Nursing Home Violence Show
This week, we look at a serious and growing problem at Canada's long-term care facilities: nursing home residents who act violently against fellow residents and staff. The issue gained national attention after Frank Alexander died in hospital four days after allegedly being assaulted by Joe McLeod at Parkview Place personal care home in Winnipeg - where both Alexander and McLeod resided - on March 24th of this year.
On our show this week, we examine violent behavior by residents at Canada's long-term care facilities - and what can and should be done to deal with the problem. I have a feature interview with Real Cloutier, Winnipeg Regional Health Authority's point man on long-term care, the same region where fatal assault on Mr. Alexander took place. He takes me on a tour of Winnipeg nursing homes to show me what they're doing in Manitoba to protect residents and staff.
I also speak with Sue Lambert, a registered nurse whose father was severely beaten by a fellow resident at the long-term care facility where Lambert's father lives.
Tune in Saturday at 11 am (11:30 am NT) and again on Monday at 11:30 am (3:30 pm NT) on CBC Radio One. Or, click below to listen to the show right now, or download the podcast:
Violent attacks at Canada's long-term care facilities are not isolated incidents. A study from Laval University published in 2005 found that more than one in five older residents at long-term care facilities act aggressively.
Documents obtained by in a CBC News Investigation back in 2007 documented a rapid increase in violent attacks in nursing homes in that province. Between 2003 and 2006, the number of violent incidents among residents of long-term care facilities more than tripled - from 446 to 1,416.
There are many factors that contribute to violence. Residents with dementia are particularly prone to aggressive behaviour. Factors such as psychological distress, sleep deprivation, even the very medications used to calm seniors - alone or in combination - may trigger a violent outburst.
The attacks range from verbal assaults to pushing and shoving to punching and kicking. The resulting injuries can be quite severe.
A summer job working in a long-term care facility helped motivate Sue Lambert to become a registered nurse. But decades later, her father was admitted to the very same nursing home - where he was beaten by a fellow resident.
"He was physically assaulted by his roomate," Lambert told White Coat, Black Art. "It was an unwitnessed attack. He was quite badly beaten about the face (with) quite a lot of bruising, a lot of cuts.
"It was pretty traumatic to get a phone saying your father has been assaulted. We put him in the nursing home thinking he's going to be safe."
Sue Lambert's father recovered from his injuries. Others aren't quite so fortunate.
Frank Alexander died in hospital four days after allegedly being beaten by Joe McLeod, a fellow resident of Parkview Place, a personal care home administered by Winnipeg Regional Health Authority (WHRA). Mr. Alexander suffered from Alzheimer's disease as does Mr. McLeod.
Following an investigation by police, Joe McLeod was charged with aggravated assault. Since being taken into custody, McLeod has also undergone a 28-day psychiatric assessment. This was not McLeod's first run-in with the law since being diagnosed with dementia. In Fall 2010, he was jailed for allegedly assaulting his wife, which led to him being admitted to Parkview Place -- the personal care home where the incident involving Frank Alexander took place. There are reports that the incident that claimed the life of Mr. Alexander was not first but the third aggressive outburst by McLeod at Parkview Place.
At issue is whether WHRA properly assessed McLeod for violent behaviour in making the decision to admit him to Parkview Place. Also at issue is whether staff at Parkview Place monitored McLeod adequately and took appropriate steps to curb his violent tendencies.
While four separate investigations into the affair work their way through the system, patients and their families wonder whether it's safe to reside in long-term care facilities.
I decided to pay a visit to Real Cloutier, the WRHA's vice-president of long-term care. We met at Deer Lodge Centre, a long-term care facility in Winnipeg of which Cloutier is also Chief Operating Officer.
Cloutier took me on a tour of the behavioural unit at Deer Lodge, a locked ward constructed especially to handle patients with violent tendencies. The ward is spacious with a wide central hallway flanked on both sides by equally-spacious rooms designed to house one resident each. Along the way, Cloutier and I passed the occasional resident. Though most were clearly confused, none was particularly agitated.
The thing I noticed right away was that residents seemed to have little contact with one another. According to Cloutier, this is by design - to minimize the risk of friction between fellow residents who lack the cognitive and emotional reserve to cope with close and unpredictable interactions with fellow residents.
Behaviour units like the one I toured at Deer Lodge aren't just designed especially; the staff who work here are especially trained to defuse tension among residents and prevent violent outbursts.
But the numbers are daunting. Cloutier says WRHA takes care of approximately 5600 residents in long term care. Eighty percent of them have dementia. Violent behavior can be quite unpredictable. Figuring out which residents are especially prone to violence is a ongoing challenge.
Cloutier says WRHA has just 26 behavior beds for the most aggressive residents. Shortly, they'll open up nine more such beds at Tache Centre, another facility across town. Even then, there'll likely be far more residents with violent tendencies than special beds in Winnipeg.
"If somebody needs a behavioural bed or a special care unit, if they're in a nursing home, the home may request additional staffing resources," Cloutier told me. "We spend about $1.3 million a year in funding additional resources to make sure the person and others are safe.
"That's the interim measure. And then, we try to identify if this is a short-term thing or a permanent thing that we need to accommodate them into a different kind of bed."
The fact that WRHA is furiously adding more behavioural beds is a strong indication that more are needed.
Across Canada, residents with violent tendencies are looked after in nursing homes with no specialized facilities or trained staff to meet their needs.
"My father is in a ward room," Sue Lambert told WCBA. "It's a very small room actually with a total of three of them in the room, so there's not a lot of personal space in there. A lot of times, they're invading each other's space.
"It begs the question as to why people with known aggression are mixed in with people who are quite frail and vulnerable. I believe having your own personal space and enough of it is critical in this facilities."
I asked Lambert whether the long-term care facility where her father lives has acknowledged responsibility for what happened to her father.
"They were sympathetic, of course, " recalls Lambert. "But there was no admission that anything had been overlooked or that it could have been prevented. His room was almost directly across from the nursing station. But still, the only way that this incident had really been picked up on was when my father wandered out into the hall with blood dripiping down his face."
Back in Winnipeg, there are four separate investigations being carried out by authorities into what led to the death of Frank Alexander and how to fix it. The Manitoba government is also considering an inquest into Alexander's death. Those investigations weigh heavily on the mind of WRHA's Real Cloutier.
"In hindsight, it's easy to say more could have been done," Cloutier told WCBA. "Obviously, with the tragic outcome, more could have been done. We need to find out what that 'more' is, and how much of this could have been anticipated.
While the investigations meander on, families of long-term care residents want to know if their loved ones are safe.
"I would never say to the public that you have nothing to worry about," Cloutier told WCBA. "Because that would set up an expectation that they shouldn't be observant. They should be observant, and if they have concerns, they absolutely should raise them with the staff who can raise them with the management of the care home."
It's an admonishment that Sue Lambert has taken to heart. Since her father's attack, she and her family find it a lot more difficult to trust the long-term care facility where their father still resides, especially since the man who assaulted him also resides there still.
"We're trying to set up a schedule where there's always one of us there every couple of days to make certain he's okay," says Lambert. "So we can watch him more carefully."