BACKGROUND: According to AGING WITH CONFIDENCE: Ontario’s Action Plan for Seniors Report, “in 2016, 16.4% of Ontario’s population was 65 years or older. By 2041, it is projected that 25% of Ontario’s population will be 65 years or older, almost doubling from 2.3 million seniors in 2016 to 4.6 million seniors” (Ontario Ministry of Seniors Affairs, 2017, p. 9). In 2010 Statistics Canada reported 4.8 million seniors in Canada of which 2.7 million, or 56% were women. It is projected that by 2031, in Canada, 9.6 million seniors and 53% of these, or 5.1 million seniors, will be women. In 2031, 1.6 million of those women will be over 80 years of age (Milan and Vezina, 2011).
In 2009 BPW Sault Ste. Marie presented Resolution Number 100.80.30 – Long Term Care Facility Elder Abuse was based on the Coroner’s Jury Verdict and Recommendations from the Inquest into the deaths of Ezzeldine El Roubi and Pedro Lopez which made 85 recommendations. Most of the recommendations specifically 18 to 21 dealt with placement of individuals, 22 to 25 dealt with specialized facilities and units, and 26 to 33 dealt with revisions to the Ministry of Health’s Long Term Care funding and staffing (BPW Ontario, 2009); Office of the Chief Coroner Ontario, 2006).
Coroner comments included: 1 in 5 elderly persons entering long-term care are aggressive and/or violent; with the closing of long-term care psychiatric beds there are no other facilities to place aggressive dementia patients; the types of patients described in the previous statement require specialized treatment and care; Ontario long-term care residents have the lowest direct contact with Registered Nurses (“RN”) in the country; the requirement of 1 RN per facility is not satisfactory as a facility could have up to 300 residents; and properly trained staff present to gather information and assist with the assessment at the initial interview would be helpful (Office of the Chief Coroner Ontario, 2006).
On January 21, 2019, The Ontario Health Coalition (2019) released the Situation Critical – Planning, Access, Levels of Care and Violence in Ontario’s Long-Term Care report which discussed the need for additional trained staff to reduce the number of violent incidents and clearly stated: “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 (BSO) teams in addition to the 4-hour minimum care standard.” (p. 37). Another reason for increased abuse in long-term care facilities includes hospital offloading, increased complexity of care and psychogeriatric cuts. Seniors with existing mental illnesses have lost over several decades, psychogeriatric unit beds, all over the province, as psychiatric hospitals were closed, and these elderly patients were shuffled to long-term care facilities that were and are not necessarily equipped or staffed to meet these seniors’ different needs (Ontario Health Coalition, 2019).
Violence in long-term care facilities is not limited to residents. The Ontario Health Coalition report (2019) subsection: Violence against Long-Term Care Staff in Chapter VI. Escalating Violence states:
In a study of workforce violence, the vast majority of Personal Support Workers (more than 95 per cent) working in long-term care homes in Ontario, Manitoba and Nova Scotia were women. Almost all of these Personal Support Workers in long-term care homes report that they have experienced violence in either physical, verbal or sexual capacity, and almost half report that they violence they experienced occurred daily…The numbers of nurses, both RNs and RPNs, who report violence is also extremely high. Most of the violence goes unreported unless medical attention is necessary (p. 29).
CBC News, reporting on the Ontario Health Coalition report, included provincial statistics showing resident to resident abuse in long-term care facilities rose from 1580 incidents in 2011 to 3238 in 2016 and that agencies, such as Thunder Bay Health Coalition have been advocating for four hours per resident direct care per day for years (CBC News, 2019; Mancini, 2019). While some of the provincial legislation has changed since Resolution 100.80.30, there continues to be issues with elder abuse and violence in long-term care facilities and there are indicators to show that the situation will continue to deteriorate unless funding is provided for more adequately trained staff in numbers able to manage the situations.
