By Zaid Noorsumar
Punched. Groped. Kicked. Killed. Violence in long-term care homes has to stop.
Staff and residents are caught in a vicious cycle of violence in Ontario’s nursing homes.
Caregivers who are punched, kicked, and spat on as they tend to residents. Caregivers who are scratched and bitten. Accustomed to bruises and burns. Groped and harassed. Burnt out, anxious, stressed and depressed.
The working conditions of caregivers in Ontario’s long-term care homes are nothing short of appalling, according to a recent CUPE-commissioned survey of over 1,200 workers. Sixty-two per cent of personal support workers experience daily violence from care recipients.
Nearly 90 per cent of personal support workers (PSWs) and registered practical nurses (RPNs) experience at least occasional physical violence.
Heather Neiser, president of CUPE local 1404, has worked as a PSW for 20 years. Over time, she has witnessed and heard about a long list of shocking incidents.
“[There was an] RPN that had a call bell tied around her neck,” she says in an interview with RankandFile.ca. “She was being strangled.”
“A PSW who was working alone on night shift – and they were short staffed and the resident grabbed her and put her against the wall and started shaking her and bashing her head against the wall,” she continues. “She never returned to work since and that was over 10 years ago.”
Where does the violence come from?
One of the more disturbing aspects about this issue is that violence in Ontario’s long-term care homes is not new.A 2008 study by York University and Carleton faculty described the situation as “out of control.” Back then, over 40 per cent of workers faced violence on a daily basis. Eleven years later, working conditions have worsened.
Researchers point to the same underlying issue: long-term care homes are severely understaffed, leading to declining quality of care.
Investments in the form of staffing and other supports is more essential than ever as the 78,000 residents in the long-term care system are older, frailer, and have increasingly complex needs.
Neiser says residents react out of frustration and despair.
“Residents are getting violent because we can’t meet their basic needs,” she says.
“They’re getting violent because they have to go to the bathroom but there’s nobody there to take them to the bathroom,” she says. “They’re getting violent because they’re in a wet brief or they’re hungry or they’re thirsty [but just not being cared for due to short-staffing].”
Neiser’s description of the interaction between residents and care providers sounds more like an assembly line than a relationship based on empathy and care.
“Literally a resident gets up, gets sat in the wheelchair, gets parked in front of the TV, gets shuffled into the dining room, gets shuffled out of the dining room, gets parked in front of the TV,” Neiser says. “If they are lucky they get toileted, then they get shuffled back into the dining room for lunch, shuffled back out to the TV until supper, shuffled back into the dining room for supper, and then they get put to bed after that.”
She says simply having more time to talk to people and form bonds with them would be helpful, but that would require more frontline workers.
The interwoven requirements of workers and residents
Although the relationship between residents and care providers could be seen as antagonistic, both groups are suffering directly as a result of years of underfunding, neglect, and understaffing.
“We advocate for the patients,” says Natalie Mehra, executive director of the Ontario Health Coalition (OHC), a healthcare advocacy group. “But in this case, the interests of the patients and the workers are the same. The conditions of care are the conditions of work.”
A recent study, titled Breaking Point, based on in-depth conversations with 57 nursing home staff working across seven communities shows the mindset of workers unable to live up to their commitments:
- “We feel helpless and hopeless because we can’t protect ourselves and we can’t protect the residents. I’m supposed to be caring for these people. There’s just not enough staff.”
- “When I go home and I’m trying to sleep at night I can still hear the poor man screaming. I’m not able to let that go. Or that poor woman lying in her bed that I didn’t have time to tend to. That bothers me even more.”
- “They’re not machinery. We’re not dealing with car parts. We’re dealing with actual human beings that you can’t rush and that deserve better than what we’re giving them. At the end of my shift I feel exhausted, mentally and physically.”
- “If a resident has died overnight, I don’t want to think that yesterday he was cold, and I didn’t have time to get the sweater he asked for on the last day of his life.”
“He later died from those injuries”
Nursing home violence manifests as assaults on caregivers but also attacks on other residents. Intra-resident homicides are not uncommon – there were 27 killings from 2012 to 2016 based on data from the coroner’s office.
“In my facility we had a resident beat another resident at two o’clock in the morning and he later died from those injuries,” Neiser says.
The OHC calculates that at 7 per 100,000, the homicide rate in long-term care is worse than the 1.55 per 100,000 rate of Toronto.
Mehra blames ageism for the apathy by public officials in responding to a situation that is no less than a crisis.
She says the prime minister, premier and mayor rightly expressed their concern at the high level of shootings in Toronto last year – but haven’t taken note of a far more volatile situation in nursing homes.
“I think that there’s a tolerance of elderly people and people with chronic illness and disabilities living in conditions that are beyond what should be tolerated in any decent society,” Mehra says.
Sexual assaults and racism
About 90 per cent of PSWs in long-term care are women, and they face pervasive sexual violence. Forty-four per cent of female staff are at least occasionally sexually assaulted.
Sexual harassment is also rampant. The Breaking Point study revealed astonishing anecdotes:
- “You’ve got a nice set of tits on you.’ I get that all the time, or they grab my butt. It’s degrading. There are times that you just sit down in your car and cry.”
- “He groped me when I was bathing him. It bothered me for a very long time, but I didn’t dare say anything because I was worried about my job. I was a single mom and I had to work.”
For staff who identify as Indigenous, racialized and new immigrants, harassment is common. Participants in the aforementioned study said:
- “She had a southern drawl and used to say, ‘Oh you. I had slaves like you.’”
- “Oh, an immigrant. Where did they find you? Downtown? Brought you here?’”
“An angry, upset workforce”
Although well-aware of the problems in nursing homes, Mehra says her recent interactions with long-term care staff jolted her nonetheless.
“I was shocked at how upset and angry and used and abused personal support workers feel,” she says.
“There are severe shortages of personal support workers across Ontario. New personal support workers start in homes – they don’t even last till coffee break because they see the working conditions and they leave.”
The revelations from the Breaking Point study convey the devastating toll on workers:
- “I’m still not the same nurse that I used to be. There are such lasting effects. It’s not just over when the bruises heal.”
- “The next day when I went in, I knew I’d be going into the room with the man that chased me down the hall. It all started coming back and I was on guard. You can’t give good care that way. You don’t want to get that swat in the head.”
Sixty-five per cent of staff in the CUPE survey said they were considering leaving their jobs.
The attrition rate accompanied by high absenteeism is fueling more violence as it overburdens the already-stretched workers. Due to low wages and terrible conditions, recruiting PSWs is a challenge.
Why hasn’t this issue been resolved?
One of the simplest solutions is to hire more staff. Ninety-two per cent of the workers polled in the CUPE survey said as much. Staffing in nursing homes is directly tied to government funding – but it’s also related to ownership.
In Ontario, there are three types of nursing homes: non-profits, government-owned, and for-profits.
Over the past two decades, the for-profit homes have come to dominate the sector. From owning a minority of nursing homes in the ‘90s, they now own 58 per cent of them.
Research shows that for-profit homes employ fewer workers to maximize profit. Consequently, they provide a lower quality of care than government-owned and non-profit facilities, although there are exceptions to the rule.
In effect, during the neoliberal era of restrained government budgets and privatization, Ontario’s long-term care has been degraded.
“We’ve been reducing taxes, especially for those who are most able to pay taxes,” says Pat Armstrong, a York University professor who has been extensively studying long-term care.
“So it’s a revenue problem,” she says. “At the same time, we haven’t expanded the healthcare system to accommodate the changes in the population, or even adequately fund a whole range of services.”
Stay tuned for the upcoming part two to learn about why ownership matters, how privatization of the industry has had a profound impact on the level of care and how successive governments have failed to address the problem.