Nursing Home Violence Show Mailbag

Our show this week looked at growing problem of violence at Canada's long-term care facilities:  nursing home residents who act violently against fellow residents and staff.  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. 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, featured an 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 took me on a tour of Winnipeg nursing homes to show me what they're doing in Manitoba to protect residents and staff.  And then, we heard from you.

"Thanks for your story on nursing home violence. This is also an issue in acute care hospitals and at our organization a group of nurses is leading an important initiative aimed at reducing Code Whites in patients with dementia or Alzheimer's.  Here is a link to a story that explains it. It's called Gentle Persuasion and its all about finding better ways of communicating with these patients - and by communicating better, reducing frustration and the risk of incidents. Gentle Persuasion began at our St. Peter's Hospital site (complex continuing care) and is now expanding to all our sites. The results have been great."

From:  Heather Pullen, Hamilton, Ontario

"My mother died in January of 2010 in a nursing home in White Rock. While there was no actual physical violence, I can tell you that, as a retired RN, I was appalled at some of the things that went on during my mother's stay there.  During the last 3 nights of my mother's life, I slept in the chair by her bed largely because I had promised her to keep a certain care aid out of her room!  The atmosphere, food, attitude of some of the staff and careless planning of medication supplies for over the final weekend of my Mom's life all have left me feeling very betrayed by our truly shameful medical system.  Elsewhere, things were not a whole lot better - communication among staff, wards, hospital departments etc. seemed non-existent."

From:  Elizabeth Savage, Langley, B.C.

"When I lived in Dawson City, Yukon, the women who trained me to care for elders had adopted Gentle Care system in which a small number of people received help with personal care and the activities of daily living using a comprehensive care model. We experienced minimal violence because we learned how to create a system, which would allow us to practice elder care under the principles of 'Gentle Care'. This system was developed by a woman who helped her father when he developed dementia it works.

"Because we were able to effectively help the elders in our care live meaningful and full lives, no matter how cognitively disabled they were as dementia clients, I thought I would be able to do the same thing for my mother when she developed dementia.  Unfortunately, I was horrified and deeply disappointed by the level of care that was available to her in the last five years of her life. 

"I did everything I could to advocate on her behalf, and what I experienced was policy and very little meaningful care for her specific anxieties.  I do believe that the care aides who helped her most often were doing their jobs to the best of their abilities.  However, the entire system had its priorities wrong and that adversely affected the way in which they were able to provide care.  Staff was task oriented; they were concerned primarily with accomplishing a certain number of tasks within a set time period such as dressing and feeding.

"I spent as much time as I could in the home caring for her myself.  If the people who cared for elders with dementia had proper training, with facilities set up to accommodate elders, things would be different."

From: Barbara Mason, Ottawa, Ontario

"My father is a resident on a secure ward at a long-term care facility.  He was very mobile and tended to wander.  Within days of his arrival, a fellow resident knocked him down.  The care facilities response was to say, "Yes that happens, did you father start something." and "We'll try to keep them apart."  To say I was stunned is an understatement.  My investigation revealed that man who attacked my father had a history of attacking other residents and staff.  The solution was to make sure the man would never be more that a metre away from a staff who could interrupt any violence episode as needed.  On one occasion, the many attacked my father as I was walking with him.  No staff were around.  I reported the incident immediately and was assured that they would keep an eye on the man.  Later that same day the man in question attacked me.  I asked for a meeting with a social worker at the long-term care facility that was bizarre to say the least.  It was suggested that my father be restrained.  I insisted the man who attacked my father be restrained and was told that if I knew the man's history I might feel different.  Eventually, the man was restrained and all was well until my father was knocked down yet again by another resident in a walker.  My father suffered a subdural hemotoma (a blood clot inside the brain); he has been in a wheel chair ever since.  I was told that the resident who attacked my father "needs to burn off her energy".  Solution - I hire personal care givers at $30 an hour for 5 - 6 hours a day to supervise my father in this resident.  You do the math."

From:  Patricia Masters, Ottawa

"People with dementia don't have behavioral issues. They are frustrated of not understanding what they know they should or of have memories of been different.  If they are frustrated at home or elsewhere they'll burst, no matter where they are. People with dementia don't remember how to express themselves, so they burst. I've seen it. If you think they have behavioural issues you are condemn too fix them ... to their beds. If you take the time and the money to understand what those persons want (it may just be the way their cloths are folded or other small tasks) you will calm them and avoid any regrettable reactions."

From:  Benoit Lauzon, Montreal

"As a Health Care Aid, I have worked in various Care Homes and have experienced violence by residents towards other residents and staff.  I have found that some nurses tend to look down on Care Aids.  During my training, I took units on both dementia care and mental health nursing. Care Aids are the one's who spend the most time with residents and because they know the residents, they are the first to notice deterioration in both the physical and mental health of patients.  These changes are usually passed verbally as well was via the Hospital nursing notes.  But sometimes, doctors don't consult the notes.  The biggest problem is staffing levels."

From:  Stephanie Beech, Salmon Arm, B.C.

"I volunteer at a long-term nursing facility in Ottawa which is run by the Salvation Army who have a long history of excellent service and treatment of individuals. This home does not have semi-private room but have rooms designated as Basic and Private. The Basic rooms are completely separate, situated in a V designation with a curtain over each room opening and they share a bathroom. The private rooms are what you would expect. Patients with Alzheimer's or dementia who are a wandering risk are all together in one unit, rooms with the same designation as above, but the unit remains locked for their safety.  It is bright, and well managed.  The residents are cared for by well-chosen staff.  I am unaware of any seriously violent incidents. Residents in nursing homes should be treated with the dignity they deserve."

From:  Patricia Pottie, Ottawa

"My husband was in long-term care for over two years.  He had dementia.  I kept a log regarding his care, which for the most part was good.  However I did find that some of the caregivers didn't always have a good grasp of the English language, thus making communication with the patient difficult.   It is no wonder that a patient would get irritated if he cannot understand what is being said.  The caregiver would subsequently also get irritated with the patient."

From:  Anne Day, Calgary

"My father was placed in a long-term care facility within the past year.  He spent over a year in hospital under the care of his GP. I live in another city and spent months trying to get my father assessed for dementia - this finally took place 9 months later.  He was medicated for his moods by the GP, and I was able to find him a bed in a private care home.  The home was not equipped to deal with dementia patients.  He ended up being readmitted to hospital some 3 months later - his mental state worsened over the 4 months he was in hospital.  He was assessed again and placed in a "complex" care home in January.  I was shocked to learn that my father was taking five different anti-psychotic medications prescribed by his GP and not by the Geriatrics specialist. I was furious because my father's mental state was getting worse while on treatment.  As my father's legal guardian, I called the physician and instructed him to stop all medication except the ones prescribed by the Specialist. Six weeks later, father's mental health has greatly improved.  He is no longer displaying violent behaviour."

As always, we appreciate receiving your comments.

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