Coroner's inquest delivers 85 long-term care recommendations

A coroner's jury recommends sweeping changes to operation of Ontario long-term care following the 2001 killing of two men at a Toronto home.

A coroner's jury has recommended sweeping changes to the operation of Ontario long-term care facilities following the deaths of two men at the hands of another resident at a Toronto home in 2001.

The jury made 85 recommendations in all, saying the provincial government needed to take more seriously, and spend more money on, nursing home care and safety.

* Coverage from CBC Toronto

Violent incidents in nursing homes are on the rise across Ontario. In 2004, violent residents attacked other residents 864 times in the province's long-term care homes, and attacked staff 264 times, the inquest heard.

There are 10 times as many attacks today as there were five years ago. The Ontario Nurses Association said there had been 11 homicides in Ontario nursing homes since 1999, and 3,000 reported attacks.

This was partly due to the fact that many of the homes' residents had behavioural or cognitive issues, an observer said.

"The number of people in long-term care who have behavioural or cognitive problems is anywhere up to 75 per cent," said Jane Meadus, a seniors advocate.

Killings at Casa Verde

The inquest came after the violent deaths on June 9, 2001, of Ezz-El-Dine El-Roubi, 71, and Pedro Lopez, 83. Another resident at the Casa Verde Health Centre in west Toronto bludgeoned them to death.

Their attacker, cognitively impaired 74-year-old Piara Singh Sandhu, had been at Casa Verde for less than a day when he killed the two men and seriously injured a third.

Sandhu was charged with two counts of second-degree murder. He died while in custody.

The inquest on Monday classified the two men's deaths as homicides, and made the recommendations aimed at improving safety in facilities for seniors.

The jury said nursing homes needed more staff and better training, because they were simply not prepared for violent seniors.

John Van Beek, who represents workers at Casa Verde, agreed. He said the problem was staff could barely look after seniors who had only minor problems.

"When one registered practical nurse has to take care of 54 residents on a night shift ... when one health care aide has to get 14 residents up in the morning and ready for breakfast ... that's no standard of care whatsoever," he said.

Call for specialized units

Casa Verde's lawyer Peter Pliszka said there was a gaping hole in the long-term care system.

"We need specialized units that are properly designed for the growing number of seniors that are coming into units that need special care because of cognitive impairment," he said.

The jury said special secure units should be built across the province. But it also said nursing homes needed to be held accountable for the government money they receive.

Many deal with violent seniors by simply drugging them into docility.

Van Beek says too many private nursing homes scrimp on the care seniors get, to pad their profits. "It's essential ... [there] can't just be a licence to print money any more for private care nursing home operators ... they need to provide the care for the money they are given," he said.

To improve the situation, the jury said the provincial government should nevertheless also give more money to nursing homes.

No comment from health minister

Ontario Health Minister George Smitherman declined to comment until he had had more time to look at the recommendations.

Sharleen Stewart, president of Service Employees International Union Local 1, attacked the Dalton McGuinty government. "Now that a coroner's jury has recommended a specific standard of care, the Ontario government must keep its election promise and legislate a specific standard of care," she said.

The ONA said the Ministry of Health and Long-term Care should fund and set standards requiring long-term care facilities to increase staffing levels to, on average, no fewer than .59 registered nurse-hours per resident per day and 3.06 hours per resident per day of overall nursing and personal care.

It said that the inquest showed that Ontario long-term care residents received only a few minutes of direct RN care per day, estimated to be the lowest in the country.

"These levels are not even close to meeting the needs of the complex and often physically aggressive residents who are now placed in long-term care facilities," said ONA president Linda Haslam-Stroud, RN.

She added: "What happened at Casa Verde is a terrible tragedy, but, unfortunately, not an isolated one."