Violence in long-term care homes prompts fears of staffing crisis


Workers in long-term care homes are reporting unprecedented levels of assault and harassment, contributing to a turnover rate that is leaving the industry at risk of a staffing crisis, a new study says.

“We heard very disturbing stories about the almost daily occurrence of physical violence, verbal abuse, sexual and racial harassment and even sexual assault that is so pervasive that it’s become normalized – as if it’s part of the job,” study author Jim Brophy told

The study, which was conducted by Canadian researchers affiliated with the U.K.-based University of Stirling and published Tuesday in the journal New Solutions, was co-sponsored by the Ontario Council of Hospital Unions (OCHU) and Canadian Union of Public Employees.

It was based on interviews with 56 mainly front-line workers at long-term care facilities in Ontario. All but three of them reported experiencing violence from residents. Most said they faced it on a daily basis.

One worker told the researchers that they had suffered a fractured tailbone when they were run over by an electric wheelchair while on the job. Some had been hurt badly enough that they needed to take time off or have their workload modified.

Another reported that a coworker was strangled while working alone on a night shift. Unable to reach her whistle, she was saved when another resident intervened.

“If you’re coming in and you’re making $20 an hour and you’re subject to physical and verbal and sexual abuse all day long, it’s not a very attractive work environment,” OCHU president Michael Hurley said in a telephone interview.

“What you have, really, is a pretty unsafe and degrading working environment.”

That normalization of abuse has serious ramifications for the morale of the workers, who have to weigh whether being attacked is worth the benefits they get from the job.

Many front-line workers reported anxiety, depression and general burnout. One nurse of 30 years told researchers that she transferred to her facility’s housekeeping department because she “couldn’t take it any longer.”

Homes are already finding it more difficult than ever to find people for some positions, Hurley said, and colleges are not graduating enough new workers to fill the void.

‘Like putting 100-pound bags of potatoes into bed’

Even though almost all of the long-term care workers interviewed for the study had stories of being attacked by patients, little blame for the attacks was assigned to the patients themselves.

Instead, most of the workers considered the attacks to be symptoms of deeper problems in the long-term care system.

They described the system as extensively task-based, giving them just enough time to perform necessary functions without any time to deviate from the plan, even to have a simple conversation with a resident.

Multiple workers made reference to feeling like they were on an “assembly line” with no opportunities to connect with the residents and improve their situations.

“It’s like putting 100-pound bags of potatoes into bed,” one worker said.

“I always consider these three things: Are they safe? Are they happy? Are they comfortable? And I feel like I can manage one out of three at best,” another said.

Workers described a culture in which they are afraid to voice concerns about violent incidents in their workplace, even when they are the victims, because they believe they will be blamed and face reprisals from management.

Also believed to be contributing to the abuse issues is a shift in the make-up of long-term care home resident populations.

There is no age requirement for admission to a long-term care home in Ontario. The admissions criteria last changed in 2010, making anyone with “high or very high physical and cognitive challenges” eligible to live in one of the homes.

This created an influx of non-elderly residents with acquired brain injuries, as well as patients on dialysis or oxygen therapy who also require more care than the homes typically offered in the past.

Despite these new demands on front-line workers’ time, the study says, there has not been sufficient allocation of new resources over the last five years to maintain previous levels of care.

“You put these two things together and you get residents who are quite frustrated, because they are to some extent neglected,” Hurley said.

Similar frustration is felt by the workers themselves. Hurley said many report feeling “inadequate” as caregivers because they are not able to provide the care they believe their homes’ residents deserve.

Traditionally run by non-profits or municipalities, a majority of homes in Ontario are now owned and operated by private companies.

Brophy questions whether this privatization might also be a root cause of the issues raised in the study, suggesting that some workers feel the facilities are being run to maximize their owners’ return on investment rather than to benefit residents and staff members.

Although the study focused solely on Ontario, Hurley and Brophy said many of the trends it highlights can also be observed in other jurisdictions.

What’s the solution?

Workers surveyed in the study also offered a number of solutions that they felt would ameliorate some of the issues they face, ranging from creating safe rooms to implementing a system to warn all staff about incidents of abuse and residents with violent histories.

The biggest theme in their suggestions, though, was much more direct: More staff is needed to deal with increasingly complex patient needs.

“We need to have very serious government intervention,” Brophy said.

“I don’t think the problem can have any chance of being rectified without a major increase in staffing and funding.”

Brophy worries what will happen if that increase doesn’t come and long-term care workers continue to leave the profession due to burnout.

If that happens, he says, the system will become “so dysfunctional that it won’t become a viable option for people at the end of their life.”

While there has not been any sign of imminent government action in Ontario, one federal MP is proposing a law change that could offer some relief to long-term care workers – albeit only after violent incidents have occurred.

NDP MP Don Davies recently introduced a private member’s bill to make people convicted of assaulting health-care workers eligible for more serious sentences than people convicted of simple assault. A similar provision already exists for transit workers.

“It should not be OK to assault a health-care worker,” Hurley said.

“Unfortunately, you’d have to say right now, given the rate of prevalence of it … that society deems it to be OK.”

The bill received first reading Feb. 28. Second reading has not been scheduled.