Nursing homes are often the last stop for many seniors who can no longer fend for themselves. Adult children agonize over the decision to place their aged parents in institutions, but do so in the belief their loved ones will be well cared for and safe.
As a story in today's Globe and Mail reveals, however, nursing homes are not always peaceful enclaves. Residents have committed 14 homicides over 16 years in licensed nursing homes in Ontario. Though that province is the only one with a coroner's committee that specifically tracks nursing-home homicides, there is no reason to believe it stands alone in this problem.
One case highlighted in the story is that of Piara Singh Sandhu, who killed two people and came close to killing a third within seven hours of being admitted to the Casa Verde Health Centre, a Toronto nursing home. His weapon? A thick piece of metal he had pried off a meal traytable.
Like all nursing-home residents, the 74-year-old had been assessed by a community-care access centre. The assessment process and the monitoring of residents in that home and others will be reviewed at an inquest next month. Mr. Sandhu, who was charged with two counts of second-degree murder and one of attempted murder, has since died.
In another case, Giuseppina Robino died after a fellow resident allegedly punched her in the head at Toronto's Villa Colombo home for the aged. According to a police synopsis of the home's own notes, the man charged with her second-degree murder, Frank Pucci, is alleged to have exhibited aggressive behaviour on several occasions before the 96-year-old woman's death. Mr. Pucci's behaviour wasbeing monitored by the home's staff.
While homicides in nursing homes are rare, they are the barometer of a problem: how to manage agitated patients whose chronic brain disease can put them at risk for aggressive behaviour and even psychosis. Minor instances of aggression in nursing homes are frequent, putting the elderly and frail at risk.
Dementia is not about to disappear; the American Public Health Association has classified it as an emergent epidemic. But the question remains: How does one deal with such residents?
Some patients with dementia are quiet and passive. Others have specific types that put them at higher risk of aggressive behaviour, poor impulse control or hallucinations. Some have an additional underlying mental illness.
Treating these patients is complex and time-consuming. The key is assessment and monitoring. Surely any senior who exhibits a strong potential for violence should not be admitted to a nursing home, and hospitals should not feel tempted to discharge such patients in an attempt to free up a bed.
To that end, provincial governments should require a standardized assessment tool before any senior is admitted to a nursing home, with an eye to determin-ing risk. And those who are admitted should be continually monitored. For instance, an infection can make a placid patient with well-managed dementia delirious.
In all likelihood, some seniors will be found unsuitable for nursing-home life as they are prone to aggression and require constant care and surveillance. Governments should designate highly specialized institutions with a team of health professionals, including psychiatrists and geriatricians, to care for these "last resort" residents. This would reverse, to a degree, the often misguided decision to remove many people from institutions who needed such treatment.
An estimated 287,000 seniors live in nursing homes across Canada today. They deserve to spend their twilight years being well cared for, living their last days in dignity and peace -- not in harm's way.