The province's under-staffed long-term care homes are growing ever more violent, where resident-on-resident altercations are becoming more commonplace and the homicide rate is seven times higher than some of Canada's largest cities, according to a recent report from the Ontario Health Coalition.
"It is higher than virtually anywhere in our society, and that is unacceptable," Patty Coates, secretery-treasurer on the Ontario Federation of Labour and a board member with the Ontario Health Coalition, said during a recent news conference at the south-end Barrie library branch.
Coates was presenting a 37-page report, titled Situation Critical: Planning, Access, Levels of Care and Violence in Ontario's Long-Term Care, which was published Jan. 21 and is being presented in communities around the province.
For its information pertaining to homicides, the Ontario Health Coalition report cites the Office of the Chief Coroner's Geriatric and Long-Term Care Review Committee's annual report from 2016.
"For everyone, it means escalating violence," said Coates, who added a "deeply disturbing trend" was found. "In the extreme, we can see that the number of homicides that are resident-on-resident is shocking."
With the number of chronic care beds cut in half and "significant" cuts to psychogeriatric bed, people with aggressive behaviours have been sent from hospitals to long-term care facilities, which has led to "serious problems" as staff training and care levels continue to emerge.
"This leads to poor resident outcomes and poor quality of life," the report says. "As a result, we are seeing a deeply disturbing rise in violence, insufficient care, injury and, in the extreme, homicides."
BarrieToday took a closer look at the cororner's report, which does not include locations, and broke the deaths into categories.
Of the 23 cases listed in that report, four included violence or trauma following an altercation with another resident, three suffered falls, two people were struck by vehicles and two involved entrapment (ie. bedrail, wheelchair). In seven other cases, there was only limited information, and in four cases concerns were raised by family over care and monitoring.
In one case, a 95-year-old man died from plastic-bag asphyxia after complaining of uncontrollable pain related to a compression fracture of the spine. The coroner's report says he had no mental health diagnoses and did not suffer from cognitive impairment.
"It reveals the extreme end of a spectrum of violence that is escalating in long-term care homes to a point that crosses all moral boundaries and should be considered intolerable," Coates said. "These are our seniors, the most vulberable people in our society."
The coalition hears "daily complaints serious problems faced in long-term care homes, where close to 80,000 seniors reside. Think about that, that's nearly half the population of Barrie," Coates said.
Those complaints include people who have been injured in long-term care.
"On occasion, they also send pictures of their loved ones covered in bruises," said Coates.
And the number of people living in long-term care is only going to rise.
In 2015, Statistics Canada reported that, for the first time in Canadian history, seniors outnumbered children. By 2035, a quarter of Canadians will be aged 65 and older. By 2041, the number of Ontarians over the age of 90 is expected to quadruple to 413,000.
The Alzheimer Society of Ontario predicts the number of residents with dementia, which is defined as decline in memory and other thinking skills, will almost double in the next 15 years. A large portion will also display aggression as the disease progresses.
"Violence is constant for long-term care staff," the report says. "This is a systemic issue for Ontario's long-term care homes and it is also a gender issue. ... Most of the violence goes unreported unless medical attention is necessary."
Even as care levels decline, and "the inadequacy of care levels is a central contributing factor," the report also indicates the blame is often placed on staff.
Staff in long-term care homes have noted they are short-staffed everyday, while also not having enough time to tend to a person's daily needs, Coates said.
"Health professionals tell us the rates of injuries have skyrocketed as staff are kicked, punched, grabbed or pushed by residents with dementia or other complex conditions," she said, which led to a closer look at the situation. "What the health coalition found is shocking and, frankly, unacceptable. If the care for the frail and the most vulnerable among us is a measure of our humanity and our compassion, then we've failed."
Ontario ranks second last in the country for the number of long-term care beds per capita.
"Not enough care means residents are fed too quickly, cannot get enough food down and lose weight, becoming frail and risking dehydration and starvation," the report adds. "It means no time for bathing or repositioning to prevent bed sores. It means no friendly visits or socialization for lonely or depressed residents."
Kerry Doyle, a registered practical nurse (RPN) in Barrrie and a member of the United Food and Commercial Workers (UFCW) union, has worked in the medical field for nearly two decades, including as a health-care aid and a personal support worker (PSW).
"On the best of days, the staff-to-resident ratio is a crisis," she said, adding the rate at a local facility where she works is one PSW to 10-12 residents, while the RPN ratio is 1:40-45. "The numbers are rates may vary, but it all depends on the facility."
Lack of required care results in behavioural issues, Doyle said.
"And as the dominoes fall, increased mental instability and aggression result in staff, as well as other residents at times, being physically and verbally assaulted," she added. "These are our parents, our grandparents. The staff that work the front lines are our sisters, our brothers, our family members. We want the best for them, and our province is failing them at epic levels."
The coalition would also like to see Behavioural Supports Ontario (BSO) in all long-term care facilities, where responsive behaviours can include grabbing, screaming, making strange noises, trying to leave, verbal aggression, agitation and wandering.
Barrie-Innisfil MPP Andrea Khanjin tells BarrieToday the health and safety of people in her riding, as well as across Ontario, "is a top priority for me and our government. Ontarians in long-term care homes deserve to live in a safe and secure environment."
"I understand that all staff providing direct care to residents must receive annual training in behaviour management, mental health, including caring for persons with dementia, and abuse recognition and prevention," said Khanjin, adding the Ministry of Health and Long-Term Care conducts an immediate inspection once information is received in relation to serious harm, or significant risk of serious harm, to a resident.
Doyle said there's simply not enough staff to cover the number of residents, a situation she called "emotionally distressful."
"If I had to make the choice again, today, would I choose to specialize in geriatrics, gerontology and long-term care and I would have to say no," she added. "I would not do this as a profession. It's just too hard physically and emotionally."
Doyle said students are also not receiving the hands-on training required to work in today's long-term care facilities. It also means less people are going into the field at a time when there is growing demand.
"There is little incentive and many pitfalls," she said, adding compensation upon graduation is "subpar for the amount of physical labour, responsibility, stress and emotional turmoil that we deal with on a daily basis. Most front-line staff work at more than one facility to make full-time hours, and are required to work weekends and holidays."
The coalition says it's time to develop a capacity plan and build public not-for-profit long-term care homes. There is also an "urgent need to build culturally appropriate homes for racialized groups, safe spaces for LGBTQ2S identified people and other equity-seeking groups," people who often have the hardest time finding a placement.
The report says the the better investment is in public and not-for-profit homes, which are oversee by an elected board of directors, versus private homes where there's "incentive to siphon funds away from care and increase profit margins."
For the full report from the Ontario Health Coalition, click here.
Ontario Health Coalition's recommendations
- Increased funding must go toward improving care. The province must also institute regulated minimum care of four hours of daily hands-on care.
- Build capacity to meet the need for long-term care beds now.
- Stop downsizing public hospitals and refrain from offloading complex patients to long-term care homes.
- Provide long-term care homes with trained staff who are able to deal with people who have increasing responsive behaviours. Homes should have in-house Behavioural Supprt Ontario (BSO) teams.