. Thorpe.

"So where do we balance their safety versus their autonomy?"

Elliot Paus-Jensen, a former geriatric social worker and a volunteer for the Saskatoon Council on Aging, was part of an elder abuse task force formed in 2005. She said the PGT told her office at the time they did not have the resources to take action in non-financial cases.

Paus-Jensen said she personally witnessed a case of elder neglect. A mother who had been looking after her son, who suffered a brain injury, became unable to care for herself when she developed dementia.

The son in turn became the mother's carer.

"He would give her his [benzodiazepines] and he didn't understand — it calmed him down, why wouldn't it calm her down?" Paus-Jensen said.

"He did other things that really put her at risk and she at one point almost died."

Fortunately the woman had a medical assessment and health workers were able to intervene.

Incidents not being tracked

Paus-Jensen said there is no way of knowing how many cases of abuse or neglect are occurring under these circumstances because it is not being tracked.

"One of the big things in abuse is isolation, physical isolation, social isolation," she said.

"So we don't know that it's happening and it's only found out if somebody is in really bad shape and they end up in emergency or somehow come to the attention of someone."

Paus-Jensen pointed to the case of New Brunswick woman Kathleen Grant, whose 45-year-old daughter was convicted of failing without lawful excuse to provide the necessaries of life.

Kathleen, who was in her daughter's care, died days after she was found with gangrene and rotting flesh and wounds from sitting in a chair in urine and feces for what could have been months. She was only found after her daughter called 911 saying her mother was not feeling well.

Paus-Jensen said she has no doubt there are people in Saskatchewan who are currently being abused or neglected by their carer.

Elliot Paus-Jensen is a former social worker in geriatrics and a volunteer for the Saskatoon Council on Aging. (Alicia Bridges/CBC)

The province has introduced new measures to protect vulnerable adults in recent years, Paus-Jensen said.

In 2013, the Health Care Directives and Substitute Health Care Decision Makers Amendment Act allowed caregivers to make decisions on specific day-to-day treatments on behalf of patients who can't.

In 2019, the Saskatchewan government made amendments to The Marriage Act to nullify marriages where one person was deemed to not have the capacity to consent to the nuptials.

Paus-Jensen said better protections for vulnerable adults should be the next step.

"They can't protect themselves, they don't recognize they are being abused, they can't get away from it," she said.

"They need third parties to say, 'hey, you were pushed down the stairs because of your injuries … it's not right, you've got bed sores galore.'"

In the meantime, Dr. Thorpe said she is finding ways to assist as best she can. She said getting the PGT to take over financial control — in cases where that is appropriate — is one way of getting better access to help the vulnerable person. She said a family member who has been relying on that money for income will often back off once that happens.

"Then we're able to deal with that person, have that person placed appropriately now," she said.

"That's better than nothing, but it still means there's nobody overseeing the health care of that person."