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Fear and violence in Canada's nursing homes

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. It gets worse. 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.

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Comments

Lynn McCleary RN

People who live in nursing homes have some of the most complex health care needs of anyone in our population, yet they are cared for in a system that does not have enough funding to hire and retain staff with knowledge and expertise to meet their complicated needs. Registered nurses have the knowledge that’s needed. Our research provides guidelines about how to make sure that the people who live in nursing homes and the people who work there are safe and have good quality of life. There just aren’t enough of RNs in nursing homes. Some nursing homes have as few as one registered nurse for 200 or more patients. The solution lies not only in increasing staffing, but also increasing the proportion registered nurses providing care in nursing homes. This could prevent the sad stories reported here.

Posted October 22, 2007 06:48 PM

megan

Ontario

This is NOT an issue about not enough staff or increased funding to nursing homes. There is absolutely no accountabilty in the existing system anyway so what good is that going to do? Please stop whining about not enough money - nobody knows where the money is going to begin with so why give more?
If Marketplace can so easily walk into a number of Ontario nursing homes and capture this type of disturbing footage - think about it - MOHLTC compliance asvisors enter these homes for routine inspections and surprise inspections. Surely they must see the same thing Marketplace depicted by hidden cameras - after all, in some cases, they are in the nursing home for days doing their inspections. If they (the compliance advisors)are not seeing this and/or not reporting it - WHY NOT???
Did I not read in one of these articles by the CBC Investigative Team no one from the MOHLTC including Smitherman would grant them an interview? (The investigative team not Marketplace). Some accountability.
Also, in 2004 Partimentary Assistant to the Ontario Minister of Health, Monique Smith travelled the province to find out "the truth" about what was happening in Ontario's LTC and report back. Her report - "A Commitment to care: A Plan for LTC in Ontario" does not have any indications about the true state of conditions or violence in LTC and yet she supposedly talked and interviewed many staff, families, residents etc. throughout this province. Maybe she forgot a few people? Maybe she only saw what she wanted to see? What a waste of taxpayer dollars to study - what?.
Is "cover-up" the order of the day?

Posted October 22, 2007 08:55 PM

Earl

Ontario

The Ministry of Health has a " no tolerance" policy when it comes to Resident's abuse, be it from staff or other residents.

It requires all Homes to comply with this policy. However when it comes to enforcing it and taking action the Administration of Nursing Homes are often left to fight it themselves.

Administrators finding themselves in the position of having to take disciplinary action to protect resident's from staff abuse often find themselves between a rock and a hard place . The rock being the Government , the hard place being Unions.

The cost of trying to terminate an employee who is found to abuse a resident is exorbitant, in the $10,000's of dollars. Unions often force the issue to arbitration's, only to protect their own interests in the eyes of their membership. Full well knowing the cost to the Home, often trying to force a monetary settlement. It is not a question of right or wrong. It becomes a question of $$$.

The Ministry of Labor appointed independent arbitrators make an extremely good living out of arbitrating union grievances in cases like these. The more cases they have to arbitrate the more they make. So it is in their interest to be on good terms with the various Unions.

In some cases staff found to be guilty of abuse by an arbitrator, have been given a slap on the wrist and re-instated in their previous positions.

The costs of these exorbitant arbritations
can not be taken out of Government funding that the Homes receives. It must be absorbed elsewhere.

In the end who losses. The Homes financially and the Residents in the end because services or staffing have to be reduced to pay these bills.

This is the protection we give our " Elderly"

Posted October 23, 2007 12:49 AM

Megan

Ontario

How do you know the costs of these exorbiant arbitrations are not taken out of the funding envelopes the Government provides to the nursing homes? I am not trying to be critical or harsh - I am just asking. Have you ever seen individual audits of a nursing home to verify how their government funding is spent? How do you know where the costs of arbitration are being absorbed or how they are being paid for if the government doesn't individually audit the finances of the nursing homes?

Posted October 23, 2007 01:54 PM

Joelene

NB

Nursing Homes are underfunded, understaffed and grossly deprived. They are in dire needs in so many ways that staff, residents and families are like the abused child that learns how to cope and wonders how they did, after they grow up and realize that this is not the way things should be.

Board of Directors, and Administration are not accountable. Boards serve no real purpose and Administrators of Nursing Homes operate at their own discretion. There is no real consistency across the provice.

There is no accountibility for abuse, neglect or harrassment for, residents, families or staff. No advocate to intercede when there is no place to turn.

When will it end? Probably not in this lifetime. Seniors are not like the abused child - they do not grow up to tell their story.

Posted October 24, 2007 01:22 AM

Barbara M. Fournier

My 87 year old and I mother worked tirelessly daily for over 20 years with increasing emotional and physical and distress attending the welfare of my 97 yr old spinster aunt (mother's sister) to keep her in the family home. However, since 2003, her false accusations spread at large that we were committing all manner of imaginary thefts and conspiracies, managed to draw certain of her clearly uninformed and I feel unqualified home care individuals into her "stalking" and fervent persecution of us, which eventually led, with their mind-boggling assistance, to the complete decimation of our small family. I sought help with our dilemma since early 2003 from these very same agencies, but we were repeatedly discredited by uninvestigated falsehoods, stonewalled by questionable professionalism and prejudice of small-minded medical and health care personnel who tout "privacy" as their shield for their abuse of us. After years of effort, real sacrifice to assist and protect my aunt, she lives alone, crippled, nearly blind, "at risk" by her own doing in the family home,without needed meds to hopefully alleviate self-generated terrors, diffuse her rages, protect us against her attempted legal, financial and social violences in our lives, assisted by new interlopers in her circles or her home care help. At least if she had been in a nursing home, the true nature of her insidious affliction might have been clearly revealed, her rages directed on others; then our credibility so often overlooked in this classic disorder would be obvious. It is no wonder after years of what we are still going through why families give up trying and "dump" their relatives into a heap of mentally unstable. Yet my aunt needs our protection more than ever now, and we cannot get to her through the astounding wall of short-sighted ignorance in both health care agencies, procedures, and the Ontario Mental Health Act.

Posted October 24, 2007 06:50 PM

Earl

Ontario

CBC you are missing the real probelm!!

Nursing Homes are mandated to have a no tolerance policy for abuse by the MOHLTC.

Yet when they try to terminate staff who have been found to abuse residents they are taken through a very expensive grievance /arbitration process by UNIONS.

In the end Homes can not terminate abusive employees. Many are re-instated by to the original jobs.

With no support or funding from the MOH to fight this process and UNIONS who have no ethical or moral values what can a Nursing Home do. Too many times down this road and they are financially burnt out.

THe system does not work.

Posted October 25, 2007 12:44 AM

Marie

Sask

A few of the comments here are making my blood pressure rise. Not only have I worked in LTC for 15 years, but 3 of my family members have been present in the same facility that I worked at.
First, NO there is not enough staff to meet resident needs. That's not a whine, that's a fact. The residents who are more vocal, or can reach their buzzer for help will get the assistance before those who cannot. It's not a just way to treat our residents, but that is the truth of the way things go. There is little to no time for interaction between residents and staff, just no time.
The special needs units that are home to many fragile altziemer's residents have on their units, sexual predetors, violent residents, psychotic residents, and no extra staff is hired to ensure that crisis situations don't occur. If staff are in rooms getting people up, toileting residents, bathing residents etc, who is looking after the rest that are alone? We never leave work feeling good about our job. If the gov'ts gave a care, there would be alternative facilities for residents who risk, by their behaviors, the safety of others. More staff, less falls, less incidents between residents, more of a safe and troublefree workplace.
Hiring RN's is not the sole solution either as most of our RN's do not help with any personal care. They hand out pills and do the bookwork mainly. What Saskatchewan has to do is bring back the Diploma Nursing Course which would have given us an additional 900 minimun RN's in the last 12 years. SRNA shut Diploma RN's out, and there went 900 potential future RN's. Now SUN cries RN shortage. As far as I see it, sometimes the powers that be connive so much that who they hurt in the end is themselves and most often the innocent residents and public who don't know what is going on. I work with both Diploma and Degree nurses for the past 15 years, and see no difference in skills. it's a terrible shame.

Posted October 26, 2007 05:11 AM

Ann Tassonyi RN

The Nurses trained in Geriatric Mental Health Assessment in the Long Term Care Facilities do their best to help assess and manage the care of complex elderly clients. The system works well if there is a position created in which staff are given dedicated time to work proactively with their complex clients. Unfortunately budgetary constraints often prohibit allocation of dedicated time for staff to work on psychogeriatric issues. However this difficulty is compounded by shortages of registered staff in the Long Term Care Homes, so that many staff are working overtime, or short staffed, placing an even greater burden of responsibility on existing staff.
Some clients’ needs exceed the capacity of the Long Term Care Homes to provide safe care because of staffing ratios, and the existing constraints of the communal environment. Waiting lists for specialty geriatric psychiatry services as well as waiting lists for the limited geriatric psychiatry specialty units are long, and tax the ability of the staff in Long Term Care Homes to manage their complex clients until they receive assistance. High intensity needs funding is helpful, but staff often feel they are managing high risk individuals in an environment that does not meet their clients’ needs, placing the individual themselves, co-residents, family members and staff at risk.
There are many issues that need to be addressed to serve these complex individuals. Education of staff in best practices for assessment and management of the elderly is important, as well as addressing staffing ratios, recreation hours, shortages of Registered Staff, wait lists for specialty geriatric services, shortages of Geriatricians, Geriatric Psychiatrists, and Geriatric Psychiatry specialty beds to serve the population in the region in which they live.

Posted October 28, 2007 04:18 AM

Jo-Ann

Manitoba

As a nurse with more than 30 years of experience working in long term care I feel compelled to offer my perspective on this issue. There are examples of poor care every where but the issue of violence and aggression is much more complex than your article would suggest. Professional nursing staff have the knowledge and skills to provide appropriate, respectful care to violent and aggressive residents. They provide this care on a daily basis and many times with great success. We work in teams with families, physicians and health care aides to develop realistic plans to respond to frightening and dangerous behaviour. Not every plan prevents all violence or aggression. When the behaviour is placed in the context of severe illness such as dementia, delirium or other combinations it is not fair to the resident to label the behaviour as violent or aggressive. It is the response to something in the physical or emotional environment of that resident. There are many gifted nurses and staff working everyday in less than ideal circumstances and doing so with success. Let's try to remember that when we are advocating for additional resources and a stronger professional presence in these settings.

Posted October 29, 2007 11:09 PM

Iris Hungle

I have been reading with interest the different perspectives on the topic of long term care, senior care and violence in the facilities. My experience with LTC began in January 2007, when my brother and I rented space in a private care facility for our father who has suffered from diagnosed dementia the past 9 years. Private care is an expensive $4000 per month as we await entrance to a public health LTC facility. The estimated wait in Calgary is a year.

The compassion of staff dealing with seniors is not an issue. Rather, inadequate staffing numbers, a lack of training to communicate and care for dementia patients, a lack of privacy for the dementia challenged and aging, diminished, and overcrowded structures to house our loved ones.

At present, we are unable to provide an adequate standard of quality for 'end of life' and I fear this will become critical over the next ten years. The system needs an influx of funding to build new structures and provide staff with training, to deal with increasing dementia related illnesses. This problem is not going to disappear, it is a reality and improvements must begin immediately.

Thank you for listening.

Posted October 31, 2007 06:37 AM

Kris

Ontario

My mother lived in a long term care facility for one month. During that time she endured verbal and physical abuse from other patients. One of these patients was found in my mother's room standing beside her bed holding a pillow. I can only imagine what she was going to do with it. We were basically told that my mother would have to learn how to fit in because these people were living there before she arrived.

I agree that the nurses and aids are over worked and understaffed, but when you have a loved one living in one of these facilities your first concern is their safety and welfare. My mother endured terrible side effects from high doses of liquid lithium given to help keep her quiet so that she would not disturb the other patients or the nurses.

I believe that we have a long way to go before we can be proud of how we take care of our aging population.

Posted November 4, 2007 12:59 AM

Mrs J Jessop

I wa s a worker ( PSW)personal support worker as well as a RCA restoritive care aide, and I can tell you from seven years of service in one nursingh ome that I wa s pushed out the door ye management ( newer management) when I wa s advocating more vocally for my patients, they keep and allow workers who have a history of abusing patients and close to management and drink with them outside of work and the ones that care for thiere residents truley fromt here heart they try to push out the door they are taking the human factor out of what is to be the best part of nursing one to one contact to replace it with robotic approach towards humans and they treat them like they have nno say in what care they are recieving, which is wrong they should be in control of the care they recieve in the later stages of thier life and not treated like animals or lesser f orms of life........

I quit nursing because it is discouraging when no one wants to listen to what is really going on and how much the government is really not giving to the homes and or how much the home is not giving to thier residents but for profit!!!!!!!!! No one is in the nursing home business and not expect to make money and they can afford to have private nurses take care of thier f amily at home not in a nursing home...


I can tell you that the owner of the home I worked at sent her father to austrailia for six months and paid for it to recover from a heart operation when the residents of the home could have used some newer activities and such for thier enjoyment instead and or things they need

Posted November 6, 2007 10:11 PM

Nola Brown

Winnipeg

The residents of the Home where my husband is, medicates the people until they have no personality and act like zombies. My husband has a behavior problem related to his dementia. The Home appointed Doctor chose to give him so much meds that we couldn't wake him for 4 days. We had to alert them to this fact, before they disontinued them. He suffered withdrawal, including hallucinations, tremors, pain and catatonia, weakness, loss of appetite and loss of weight.
He has a companion now (one on one) who love working with him, because he is such a nice guy and they know that to force him to do something he doesn't want to do will cause a temper tantrum. They know that if they wait 5 minutes he will cooperate.
This is common behavior for dementia and it takes patience and training for the staff to handle it.
Some of the workers cannot read or understand English. Of course they are scared.
He is in a private Home (Central Park Lodge) and it is listed on the Stock Exchange and so they must show a profit, therefore cutting as many corners as they can.
If there was any way I could take care of him at home I would. As it is I am there every day to monitor his care.
Surely, there is a better way to care for our senior citizens,who cannot help their plight.

Posted November 6, 2007 11:08 PM

Bonnie Arnold

My mom was in a nursing home in Scarboro for a year. In that year she was abused in the shower, she was always covered in cuts and bruises that they could not explain, or would say she banged it on the wheelchair (the cut was on the inside of her leg). We had to bring it to their attention how badly the cut was infected, even the RN that looked at it was disgusted when she saw it. She left a call for the doctor to come look at it as she needed anti biotics.

Another time her foot was 3 times the size it should have been the PSW said "oh her shoe must be to tight" what it really was they put the bandage on too tight and cut off the circulation.

We tried for months to get her moved and all we got was passed from CCAC to Compliance Office and it wasn't until we sent a copy of the journal we kept to these offices that they finally got back to us. Not soon enough as my mom tied a few weeks later.

These homes need to be monitored more closely. The seniors are give no respect and definately no dignity as they are quick to shove them in a diaper weather they need it or not.

We the baby boomers are the next generation for these homes and we need to speak up NOW for those poor souls who have no one to fight for them.Remember WE are next.

Posted November 14, 2007 02:30 AM

Debbie daniels

Ontario

My father was in a long term care facility for only 1 month,in that time he was beaten up twice by another resident and over medicated,his denture got lodged in his airway for 4 days before anyone noticed.The only way they discoverd the denture was because of the severe infection in his throat and lungs he was getting, He died due to infection a couple weeks later.
Totally unacceptable,no apology no remorse for their actions.They just wanted to know when I could pick up his belongings and vacate his room so the could get another patient in.Filed report with Ministry of health all accusations were found to be valid.

signed, sickened in Ontario

Posted February 10, 2008 06:01 PM

Elizabeth Raposo

My Grandmother is currently at Fairview Nursing Home Ltd at 14 Cross St. Toronto, ON. The Owner(Herbert Chambers) the Administrator of Care (Leatrice Pinder) are terrible people running a terrible operation. We have been complaining for months that my Grandmother is not being changed out of her night diaper till the next day.We have evidence and are currently dealing the Ministry of Health into an investigation. There answer is that the medication she is on is making her urinate...duh everyone urinates. So they think that this is the cause of her sitting in her feces for more than 12 hours. Please someone shut these people down!!! She is on a waiting list for another place, as we fear that her life is in jeopardy. We have made complaint after complaint and they just give us B.S. answers.

Posted February 20, 2008 03:31 AM

Ella Grace

Hello, I am an American, working as a Social Services Director in a nursing home in California, and also on my master’s degree in Health Administration. Our dietician used to work in Canada, and raves about the great building she was in. I must say that every one of the comments resonated with me, and it sounds terribly much like the U.S. I know there are better and worse nursing homes, but I must say that in my building the management does care, and so do the nurses and the aides. Almost everyone is doing the best they can, but providing full care, 24/7, for 98 people is hard to do perfectly.

In school I am trying to figure out a better way to do LTC. I am exploring the 'household model' that is becoming available in both Canada and the U.S. Maybe smaller groupings of folks will prove more manageable. It has a lot of positives going for it.

Also, I think we need to think about what 'good elder care' really means. So many of the elders I spend time with really don't want to be alive anymore. They are tired, achy, lack appetite, and once they feel comfortable with you, will tell you they are 'done'. Everyone around them goes to great lengths to extend their lives, but in reality, many are only still alive because their family or society insists on it. …Just a thought.

Posted February 24, 2008 02:50 AM

Ed Bailey

My mother has been a resident of a personal care home, for the past one and a half years. She is 94 years old. She was in excellent health until 5 years ago. Then she had a stroke and contracted Alzheimer's disease. Her mental health has degenerated. For three and a half years after she had her stroke she lived in her own home with home care assistance as well a lot of help from her children.
She became more difficult for all of us to handle. Initially she resisted our efforts to move her into a nursing home. Her behavior became more and more bizarre so we tried very hard to convince her of the need to place her in a safer environment. Finally she relented and allowed us to place her in a facility. Even before she moved into the nursing home she became cantankerous and began to exhibit violent behavior.
After she became a resident of the home she was upset with us for placing her in the facility. She became aggressive and apparently hit other people with her cane. The cane was taken away and she was medicated. The attacks stopped, but she became so dozey that they had to reduce the medication level. Recently she attacked another resident. Her medication was increased again.
There are times that she has had numerous bruises on her body. We know that she falls on a regular basis and that she is very aggressive at times and tries to do battle with the staff who try to restrain her.
The care that she gets is great. The staff at the nursing home are very caring and competent. We have nothing to complain about her care. People say that the care homes are understaffed. The only way that they could be fully staffed is if they had one on one care 24 hours a day. Who will pay for that?
For people who complain about the way their parents are looked after I have a suggestion, take them home and see how difficult it is to look after a person who has dementia and Alzheimer's as well as being aggressive to boot.

Posted October 29, 2008 06:37 PM

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