There were 42 cases of abuse involving residents of long-term care homes in Nova Scotia in 2017, including two where staff sexually abused residents, investigations conducted by the Department of Health and Wellness determined.
Physical abuse was the most common finding, with 14 cases. There were 10 cases of emotional abuse, nine cases of neglect and six cases where residents sexually abused other residents.
Nine investigations are still open. It's not clear in some of the cases whether the abuse was perpetrated by a resident or by someone working in a facility.
Reports on the incidents were obtained by CBC through Freedom of Information legislation.
Though the incident reports say summaries of each case of abuse are "limited to high-level details to ensure resident specific information is protected," the descriptions are almost entirely greyed out. In many reports, most of the directives given to the facilities are also redacted.
Four reports make reference to staffing shortages when the abuse occurred, others say units were fully staffed. Several reports reference delays in reporting or found staff were unaware of the responsibilities they have under Nova Scotia's Protection of Persons in Care Act.
Unclear if staff were disciplined
One case, which involved a resident's death at Windsor Elms Village, found a "failure to provide adequate care and medical attention." It also found there were "differing understandings" about notifying the medical examiner and directed the facility to clarify that process for staff.
The facility "takes every opportunity to incorporate feedback from our regulators that supports continuous quality improvement and we are confident in the care we provide our residents at all times," said Windsor Elms Village's CEO Susan Hayes in a statement. She said she couldn't comment on specific resident situations.
Administrators at the two homes where the sexual abuse involving a staff member occurred said they couldn't comment on the specific cases due to privacy concerns. Care in long-term care facilities falls under the provincial Personal Health Information Act, which means details of people's treatment can't be disclosed.
The province defined the abuse as "sexual contact, activity or behaviour between a service provider and a patient or resident." In both cases, it's unclear what, if any, discipline staff faced as a result, or if police were ever contacted.
One case happened Aug. 4, 2017, at The Mira long-term care centre in Truro. The incident was confirmed by security footage and witnesses, according to the incident report.
Pat Falconer, The Mira's administrator, said she reported the incident after witnessing it, but couldn't discuss any further details.
She also wouldn't say whether the home contacted police. Truro Police Service said they have no record of any reports from the facility on Aug. 4, the date of the report.
The Protection of Persons in Care report found there needed to be more monitoring and supervision of staff when there are concerns "behaviour has potential negative impact on a resident." It ordered the home to take seven steps, including updating its policies around what constitutes sexual abuse and to ensure staff know they have a duty to report any suspected abuse.
"We followed all the directives that were set out and as well, any time there is any situation that we find, we report it. We take all the necessary steps and report any incident to the appropriate authorities," Falconer said.
'Their safety is paramount'
Another case of sexual abuse involving a staff member occurred Aug. 31, 2017, at the Victoria Haven Nursing Home in Glace Bay. A spokesperson for the Cape Breton Regional Police said the force has no records related to being called to that home.
A report on that incident issued three directives to the facility's administrator.
They included making sure contract staff receive training, that anyone caring for people in the home learn about policies on abuse and that "when there are/or suspected interactions occurring between a service provider and residents, the administrator must ensure that appropriate action must be taken to ensure resident safety."
Ramsay Duff, the CEO of the MacLeod Group, of which Victoria Haven is a part, said its facilities always implement directives issued by the department.
"There is no greater requirement for us than to maintain the well-being of our residents and their safety is certainly paramount among their well-being," Duff said.
Perry Sankarsingh, who oversees the Protection of Persons in Care team for the Department of Health and Wellness, said the department's practice is to refer sexual abuse cases involving staff to local law enforcement.
"I can't speak to the records of the police service, but certainly it is part of our process," he said.
He said, in general, any case of abuse where staff are the perpetrators are "very rare."
"It's one of those things, when it does happen, it's explosive and it captures the public attention," he said.
Nova Scotia RCMP say they investigated four cases of abuse at homes within the agency's jurisdiction in 2017. Three related to physical abuse and one to a finding that a resident sexually abused another resident.
Cpl. Jennifer Clark said in that case, the victim was unable to provide a statement due to their health. In two of the physical abuse cases, the alleged perpetrators were "not capable of understanding their actions due to their medical status," Clarke said. Charges "were applicable" in one of the physical abuse cases but the suspect died before that happened, she said.
10 people investigate complaints
Under Nova Scotia's Protection of Persons in Act, staff, volunteers and administrators at long-term care facilities must report any suspected physical, psychological, emotional or sexual abuse. This includes cases involving neglect or theft.
Sankarsingh said the team of 10 people who work in the Protection of Persons in Care office follow up on each report.
"We don't let go of the file until not only the investigation report has been released but until the directives have been implemented," he said.
"My staff and the people in this department are Nova Scotians and residents and they have daughters and mothers and family in long-term care .... we are equally engaged as the general public is around concern, concerns around the quality of care provision in long-term care."
The province defines abuse in several categories including: physical force, mistreatment that causes emotional harm, issues related to medication, sexual abuse involving staff and between residents, issues related to money and failure to provide "adequate nutrition, care, medical attention or necessities of life without valid consent."
With files from Susan Allen and Jack Julian