There have been at least 29 homicides in six years inside long-term care facilities in Ontario, according to a new report that blames the violence on underfunded nursing homes and cuts to hospital beds for seniors with complex illnesses and advanced dementia.
The Ontario Health Coalition, an advocacy group that lobbies for public health care, says the province’s 627 nursing homes have become more dangerous as the typical resident has grown older, sicker and more prone to dementia-driven aggression.
But the gradual escalation in resident-on-resident violence at nursing homes is not the inevitable outcome of an aging population, according to Natalie Mehra, the coalition’s executive director.
Rather, she blames successive provincial governments for squeezing the funding for health care – especially funding for hospital beds – to the point where the frailest and neediest patients are dumped in nursing homes that do not have enough money or staff to care for them.
“Today’s long-term care homes are the psychogeriatric hospitals and chronic-care hospitals of yesteryear,” Ms. Mehra said. “Only they’re not funded anywhere near to the same extent.”
The average public funding for a bed in a long-term care home – the heavily regulated and partially government-funded places better known as nursing homes – is $170.14 a day, the report says.
That is much less than the $450-to-$500 a day the province spends on hospital-based complex continuing care, where half the beds have been eliminated over the past 30 years as governments of all stripes transferred more health services to the community.
The figures in the Ontario Health Coalition’s report, released Monday, are drawn from publicly available sources, including annual reports from the Office of the Chief Coroner of Ontario, which has a committee that reviews all homicides inside long-term care homes. The coroner’s office defines homicides as one resident causing the death of another; the definition does not imply criminal culpability.
The coroner’s office recorded three definite and two possible homicides inside long-term care in 2012, followed by five, eight, seven, four and two such homicides in each of the subsequent years.
The tally does not include any of those murdered by Elizabeth Wettlaufer, the former nurse who is serving a life sentence for killing eight residents at two southwestern Ontario long-term care homes.
One of the cases that the coroner’s geriatric and long-term care review committee described in its 2017 report is typical of how homicides unfold inside nursing homes.
On March 29, 2016, a 92-year-old woman died almost two months after a fellow resident pushed her, causing her to fall and break a hip.
The victim had psychosis, dementia, congestive heart failure, diabetes, arthritis and cataracts, among other ailments. She was on 12 different medications. She often yelled and pushed other residents with her walker, including the 73-year-old woman who shoved her and, ultimately, caused her death.
The 73-year-old was also plagued by dementia, anxiety, depression, arthritis and other illnesses; the review describes one incident in which she entered someone else’s room, toppled furniture and proceeded to undress and walk around.
“Part of the problem is that we just send everybody to long-term care and say, ‘They can just take care of everything,’” said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly. "Well, they can’t.”
Hayley Chazan, press secretary to Health Minister Christine Elliott, blamed the previous Liberal government for leaving the province with “a fractured health-care system that does not work for the people of Ontario."
However, she also said by e-mail that all front-line staff in long-term care receive annual training in managing the behaviour of patients with dementia and mental illness, and that an immediate inspection is undertaken whenever there is serious harm, or risk of harm, to a resident.