A View of Death by Murder in Seniors Homes

I was saddened at the news of the death of a Senior Resident who was killed by another Resident of that Home in the Toronto area.  A seventy-five year old gentleman assaulted and killed a seventy-two year old woman who was also a Resident and inflicted injuries on a ninety-two year old woman.  He has been charged with second degree murder and assault.

Did it have to be that way?

There are a number of cautionary statements that should be made for those who read these accounts or listen to them on the news, but before I address them, I need to tell you a story about my personal experience with violent Residents.

Once upon a time, not all that long ago, I was the acting Director of a Long Term Facility, and we admitted a gentleman to one of our units.  The assessment by CCAC and admission history from the family did not indicate a potential for violence.  In fact he was delightful and seemed happy with his room with its large view window and naturally a little shy.

I went to welcome him when he was admitted and again at the evening meal to introduce him to his table mates help him feel some level of comfort.  He was pleasant.  But one late afternoon all that changed.  He suddenly became aggressive, and ranting and swinging and tried to get out of a second storey window.

The staff reacted perfectly, removing all other residents who may be at risk, keeping constant contact with the man and directing others to call the police.  He was safely removed from the Home to the psychiatric unit at a local hospital.

After a time (I am not sure of how many weeks as I naturally don’t have exact notes to refer to) the hospital, CCAC, Social Workers, Psychiatrist all wanted to have a meeting to discuss his return to the Home.  I took a stand that this man still posed a risk to the rest of our fragile population.  Everyone else took a stand that he was safe to return but could not promise me that he was in fact ‘safe’.  There were actually a number of meetings, by phone with the hospital, discharge planning, and CCAC.  They were mad and frustrated and I was standing firm.

*Please note that explanations of how the LTC system works would involve a great deal of information and could not possibly be disseminated in one article.  It is a complicated and complex system, and I caution you not to make judgements based on who says what and suggested ‘solutions’ from a myriad of sources.

Anyway, the hospital wanted him out.  Hospital administrations are under a great deal of pressure not to allow patients to stay one day longer than what the Ministry perceives as necessary.  As a result, the old pendulum effect is that many people are discharged too early which leads to its own problems.  I argued that this gentleman should be put on a general medical floor with other patients to see how he managed – which led to a very loud roar of ‘how dare you suggest something so reasonable you idiot.’

While this struggle went on our staff were busy.  My nurses, some of who were among the best I have ever seen, along with our Social Worker were seeking a solution that would allow re-entry.  He was not judged as evil or bad but as a resident we/they truly cared about and wanted to see safe and happy.

They closely examined all the information we had about him, and finally pieces of the puzzle came together.  He was a boy of about nine when Nazi Germany occupied his country.  He had seen his best friend killed by soldiers.  He lived his youth in justified fear and in his aging mind he began to live in the reality of those days and at times could not distinguish between now and then.  We were unable to understand his ramblings in his native tongue at the time of ‘the episode’, but gradually some things became clearer.  He did not see himself as the aggressor but a victim.  The staff in uniform he viewed as the enemy.  He was not trying to commit suicide when trying to get out of the window –a consideration that had to be made if only to rule it out – but was trying to escape danger. It is interesting to note that while the committees and Drs. insisted this fellow had no violent episodes in hospital, a quiet chat on the side with staff actually doing the care revealed that he was  not violent because he was restrained physically and pharmaceutically, something that is prohibited in Long Term Care Facilities.

What happened is that a bed became available on one of our secure units and he was admitted there.  More staff specially trained in cognitive function and dysfunction embraced his welcome and for a while he was fine.  Eventually he was moved to another secure unit and again in time began resort to aggression again.  By that time I was on my way out and the solution lay with other brighter fresher minds.

The purpose of telling that story is to let you know the potential for deadly action and reaction by Residents is there every day, and the solutions are not so easy.

When something like this happens it becomes a blame game.  The unions, in this instance CUPE, starts yelling about needing more staff, the administration gets blamed for non-action on Ministry findings *and let me tell you there is a lot wrong with the Ministry of Health and Long Term Care in Ontario who list findings of non-compliance which may in truth be minor or major but are at times like this with no regard to severity.  As a matter of fact I believe their standards were created to CYA (cover your ass) or actually their asses when something does go wrong.  ‘Not our fault’.

Too much in Health Care today is about finger pointing somewhere else instead of taking responsibility.

Unions, or anyone else who pounds their fists and shrieks when an incident occurs, take the easy way out.  More Funding.  More Staff.  More more more.  I would suggest in fact that MORE is not what we need.  I would suggest that every level right down to the front line direct care level has become about, ‘Not our fault’.

I would suggest that layers of management structured to justify position and documentation need to be stripped bare. 

RNs need to be back on the floor, not doing QA reports, company reports, ministry reports, but front line assessing and directing care, teaching, coaching, and mentoring.  The MOHLTC has made reflection of care an idiots game of using the right words or turn of phrase and God help you if you fail to put it ‘just right’.  Documentation does not reflect care, it is purposefully complex.  Get back to basics.

Staff in this current case documented over a long period of time the violence and potential violence of this particular gentleman – their way of saying, ‘not my fault’.

Senior administration will blame those below who will argue, well we told you.

People are so busy justifying and avoiding blame or responsibility the actual front line care is compromised.  When a budget has to be cut it is the front line that suffers.  This is a truth, and the fact is that somewhere above that front line another position for the justification of moneys will probably be created.

I believe the surprise at this deadly event is not that it occurred but that it has not occurred more often.

For many people old age and dementias of one sort or another leads them to live in a younger time, not just in memory but in actuality.  Many years ago one woman in LTC would shriek absolutely terrified during her shower.  It turned out she was a survivor of Nazi death  camps which gave the term ‘shower ‘ a whole new meaning.  There are still survivors of wars who relive those events again and again.  Residents who never experienced war but lived through spousal abuse relive the moments.  The good old days for many are in fact the bad old days and once they take up residence in those aging brains the reality changes.

The company who owns this particular Home is a good company, they have to be to have survived and thrived in this particular atmosphere that challenges and prevents really addressing the problems.

All I can say is don’t be too quick to judge or believe anything written or reported in this situation.  We don’t know the specifics and the answer is not clean and neat.

Long Term Care in Ontario needs a completely new approach, one so daring that it might undermine the comfortable justification not my fault approach of today.  Somewhere out there are people who know what has to be done and hopefully they will be brave enough to step up and take on the misguided leaders and politics in this very sick system.  Just remember that in spite of this – good care is being delivered, Residents are being kept safe.  But I do find myself wondering if this is just because of plain old dumb luck or if perhaps we will be brave enough to make the changes.

One thing I am pretty sure of – good care and safety are a result of our front line workers who persist under a cumbersome system because they do really care.

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9 thoughts on “A View of Death by Murder in Seniors Homes”

  1. This post must have taken a long time to put together Chris, and we appreciate the caring, understanding thoughts you have so obviously put into it.
    Understanding why things like this happen in Seniors Homes is vital so that the problem can be dealt with in a caring, positive way, and you bring out so many good, valid points here. There are many people working in these homes who really do care – hopefully some of them will stand up and confront misguided leaders and politicians in this uncaring system we have at the moment.
    The whole health care system needs a complete overhaul (worldwide) to bring it up to scratch.

  2. People like you need to be the ones in charge of designing long term care. The hospitals here are developing programs to try and ensure that patients do not return to the hospital for the “same complaint”. My suggestion is they ADMIT them and treat them FOR that complaint and make them better. Not “stabilize them” and send them home (elderly, with no family/support/transportation) to follow up with their doctors and the specialists they need to see. I tried arguing that this population is 1) limited in their own resources 2)and this generation is used to the hospital admitting, and resolving serious health crisis. Not ship them home unattended with orders to follow up. I have been given reasons like: the patient walked 80 feet so they will discharge today. And the best was the patient took EIGHT STEPS so they were going to discharge.

    I could go on and on.

    YOu so eloquently explained severe problems, we have them as well. And you are right. The “CYA” policy is every where.

    And meanwhile, people are suffering.

  3. Fabulous! This must have taken a good chunk of time to put together…

    Chris, I’ve seen how Ministries (Education AND Health in my case) – who have not been in the realities of the field – sit in their departments of heroism, building new formulae to save even more tax dollars. Ha!!

    I really appreciated your post. It’s factual and REAL. The way that financial pictures and results drive the care of people (young and old) makes me want to shove their noses in some authentic situations.

    I listened to White Coat – Black Art one day as the doctor-commentator described how infections have the CHANCE to be on the increase. Each procedure had a time limit. If a Dr. goes over the time, where’s the only place where you can cut corners? Yep…washing hands!

    Gotta get “common” back into sense.

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