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Health coalition chair: Long-term-care homes becoming dangerous places to live

'Situation Critical' reveals 27 homicides in LTC homes across the province in a five-year span
Sudbury Health Coalition chair Dot Klein looks over the report, “Situation Critical,” with Terry Martyn, a member of the family council at Pioneer Member and the Grand Family Council. (Arron Pickard)

The chair of the Sudbury Health Coalition said the most dangerous place to be in Canada is a resident of a long-term care home.

Dot Klein said the Ontario Health Coalition's report titled “Situation Critical” reveals there were 27 known homicides in a five-year period in long-term care homes across the province — and those are resident-on-resident killings and does't include incidents of staff killing residents.

The report is being released in communities across the province, and takes an in-depth look at the increased need and inadequate levels of care in the province's LTC homes, in which nearly 80,000 people live.

The report says the lack of staffing required to monitor aggressive LTC residents is one the central factors that has led to such a high level of resident-on-resident violence in Ontario's long-term care homes.

Norma Timmermans' husband, Byron, was a victim of violence when he was a resident at a long-term care home in Greater Sudbury.

He was pushed out of a chair in the TV room, because another resident wanted to sit there, Timmermans said. The fall fractured his clavicle.

Byron suffered from vascular dementia, and lived on the lock down unit of that facility. According to statistics, 81 per cent of people in long-term care homes have some form of cognitive impairment, with nearly one-third displaying severe cognitive impairment.

It was another resident with dementia that pushed Byron out of a chair favoured by the residents. He simply wanted the chair. Almost half of residents in long-term care exhibit some form of aggressive behaviour, the report says.

Other residents would constantly enter Byron's room and take his clothes and other personal items -- anything they could get their hands on, she said. This all happened during the year and a half Byron lived at the long-term care home. He died in 2012 at age 72. 

Timmermans said she feels guilty for agreeing to let her husband live in a long-term care home. 

“If I had to do it all over again, I'd have kept him home and hired someone to come into our home to care for him,” she said.

Timmermans was also a panel member at the launch of “Situation Critical.” 

The report says the level of violence at long-term care homes will only escalate as the severeness of residents' mental health challenges increase and care levels decrease.

The report says the number of resident-on-resident assaults increased 129 per cent between 2011 and 2016. Staff at LTC homes saw a similar increase in the number of assaults by residents, with more than 95 per cent reporting they have experienced physical, verbal or sexual violence. More than half report they experience violence daily.

Klein, a registered nurse who has worked in long-term-care for 14 years, has seen a great deal of violence in her experience. Even so, she called the information contained within the report “shocking and unacceptable.”

With respect to residents with dementia, many of them wander at night. They wander into another resident's room, and they think it's their room. They try to throw the resident out of their own room, thinking it's their room. Or worse, they may actually choke the resident, and if they don't kill them, it means the level of care required for the victim will increase. 

“This should serve as a wakeup call that can no longer be ignored,” Klein said. “What we found is that long term care homes have a homicide rate seven times higher than that of the largest cities of our country.”

Homicide sounds sensational, she said, and the intent is not to scare people, “but we need to shine the spotlight on this issue so we can finally address it,” she said.

“The data contained with in the report should raise some serious questions with policy-makers. I'm excited this report is finally being made public. We want action. Together, our voice will be stronger.”

The province is making moves to reduce funding even more, she said. – most of our LTC homes in Northern Ontario are privately owned – profit is what is driving the fact the staffing levels are getting lower and lower – we want the province to assure us that public health care beds in LTC facilities will be increased – right now, there are less public beds available beds in LTC than there are in privately funded facilities

The report makes a number of recommendations, including:

-Levels of care in Ontario's long-term care homes must be improved and this improvement must be mandatory and enforceable. Increased funding must go to improving care. The Ontario government must institute a regulated minimum care standard of an average of four hours of daily hands-on direct nursing and personal support per resident to provide care and protect from harm.

-A plan must be developed and implemented to build capacity to meet the need for long-term care beds now, but a decade down the road, and this capacity should be build in public and non-profit homes that are operated for the public good. Long-term care capacity planning must meet the ethno-cultural needs of all Ontario residents, and special attention and urgency must be given to redress the disproportionate wait times and differential access issues experienced by equity-seeking communities. 

-Public hospital downsizing must be stopped and public hospital capacity rebuilt to meet population need, according to the evidence. The offloading of complex patients into long-term care must stop.

-Long-term care homes must be resourced with trained staff able to deal with the increasing responsive behaviours in the homes. Homes should have in-house Behavioural Support Ontario teams in addition to the four-hour minimum care standard.
“I really hope the public realized just how critical this is, and really starts to pressure the province to respond to our recommendations,” Klein said. “This isn't stopping.”