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Hi, I am on a small volunteer board of directors of my apartment building (66 units) which is not any kind of "facility" or "residence" for the elderly in any official capacity, but which has a lot of very elderly residents (at least 1/3) some of whom have been there for decades and grown old there.



The board is seeing some emerging problems with some of these elderly: falls in the basement not discovered for hours; people ill in their apartments without asking for help and discovered by accident by neighbors; people with alzheimers wandering in the corridors; people boiling pots dry; people leaving their faucets running for hours and forgetting flooding the downstairs neighbor; people too deaf to hear their smoke alarms or too frail to make their way to the safe meeting point in the case of a fire.



Some of them have CLSC home visits (sort of community clinics), some don't, some don't want it.



We have drawn up a list of these vulnerable people and it looks pretty daunting to deal with for a team of 4 volunteers. We deal with each issue as it arises. We have no policies or protocols treating the safety of our elderly residents, nor do we really know what to do, but it's becoming clear we'll need to have some kind of best practices in writing.



Do you know of any protocols that we could use as a guide?


Thank you,

SCIE has become a go-to source for me over the last year or so:

https://www.scie.org.uk/search?sq=sheltered+living

Yikes! - there are 186 related articles in this section. Not all of them will be of use, of course, because you're not setting up a service as such; but I hope that if you tinker a bit with your search options you'll find service studies, descriptions and guidelines that you can pick from to design your own framework.
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Is your building a coop or condo?
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JoAnn29 Oct 1, 2019
Read OPs reply to my post. She is from Canada and found the only option they have is to document the residents actions.
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Alva, you raise some important issues:  intent, and purpose, which would be factors in the event of accidents, and in subsequent litigation, if any.  

These are good reasons to get some serious legal advice before making changes, and to create policies and stances which delineate what the purpose of the facility is, what it does and does not provide for.   I.e., establish baseline intents and purposes.
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My only concern with this is the law, likely because my Partner spent his life in Real Estate Management; mostly commercial buildings, but some condos as well. Trying to think of what you didn't think of was his job.
Sometimes things you attempt to do for safety come back in odd ways to bite you in the bottom under the heading of "what you did NOT do" or think of.
Usually making "best efforts" always comes out in your favor in a suit. The thing is things can also vary on whether just an apartment building owned by an owner, or whether a co-op with buy in or condo.
Let us say you have addressed about 20 issues, grab rails, safety mats, stair stick to prevent sliding, raised toilets, monitoring cameras, automatic lighting going on and off and etc. You, the board, the owner? Have made "best efforts" for safety.
BUT there is one hidden issue no one thought of; and a Senior ends up injured. Now you have the family. The family sues management/owner (because they look for the deepest pockets), and this is the argument in court:
"You KNEW you had elders in this building who were not safe.
You had board meetings and you discussed safety issues.
You addressed some issues, but you did NOT address THIS issue.
And you should have. Because you KNEW...........etc."
Of course people and families can always sue in our litigation prone times, but probably making "best efforts" is a good idea. Certainly morally this is the right thing to do and could save life and limb. But boy, it's a big job in quite a bit building, and would not be cheap by any means.
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Hazelthebunny Oct 1, 2019
Exactly! I am starting to think that we should strike the issue of senior safety off the board meeting agendas.

I hate to say it but if we are pursued legally over something and the building funds are bankrupted, then none of us have a place to live. And all because we started meddling in elder care.

I think we need to stop this train before it starts by refusing to engage with the issue. Sad but true...
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Security cameras and panic buttons in parking garages, laundry rooms, stairwells and storage units are doable if the landlord is willing, but someone would have to monitor cameras in order for them to be effective and the panic buttons have limited use for those who may be injured to the extent that they can't reach them.

Is there any agency in Quebec to which you can report a vulnerable elder like our American friends have with APS? I know there is nothing in Ontario short of contacting the office of the public guardian or filing a police report.
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Hazelthebunny Oct 1, 2019
I think it's the Public Curateur, in Quebec. It seems to deal mostly with cases of abuse, negligence, or mistreatment, rather than just vulnerability. But as far as I can see there's nowhere else to report.

there's an elder abuse helpline https://www.aideabusaines.ca/en/ but again, not really about general vulnerability.

And the police, I suppose.

I suppose we'd have to start with these.
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You've gotten a lot of very, very  good suggestions.   

Addressing your response to CWillie on the issue of not doing anything, I think that would be a mistake.  Fortunately or unfortunately, a situation exists, and there may be some fiduciary capacity of the Board to at least acknowledge the needs of residents.   That would turn on health law liability, an area in which I have no familiarity.

I would suggest considering a consult with a real estate attorney who represents not only commercial entities but one who represents individual and chain rehab, IL, AL, and similar facilities.   

Better yet, You might also consider a healthcare law firm; it's probably more likely that you'll find an amalgam of relevant practice areas in that kind of firm.   Health care law was a new practice area a few decades ago.  I suspect it's grown given the number of aging people and the facilities created to address their needs.

This is one of the most helpful threads I've seen on the topic of aging in place.

In the meantime, have you considered monitors, and perhaps something like motion sensors for the areas in which the elderly are falling?   Or is there another area to which the common facilities could be moved?  

When I was much younger and lived in an apartment complex, laundry facilities were also in the basement.  I wasn't concerned or afraid then, but now I'd be more concerned about people who have no legitimate reason to be there, and in fact may be there for nefarious purposes.    
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I agree with Ahmijoy, this is not your responsibility. Your complex was not built for "Seniors". To do what needs to be done for their safety, your owner would have to revamp the complex. Lots of money. I wouldn't think by law he is obligated to do this. Those complexes that are 55 and up do equip their buildings with safety measures for Seniors. It may be time for those Seniors that are falling and show signs of Dementia to find places to live that can meet their needs.

You may want to research state laws concerning your responsibility to these residents. Are you able to, under the circumstances, not renew their leases because they are now a liability? Call your insurance company and see where you stand with them.

My idea would be to get all this information together. Then have
a meeting with the families of these residents. Maybe having a rep from the insurance company there. Explain the problems that are arising now their family member is aging. Your limited liability. That its the families responsibility to find accomadations that better meet the needs of their family member. If there is no family, then Adult Protection Services should be called into evaluate those residents u feel need help.

Even 55 and up complexes are not responsible for residents. They just provide a more safe environment. Your building having wheelchair accessibility is probably the law. In addition, 55 and up complexes provide bars in the shower. Showers you can step into. Maybe an apartment that is more open, less walls. Another thing I would check out, is if the complex would allow bars to be installed in showers at the residents expense.

I admire that your Board is aware of the problems and are trying to solve it but in the end, it the residents families that need to be made aware of the problem and need to solve it. It may take you saying that the residents lease will not be renewed, because of the liability involved.

I worked as a Secretary for a Visiting Nurse Assoc. I had a table set up where people came in for appts. On that table I had pamphlets from Office of Aging concerning the resources they had. All the ALs and LTC facilities. All the Care agencies in the area. The local durable equipment store. List of Flu shots being given free in the area. (This I got from the health dept.) This would be nice to have set up at the meeting for the residents families.

Good Luck in your endeavor.
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Hazelthebunny Oct 1, 2019
Thanks, JoAnn. I had a look into the policies in our province (Quebec, Canada) and there is no way, absolutely no way, for a landlord or corporation (in our case, a board) to oblige a tenant to leave unless the tenant doesnt pay, damages the premises, or disturbs other tenants. No special provisions appear possible in the case where a tenant is a danger to himself or herself by continuing to live independently in a building.

We just need to create a file of complaints or incidents about a tenant to use as a basis for resiliation of the lease (in quebec, "eviction" means obliging the tenant to leave in order to demolish or divide up the unit).

So, documenting incidents of pots boiled dry, taps left on and flooding the downstairs neighbors, wandering and knocking on doors, hoarding and unsanitary premises, etc.
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This might be indirectly helpful; it's not directly responsive to your question.

You might check out the Village Movement and its info clearinghouse, the Village to Village Network. (vtvnetwork dot org) It grew from an experience in Boston when a group of elderly neighbors in an apartment complex created a membership based, voluntary structure to facilitate their "aging in place." The movement has spread --- there are now several hundred "villages" in the U.S. --- and the Network publishes handbooks, protocols, etc., for establishing and operating villages. The village may be a building, a neighborhood, a city block, etc. Note: most or all assume that the members will pay dues to finance the costs of operation. I don't know anything except what I have read, but it sounds interesting.
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Hazelthebunny Oct 1, 2019
thats an interesting model.

In my case, it wouldn't work as most of the elderly in the building are subsidized by the government as they are deemed low income, so they couldn't pay dues as they just don't have the funds. But yeah, where there is private money, this sounds really interesting!
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Hazelthebunny Oct 1, 2019
thank you very much, I'll have a look at this
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There is a complex in NYC called Penn South that is doing what you are looking to do. You might try to contact them.

The NYC Department of Aging has some good materials on "NORCs"--Naturally Occuring Retirement Communities. I'll see what I can find.

I know that Penn South hired at least one Social Worker to coordinate getting older residents hooked up with municipal services--think meals on wheels, etc. But you are such a small building, I doubt you could bear the expense.
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I don't understand what it is you are trying to do or what authority your group has to accomplish anything meaningful?
Making a list of those at risk is beneficial but I can't see what you can do about it beyond setting up a chain of volunteers to check on them. An IL often has contracts in place that force an eviction of residents who are becoming a danger to themselves and to the building as a whole, you don't have that option. You can't force residents to were alert pendents or to accept caregivers, you can't offer supervision of people who are too frail, deaf, blind, confused to function safely on their own. As far as I can see the best you could offer is contact information for your area agency on aging and I suppose you could contact adult protective services if you see anyone who is at risk.
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Hazelthebunny Sep 13, 2019
We're not 100% sure what we want to accomplish either, to be honest. We've just noticed that the elders in the building are being found flat out in the basement, getting reports of water and smoke damage from their apartments, seeing them wandering absently with their walkers when their kids (who also live in the building) are aware they have alz. Our president is worried lest "something should happen" to one of them.

Maybe we ought to take the position that ahmijoy above suggests which is that we continue to have no policies or protocols in place, and acknowledge no responsibility specifically over the welfare of seniors, so as to minimize exposure to lawsuits.

The truth is we are not equipped or trained to handle their growing needs, so maybe the best position to take is "dont ask, dont tell" and aside from calling 911 is necessary, let them assume responsibility for themselves. If something happens, so be it?
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You can use your state’s Guidelines & Standards for AL. Do a google search for “AL Conditions, guidelines for regulation”. In Medicare/Medicaid these are called “Conditions of Coverage@ & it’s in the Federal register online.
Each state regulates Assisted Living staffing requirements and standards the center should follow when setting up and running an AL.
You are somewhere between both.
I don’t understand exactly what you are asking, as you are a “volunteer”? Sounds like you live in a building with many Section 8 seniors and their health is being compromised as they are not in the proper setting to receive the care they need. And you are volunteering to fix it.
I admire your concern. Glad someone is looking out for the seniors where you live.
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No protocols but a few thoughts. And by the way, I think this is a growing problem with aging baby boomers.

This link is the results of a Canadian study on Aging in place that might be of interest.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342846/#!po=23.5537

The book “Being Mortal” by Atul Gawande is a great resource for looking at the big picture.

Also google the ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living). These activities have to be addressed for each elder.

The Area Agency on Aging for your County offers many services. You could contact them for advice. Take a look at their website to see what they cover.

Also familiarize yourself with Adult Protection Services should you need to call on their services for those residents whose self neglect needs attention by someone with the authority to take action.

Perhaps you already have data for each resident that lists a “who to call should there be an emergency”.

If not, that’s probably something you would need to do for all 66 apartments.

It’s a big problem the four of you have. I think it’s important and I wish you luck.
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I don’t think you and your other volunteers should take on the responsibility of Seniors who perhaps are no longer able to live on their own safely and could even been endangering the safety of your other residents. This is a noble undertaking but when you make yourselves responsible for their safety, you could also be leaving yourselves open to lawsuits if things go wrong. You would, in theory, have to make your entire building handicap accessible. Each resident would have to be evaluated according to their needs and those needs provided for. You’d have to have someone provide well checks daily. This is a massive, expensive undertaking. You mentioned you have the list of needy residents. I would contact their nearest relatives and inform them that in your opinion, their family member is in need of their attention and perhaps may also need alternate living arrangements.
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Hazelthebunny Sep 13, 2019
actually , so far as the building is concerned, it is wheelchair accessible, thank goodness.

But about taking responsibility for assessing needs and then providing for those.... yikes. I agree, that's something I don't think we should touch.
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