When it comes to abuse, rural long-term care homes face unique challenges

Across eastern Ontario, the number of reported cases have more than tripled from 2011 to 2016, according to the most recent data from the Ministry of Health and Long-Term Care. More than half of the homes with the highest rate of abuse were in small towns.

Staff-on-resident abuse reports more than tripled in eastern Ontario from 2011 to 2016

Everything happens around the kitchen table at the North Renfrew Long-Term Care Centre.

The Deep River, Ont., home is small, with only about 20 beds. At any given time you'll find residents crocheting, reading, eating or napping around the big wooden table.

"It's a big weird happy family," the home's administrator, Kim Rodgers, is fond of saying.

And it does seem to be a happy home, where no one wears a uniform and residents walk the hall freely at their own leisure. There's even a "caternity ward" where the home fosters pregnant cats and their litters.

But it's also the long-term care home with the highest ratio in eastern Ontario, between 2011 and 2016, of reported incidents of staff abusing residents.

Across eastern Ontario, the number of reported cases have more than tripled in that period, according to the most recent data from the Ministry of Health and Long-Term Care.

More than half of the homes with the highest rate of abuse were in small towns.

The large table is a hub of activity in the North Renfrew Long-Term Care Home. (CBC)

The North Renfrew home faces many of the same challenges faced by long-term care homes across the province, but several small-town homes tell CBC problems are even more severe in rural areas, where there's less access to funding and resources.

"[There could be] a shortage of staffing, but also a lack of specialised staff," said Candace Chartier, the CEO of the Ontario Long Term Care Association, which represents 70 per cent of homes in the province.

One of the hardest things to deal with is attracting personal support workers to remote areas of the province, especially when those sorts of jobs are plentiful.

There is a definite lack of specialized psychiatric and geriatric services in Ontario, especially in rural areas.- Lee Griffi, spokesperson for Caressant Care Bourget

It's even more difficult to attract staff that specialize in behavioural supports for residents with dementia and other cognitive disabilities, Chartier said. 

In the North Renfrew home, a specially-trained staff person is on-site one day per week. But at Caressant Care Bourget, another home with a high ratio of abuse cases, specially-trained staff are only available for six days every two weeks.

The home's spokesperson, Lee Griffi, said the home would benefit from a full-time team.

"There is a definite lack of specialized psychiatric and geriatric services in Ontario, especially in rural areas," Griffi said in an email.

The funding model for long-term care homes also doesn't provide special consideration for the needs of small-town centres, several homes pointed out in statements to CBC News.

The only ministry requirement in terms of staff ratios is that every home must have one registered nurse on shift at all times — and that's more difficult to fund in smaller homes with fewer beds.

CBC News put the concerns of some of the homes to the Ministry of Health and Long-Term Care but did not receive a response.

In the past, the minister has vowed to improve access to staff trained to provide behavioural supports across the province.

While allegations of abuse bring to mind horrifying cases like the one at Garry J. Armstrong in Ottawa, where video surfaced of a resident being punched in the head by a caseworker, the situation in Deep River is more subtle.

"We have never had any physical abuse or sexual abuse," Rodgers said.
Kim Rodgers has been administrator for the North Renfrew Long-Term Care Centre for 15 years. (CBC)

She recalls one case that involved a man who wore the same plaid shirt every day. At night, staff would sneak in, grab the shirt, wash it and return it before he woke up.

One night, a new care worker didn't do that. Instead, she told the man that he stinks and that he had to wear a different one. The incident was reported to the ministry as a possible case of verbal abuse.

"That's absolutely unacceptable, because she had affronted his dignity," Rodgers said.

Of the 15 cases of staff-on-resident abuse reported to the ministry at North Renfrew Care Centre, Rodgers said most involved verbal abuse, including using a negative tone of voice when addressing residents.

There were also allegations that a resident's care plan was not strictly followed, which amounts to neglect. Some of the reports have been disproven by ministry investigations, she said.

The disproportionately high number of cases in the Deep River home may have something to do with the close quarters everyone lives and works in, Rodgers said.

"Being smaller, we pay attention to the work that our staff are doing. And we'll know if they're slipping," she said.

John "Archie" Robertson, 92, has lived in Deep River, Ont., for 60 years. (CBC)

Despite the high ratio of reported abuse cases at the North Renfrew Care Centre, the waiting list for a bed includes nearly 80 people.

John "Archie" Robertson, 92, has lived in Deep River since he moved to Canada 60 years ago. When it was time to move to a long-term care home, he found himself in Richmond Hill, Ont., near Toronto.

When a bed became available at North Renfrew, he jumped at the chance to go home.

Robertson said access to small-town homes is important for people who don't want to leave their communities.

"I've got no other home, so it's a very emotional attachment to the place," he said.

How CBC analyzed the data on Ontario's nursing homes

CBC analyzed six years (2011-2016) of data from Ontario's Ministry of Health and Long-Term Care, public records and the Canadian Institute for Health Information (CIHI).

We compiled all abuse and neglect situations by caregivers and between residents that were reported by each long-term care facility in the province, as well as their self-reported percentage of residents with dementia and residents taking antipsychotic drugs without being properly diagnosed with psychosis.

The abuse rates were normalized using the most recent number of licensed beds of each home — considering closures, openings and major merges. Some homes might have underreported or failed to report during the time period we analyzed. Our analysis couldn't consider staffing ratios, as the province doesn't compile them.

Please also note that the numbers report suspected incidents of abuse or neglect, as reporting anything is mandatory for homes. The numbers include emotional, verbal and physical abuse or neglect, as there are no current subcategories in the Critical Incidents System (CIS).

With files from CBC Marketplace