13 homicides in long-term care the 'tip of the iceberg'

The 13 homicides found to have been committed in long-term care homes in 2013-2014 are just the "tip of the iceberg," says the coroner who chaired the committee that wrote the report.

But Ontario's Ministry of Health and Long-Term care says it's taking the necessary action to address the issues raised in the report released last October, a report that described the extent of violence in long-term care homes across the province.

The Geriatric and Long-Term Care Review Committee 2013-14 Annual Report, issued by the Office of the Chief Coroner for Ontario, looked at 45 deaths in long-term care homes during that period, and found 13 cases classified as homicides.

Dr. Roger Skinner, a regional supervising coroner and chair of the committee that wrote the report, later described those 13 cases as only the “tip of the iceberg”, because most altercations between residents at long-term care facilities don't result in death, but are often reported as accidents when a resident is injured.

In July 2014, a resident at Finlandia Village's Hoivakoti Nursing Home died in hospital after falling in the dining hall and suffering a head injury after striking the wall.

The fall happened after a minor disagreement with another resident, but police determined it was an unintentional accident.

Long-term care experts say the majority of altercations involve residents with some form of dementia.
To address the issue, the province says it is investing $44 million per year into its Behavioural Supports Ontario (BSO) initiative.

Through the initiative, more than 600 personnel across Ontario have been trained to identify triggers and address challenging behaviours that may result in harm.

“These BSO units are administered through a combination of teams in our long-term care homes and through mobile teams that service long-term care homes,” said Ministry of Health and Long-Term Care spokesperson Mark Nesbitt in an email to NorthernLife.ca. “In addition, the lon-term-care sector has received over $20 million to provide staff training in resident safety and to advance the quality of care residents receive.”

Nesbitt said the ministry also launched Ontario's Dementia Strategy Expert Panel in July 2015 to develop a provincial dementia strategy.

“To ensure the Coroner’s recommendation is addressed, the ministry has asked the Dementia Strategy Expert Panel to specifically examine the issue of resident-on-resident violence,” he said. “We have consulted with the Chief Coroner to ensure this approach satisfies his recommendations and he is fully supportive of this approach.”

But NDP health critic France Gélinas said there has not been a sufficient government response to the coroner's office report on long-term care homes.

“The issue of violence in our long-term care homes has to be addressed,” she said.

Although all long-term care homes in the province have access to the Behavioural Supports Ontario mobile teams, not all have in-house staff who are part of the program, and only eight have behavioural support units, designed specifically for residents with behavioural issues.

Sudbury's Pioneer Manor does have seven staff members – three registered practical nurses and four health care aids – who are trained through Behavioural Supports Ontario, but does not have a behavioural support unit.

“They help provide services for our residents that have more complex responsive behaviours,” said Kim Pelkman, Pioneer Manor's manager of therapeutic services.

Pelkman said Pioneer Manor has been involved with Behavioural Supports Ontario since 2012.

The seven staff members are trained to identify verbal, physical and repetitive behaviours associated with risk, and to mitigate the potential for violent behaviour.

“Sometimes it's something as simple as noise in the dining room setting someone off,” Pelkman said.