Violence in institutions is a terrible thing. Violence of any kind. Unfortunately, the extreme incidents, like this one, get all the press. People stand up in horror, yet no one is willing to step up to prevent it.
There are many stakeholders in senior healthcare. But there are only two place where seniors may be placed in an institution.
What people do not understand is that there are various kinds of residences.
1) A retirement home
2) Long-term care (LTC) (AKA 'nursing home')
There is a huge difference between the retirement home and LTC
In the first, a senior will choose to live there, with some support in ADLs, such as group meals, housekeeping services, administration of pharmaceuticals, and so on. They can buy more services, and CCAC may send in more support. Life in a retirement home is controlled by a for-profit landlord, who is governed by the Retirement Homes Act.
In a LTC, the institution is, statistically speaking, a for-profit, but it is forced to abide the rules and regulations of the LTC Act, with strict protocols for reporting incidents.
There are no rules regarding the number of staff on duty.
There are no rules on how many nurses are available. Most staff are Personal Support Workers. They work under the nursing department, but have no nursing qualifications. PSWs are trained, most have a certificate, after earning a grade 12 education. There are various levels of competence, various training programs (all unregulated), various levels of knowledge, kills and values that staff work by within an institution. Employers demand different things from staff. Employers are not mandated to provide a particular level of staffing. I sat two days in a row, for 5 hours with a pallative client (a veteran), and the nurse in this for-profit, run-down retirement home, never darkened the door. His room was filthy. He had undiagnosed pneumonia. They told family that they were able to manage his care. They were not.
What family members need to know is how to protect their loved ones
This dear husband meets with his spouse and two other hubbies in the activity room. They chat, share stories, enjoy life.
Visit regularly and irregularly
Understand the limitations of the residence, purchase extra support if required
Ensure that the physicians are making regular visits, with you there
Volunteer, provide assistance in terms of time, energy or support
Speak truth to power
Complain to someone, take notes, cite incidents
Establish a rapport with staff
Meet regularly with the physician, charge nurse
What should we demand of these institutions?
My friend, Miranda Ferrier, President of OPSWA . We are in agreement about many of the issues in staffing.
1) Better and consistent training and regular upgrading for PSWs; including Non-violent Crisis Intervention, Gentle Persuasive Approaches in Dementia , standardised programs.
2) Regulation of PSWs
2) Staffing ratios that are based on the needs of the residents, not the budget of the for-profit home.
3) Early identification of disorders, such as aggressive dementia residents, with early intervention.
4) Proper placement of such residents, in locked facilities, with intense support, and high caregiver/resident ratios.
Identify violent residents with dementia. Charge them with assault, these statistics can be recorded and must be reported. Ensue that they are in a locked wing.
Protocol: report to family, report to police, report to MOHLTC
Put staff on alert: each LTC and MOHLTC provide extra staff for locked wings, and violent offenders.
MOHLTC provides expert consultants to work with LTC.
Move offenders immediately.
Lockdown the perpetrator after an attack, charge them. More staff at night. Residents do not necessarily sleep well.
Banish the myths of the gentle, aging senior. Deal with protecting those who are victims.
Complaints about long-term care If a senior is in Long-Term Care the government has rules and regulations that abound. Long-Term Care homes in Ontario have a strict complaints process. If there are complaints, and there are enough, then they go on warning and are said to be non-compliant. As a Transfer Payment Agency, they must fulfill the obligations of their mandate.