Resident-on-resident violence on the rise

TORONTO – An investigation has found that reports of resident-on-resident abuse have risen sharply in Ontario nursing homes. Reports have increased from an average of four per day in 2006 to nine a day in 2016, despite only a small increase in the number of residents – to 78,000 in 2016 from 75,000 in 2006.

The investigation was conducted by CBC’s Marketplace, which found a number of factors behind the rise.

For one thing, a growing portion of the nursing home population suffers from dementia, and many facilities don’t have enough staff to handle the behavioural challenges that come with it.

As well, some nursing home officials say the increased numbers reflect more thorough reporting practices.

According to the most recent provincial data, reports of resident-on-resident abuse rose 105 percent in just six years, from 1,580 in 2011 to 3,238 in 2016.

Meanwhile, the prevalence of dementia increased from 56 percent of residents in 2009-2010 to 63.1 percent in 2016, according to the Ontario Long Term Care Association, which says it represents 70 percent of facilities in the province.

“We have a much older and sicker and frailer population, so you’re getting more people who are acting out and have these behaviours. And the people that they are acting out against are frailer and more likely to suffer some kind of consequence,” says Jane Meadus (pictured), a staff lawyer at the Advocacy Centre for the Elderly in Toronto.

Workers have been calling for a minimum staff-to-resident ratio in Ontario long-term care homes for years. The province only requires there be a registered nurse on duty 24 hours a day.

It’s difficult to prevent violence if there aren’t enough workers on the floor, says Miranda Ferrier, president of the Ontario Personal Support Workers Association, which represents 35,000 PSWs and advocates for standards in the profession.

“When we’re talking about putting more care into the system, we need to talk about more scrubs on the floor. How many staff do you have?” she says. “I truly believe that is the answer to so many of our problems.”

So, too, is proper training, Ferrier says. The majority of PSWs aren’t trained in crisis prevention and intervention strategies for people with dementia, she says. “That’s not mandatory for us.”

At night, when residents with dementia tend to need the most support, staffing levels can be especially low, she says. “They don’t sleep. They’re up. And they’re up all night. And typically what they’ll have is one personal support worker on a floor of 25 or 30 [residents].”

Another factor: Antipsychotic medications used to be more widely prescribed in nursing homes to treat symptoms of dementia such as aggression. In 2012-2013, nearly a third of seniors in Ontario facilities were prescribed these drugs without a related diagnosis of psychosis.

But there has since been a push from families and advocates to get seniors off antipsychotics because the drugs were found to have dangerous side-effects, including increased risk of confusion, falls and death.

CBC hired two statisticians to analyze government data from more than 600 long-term care facilities in the province over the past five years. They found that as antipsychotic usage went down, reports of resident-on-resident abuse went up.