RA7 Facilitator Online Training

Transcription

1 RA7 Facilitator Online Training February 19 & 26, March 5 & 12, 2013 Session One c Nidus. All rights reserved. Permission for use by trainees only. This is not legal advice.

2 Welcome Joanne, Jessica & Tegan Nidus Coreen & Bev Surrey ACL Yisrael & Jaret Milieu Family Services Crystal Pivot Point Chang Sunshine Place Teresa & Shirley Langley ACL Tracy & Debbie CLBC, Analysts Home Share

3 Session one Your role as RA7 facilitator. Terminology. RA basics. Capability/competency requirements. Areas of authority and what is not covered under Section 7. Roles and duties. Extra safeguard requirement.

4 Role of RA7 Facilitator You are providing information and support with the process of making, registering and using a Representation Agreement. You are not a judge or enforcer of right and wrong. You are not an assessor of capability. Be aware of your own biases and triggers. Be aware of possible conflict of interest real or perceived. Have a plan in place for referrals. You need to set up a system for record keeping and policies around privacy.

5 RA Basics Everyone involved in RA must be 19 years old or older. Individual making the RA = the adult Representative, alternate, monitor Witnesses Adult may make an RA even if he/she does not currently reside in B.C. The RA must be made according to B.C. legislation and the adult should have a B.C. address for mail/contact. No legal professional is required.

6 Terminology Representation Agreement with Section 7 standard powers = RA7. Representation Agreement with Section 9 broader powers = RA9. Personal planning = making arrangements for while you are alive in case incapable of informed consent. For adults who need help TODAY RA7 supported decision making. For adults who want to plan for the FUTURE RA9 + Enduring Power of Attorney substitute decision making.

7 RA7 Capability Requirements There are NO specific capability requirements to make a Representation Agreement with Section 7 standard powers. This means there is no assessment of whether the adult is capable/incapable according to a set of arbitrary criteria. Instead, the focus is on: How is this individual capable?

8 Nidus Resources on Capability Representation Agreements and Capability Expression of Wishes Tips for Strengthening a Representation Agreement Video: Differences between RA7 and Adult Guardianship. Slideshow: Making RA7 The above are available under Preparation Materials for Session One at

9 Areas of Authority The law divides our life into four major areas. Health Care Personal Care Financial Affairs Legal Affairs

10 RA7 Areas of Authority Section 7 lists authorities standard powers that relate to all four life areas. Minor and major health care. Defined in the Health Care Consent and Care Facility Admission Act.

11 RA7 Areas of Authority Section 7 lists authorities standard powers that relate to all four life areas. Minor and major health care. Defined in the Health Care Consent and Care Facility Admission Act. Personal care. Defined in the definitions section of the RA Act.

12 RA7 Areas of Authority Section 7 lists authorities standard powers that relate to all four life areas. Minor and major health care. Defined in the Health Care Consent and Care Facility Admission Act. Personal care. Defined in the definitions section of the RA Act. Obtaining legal services and instructing counsel Defined RA Act Section 7.

13 RA7 Areas of Authority Section 7 lists authorities standard powers that relate to all four life areas. Minor and major health care. Defined in the Health Care Consent and Care Facility Admission Act. Personal care. Defined in the definitions section of the RA Act. Obtaining legal services and instructing counsel Defined RA Act Section 7. Routine management of financial affairs.* Defined in the RA Act Regulations. * Extra safeguard required discussed later in this session.

14 RA7 Areas of Authority CanNOT authorize a representative, under RA Act Section 7, to refuse life supporting care on adult s behalf. Practically speaking, this decision would be made by consensus of family + medical team according to the adult s wishes, values/preferences. No one can sign a DNR/no-CPR or living will or advance directive or degrees of intervention on behalf of an adult (unless authorized under Section 9). There is something called a physician s order for DNR/no-CPR. It s legal status is unclear.

15 RA7 Areas of Authority CanNOT authorize a representative, under RA Act Section 7, to move or manage adult against their objections. (Mental Health Act might be used if adult deemed danger to others or self.) CanNOT authorize a representative to make decisions about treatments outlined in the Health Care Consent Regulation. Example treatment with no known benefit, transplantation, participation in research not supervised by a committee listed in the Regulation.

16 RA7 Areas of Authority A representative cannot make decisions about matters that are against the law. (Example: euthanasia, assisted suicide.) A representative cannot assist the adult with decision making or consent on the adult s behalf about sterilization for non-therapeutic purposes. If an adult is involuntarily committed under the Mental Health Act, a representative does not have authority for decisions about treatment or placement that are related to the adult s mental disorder. Still has authority for other health care.

17 Nidus Resources on Authority Representation Agreements Overview Fact Sheet RA7 Fact Sheet RA9 Fact Sheet The above are available under Preparation Materials for Session One at Definition of Routine Management of Financial Affairs RA7 Preparation Guide These provided by and Session Two.

18 Roles and duties in RA There are 3 roles that can be assigned in an RA: Representative. Alternate representative. Monitor.

19 Roles and duties in RA There are 3 roles that can be assigned in an RA: Representative. The person who has legal authority to ASSIST the adult or, if necessary, make decisions on the adult s behalf. Alternate representative. A back-up in case the representative is unable or unwilling to act or continue acting. Monitor. A person who acts as a safeguard and support and that the Agreement is working for the adult. The monitor does not have decision making authority on the adult s behalf. The RAAct says, no one can prevent the monitor from having contact with the adult.

20 Who can be named in RA? As of Sept. 1, 2011, there are restrictions on who can be named/appointed in an RA: You cannot name a person to be a representative or alternate if he or she is compensated to provide health care or personal care services to the adult. (Example: paid caregiver, home share provider, family doctor.) This restriction does not apply if the person is also the spouse, parent or child of the adult. However, CLBC policy may not recognize these exceptions for its services. The restriction does not apply to Agreements made before Sept. 1 st.

21 Who can be named in RA? Restrictions as of Sept. 1/11 continued: You cannot name a person to be a representative or alternate if he or she is an employee of a facility in which the adult lives and through which the adults receives health care or personal care services. (Example: group home staff, care facility staff.) This restriction does not apply if the employee is also the spouse, parent or child of the adult. However, CLBC policy may not recognize these exceptions for its services. The restriction does not apply to Agreements made before Sept. 1 st.

22 Duties in RA Act Duties for each role are outlined in the RA Act. Each person named in a role must sign a legal Certificate declaring he/she will uphold his/her duties. Section 16 duties of representative/alternate. Section 20 duties of monitor. A representative has the right to access information and documents that the adult is entitled to and that relate to the representative s authority or the adult s incapability (Section 18). A representative cannot delegate their authority, except for investments and only to a specialist.

23 Expenses and fees for those appointed A representative and monitor are entitled to be reimbursed from the adult s funds for reasonable out-of-pocket expenses that result from carrying out their duties. (Often not claimed in the case of RA7.) A representative cannot be paid a fee from the adult s funds for health care decision making and for other areas only if authorized by the Court. A monitor cannot be paid a fee from the adult s funds unless authorized by the Court.

24 Nidus Resources Roles & Duties Role of Representative Role of Monitor The above are available under Preparation Materials for Session One at

25 Extra safeguard requirement If authority for routine management of financial affairs is included in an RA7, an extra safeguard is required.

26 Extra safeguard requirement If authority for routine management of financial affairs is included in an RA7, an extra safeguard is required. The extra safeguard can be met by: Appointing someone in the role of monitor. o The monitor can be appointed for finances only, or for the whole Agreement.

27 Extra safeguard requirement If authority for routine management of financial affairs is included in an RA7, an extra safeguard is required. The extra safeguard can be met by: Appointing someone in the role of monitor. OR o The monitor can be appointed for finances only, or for the whole Agreement. Appointing two or more representatives and requiring them to act together (jointly) for finances.

28 Extra safeguard requirement The extra safeguard is waived if the representative is the adult s spouse. However, if an alternate is named the extra safeguard requirement needs to be addressed.

29 Intent of Law Reform The RA Act shifts the focus from doing for to doing with. This means shifting from a paternalistic approach of taking over an adult s decision making rights (guardianship) to supported decision making which keeps the adult in the driver s seat no decisions about me, without me. Shifting from best interests (what others think is best for the adult) to self-determination what are the adult s wishes, values/preferences.

30 Intent of Law Reform How can we support, encourage and model this shift for personal supporters/representatives? From focus on disabilities to focus on capability? From doing for to doing with?

31 Contacting Nidus Please any questions or comments to If you need to contact Joanne: Ext 222 or (cell)

32 Thanks to CLBC For funding to provide this training February & March And thanks to Surrey-Delta area for their collaboration and support.