NHF

[2021] QCAT 412

QUEENSLAND CIVIL AND
ADMINISTRATIVE TRIBUNAL

CITATION:

NHF [2021] QCAT 412

PARTIES:

In applications about matters concerning NHF

APPLICATION NO/S:

GAA6688-21
GAA8404-21
GAA8405-21

GAA13727-21

MATTER TYPE:

Guardianship and administration matters for adults

DELIVERED ON:

1 December 2021

HEARING DATE:

10 November 2021

HEARD AT:

Brisbane

DECISION OF:

Member Casey

ORDERS:

1.   The Tribunal does not grant leave for FLP to withdraw her applications for the appointment of a guardian and administrator for NHF.

2.   Public Guardian is appointed as guardian for NHF for the following personal matters:

(a)   accommodation; and

(b)  health care.

3.   This appointment remains current until further order of the Tribunal.  The appointment is reviewable and is to be reviewed in five (5) years.

4.   The Public Trustee of Queensland is appointed as administrator for NHF for all financial matters.

5.   The Tribunal dispenses with the requirement for the administrator to provide a financial management plan.

6.   The Tribunal directs the administrator to provide accounts to the Tribunal when requested.

7.   This appointment of the Public Trustee of Queensland remains current until further order of the Tribunal. 

8.   The following Enduring Power of Attorney for NHF is revoked pursuant to s 116(d) of the Powers of Attorney Act 1998 (Qld):

(a)   The Enduring Power of Attorney dated 25 May 2020 appointing SNC as attorney for financial, personal and health matters.

CATCHWORDS:

HEALTH LAW – GUARDIANSHIP, MANAGEMENT AND ADMINISTRATION OF PROPERTY OF PERSONS WITH IMPAIRED CAPACITY – ADMINISTRATION AND FINANCIAL MANAGEMENT – where the Tribunal is satisfied the presumption of capacity is rebutted – where an enduring power of attorney is revoked – need for the appointment of a guardian and an administrator

Guardianship and Administration Act 2000 (Qld) (‘GAA’), s 5, s 11, s 12, s 14, s 15, Schedule 4
Powers of Attorney Act 1998 (Qld) (‘POAA’), s 87, s 109A, s 43, s 62, s 85, s 86, s 87, s 70, s 103, s 116
Queensland Civil and Administrative Tribunal Act 2009 (Qld) (‘QCATA’), s 46(2)
Human Rights Act 2019 (Qld) (‘HRA’), s 13, s 19, s 24,
s 25, s 48

APPEARANCES:

Applicant:

FLP – facility manager of the residential aged care facility (phone)

Others:

NHF – the adult (phone with applicant)

SNC – son of the adult (phone)

Representative of the Public Trustee of Queensland (phone)

REASONS FOR DECISION

1. NHF is 91 years old and of Italian heritage. NHF receives accommodation and care in a residential aged care facility (‘facility’).  His wife, who had been receiving care at the same facility, recently passed away.

2. On 12 May 2021, the Tribunal received an application from FLP, the facility manager, seeking the appointments of the Public Guardian as guardian and the Public Trustee of Queensland as administrator for the adult.

3. The applicant provided the Tribunal with a copy of an Enduring Power of Attorney dated 25 May 2020, whereby NHF appointed his son, SNC, as his Enduring Power of Attorney for personal/health and financial matters, with the attorney’s power for financial matters to begin immediately.  The attorney’s acceptance was signed on 23 May 2020. 

4. In her application to the Tribunal the applicant submitted that SNC, as the adult’s Enduring Power of Attorney, was not providing accurate information to the facility, nor was he responding to phone calls and emails from the facility.  The applicant provided an invoice to the Tribunal which the facility sent to SNC identifying that the adult’s accommodation/care fees were in arrears by $13,772 as at 30 June 2021, with the last payment being made on 31 March 2021. The applicant submitted she was seeking an order of the Tribunal to ensure the management and provision of quality decision making for the adult’s financial and healthcare needs.

5. On 18 June 2021, the Tribunal initiated an application for an order about an Enduring Power of Attorney.

6. The Tribunal received a further application from FLP on 9 November 2021, seeking leave to withdraw her applications, stating that NHF wishes to maintain his financial independence.

   The Legislation

7. The Tribunal is required to determine capacity as at the date of hearing in accordance with section 12 of the GAA as the Tribunal must be satisfied that the adult has impaired capacity before it can further consider the applications for the appointment of a Guardian and Administrator for the adult.

8. The adult is presumed to have capacity in accordance with General Principle 1 of the GAA.[1]

   [1]GAA, Section 11B.

9. The GAA defines capacity as follows:[2]

   Capacity, for a person for a matter, means the person is capable of -

   (a) understanding the nature and effect of decisions about a matter; and

   (b) freely and voluntarily making decisions about the matter; and

   (c) communicating the decisions in some way.

   [2]GAA, Schedule 4 (definition of ‘capacity’).

10. In the determination of capacity for an adult for a matter, the Tribunal must consider the type of decisions to be made and the support available to the adult from the adult’s existing support network.[3]

    [3]GAA, Section 5(c).

11. The Tribunal is to consider the medical evidence and submissions from the parties to determine if the presumption of capacity is to be rebutted for the adult.

12. The Tribunal, when considering the appointment of a guardian or administrator, must be satisfied not only in regard to capacity, but also of the other matters set out in section 12 of the GAA.

13. The Tribunal is required to act in accordance with sections 14 and 15 of the GAA when appointing guardians and administrators. The appointee must satisfy the requirements of section 14 including that the person is appropriate for appointment in accordance with the appropriateness considerations set out in section 15 of the GAA.

14. The Tribunal must have regard to the POAA in its consideration of NHF’s Enduring Power of Attorney dated 25 May 2020.

15. The Tribunal has the same jurisdiction as the Supreme Court of Queensland in respect of Enduring Powers of Attorney in accordance with section 109A of the POAA. As there is an attorney, it is necessary to consider whether the attorney is carrying out the requisite duties in such a way as to protect the adult’s interests and is otherwise acting in accordance with the POAA.

16. When applications to the Tribunal are made under the GAA, applicants may only withdraw their applications when granted leave to do so by the Tribunal.[4]

    Should the Tribunal grant leave for the applicant to withdraw their application?

    [4]QCATA, Section 46(2).

    Evidence

17. The Tribunal considered the written evidence provided to the Tribunal by the applicant in relation to the adult’s personal and financial circumstances.  The written evidence included documents provided by the applicant in relation to scores attained by the adult on cognitive assessments, the details of which are outlined below [See ‘Does NHF have capacity to make personal and financial decisions?’]. In her oral submissions seeking leave to withdraw her applications, FLP provided new information to the Tribunal. She told the Tribunal that the adult had been distressed about his accommodation fees being in arrears and that he knew he had sufficient funds to remove the debt, however he was unable to facilitate payment as the adult’s substantive savings were held in a bank account that had been changed into an account in SNC’s name.FLP further informed the Tribunal that the adult’s wife had passed away since the initial applications were lodged with the Tribunal, and that the adult was subsequently enjoying more communication with SNC.  She said the adult did not want the application to proceed as he did not want to damage the relationship with SNC. FLP told the Tribunal that the adult had ‘sorted out’ the payment of fees owing to the aged care facility by being supported by a staff member to withdraw accessible funds and arrange a direct debit to the accommodation facility from the account into which he receives his pension. FLP said the adult’s attorney was aware of the facility’s actions in relation to the withdrawals and the establishment of the direct debit payments to the facility.

18. The Tribunal considered the written and oral evidence.Notwithstanding FLP’s application to withdraw her previous applications, a Tribunal-initiated application for an order about an Enduring Power of Attorney is before the Tribunal.In consideration of the written clinical evidence in relation to the adult’s cognition and decision making capacity provided by the applicant (outlined below), together with the adult’s vulnerabilities as described by the applicant, the Tribunal determined that the applications for the appointment of a guardian and administrator for the adult should be heard in conjunction with the Tribunal-initiated application in relation to an order about an Enduring Power of Attorney.

    Conclusion

19. Accordingly, the Tribunal did not grant FLP leave to withdraw her applications for the appointment of a guardian and administrator for the adult.  The applications were heard in conjunction with the Tribunal-initiated application at the hearing.

    Does NHF have capacity to make personal and financial decisions?

    Evidence

20. The Tribunal received written medical evidence in relation to the adult’s decision-making capacity.  The reports are referred to below.

21. In a report dated 27 October 2020, LC, an occupational therapist, provides that the adult attained a score of 9/30 on the Montreal Cognitive Assessment Test for Dementia (MoCA) on 4 June 2020 and a score of 22/30 on the Rowland Universal Dementia Assessment Scale (RUDAS) on 27 October 2020.  LC wrote that, at the time the report was written, the adult had been regularly attending the bank from the facility, unsupervised, to withdraw cash which he later misplaced.  She said that although staff were finding some cash in his room, the actual amount of cash that had been recovered may not have been the amount withdrawn by the adult. LC recommended that the adult be supervised by either facility staff or family when shopping, banking and withdrawing cash, and that he should to be prompted to ensure he stored cash securely in his wallet, lock box or locked drawer in his room. 

22. In a report dated 8 December 2020, WC, a registered nurse and clinical manager at the aged care facility, wrote that the adult was diagnosed with dementia by a geriatrician in October 2020.  WC stated that the adult attained a score of 10 on the Psychogeriatric Assessment Scales (PAS) on 4 December 2020 which was indicative of moderate cognitive impairment.  WC provided that the adult experiences acute confusion and disorientation and lacks insight into his cognitive deficits and care needs.  She added that the adult experiences anxiety and regularly accuses others of stealing his money.  In the clinical manager’s opinion, the adult is able to make simple, not complex, health care decisions, and unable to make all decisions in relation to his finances, lifestyle and accommodation matters. WC also provided the opinion that the adult is unable to understand the complex criteria required to make or revoke an Enduring Power of Attorney.

23. In its determination of the adult’s decision-making capacity, the Tribunal received oral evidence from attendees at the hearing.

24. NHF provided minimal and contradictory evidence to the Tribunal when prompted to do so.  He said he did not know when he entered the residential aged care facility and that he could not remember making the Enduring Power of Attorney of 25 May 2020.  He reported that he received an Australian pension of approximately $700 per fortnight.  He told the Tribunal that he was making his own decisions and then revised his submission stating that his decisions were being made by SNC.

25. FLP told the Tribunal that the adult has memory issues.  She said the adult made his own decision to go to the bank to pay the facility in the context of her ‘having ongoing conversations’ with the adult wherein he questioned if his fees had been paid.  She said she did ‘not put pressure’ on the adult to pay the facility as ‘it’s something he wants to do’.

26. SNC stated that he has experienced frustration as the adult is ‘becoming a little bit forgetful’. He said that he had ‘probably’ commenced acting as the adult’s attorney.  In relation to the management of the adult’s financial matters, SNC submitted he had ‘allowed’ the adult ‘the ability to do it himself and supervise it’.  He added that FLP said of the adult ‘that he was 100% OK’.

27. The Tribunal considered the clinical and oral evidence.  The Tribunal places much weight on the information contained in the report of LC, occupational therapist, and the clinical opinion of WC, the registered nurse and clinical manager of the residential aged care facility. The evidence establishes that NHF has cognitive deficits as a consequence of dementia.  The diagnosis was made in October 2020 by a geriatrician, and has been informed by results attained by the adult on standardised assessments including the MoCA and RUDAS.  The results on the PAS in December 2020 were consistent with the previous findings. 

28. When considering capacity for an adult, the Tribunal must give consideration to the nature of the decisions that are required for NHF and the support available to him. NHF is residing in the facility.  He has complex physical comorbidities against a background of dementia. NHF’s health care requires monitoring and management. Decisions are necessary to afford the adult appropriate and sustainable accommodation and care within a residential aged care facility.  His financial matters must be managed so that his assets are identified and protected and his income is utilised to ensure permanent tenure at an aged care facility.  The adult’s Enduring Power of Attorney has submitted that he has probably commenced acting in that role and is supervising the adult’s financial decisions, having been requested to do so by the facility.

    Conclusion

29. Upon consideration of the evidence, and having regard to the nature of decisions required for NHF and the support available to him, the Tribunal determines that due to NHF’s cognitive deficits associated with dementia, NHF is unable to make financial and lifestyle/accommodation decisions and complex health care decisions. The Tribunal, therefore, is not satisfied that NHF understands the nature and effect of his financial and lifestyle/accommodation decisions, nor his complex health care decisions. Accordingly, the Tribunal rebuts the presumption of capacity for NHF for financial, lifestyle/accommodation and complex health care matters, including the complex matter of making or revoking an Enduring Power of Attorney.

    Is the current decision-making regime meeting the adult’s needs and protecting his interests?

30. In the context of the Tribunal’s rebuttal of NHF’s capacity for personal and financial decision making, the Tribunal was tasked with determining whether the attorney is carrying out the requisite duties in such a way as to protect the adult’s interests and is otherwise acting in accordance with the POAA. There must be an adequate and effective decision-making regime in place for the adult, as otherwise his needs will not be met and his interests will not be protected.

    Evidence

31. FLP and SNC provided contextual information about the adult’s engagement with the facility. They submitted that the adult had initially entered the facility on 25 May 2020 (the same day as the Enduring Power of Attorney was made) to be with his now deceased wife, who was placed at the facility as a consequence of a decision made by her daughter as her Enduring Power of Attorney.  In June 2020, the adult left the facility in an unsuccessful attempt to return to his home, however a neighbour subsequently supported him to re-enter and remain at the facility. According to FLP, after a period of respite care in the facility, the adult attained permanent tenure on 7 September 2020.  She said that SNC has not signed the agreement with the facility despite emails sent to him on 27 November 2020 and 24 December 2020 requesting him to do so.

32. In her evidence to the Tribunal, FLP provided further details in relation to events which occurred in the month prior to the hearing.  She stated that SNC had requested information about adult’s accommodation fees and had assured her they would be paid.  FLP said that an invoice was sent to SNC on 7 October 2021 which was followed by three emails between 11 October 2021 and 26 October 2021. FLP submitted that the adult’s accommodation fees were in arrears by approximately $15,000 when the direct debit was instigated in late October 2021. She said that the adult had also commenced ‘paying into’ the facility withdrawing $1000 per day for five days using his key card to which SNC had granted him access, and that the most recent payment occurred on the day preceding the hearing.  She said that the adult had attempted to access more of his cash assets on occasions, however as the ‘account is not in his name he can't do that’.  She said SNC had been aware of the payments to the facility and the actions of the facility’s staff member attending the bank with the adult. FLP submitted that the cash and cheques were kept in the safe at the facility and were all receipted, as the adult ‘stresses he owes money’.

33. In her application for the appointment of a guardian, FLP raised concerns that SNC was not contactable when health care decisions were required.  These concerns were echoed in the report of WC, which provided the adult has complex conditions including bladder cancer (2020), non-insulin dependent diabetes mellitus and chronic lower respiratory tract disease.  At the hearing, FLP advised that, in her role as facility manager, she was not aware that SNC had made any health care decisions for FLP since the adult’s admission to the facility.

34. SNC submitted that the adult and his wife had been admitted to the facility ‘against their wishes’ and that there was friction between the families which escalated when the daughter of the adult’s wife, acting as her attorney, withdraw half the cash in the couple’s joint account. SNC said he then withdrew the remaining funds in the joint account eighteen months ago at the adult’s request, and placed them in an account in his own name to keep them safe. He submitted that the adult has ‘full control’ over the $42,000 deposit.  He stated the account is unable to be accessed with a card. 

35. SNC further submitted he did not recall receiving requests to sign the aged care agreement and that he assumed he had submitted the relevant documentation to Centrelink in relation to the adult’s income and assets and his consequential contribution to his aged care. He said he was unaware the facility was not being paid until he was advised in October 2021. He stated he was under the impression the adult was withdrawing cash and ‘paying them along the way’.  SNC said that ‘under direction from me’ a staff member from the facility redirected the adult’s pension from the joint account to the accessible account and arranged for the direct debit of accommodation fees to the facility.  SNC further submitted that he was aware the adult had withdrawn $5000 to reduce the debt to the facility and that the funds were held in the safe and had been receipted.  He said that if money had ‘gone missing over the last 18 months I am never going to find it because there is no paper trail for it’.  He said that he had asked the adult previously not to withdraw large sums of money and that, at times, the adult has been ‘mad’ at him.  He said he had tried to give the adult ‘his independence’.

36. The representative of the Public Trustee of Queensland made oral submissions upon hearing the above evidence. He expressed concern that funds were transferred into SNC’s name and that SNC had not signed the agreement with the facility.  He also submitted that if the adult was correct in saying he was receiving the age pension at $700 per fortnight, he may not be receiving his full entitlement and there may be undeclared assets, which could alter his contribution to his aged care.  The representative stated that SNC, as the adult’s attorney, had not acted to protect the adult when he enabled facility staff to attend the bank with the adult to organise the direct debit and withdraw funds to pay the facility. Additionally, it is unclear how the residual debt to the nursing home will be repaid.

Determination

1. The Tribunal considered the written and oral evidence.

2. SNC, as the adult’s attorney for personal/health and financial matters, is required to act in accordance with the POAA and make decisions for the adult, having regard to the General Principles[5] and Health Care Principle.[6]  His legislative obligations include liaising with the adult and relevant stakeholders (e.g. medical and health professionals, service providers, financial institutions) to make informed decisions in the adult’s best interests.

   [5]GAA, Section 11B.

   [6]GAA, Section 11C.

3. In his oral evidence to the Tribunal, SNC provided inconsistent information in relation to his understanding the adult’s dementia and its impact on his financial decision-making capacity when he stated that he had ‘probably’ commenced acting as the adult’s attorney for financial matters. He submitted that he had thought the adult was paying his own accommodation fees. Against this is SNC’s evidence that he had signed multiple documentation upon the adult entering the facility in 2020, which he assumed included information required by Centrelink in relation to the adult’s income and assets. He also submitted that he had become frustrated by the adult’s memory deficits and pondered the possibility of the adult misplacing unknown amounts of cash over the past eighteen months as a consequence of the adult’s withdrawals at the bank.  SNC also told the Tribunal that he was attempting to protect the adult’s funds when he removed $42,000 of the adult’s cash assets to an account in his own name.  He said he provided permission for facility staff to attend the bank with the adult to withdraw cash and establish a direct debit in order to pay the facility, upon advice from the facility that the adult was ‘100% OK’.

4. The Tribunal accepts that SNC has received inconsistent information from the facility in relation to the adult’s decision-making capacity over the past eighteen months in the context of the adult’s progressive cognitive decline. The adult entered the facility initially on his own accord, in the context of seeking to be with his wife, however in October 2020 he was diagnosed with dementia by a geriatrician.  Significantly, the facility then sought SNC to effect financial decision making for the adult as his financial attorney in the context of the adult’s diagnosed dementia.  The facility provided repeated written requests in 2020 for SNC to sign the aged care agreement and, in 2021, to pay the accommodation debt and ongoing accommodation fees.

5. The evidence establishes that SNC, as the adult’s attorney, should have acted to meet the adult’s needs and protect his interests in the context of the adult’s diminishing abilities and increasing vulnerabilities, as diagnosed by the geriatrician, and when he was requested to do so by the facility.  Instead, SNC transferred $42,000 of the adult’s cash assets into an account in his own name as he was concerned the daughter of the adult’s wife would deplete the remaining funds of the couple’s joint account.  SNC did not sign the agreement with the residential aged care facility, nor did he ensure ongoing payment of accommodation fees. He did not attend to the full repayment of the adult’s debt to the facility.  SNC is also unaware if Centrelink has been advised in relation to the adult’s assets and income, and is therefore unaware if the adult’s pension and accommodation fees are appropriate to his circumstances.  Furthermore, by his own evidence, SNC agreed to facility staff attending the bank with the adult to enable the adult’s funds to be transferred to the facility, at which they were employed, through several cash/cheque withdrawals and through the establishment of a direct debit payment to the facility. A residual debt to the facility remains, in the absence of SNC facilitating payment from the adult’s savings, which are currently held in an account in SNC’s name.

6. The Tribunal is not satisfied that SNC understands his legislative obligations as an Enduring Power of Attorney.  He has not been cognisant of the nature and extent of the adult’s cognitive deficits, nor has he been available and contactable when the facility has called upon him to exercise decision-making for the adult. SNC has not kept the adult’s finances separate to his own,[7] has not kept records[8] and, by transferring $42,000 of the adult’s cash into an account in his own name, SNC has engaged in a transaction that would give rise to the presumption that the attorney is unduly influencing the adult.[9]

   [7]POAA, Section 86.

   [8]POAA, Section 85.

   [9]POAA, Section 87.

   Conclusion

7. The Tribunal determines that SNC is not discharging effective decision making in the current circumstances as Enduring Powers of Attorney for NHF for personal, health and financial matters, in a way that was consistent with the legislative requirements including the General Principles[10] and the Health Care Principle.[11]

   [10]GAA, Section 11B.

   [11]GAA, Section 11C.

8. The evidence establishes that the current decision making regime, with SNC as the Enduring Power of Attorney for financial and personal and health matters, is not meeting the adult’s needs nor protecting his interests. 

9. Accordingly, the Enduring Power of Attorney for NHF dated 25 May 2020, appointing SNC as attorney for financial, personal and health matters, is revoked pursuant to s 116(d) of the POAA and can no longer be acted upon.

10. Pursuant to section 12 of the GAA, the Tribunal determines there is a need for the appointment of a guardian in relation to health care for the adult due to the adult’s complex physical comorbidities in the context of his progressive cognitive decline with dementia. The statutory attorney regime[12] is not appropriate, as the adult’s son, SNC, would be his statutory health attorney of first resort.  SNC has demonstrated that he does not understand the nature and effect of the adult’s dementia, nor has he been available and accessible to the adult when required.

    [12]POAA, Section 62.

11. The Tribunal considered whether there was a need for the appointment of a guardian for accommodation decisions.  The evidence establishes that FLP, as facility manager, placed the adult who, by her own submission was experiencing cognitive decline as a consequence of dementia, in a position of financial vulnerability when facility staff accompanied the adult to the bank to withdraw money to pay the facility.  It is of further concern to the Tribunal that these events were preceded by facility staff entering into multiple conversations with the adult advising him that the attorney was not responding to their attempts to contact him and that the adult’s fees were in arrears. The behaviour of the facility staff would have caused the adult distress in relation to the lack of decision-making and support from his attorney and the associated risk to his ongoing tenure at the facility. The Tribunal is of the view that the facility staff, as persons who identified and recognised the adult’s cognitive deficits, served to increase his vulnerability. The actions of the facility personnel give rise to the question of whether the adult’s current accommodation and care requirements are being met while he remains at the same facility. The Tribunal therefore determines that an accommodation decision is required.

12. Section 14(2) of the GAA provides for the Tribunal to appoint the Public Guardian as guardian for matters when there is no other appropriate person for appointment. The Public Guardian is an independent decision maker, with extensive knowledge, skills and experience in applying the General Principles[13] and the Health Care Principle[14] to decision-making.

    [13]GAA, Section 11B.

    [14]GAA, Section 11C.

13. The Public Guardian is considered by the Tribunal to be an appropriate appointee, having regard to the provisions of section 15 of the GAA.

14. Accordingly, the Tribunal appoints the Public Guardian as guardian for NHF for the matters of accommodation and health care.

15. The evidence further establishes that, pursuant to section 12 of the GAA, there is a need for the appointment of an administrator for the adult for all financial matters, as his financial needs will not be met nor his financial interests protected without the appointment of an administrator.

16. The evidence establishes that an independent, skilful administrator would be required to consult with all stakeholders, including the guardian, and make decisions that best meet the adult’s needs in accordance with the General Principles.[15]

    [15]GAA, Section 11B.

17. The Tribunal is of the view that the Public Trustee of Queensland, as an independent, skilful and experienced administrator, would be able to make financial decisions that best meet the adult’s needs, in accordance with the general principles. The Public Trustee of Queensland is considered the appropriate appointee, having regard to the provisions of section 15 of the GAA.

18. Accordingly, the Tribunal appoints the Public Trustee of Queensland as administrator for NHF for all financial matters until further order of the Tribunal.

19. The Tribunal gave consideration to the relevant human rights as set out in the HRA. As required by section 48 of the HRA, the Tribunal must interpret statutory provisions to the extent possible that is consistent with their purpose in a way that is compatible with human rights. NHF’s rights to privacy,[16] freedom of movement[17] and property[18] are engaged and limited by decision of the Tribunal to appoint a guardian and administrator for the adult. On balance, the decision of the Tribunal ensures that the adult’s finances are managed so that he can receive accommodation and health care commensurate with his increasing needs in the context of his progressive cognitive impairment. Taking into account the above findings in relation to the criteria set out in the GAA, the Tribunal is satisfied that the benefits of the decision of the Tribunal outweigh any limitations imposed on the adult’s human rights and that the decision of the Tribunal is the least restrictive option given the adult’s vulnerability. Accordingly, the Tribunal determines that the limits imposed by the decision of the Tribunal are reasonable and demonstrably justified in accordance with section 13 of the HRA.

    [16]HRA, Section 25.

    [17]HRA, Section 19.

    [18]HRA, Section 24.