Nursing homes: Fear and violence

Canada’s nursing homes are supposed to be places where seniors go to spend the rest of their lives in security and safety. But a CBC News investigation, Beaten Down: Fear and Violence in Canada’s Nursing homes, has found that long-term care facilities can be dangerous places where residents attack residents, residents attack staff, and staff abuse residents.

But the story doesn’t end there. Nursing homes in provinces such as Ontario have become so violent and dangerous for staff, that ministries of labour are targeting the homes for beefed-up inspections. In British Columbia, the increasing compensation claims filed by workers being attacked by residents was becoming such a problem, that WorkSafeBC commissioned a special report to study ways to address the problem.

Nursing associations and seniors’ advocates complain about being short staffed and a lack of training. What training there is, has been deemed in many circumstances to be inadequate because it still leaves low-paid personal support workers ill-prepared to deal with a nursing home population that is older, sicker and more mentally unstable than they were even 10 years ago. This, at a time when coroners' reports, special studies and a number of experts on long-term care, have warned governments that problems were in store if they didn’t take action such as increased training for workers.

Documents obtained by CBC News show that in Ontario, violence in nursing homes has been increasing rapidly over the past few years. Between 2003 and 2006, the number of violent incidents among residents reported in the province more than tripled, from 446 to 1,416 cases, according to Ontario government documents.

More than 150,000 Canadian seniors were living in residential care facilities across the country in 2004/05, according to figures released by Statistics Canada in the spring of 2007. That's one out of every 30 people aged 65 or older.

The numbers are far higher for people 85 and older — about one in five. And many of them require constant care. Alzheimer's, the most common form of dementia, is estimated to affect one in 20 Canadians over the age of 65 and one in four of those 85 or older.

"The pushing and the shoving, when you're dealing with frail, elderly people, will often end up in serious injury or death," Jane Meadus, a lawyer who has fought to keep violent residents out of nursing homes, told CBC News.

She says an increasing number of people with violent dementia and other illnesses are ending up in the residences because nursing beds are much cheaper and governments have shut down more expensive psychiatric beds.

"The nursing home beds are definitely the cheapest beds around. And they are what I would say is the dumping ground," Meadus said.

The government's own research suggests that one nursing home resident in five is now considered highly aggressive.

During the past 15 years, there have been repeated recommendations for sweeping changes to make nursing homes safer. The recommendations have come from juries at coroner's inquests as well as annual reports from the geriatric and long-term care review committee to the Chief Coroner of Ontario.

In 2005, an inquest looked into the deaths four years earlier of two residents of a Toronto nursing home. They were attacked in their room by a fellow resident who was suffering from dementia. Both men died of blunt trauma to the head. The jury made 85 recommendations. Among them were:

• The Ministry of Health and Long-Term Care should fund specialized facilities, as an alternative to long-term facilities, to care for demented or cognitively impaired residents exhibiting aggressive behaviour.
• The facilities, in consultation with experts in the field, should be designed using the model of the Dorothy Macham Home at Sunnybrook and Women's College Health Science Centre to meet the physical and staffing requirements of these high-need residents.
• The ministry, in consultation with representatives from the long-term care industry and health care professionals, should develop short- and long-term strategies for the care and treatment of physically aggressive patients with dementia.

The jury also recommended that if a resident is placed in a nursing home and the resident turns out to "have a complexity of care, such as aggressive behaviours, that cannot be safely managed," there should be a mechanism in place to quickly transfer the resident to a facility that has the capabilities to care for the resident.

The recommendations are similar to ones made by previous inquest juries. They are also similar to recommendations made by the geriatric and long-term care review committee, which reports every year to Ontario's chief coroner.

In 2001, the committee's 11th annual report said:

"With increasing frequency, long-term care facilities are being challenged by demented residents with aggressive tendencies. All long-term care facilities in the province of Ontario should develop strategies to manage these most difficult residents."

Two years earlier, the committee's ninth annual report made this suggestion:

"Given that the projected number of demented patients requiring institutional care is expected to increase dramatically in the coming years, it is recommended that the Ministry of Health, in consultation with representatives from the long-term care industry and the health-care professions, develop both a short-term and a long-term strategy to manage physically aggressive, demented patients. Inherent in this recommendation is the recognition of the principle that the safety of other vulnerable residents within long-term care institutions must be maximized."

Implementing those recommendations would go a long way toward making nursing homes safer, lawyer Meadus says.

But the Ontario government hasn't implemented any of them. The government does not want to build "jails for the elderly," Health Minister George Smitherman says.

"I do understand, of course, the necessity of protecting individuals from one another," Smitherman told CBC News. "We can take appropriate steps to do that, but within an environment of long-term care instead of creating some segregated model where we've got all those individuals in newly built facilities."

Residential care facilities are not governed by the Canada Health Act. It's up to individual provinces and territories to set spending levels.