Patients in Ontario long-term care homes are at growing risk of abuse and neglect if shortcomings underscored in this week's auditor general's report aren't addressed, say advocates and workers at long-term care facilities.

"You're going to get more and more abuse. You're going to get more and more neglect," said Linda Assad Butcher, a retired ER nurse and dean of nursing whose husband, diagnosed with early onset dementia, lives at the municipally run Gary J. Armstrong facility in Ottawa. 

Auditor General Bonnie Lysyk detailed Wednesday how the Ministry of Health and Long-Term Care fell behind on its critical-incident and complaint inspections across the province, because of a doubling in the number of complaints between December 2013 and March 2015. 

Workers and a patient advocate tell CBC News the province is not addressing the root causes behind the ballooning number of those complaints.

'Most long-term-care workers would not want to see their loved ones in their own workplace.' - Joanne Waddell, CUPE

They describe a system where overstretched, underpaid workers are expected to handle more and more residents — many arriving with increasingly complex care issues because of earlier releases from health-care facilities. Residents miss meals, continent patients are put in diapers because no one can bring them to the bathroom in a timely fashion, and there aren't enough personnel to ensure violent patients don't hurt others, the workers say.

"Most long-term care workers would not want to see their loved ones in their own workplace," said Joanne Waddell, the eastern Ontario spokesperson on long-term care issues for the Canadian Union of Public Employees (CUPE).

She said personal support workers face a job that has become a steady stream of telling patients, "Just wait a minute, I'll come back to you."

"You can't even walk down a hallway and make eye contact with patients because you know you don't have time to stop."

'Unsafe' work environment

Waddell said the average ratio is one personal support worker for every 10 patients. If a worker calls in sick, employers sometimes don't replace them, creating an "unsafe" work environment, she said.

The constant corner-cutting is distressing, according to Waddell.

"If you were continent before you went in there, it's just easier to all of a sudden be incontinent, you know. They'll put you in disposable briefs and stuff because they can't get to you. So your independence is gone, and making them feel good about who they are is gone. It's about what's easiest."

"The demand on staff is mind-boggling," said Assad Butcher, who also helps families navigate the long-term care system. She said the Ontario government needs to think of the auditor general's report as a wake-up call that more resources are needed for direct patient care. 

"I'm wondering what kind of staff will be there to help me — that's the scary part." - Linda Asaad Butcher, wife of resident

The auditor general cited Ministry of Health statistics showing a jump in the number of compliance orders handed out to Ottawa facilities to 175 from about 100 between 2013 and 2014.

A lack of staffing and training have hampered compliance with government orders following complaints, administrators told the auditor general. Ontario facilities failed to comply with between 17 and 40 per cent of orders after inspections, depending on the region. 

13 homicides in long-term care

That report comes on the heels of an October report by the office of the province's chief coroner, which examined deaths at long-term care facilities, including 13 that were considered homicide in 2013 and 2014. It urged the Ontario government to take action against increasing violence, including patient-on-patient violence.

"The increase in the number of complaints reflects a system in crisis," said Kelly O'Sullivan, chair for health-care workers for CUPE's Ontario section. She said between the auditor general's and coroner's reports, "we should be greatly concerned about the state of long-term care facilities in Ontario."

'One worker told me she broke down crying in the parking lot.' - Kelly O'Sullivan, CUPE

O'Sullivan said she spoke with personal-support workers in Ottawa this week who are concerned the workplace situation is putting more residents at risk. 

"One worker told me she broke down crying in the parking lot" after she counted cars and realized they'd be short staffed again, O'Sullivan said.  

She said one facility is making patients wake up at 4 a.m. to be bathed to make sure they can satisfy the government requirement with the staff they have. 

'It's becoming more unsafe'

Akos Hoffer, CEO of Ottawa's Perley and Rideau Veterans' Health Centre, agrees the number of hours per patient is a problem. 

He said the ministry has very demanding standards, but limited government funding means facilities can't hire enough staff. 

Bonnie Saucie, who represents CUPE workers at the Perley, said she feels it's becoming more unsafe for the workers there. "And I believe it's becoming more unsafe for the residents," she said.

CUPE would like to see a mandatory minimum number of hours per resident enforced by the province. O'Sullivan said their own research suggests right now personal-support workers can only offer 2.5 hours a patient. They would like to see that raised to four hours. 

Asked to comment, the Ministry of Health and Long Term Care provided a statement from earlier this week from Dipika Damerla, the junior cabinet minister for long-term care. Responding to the auditor general's report, she said the ministry will "support the improvement of the inspection process of LTC homes."  

Outstanding high-risk complaints have now been inspected, Damerla said, and the ministry is working on curbing repeat offenders.