Programs to curb abuse at long-term care homes helping, but not enough

Much of the abuse at long-term care homes stems from resident-to-resident assaults, but there's a new provincial program, Behavioural Supports Ontario, to help counter the problem.

The program is designed to help staff better care for and protect residents with dementia - but it's a solution that isn't always working.

That's largely because the program doesn't work if it isn't effectively used, and that's all too often the case.

According to the Ministry of Health and Long-Term Care, over the past three-and-half years, there have been 1,500 reported cases of abuse or neglect in southwestern Ontario's long-term care homes - and many of those cases involve dementia residents assaulting each other.

To help curb resident-to-resident violence, the Behavioural Supports Ontario (BSO) program was developed, which comes up with individual plans for residents with cognitive impairments and sends trained personnel into homes.

Ritz Lutheran Villa in Mitchell, Ont. has dealt with resident-to-resident violence before, and its director says, BSO helps.

Tanya MacDonald says "Having the BSO people to do the assessments and set up the care plans, that's been a huge part...We have a couple of days a week at this home, but we would love to have even more than that."

Across the province $44 million is spent on specially trained personnel for the program, with southwestern Ontario getting about $6 million.

Total funding for the BSO program per Local Health Integration Network in 2013-2014 according to the Ministry of Health and Long-Term Care:

LHIN		BSO Additional Healthcare Personnel $M	200 BSO Nurses $M	300 BSO PSW $M	Totals $M
Erie St. Clair		0.7733	0.9164	0.9298	2.6195
South West		1.0499	1.2218	1.2397	3.5114
Waterloo Wellington		0.7802	0.9164	0.9298	2.6264
Hamilton Niagara Hamilton Brant		1.2680	1.4509	1.4980	4.2169
Central West		0.6199	0.7636	0.7232	2.1067
Mississauga Halton		0.9406	1.0691	1.1364	3.1461
Toronto Central		1.0327	1.2218	1.2397	3.4942
Central		1.2868	1.5273	1.4980	4.3121
Central East		1.3359	1.5273	1.5496	4.4128
South East		0.7877	0.9164	0.9298	2.6339
Champlain		1.2144	1.4509	1.4463	4.1116
North Simcoe Muskoka		0.7392	0.8399	0.8781	2.4572
North East		0.8526	0.9927	1.0331	2.8784
North West		0.4113	0.4582	0.4649	1.3344
Totals		13.0925	15.2727	15.4964	43.8616

Miranda Ferrier, president of the Ontario PSW Association, is a big fan of program, but says, it's too limited.

"What a lot of people tend to think is that there's always a team on every shift that are trained in the BSO, when in actuality and in reality, there aren't."

That's something Belinda Strickland knows that all too well. Her husband Dennis Strickland is currently in the hospital after he assaulted another resident, for the second time.

"Dennis got confused, he got agitated and he slapped the gentleman, as this is happening there is an employee that witnessed all of this and didn't step in until Dennis slapped the gentleman," she says.

Tendays earlier the BSO had developed interventions to decrease his anger and agitation, for example relocating him or giving him a tool belt filled with activities to easily distract him.

But Belinda says "None of this was done - the recommendations - they had 10 days to put it in place, and none of this was done."

And Ferrier says that's often the case, "A lot of PSWs don't know there's a plan in place for certain residents, because I guess the home doesn't have the time to tell them or doesn't make it a priority."

For Ada Cuthbert, a repeated victim of assault, there's a different type of plan in place - a protective one.

A chair is placed in front of her door and a banner of sorts is attached over the doorway to stop people from entering her room.

But her daughter Carol Cuthbert says, it isn't enough, especially since it isn't always there, "Chair wasn't there, chair was down the hall, banner down, banner gone."

The most recent attack on Ada was at the hands of a man with a history of dementia-related violence, and Carol says security measures should have been put in place from the onset, and blames the home.

"All those PSWs and nurses and doctors and they all know about 'Joe Blow' and what he just did for the past five weeks. Why was there nothing in place after the very first time he hurt somebody?"

St. Joseph's Health Care's Karen Perkins says it isn't that easy, "If we isolated these individuals and it was just something that would happen occasionally, how wrong would that be? If that was your family member, how wrong would that be?"

Neither minister involved in long-term care would speak with CTV News on camera, but in a statement, Associate Minister of Health and Long-Term Care Dipika Damerla says she has zero tolerance for abuse, neglect or harm - which is why there is now stronger enforcement and better inspections of long-term care homes.

But while inspections may be better, penalties for violations are minimal.

St. Joseph's Mount Hope Centre for Long Term Care was inspected after Ada's Valentine's Day beating, and for the other assaults the home didn't originally report to the Ministry.

In the end, their punishment for violating several sections of the Long-Term Care Homes Act - including failing to protect a resident from abuse - was a compliance order and the requirement that they develop a plan for reporting abuse to the Ministry and for better protecting residents.

It wasn't the first time the facility was cited for these types of violations and yet there were no fines, no real punishment.

Ada's daughter Carol says "To me, there's no excuse for people getting assaulted in long-term care...I will eat anything you hand me that is a reason for that. Because it just shouldn't be, and when it does happen, you don't sweep it away."

And Ferrier says it will get worse if homes don't fix the underlying problems, including "lack of staffing, lack of knowledge, lack of communication."

Coming up in part three: Find out what the most common issues long-term care homes and residents are facing, and how they are being dealt with.

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