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.