Workers Health & Safety Centre

Violence in long-term care cries out for prevention: new reports

Personal support worker who has experienced workplace violence
Two new reports reveal a troubling reality of violence suffered by workers in Ontario long-term care facilities, a reality in need of immediate interventions say proponents.
A survey of almost 1,300 personal support workers (PSW) and registered practical nurses (RPNs) employed in Ontario long-term care facilities found nine of every 10 care workers have experienced physical violence while working. Almost half report being physically assaulted on a daily or weekly basis.
This survey, commissioned by the Ontario Council of Hospital Unions (OCHU)/Canadian Union of Public Employees and CUPE Ontario, also found more than 60 per cent had faced sexual harassment at least once, while 43 per cent reported being sexually assaulted.
Almost 60 per cent of survey respondents said at least half of all violent incidents they had experienced occurred when their unit was understaffed.
“The extremely high level of verbal, sexual and physical violence against long-term care staff described by our polling should concern everyone who works in, or is resident in, or who has a family member in long-term care in Ontario,” said Candace Rennick, CUPE Ontario secretary-treasurer and former PSW. “An environment this violent and degrading for long-term care workers must surely also be unsafe for residents.”
To this last point, three of every four caregivers polled believe they are not able to provide adequate care due to workload and low staffing.

A second report released in concert with the CUPE survey, entitled Breaking Point: Violence against long-term care staff, sought to document the first-hand experiences of affected workers, their vision for safer work and the many barriers in pursuit of this vision.

Violence normalized

This in-depth investigative study involved 56 workers interviewed in group sessions in seven Ontario communities between 2016 and 2018. All but three of these workers experienced violence first hand—most on a regular basis. They reported being punched, slapped, bitten, pulled to the ground and spat at. Many were inappropriately touched, grabbed, groped and otherwise sexually assaulted. Most report verbal abuse by residents and their family members.
This study also revealed a culture of complicity among some management – this despite significant legal employer obligations to protect workers. For co-author and noted occupational health and safety researcher Dr. Margaret Keith, most troubling is how completely demoralized the workers were, often citing lack of compassion or support from management when reporting their concerns or actual assaults.
“The systemic normalization of physical and sexual abuse is appalling,” says Keith. “So is the unaddressed emotional trauma reported by so many of the front-line care workers we talked to.”

Pursuing prevention

Study co-author, Dr. Jim Brophy, who, with Dr. Keith, is affiliated with University of Windsor and University of Stirling (UK), explains, “We heard loud and clear from nurses and personal support workers in every community we visited unless the issue of underfunding and understaffing is addressed, worker abuse and inadequate resident care will continue.”
In addition to understaffing and related issues of working alone, many other risk factors place these workers in harms way. These include lack of or inadequate training to deal with aggressive residents and poorly designed work environments which leave staff with limited escape routes or inability to communicate when help is required.
Care workers also report how fundamental changes in the way long-term care facilities function with less emphasis on care and more on efficiency and productivity impede their ability to provide any degree of emotional or social care. This, suggests researchers, “has a direct impact on residents’ quality of life and may contribute to their agitation, fear, or confusion, which can then lead to aggression.”

Barriers to prevention

A major hurdle in the pursuit of prevention is the lack of public awareness. Researchers found fear of reprisal forces many workers to suck it up and suffer in silence. 
“I would suggest this sector has done a troublingly effective job of keeping a lid on what is both an occupational and public health epidemic,” says Brophy, “These findings should precipitate a critical examination of this crisis by government regulators and family members whose loved ones live in these facilities.”  
Michael Hurley, president, OCHU/CUPE, who also collaborated on this research, goes further still, calling on the provincial government to adopt minimum staffing levels in long-term care. To this end, CUPE is leading a lobbying effort to have the Long Term Care Act amended to include four hours of care per day.
Hurley adds, statutory protections for staff who report or speak up about the problem of violence are needed. And, the federal government needs to treat sexual and physical assaults against health care staff by mentally competent persons as serious criminal offences.

Training for prevention

Among employer obligations under the Occupational Health and Safety Act is the duty for employers to develop and implement workplace violence and harassment policies and program(s). To this end, the employer must also provide all workers with information and instruction on the content of these policies and related measures.
For our part, the Workers Health & Safety Centre (WHSC) offers a range of resources and a Workplace Violence and Harassment Prevention Training program designed to help workplace parties better understand workplace violence, harassment and bullying and to fully comply with legal obligations. We also offer training programs to help employers meet the training and competency requirements for supervisorsjoint committee members and worker health and safety representatives, who all play essential roles in the pursuit of healthier and safer workplaces.

To learn more:
Call:   1-888-869-7950 and ask to speak with a training service representative