The victim was an 86-year-old woman, her assailant a 75-year-old man. Both suffered from dementia, and when their paths crossed one day at the long-term care home where they lived, the result sent her to hospital with a broken pelvis and wrist and a gash on her forehead that needed stitches. She died in hospital a month later. Police were called, but no charges were laid.
Such resident-on-resident assaults are all too common in long-term care facilities, according to a report to Ontario's chief coroner that calls on the province to take immediate action.
The report, which was quietly released last month and has yet to receive a response from the province, looks at 45 deaths that were referred in 2013 and 2014 to a special committee of the coroner's office. Among them are 13 cases classified as homicides at long-term care homes, including one in which an 82-year-old woman was stabbed to death by her husband during a Boxing Day visit before he slit his own throat.
"If this was a small town, this would be a horrifying murder rate," said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly.
Roger Skinner, a regional supervising coroner and chair of the committee that wrote the report, describes the extreme cases it documents as the "tip of the iceberg." Many altercations likely go unwitnessed and are deemed accidents, he said, and most do not result in death.
The committee, made up of professionals who work in the field, recommends the province strike an expert panel immediately to deliver a plan.
"The issue of resident-on-resident violence in [long-term care] homes is an urgent and persistent issue," finds the report by the Geriatric and Long-Term Care Review Committee.
Given the aging population, the issue is not going away, Dr. Skinner said, and so an appropriate response is required.
"What we are doing is well and good, but it hasn't been enough," he said. "There has to be a better way to deal with it. Obviously, you don't want to throw your mother with dementia into jail," he said, but leaving her where she is may not be appropriate either.
Ms. Meadus said most homicides in nursing homes follow a similar pattern with one resident pushing another, causing injuries that later lead to death. Charges are rarely laid, often because of the mental state of the assailant, she said.
Only six facilities in the province have units for residents who need behavioural support, and the waiting lists are long, she said.
Dipika Damerla, associate minister of health and long-term care, said the government is reviewing the recommendations in the context of its province-wide dementia strategy. Every serious incident that takes place in a long-term care home should be reported to the ministry, she said, and every resident should have an individualized care plan.
Candace Chartier, chief executive officer of the Ontario Long Term Care Association, which represents private, not-for-profit, charitable and municipal nursing-home operators, said her board will meet with the chief coroner in January to discuss the findings. She said more provincial money is needed to care for residents with increasingly complex needs.
Residents are arriving sicker, she said, and more than half of the 77,000 people in long-term care have some form of dementia. Resident-on-resident violence is top-of-mind every day, she said, and homes are doing what they can with the resources they have. "This is probably our biggest issue."
France Gélinas, the NDP health critic who called a news conference Tuesday to draw attention to the report, said without proper support, residents in long-term care risk hurting themselves, each other and staff. "This report cannot be allowed to gather dust," she said.
Asked if the ministry will make public its response to the coroner's committee, Ms. Damerla said it will "respond to the recommendations in the standard way we always do," but could not provide further details.