Where does the Rot Start in Nursing Home Abuse?

This story has been bouncing around the Canadian media since last May. Camille Parent, the son of a nursing home resident, set up a hidden camera in his mother’s room for four days after she (the nursing home claimed) was assaulted by another patient. The results were appalling. Watch here:

The nursing home immediately fired the four staff members seen in the video; the contract of the director was not renewed. The police, however, have decided not to prosecute; the legal case for pressing assault charges, they said, is a lot narrower than what you or me would consider abusive.

That the standards in this nursing home are so abysmally lax is nearly beyond comprehension. Just after this particular facility opened about ten years ago, I accompanied a friend on a tour of the place. I remember thinking at the time, “If I ever need supportive care, this is where I want to go.” They had an exemplary care model, good staff/patient ratios, and a well-designed environment.

For me, it was interesting the reflex reaction of the director was to axe the employees involved, because as we all know, the best way to address issues in any health care institution is to fire employees.

Voilà! Problem fixed!

The problem with this hypothesis (i.e. the Rogue Employee Theory) is that four employees in four days with one patient displayed behaviours that were, um, sub-optimal.

No, sorry. You can’t just blame the employees, though they need to be accountable for their actions. The administration of the nursing home needs to take some (most?) of the responsibility for permitting an institutional culture where waving faeces-soiled wash cloths in patients’ faces, and canoodling in patients’ rooms is acceptable behaviour.

Let’s take a look at the Mission and Values statement of the nursing home:

Our Mission

St. Joseph’s at Fleming is a non-profit long term care health provider committed to excellence in the delivery of quality care and services to persons of all faiths. Continuing the legacy of the Sisters of St. Joseph of Peterborough, the Home takes pride in a model of care distinguished by compassion, dignity, respect and integrity.

Our Vision

Leader and valued partner in long term care through the use of innovation and best practices in living, learning and caring.

Our Core Values

Living
St. Joseph’s at Fleming is committed to creating a healthy living and working environment that:
[. . . ]

• Treats people with fairness and social justice

[. . . ]

Learning
St. Joseph’s at Fleming is committed to creating a unique learning environment for Residents, families, staff, volunteers and students that:

• Promotes innovation and best practices

[. . . ]

• Develops leadership and promotes teamwork

Caring
St. Joseph’s at Fleming is committed to providing exemplary physical, emotional and spiritual care to our Residents, their families, staff and volunteers. Our philosophy of care:

• Engenders trust, healing and wholeness 
• Integrates best practices and innovative solutions
• Promotes individuality as well as personal and spiritual growth 
• Is characterized by compassion, respect, dignity and the sanctity of life

All of which is very good, anodyne and even commonplace, and I am sure it looks very nice hanging in the front lobby. It’s pretty easy to point out where the nursing home and its employees betrayed its own mission and values, so obviously, it’s not enough. If I were the provincial investigator looking at this nursing home, my very first question would be, “How are your values exemplified in how you provide care?” In other words, how do you ensure institutional values — all those warm fuzzies listed above — align with the personal values of the staff? (Clearly, they didn’t in this case.) And also: what policies and procedures do you have in place that address abuse? What education do you give staff around patient abuse, or the issues that surround the care of cognitively impaired patients?  How do you evaluate the effectiveness of that education? How do those in leadership positions role model behaviour? What processes do you have in place to care for demented patients? How do front line staff participate in the development of such processes? How do you reward/celebrate excellence? And so on.

I’m guessing the answers to most of such questions would be “a little” or “not at all.”

So who should be held accountable?

The front line staff?

Yes.

The leaders, the managers and the administrators?

Yes. Probably more so.

So what do you think? Who is to blame? Staff or administration or both?

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  1. #1 by Allyson on Sunday 22 September 2013 - 1036

    Living in the city this home is located as well as having taken care of transfers from this home to ER it is the responsibility of both.
    Very sick and sad situation. A situation that should never have the ability to occur…once little own on numerous occasions.
    The local police faultered as well, they should have been more involved and have remained involved.
    Elder abuse is alive and happening everywhere…why is it tolerated. We don’t tolerate child abuse… Same thing just different end of the age spectrum!

  2. #2 by Beth Boynton on Sunday 22 September 2013 - 1051

    Thanks for this compelling post and video. Tragic, but not surprising. I will blog about it too. Like you, I think there organizational & individual responsibilities. I also think our society (and don’t for a minute think this doesn’t happen in the USA) is partly responsible. What kind of long term care do ‘we’ want, how much does it cost to provide it, how can we support the people who do the work, identify and discipline those who are abusive, prevent burnout….?

    I work as a per diem RN in an alzheimer’s unit and can see what happens when the work isn’t supported e.g. with enough staff and resources, leadership training and supervision, realistic expectations for care, emotional intelligence training, and ultimately discipline. There is no excuse for this kind of behavior and yet it is a reality….but firing the people won’t solve the bigger problems….they must be prevented. Endless inservices and computer training about abuse without adequate resources and supervision is little more than an act of compliance.

    Taking care of staff before they get burned out is a key organizational responsibility. In that vein, I highly recommend Elizabeth Scala, MSN/MBA’s program called Rejuvenation Collaboration. It is an affordable way for organizations to bring self-care awareness and programs into the worksite. http://rejuvenationcollaboration.com/

  3. #3 by sm on Sunday 22 September 2013 - 1126

    Staff in nursing homes are often undereducated, and come from the limited view that the aged should know better, can be taught with punishment. AND, seniors will try to protect themselves. My alzheimer’s afflicted mom fought the staff, every bath day, to keep her clothes on. Sometimes, when I could I would come and be with her, and try to slow the staff down, to explain to my mother what was about to happen so that she had a sense of consent. When I wasn’t there, I am sure they were rough and insensitive and chastised my mother for trying to keep strangers from touching her groin with a washcloth or shower jet.
    The staff are rushed and have no idea about what dementia means. They have quotas of what must be done in a certain period of time and do it, regardless of the distress to the residents.

  4. #4 by MgS (@MgS_2011) on Sunday 22 September 2013 - 1148

    One employee could be considered an aberration, four employees is a pattern. When it is shown to be a pattern, the administration needs to be held held accountable in addition to the employees.

    If problems like this are pervasive in the system, then the system itself needs to be examined.

    In short, when issues like this arise, culpability escalates up the ladder as the problem is demonstrated to be more pervasive than an isolated incident.

  5. #5 by elle on Sunday 22 September 2013 - 1420

    Staff are overworked & poorly taught & supervised. Everyone is overworked, but front line staff the most. When they burn out, there is no where to go & no one to help, and their frustration gets taken out on people who can’t fight back. I am NOT CONDONING abuse, which is NEVER acceptable. But perhaps the frontliners are abused in a less obvious way. Management is responsible… tho this does NOT excuse the individuals who abuse.

  6. #6 by thibeaultda on Sunday 22 September 2013 - 1732

    One last try…. please email. D

    ________________________________

  7. #7 by jenjilks on Thursday 26 September 2013 - 1002

    I think the rot begins with one or two employees who get away with abusing clients. It starts small with theft, poorly trained staff (all they need is their gr. 12). It is exacerbated by peers who either report the abuse, or think it’s an acceptable way to manage their stress. They blame staffing. They blame management. It ends when such abuse is reported to administration, who nips it in the bud.
    It builds in institutions where profits trump values. I have not seen any abuse in the retirement homes, or long-term care places where I have volunteered. I have seen neglect, which I reported. The retirement home organization, to whom I reported the neglect, denied that there was an issue, since the family was aware of the situation. The nurse in charge of the home berated my direct supervisor for my interference by reporting the neglect to the family. There are many myths around abuse. I also blame family members who do not complain to the correct authorities. I complained about a particular protocol, on behalf of a friend in LTC, and the Ministry inspector helped clear things up.

  8. #8 by assisted care facility on Monday 03 February 2014 - 1012

    It’s amazing to visit this web site and reading the views of all colleagues on the topic of this article,
    while I am also zealous of getting experience.

  9. #9 by Lauryn Maurus on Tuesday 04 March 2014 - 1027

    This is really attention-grabbing, You are a very skilled blogger.
    I have joined your feed and sit up for in the hunt for extra of your excellent post.
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  10. #10 by Acls online on Tuesday 15 April 2014 - 1123

    I totally agree that the staff is overworked and under appreciated, Management should be more professional and take responsibility!
    Best regards

  11. #11 by linguistic validation on Monday 12 May 2014 - 0938

    True! This happens in every country and every institution. The staff is most of the times under appreciated and when something bad happens guess who’s to blame for? Not the management, that’s for sure.

  1. Would These 3 Steps Prevent Elder Abuse?

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