All About Resident-to-Resident Violence in Long-Term Care
The Stories – Seeking Solutions
Click on the following video clip to understand what is happening:
"Fighting for Dignity"
(The above video was made in 2020 by Terra Nova Films and is available for rent or purchase, we have no affiliation, we leave it here for demonstration purposes.)
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| Image courtesy of Stuart Miles at FreeDigitalPhotos.net |
"In order to avoid future acts of violence, we seek solutions. Bringing this old story of violence in Long Term Care back to light is an opportunity to implement solutions, such as increased staffing, in a timely manner to assure safety for our most vulnerable."...
"Those participating in making change are working together, assisting one another towards a common goal. Rather than finger-pointing and blaming others, focus on action towards solutions." ...
A team of three dedicated professionals who all belong to the professional LinkedIn group, Gerontology Professionals of Canada, decided to team up to formulate a response to the W5 documentary, Crisis in Care. These three professionals, who are all committed to providing care to older adults and their loved ones, responded very strongly to this unfortunate state of affairs. Eleanor Silverberg, BA, Psych, MSW, RSW drew up the initial draft and asked Angela Gentile, MSW, RSW and Victoria Brewster, MSW for their contributions. Seeking Action for Safety in Long-Term Care Facilities was completed on February 20, 2013, and was forwarded to the following individuals/organizations (responses added in italics):
- Prime Minister of Canada, Stephen Harper - Response received (see sidebar)
- W5, Sandi Rinaldo, the investigative team and the producers
- Federal Health Minister, the Honourable Leona Aglukkaq
- Alzheimer Society of Canada, CEO, Mimi Lowi-Young
- Alzheimer Society of Ontario, CEO, Gale Carey
- Alzheimer Society of Manitoba, CEO, Sylvia Rothney
- Federation of Quebec’s Alzheimer Society, CEO, Sandro di Cori
- Ontario Minister of Health and Long-Term Care, Deb Matthews (response received)
- Quebec Minister of Health and Social Services, Dr. Réjean Hébert
- Manitoba Minister of Health, Hon. Theresa Oswald (response received)
The following additional individuals/organizations have also received this information, with a request for support:
- Canadian Alliance for Long-Term Care
- Healthy Living, Seniors and Consumer Affairs Minister of Manitoba, Hon. Jim Rondeau - He referred the letter to Manitoba Minister of Health for follow up
- Minsitere de la santé des Services sociaux
Please feel free to share, comment below, offer your suggestions or comments on how we can work together to make our Long Term Care facilities safer for our most vulnerable.
Warm regards,
- Angela G. Gentile and Eleanor Silverberg
19 comments:
Kudos to you for taking this on. I have heard many terrifying stories with terrible endings. Hope this doesn't get excused and covered up. Keep up the good work. There are many that agree this is the time for change.
Being elderly doesn't mean we don't deserve to live a decent life without fear.
Comments by Donna Kinvig, published by special permission, member of the Canadian Health & Healthcare Consultants group on LinkedIn:
"...the impact of having residents with complex mental health issues such as organic cognitive impairments is placing a significant burden on the health care system as our population ages. Yes, there is a need for a multi-disciplinary, holistic specialized care planning starting with highly individualized nursing care. The provision of this care is highly labour intensive and requires significant commitment to on going education of staff to ensure both patient and staff safety and of course associated resourcing levels.
Solutions do not come easily, ultimately it is the collaboration between family, staff and the wider treatment teams that is relied upon in the provision of high quality care. Geriatric care is not a specialty that either medical staff or nurses are banging on doors to work in, it is not as 'attractive' as other areas highly valued in our society such as ER, ICU, etc however the reality is that the demographic statistics scream for the increased need for those who are committed to and wish to make a difference in the lives of our elders. Incentive programs, identification of those nurses who have a talent for this specialized work and the creation of education programs in Nurse Practitioner education are all ways to increase the flow of talent to this area. Education programs in neuropsychiatry, dementia care, complex organic brain disorders, and monetary and educational incentives to work in this area need to be considered. Conversations across our communities to ensure culturally competent care need to be started as well. Vulnerable groups such as children, the elderly and mentally ill, have been my professional and personal concern both as a former Police Officer and nurse for many years now. This is an area I feel passionately about, count me in on any conversation."
and "I am curious to know, is there a specialized section of the MOH that deals with complaints of elder abuse ? or perhaps each health authority Patient Safety/Quality investigates and reports to the MOH?"
You bring up some good points, Donna and glad to hear you are on board with this cause. I do not think this completely answers your question but this link from the Canadian Network for Prevention of Elder Abuse has information about Elder Abuse in institutions, although it is dated from 2011
http://www.cnpea.ca/abuse_in_institutions.htm#What Are the Rights of People Living in Long Term Care Facilities
Does anyone have information that is more recent?
I have read your blog and article which are both outstanding in dealing with issues that have and will continue to be difficult for all involved in the caregiving process. Mother had a horrible experience when she was in the CCAC funded faciity in Unionville when she was attacked by a man who suffered from "Sundowning" issues. She was pushed twice which resulted in bruising but what was worse was her fear of being in the facility since he entered through her room's closed door. When I brought her home she lodged a complaint with the Director of the facility who, in turn, did nothing apart from sending her flowers. The bottom line is not only is there a lack of qualified individuals to work with these Alzheimer's patients, there is a lack of facilities to house them. Instead, they are comingled with folks recovering from strokes and other ailments which puts many at risk.
I am very glad that the initiative has been taken by this group. There has to be positive, constructive ideas and action, not grandstanding media wasting time and filling up the news shows.
What I am hearing constantly is that there are not enough support staff in the homes. Why not encourage students to go into that fields because there will be jobs available. The need will not be diminished. It is a known fact that the population is just getting older.
What will happen to the aggressive patient that recently did all that harm in the nursing home? What jail is going to keep a dementia inmate? Are there homes that meet the security he will need? Will he be returned and a guard will be put outside his door? Will he be sent back to his family?
These problems will not go away. Funding cannot be an issue. Funds will have to be diverted to resolve this. After all, if our government can support an unelected, unaccountable senate at top wage, it can find a way to protect it's citizens. They will be old soon too!
Re: Woman killed, another injured, in attack at seniors residence in Scarborough | March 15 2013
http://www.thestar.com/news/gta/2013/03/15/woman_killed_another_injured_in_attack_at_seniors_residence_in_scarborough.html
My thoughts towards this story are twofold:
Canada's criminal justice system is meant to punish the criminally responsible - I find it concerning that insofar as this story has been covered, the mental state of the accused has yet to be mentioned. This will potentially lead to the man's unwarranted stigma of criminal liability that he will carry with him for the remainder of his life, and will undeniably affect the care that he will receive. (Of course, this is assuming that Mr. Brooks has some type of cognitive impairment and that the murder was not a voluntary act.)
Nevertheless, the strong focus on under-staffing and the Ministry's failure to provide the adequate staffing coverage that it is supposed to is truly, in my opinion, the crux of the argument. I hope that the continued publication of this frustration will place pressure on the Ministry to reconsider its allocation of funds and to increase the allowances it provides for Long Term Care Facilities -- both for staffing and for sufficient training in like circumstances.
There is no time for "Round Table Conferences" the Ministry must act and "SOON" before another senior is battered to death. We as workers with "Older Adults" do not want to be part of the problem but rather part of the solution. We have to speak up, speak out and speak loud. Advocate, Advocate, Advocate until something is done. More funding, more staff and more training is necessary. This abuse must be stopped!!!!
I fail to see how this not a budget issue. I am not jumping on the lack of staff bandwagon either. I feel the system is not been prepared for the amount or types of dementias or phycologicak issues that it is being overloaded with, the lack of training be provided for staff to deal with these issues. I still am not shocked to see this happen, I a saddened, but not shocked.
I am still trying to figure out when the system as a whole will wake up, plan for the evening shift or 12:00 till 08:00 as the shift for the most potential for this to happen. I find most medical facilities fully staffed in office and floor staff during the day, but after 4:00PM the offices are mostly empty the floor staff is reduced and activaton is halved and almost non- existant after 9:00PM.
Long term care facilities require more front line staff especially on their behavioural units. My father lives in a long term care facility, on a secure behavioral unit where he shares the care with 11 other residents (personal support worker (PSW) care ratio is 1:11 during daytime hours). Funding desperately needs to be directed to front line services (PSWs in long term care settings), especially considering the aging Canadian population. Child daycares are government regulated to have a 1:5 staff ratio for children under the age of 6, yet a dementia care unit (where the cognitive function of residents is equal to or less than a 6 year old child), and where the personal care, behavioural and medical needs are significant, there is a care ratio of 1 PSW for 11 residents. Most of these residents require total care with their basic activities of daily living, including toileting and feeding and behavioural intervention. How is this justifiable? I have forwarded these concerns to the assistant Minister of Health and I still await a reply.
Reprinted with permission, from Joanne Conte Casola:
Here is my response to Dr. Helena Jaczek MPP (and assistant to the Minister of Health).
Further to my letter dated Feb 26 2013 to request changes be made to improve staffing in Long Term Care facilities, I support the initiative undertaken by Eleanor Silverberg MSW ( http://actionforsafety.blogspot.ca/ ). I understand that you have forwarded my concerns to the Ministry of Health and Long Term Care however I have not yet received any contact or response. I would like to know if these concerns are being addressed with proactive solutions, especially in light of the recent media coverage regarding the risk to residents living in long term care. I know I represent the opinion of a significant number of others who are vulnerable, incapable, or too burdened by their circumstance to take action. Thank you for your attention to this matter.
Joanne Conte Casola, OT Reg. (Ont.)
Occupational Therapist
I have been reading through all of these comments, and I appreciate everyone's input, perspectives and expertise. I have found two quotes that I thought were very relevant, and I'd like to share them with you:
"...the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped. " ~ Last Speech of Hubert H. Humphrey
"A nation's greatness is measured by how it treats its weakest members." ~ Mahatma Ghandi
Almost one month later since our project "Seeking Action for Safety" started, and we have only received one reply. That was from the Prime Minister's office, saying that the responsibility lies with the provinces.
I am saddened by the lack of response, yet hopeful that more exposure and awareness to this situation will make people wake up. I'd like to see Canada be a leader in the area of managing Resident-to-Resident Aggression. This would be a true example of the morality and greatness of our nation.
Thanks everyone for your responses and comments. Keep 'em coming!
I am a PSW in a long term care facility. The ratio in our home is 1PSW to 15 residents (day shift) 1 psw to 22 residents (evening shift) and 1 psw to up to 30 residents (midnight shift). It does not matter how much education you give us PSW's when the amount of residents we have to look after is such a huge number. The gov't needs to mandate to all homes, regardless if they are privately owned, that the ratio should be that as the same as in child day care. 1 to 5. at all times. I know you are not suppose to compare the elderly with a child, but come on people, as we get older we regress back into childhood. ever hear the saying "once a man twice a child" its so true.
I along with the rest of my coworkers, try out hardest to give 100% care to each of our residents, but when you are only given approximately 10 mins per shift per resident its almost impossible. PSW are now being told by govt to do dietary as well as all our charting (which MUST be done) I really think the gov't needs to actually step into a long term care facility and see exactly what is happening.. WE NEED MORE FRONT LINE STAFF IN ALL LONG TERM CARE. GOV'T SHOULD BE MANDATING THIS INSTEAD OF ALLOWING THE OWNERS OF THE FACILITY TO LINE THIER POCKETS.
I believe that it is time that we look at additional training and making the system responsible for providing additional funding for staff. I am saddened by what is occurring in our long term care home (although I would not use the would home) These seniors have served our country, provided support to our generation, paid into the system and this is how we repay them. This is how we treat them with dignity and respect. I have being working with seniors for over 15 years, believe that although we see responsive behaviours with dementia, we must be the ones to stand up and do something...who is going to do something...how many doors do we need to knock down in order to allow these people to be treated as such and provided the level of care they need and are deserving of. Thank-you for bringing this to the forefront. If the governments solutions is Behavioural Support Ontario (BSO) they better think again or rethink how BSO has been rolled out.
Long term care facilities are too often in the news for abuse and subpar safety standards. It’s important that everyone get involved to ensure this is less of a concern.
I have read through the comments and the common theme appears to be, offer education and increase staffing levels. I agree with both strategies; BSO has been another tremendous resource. Resident to staff ratios need to be mandated by the government being 5:1 or even 8:1 depending on the level of care required by each resident.
I have worked in LTC for 25 years now, both as a Health Care Aide and now as a Social Worker and I am very thankful to say I have never witnessed a resident death by another resident. Having said that, the MOHLTC is in our home practically every month investigating resident to resident abuse. We have even been accused of "over-reporting." The most severe cases of violence are committed by individuals who never should be placed with vulnerable older adults in the first place; ie. violent offenders, criminals, psych patients.
The bigger issue I see, is the lack of appropriate facilities for violent residents. A person who has had a life history of domestic violence/ abuse, gets older and requires care, will still be placed in LTC for lack of a better place. We need more forensic behavioural units. Our community has opened a specialized geriatric psych unit in one of our hospitals for such individuals, but there are only eight beds and it is intended to be short term. Once a person is stabilized, he/she may be placed back in LTC. The article below explains better what I am referring to. Residents with a violent history should not be placed with frail, vulnerable residents. Once a home has accepted a resident (based on information that is not always accurate) it is very difficult to get them out. We can send the resident out to hospital, but they sedate the resident and send them back, angry we sent them in the first place.
Another issue, in my opinion, is the reduction of antipsychotics drugs. Some residents have been using medications to stabilize their behaviours for years. Fact is, they were using them for a reason deemed necessary by a doctor. Now, all the sudden, because they are older, they no longer require them? Our home has seen a tremendous increase in responsive behaviours in general, since the reduction came about. We currently have two Alzheimer/behavioural units (60 beds) and for the most part, gentle persuasive approach has been effective, in conjunction with both the internal and external BSO team recommendations, but some residents require meds for their own safety and the safety of others. I am not saying don't reduce. I am simply saying not every resident should have these meds. discontinued.
Bottom line- there is no easy answer. What is clear is that we need the right facilities for the right individual. Having appropriate, well staffed facilities would go a long way in reducing resident to resident injuries.
http://fhs.mcmaster.ca/psychiatryneuroscience/clinical_forensic.html
Thank you for your comment. You have made some excellent points. The link to the Hamilton psychiatric unit has been added to our solutions page of this site. Hopefully other cities will take more action for safety in protecting our most vulnerable elderly.
I certainly agree that the W5 report on the instance of resident neglect was horrendous. When mistakes such as this are made, people must be held accountable. I can't imagine how horrible that must have been for the resident and his family.
However, looking at the larger picture, I cannot lose sight of the fact that we, as a society have created the circumstances whereby mistakes such as these can occur. As a society, we determine who is elected and in turn, what the political agenda will be. In Ontario the funding to long term care homes is based on a flawed funding model to start with. The fact is, as levels of care have increased, and continue to increase every year, the reimbursement to the Homes is proportionally declining. Without change, it will only get worse. Why din't they focus on that reality with the Minister of Health and LTC?
What I find equally frustrating in this situation is the unbalanced reporting by CTV's W5 investigators. Instead of focusing on the government's lack of financial support for the care of our vulnerable seniors, they pointed to a company that "makes millions of dollars" - implying that this is the root cause of the problem. With a little more investigation they would have found that all funds for nursing, food and programming MUST be spent on residents - or be returned to the government. The Homes cannot use these monies for anything else, including profits.
When I see this kind of negligence in reporting, it highlights the sensationalism that drives the media, thereby inciting misdirected public scrutiny. Such omissions ultimately reinforce sceptical public perception, and foster the notion of a "fake news" environment in our system.
Thank you for your comment. You certainly make some valid points. It is so important to focus and take action towards solutions and that includes competent reporting which you pointed out.
I have been working in this field for over 15 years. There is a simply solution to this problem...overhaul the system. Stop putting in stop gap measures such as BSO (I am part of BSO)...Stop having overpaid executives sit around the BSO tables or other task force like tables to discuss the same problem but using new language. The ministry has thrown so much money at these 'new' initiatives and holds those who receive the monies to minimal accountability. How many bodies were seen appears to be preferable to outcome measures.
LTC homes are essentially institutions and residents are made to adhere to rules. Ontario needs to use the dutch model of small scale living...residents are taken off any meds when they arrive. Staff are expected to help them adjust and to discover the reason for their behaviours. They can get up when they want...they can go to bed when they want...8 residents share a living area with a kitchen. They have their own rooms with a shared washroom. It is seldom that they have to resort to anti psychotic medications and if they do, they use them for a short period of time and then if it has no effect, they go back to the staff and ask them to figure out a solution. Staff on the whole have 4 years post secondary education. Staff to resident ratio is 2:8 in the morning. 1:8 in the afternoon/evening and no one at night in the shared living space, but the facility itself has staff who monitor the residents for unusual patterns. They employ sensor technology along with knowing the sleep time patterns of the residents...if a resident who doesn't normally get up, starts wandering around, one of staff will come and check on them. So much government money is wasted by the MOHLTC...look at the current restructuring of home care...CCAC...instead of a CEO, VP and Director of client services, there are now 5 sub LHIN directors...who probably grace the sunshine list.
When the first resident on resident murder was highlighted 17 years ago, a task force was created to work out the recommendations made by the inquest. The task force did brilliant work and came up with the Toronto LTC Mental Health Strategy. Education took place, binders were sent to EVERY LTC home in Toronto...when I would ask staff, the DOCs about the guidelines and how they were applying them, I would get a blank look...apparently these languished on the shelves of administrators.
Education is provided to staff...I used to provide this as part of a government funded initiative. We would get staff at the end of their shift for 1/2 hour or at the start of their shift...and the expectation would be to teach them about the three geriatric giants: Dementia; Delirium and Depression....Didactic teaching - talking at adults...I used to ask if I could split the education into a series - they couldn't guarantee the same staff could come back. Bedside coaching is very effective - having in house behaviour support teams actively involved in resident consultations is also effective...helping staff apply the didactic teaching so that it makes practical sense...these would help current programs be much more effective. I love my clients and i love the staff I work with - but the systemic bungling and "politicking" is so demoralizing... our older adults deserve better and so do the front line staff who work under impossible conditions.
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