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Violence against workers rampant in long-term care: report

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They’re mostly women, overburdened at work, some withstanding punches, groping, and insults daily from the people they’re employed to help, researchers say.

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Ontario long-term-care home workers rarely complain, for fear of reprisal from their employers, and amid an absence of hope anything will change, said Jim Brophy and Margaret Keith, authors of Breaking Point: Violence Against Long-Term Care Staff.

If workers do speak out – said the duo behind the recently self-published, peer-reviewed study – they’re told the physical and verbal abuse they suffer, and the mental pain it breeds, is just part of the job.

“The system is at a breaking point … staff are at a breaking point,” Brophy said

He and Keith, formerly of the Occupational Health Clinic for Ontario Workers (OHCOW) in Sarnia, and now researchers associated with the University of Windsor and University of Stirling in the United Kingdom, said they’ve spent the last several months meeting personal support workers (PSWs), registered practical nurses (RPNs) and others subject to abuse in the system.

Once nursing homes for the aged, now catch-alls for people of all ages with cognitive disabilities and other needs, Ontario’s long-term-care homes – mostly private-run facilities – are understaffed and underfunded, the duo said.

The situation leaves workers – about half of whom are racialized, indigenous or immigrants – in an impossible situation wherein they’re often individually responsible for a dozen or more residents’ care and can’t give them the personal attention they need, they said.

Workers are spit on, slapped, punched, sexually assaulted, burned with hot coffee, and confronted with racial epithets from residents, some dealing with dementia, and agitated by the abrupt, assembly-plant-like approach to care, they said.

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Family members, irate their loved ones aren’t receiving enough attention, turn their ire – often verbal – on the people least able to make a difference, they said.

Their decades of work in occupational health didn’t prepare them, Keith said, for the horrors they heard, mostly from personal support workers who have the most frequent contact with long-term-care home residents. Many workers were shaking or in tears as they recounted attempted rapes, tooth-popping blows, and bruising attacks, she said.

“Every single person has a story or many stories to tell,” she said.

According to an accompanying Public Polling poll – commissioned by the Ontario Council of Hospital Unions (OCHU/CUPE) and the Ontario division of the Canadian Union of Public Employees (CUPE Ontario) – 88 per cent of long-term care staff experience physical violence, while 62 per cent of PSWs experience it every week.

About two-thirds are considering leaving their jobs.

Seven communities, including in southwestern Ontario, were part of
Brophy and Keith’s study, Breaking Point: Violence Against Long-Term Care Staff, but locations aren’t specified to protect the workers’ identities, Brophy said.

“Everywhere we went the stories were the same.”

More funding for staff, four-hours-minimum of care per resident per day, and enhanced safety measures like call buttons are changes that could make a difference, they said.

About 92 per cent of survey respondents are “convinced extra staffing could do a lot to prevent violence because it could keep the atmosphere, the environment calmer,” Keith said.

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Violence in Canada’s system is six times more prevalent than in Scandinavia, where the system is set up differently, Brophy said.

“The bottom line is this is all preventable,” he said.

“If we cared enough about end-of-life care then we would have different kinds of institutions and societal supports for these types of facilities.”

Sensitivity training is also needed for management so workers are supported, Keith said.

People working in the field have been warning others to stay away, contributing to a current personal support worker shortage in the province, Brophy said, noting a major component of the study is violence against women – about 85 per cent of nursing-home worker survey respondents are female.

“We’re at a point in society where women are just not tolerating that,” Brophy said. “There have been some real lines drawn.”

Brophy and Keith published a similar study two years ago, examining violence in hospitals, as well as long-term care.

Violence is common in both settings, Keith said.

“But in the long-term care facilities, it just seemed to be a much more daily occurrence. It was more prevalent.”

It’s what prompted this closer look at long-term care, she said.

They’re speaking out because workers cannot, Brophy said.

“The health of these health-care staff is a real barometer of the health of the health-care system,” he said.

“And we all have a stake in that.”

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