At least 29 Ontario long-term care residents killed by fellow residents in 6 years

There have been at least 29 homicides in Ontario's long-term care homes in six years as a result of resident-on-resident incidents and that number may under-report the problem, according to the head of the Ontario Health Coalition.

"We've been very concerned because increasingly we're getting reports in from family members and from workers and health professionals that the violence levels in long-term care homes are intolerable and unacceptable," said Natalie Mehra, executive director of the OHC, a watchdog for Ontario's public health care system.

The incidents usually involve at least one patient with dementia, which can manifest as aggression.

The tally came out today as part of a report on long-term care in the province by the OHC, which wants to raise awareness of the issue of violence in long-term care.

The OHC counted the number of deaths deemed homicides by Ontario's Office of the Chief Coroner in its annual Geriatric and Long Term Care Review Committee reports.

In 2014, the chief coroner called homicides in long-term care an "urgent and persistent issue."

And there is some evidence the cases deemed homicide by the coroner do not show the full picture, Mehra says.

Assaulted in the hallway

Keith Wood is not counted in those numbers, yet. He was 79 when he died on Nov. 16, 2016, of blunt force trauma, 12 days after being assaulted by a fellow resident in the hallway of a long-term care home in Mississauga.

"He was a lot of fun and to watch him fade was the hardest thing really, really the hardest thing. That's why I made sure that I was there for him," said Madeline Wood. The pair were separated when Keith Wood went into a nursing home, but she continued to take care of him and had power of attorney on his behalf.

Keith Wood was heading to his room to use the washroom before lunch when the altercation occurred. Madeline Wood says staff heard "a thud" a few minutes later.

"The staff went running and apparently he was lying there."

Why the numbers may not be the complete picture

A fellow resident was charged with manslaughter and the case is still in front of courts, which may be why Keith Wood's death doesn't yet appear.

There might be a delay in referring homicides to the Geriatric and Long Term Care Review Committee "depending on when the court proceedings have concluded," according to a spokesperson for the coroner's office.

There are also deaths that are not deemed homicides, but occur very shortly after an incident of resident-on-resident violence.

"We think it's very likely that the number is higher than the 29 that are reported by the coroner in the last six years," Mehra said. "And we also know that the violence that does not result in death… is even higher than that."

Doubling of abusive incidents

According to the most recent provincial data, reports of resident-on-resident abuse more than doubled in just six years, from 1,580 incidents in 2011 to 3,238 in 2016.

There is the case of 84-year-old Meyer Sadoway, reported by CBC Marketplace last year. Sadoway died four days after he was pushed by a fellow resident in his long-term care home in Toronto.

His case was examined by the coroner's committee, but since he wasn't X-rayed immediately after the altercation, it was unclear if the push caused the broken hip which landed him in the hospital the next morning. In the end, the death was not labelled a homicide.

Two additional deaths in the 2012 report were possible homicides, but are not included among the three homicides listed by the Geriatric and Long Term Care Review Committee. One woman died of an unwitnessed fall and the report indicated she may have been pushed by another resident.

In the second death, a woman was found on the floor of her room. A fellow resident's shoes were found in her room and her blood was on his pyjamas. A document after the incident stated the long-term care home believed the other resident may have wandered into the woman's room and pulled her out of bed.

Advocate wants more staff to reduce violence

With less than 80,000 people living in long-term care in the province, the homicide rate is high, said Mehra.

"It's a level of violence that would be unacceptable anywhere in our society and certainly should not be tolerated for the frail and vulnerable elderly."

Information about incidents with nursing home residents that result in death is not easy to find.

It's a "major, chronic barrier for shedding light on risk factors and prevention" of such incidents said Eilon Caspi, a gerontologist and dementia behaviour specialist at the University of Minnesota. Caspi published a study looking into the circumstances of 105 North American nursing home resident incidents that caused death in May 2018.

His study found that, in 62 per cent of the cases, the incidents were not witnessed by long-term care staff. The study identified increased staffing levels and training programs as efforts that could prevent deaths in similar circumstances.

Those are measures also recommended by the OHC.

"We don't think it's in the public interest to scare people away from long-term care," Mehra said. "We think that it's in the public interest that this has to be exposed so it can be dealt with and fixed."

Madeline Wood said she thinks things need to change in nursing homes.

"There's this attitude, at least this was my feeling, there's this attitude that 'Oh you're old, you'll die.'"

The memory of saying goodbye is still painful more than two years later.

"I whispered into his ear 'parting is such sweet sorrow. I'll be here in the morning if you're still here. If you're not, I'll understand.' I was home about an hour when they called to say he died.

"I think he was still sort of hanging on and hanging on and I think I gave him an out in a sense in saying that."