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The greatest danger old people face in nursing homes? Other residents

Stories of elder abuse in long-term care facilities usually involve rogue staff. So you may be surprised to learn that the vast majority of violent assaults in Canadian nursing homes involve one resident attacking another.

You may be even more surprised to learn that the problem has been growing for years, and that one public report after another has recommended changes (to funding, to training, to institutional protocols) but that these recommendations have been systematically ignored.

In this episode, we take our cameras into several nursing homes in Ontario. We don't have to wait long to see the violence first-hand. As Erica Johnson reports, it's a complex problem with a complex solution, mostly dependent on funding.

For more on violence in nursing homes, tune into CBC Radio on Monday, Oct. 22, for Beaten Down: Fear and violence in Canada's nursing homes. A CBC News investigation.

The statistics
Incident reporting rules vary greatly from province to province, so comparisons across the country are difficult. But in Ontario alone, the number of assaults between nursing home residents has tripled over a three year period:

2003 - 446 assaults
2004 - 864 assaults
2006 - 1415 assualts

On average there are now four attacks reported every day in Ontario. The Ontario government's own documents reveal that one in five nursing home residents is now considered "highly aggressive."

There have been almost twenty resident-to-resident homicides in Ontario nursing homes in the past 10 years. The assailants have been as young as 35 and as old as 92.

For almost 15 years Ontario?s coroners have made dozens of recommendations, warned about violence and urged the government to protect the elderly from aggressive residents.

In 2005, after an inquest into the beating death of two long term care residents the Ontario coroner for geriatric and long term care made 85 recommendations. Most have not been implemented. Here's a link to the coroner's report from that inquest.

The incident reports
Under Freedom of Information requests, Marketplace obtained copies of several "Incident Reports." These are the documents staff at care facilities must complete after a violent incident. Names of residents, staff, and facilities have been removed.

The reports to the Chief Coroner
Every year, the Geriatric and Long Term Care Review Committee to the Chief Coroner of Ontario prepares a report, meant to draw attention to areas of concern in the province's system of care for the elderly. The following links point to those reports for the years 1993 through 2006,

For most years, we have added yellow highlighting to mark items connected with resident-on-resident violence in nursing homes. (The 2005 report is not currently available in electronic form. We hope to post it here shortly.)

  • 1993 (See p.22 recommendation on identifying "factors for aggressive behaviour")
  • 1994 (See p.9 recommendation against sending patients to homes without appropriate staff or facilities)
  • 1995 (See p.7 recommendation for policies to ensure individualized treatment for behaviourally disturbed residents)
  • 1996 (See p.10 recommendation for ongoing observation and intervention in cases of behaviour change)
  • 1997 (See p.7 recommendation for extensive communication within care team in cases of behavioural problems)
  • 1998 (See p.10 recommendation for provincial policies and strategy "to manage physically aggressive demented patients")
  • 1999 (See p.14 recommendation for ongoing staff training in management of aggressive behaviours)
  • 2000 (See p.10 recommendation against first-line use of drugs to control behavioural problems)
  • 2001 (See p.16 note: "with increasing frequency, long term care facilities are being challenged by demented residents with aggressive tendencies")
  • 2002 (See p.8 recommendation for improved documentation standards for Incident Reports)
  • 2003 (See p.18 recommendation that elderly patients with unsafe behaviour only be discharged to facilities that can provide "safe environment and level of supervision")
  • 2004 (See p.15 recommendation for comprehensive assessment tool to identify unsafe behaviours before elderly patients are placed in long term care facilities)
  • 2006 (See extensive p.10 recommendations on placement of behaviourally problematic patients)
What to do if someone you love needs long term care
Before a move into a care facility:

  1. 1. Ask about assaults. Find out how frequently they happen, and what procedures are followed for intervention and prevention.
  2. 2. Ask about staffing levels. Ask how many of the staff are trained in handling patients with dementia. What is the staff to resident ratio?
  3. 3. Visit the home. Don?t do just one tour; also visit unannounced. Visit at different times including during meals and at night. Does the home smell? Are staff available? Are the residents lining up in the hallway or wandering around? Does there seem to be anything for residents to do?
  4. 4. Visit different floors. Ask to see different floors in a home, including any locked wards. If your request is refused, that is a good sign there may be problems on other floors. Generally the first floor has the residents with the fewest behavioural issues, because that location is closest to the door.
  5. 5. Talk to people. Does the home have a family council? Talk to people on the family council, talk to residents, talk to family members.
After move-in:

If you have questions or concerns about resident to resident abuse in a long term care home, first discuss your concerns directly with the home's administration.

If you witness an incident of abuse, immediately alert staff and make sure the incident is recorded in writing.

If your concerns are not addressed to your satisfaction, contact the ministry responsible for Long Term Care in your province.

Here are some useful links:
Advocacy Centre for the Elderly
Concerned Friends of Ontario Citizens in Care Facilities
B.C Coalition to Eliminate the Abuse of Seniors
National Coalition for Senior Mental Health
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