Types and Frequency of Abuse

Mom with her great grand daughter Kara.

I've been trying to write this for days. I've started it three times! Every time I get an answer to a question related to senior abuse in long term care it raises ten more questions. I'm developing the perception that protecting seniors in long term care is a maze of smoke and mirrors. I had no idea how many roadblocks, intentional or otherwise, were in place to keep abuse of seniors out of sight.

Today's post will begin to outline the amount and type of senior abuse in Nova Scotia's long term care facilities. The Protection of Persons in Care (PPIC) division of the Nova Scotia Seniors and Long Term Care department has published data on abuse beginning in fiscal year 2017/2018 up to 2023/24. You can find it here. Scroll down and select the year you wish to view. Protection of Persons In Care investigates allegations of abuse in long term care facilities as authorized by the Protection of Persons In Care Act. They aren't affiliated with the police.

The Act Regulations define abuse as:

                    (a)      the use of physical force resulting in pain, discomfort or injury, including slapping, hitting, beating, burning, rough handling, tying up or binding;

 

                   (b)     mistreatment causing emotional harm, including threatening, intimidating, humiliating, harassing, coercing or restricting from appropriate social contact;

  

                  (c)      the administration, withholding or prescribing of medication for inappropriate purposes. 

                  (d)     sexual contact, activity or behaviour between a service provider and a patient or resident;

 

                   (e)      non-consensual sexual contact, activity or behaviour between patients or residents;

 

                   (f)      the misappropriation or improper or illegal conversion of money or other valuable possessions;

 

                   (g)     failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent.

As you can see, these are serious issues - violence, assault, sexual assault and more. As an example, my mother, who screamed in pain intermittently for days and begged for help, was investigated as a category (g). 

Protection of Persons In Care receives approximately 500 calls per year alleging abuse, investigates approximately 55 cases and confirms abuse in approximately 35 cases. The numbers vary slightly from year to year but aren't trending down. Here is some information from the Protection of Persons In Care data from fiscal year 2017/18 to March, 2024: 

1. The five facilities with the most confirmed cases of abuse are all for profit facilities.

• Shannex's Arbourstone - 12 cases of abuse
• GEM Health's The Admiral Ling Term Care Centre - 10 cases of abuse
• GEM Health's Melville Lodge - 9 cases of abuse
• Shannex's Parkstone Enhanced Care - 8 cases of abuse
• GEM Health's The Mira Nursing Home - 8 cases of abuse

2. There have been approximately 245 confirmed cases of abuse in long term care facilities from 2017/18 to 2023/24.

3. There have been 56 confirmed cases of physical force used against vulnerable long term care facility residents, resulting in pain, discomfort or injury, including slapping, hitting, beating, burning, rough handling, tying up or binding. 

4. There have been 48 confirmed cases of non-consensual sexual contact, i.e. sexual assault between residents in long term care. There have been 4 confirmed cases of sexual contact between residents and service providers in long term care. The definition above doesn't include non-consensual sexual contact between residents and service providers. If anyone knows why please let me know. Presumably is would be a case for police, but then so would many of the other abuses.

5. There have been 45 confirmed cases of failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent.

I also compared the abuse data to the Nova Scotia Nursing Homes and Residential Care Facilities Directory. This enables:

1. Comparing abuse data at for profit and not for profit facilities - as noted above, the five facilities with the most number of abuses are for profit. Many public and not for profit facilities also have repeated confirmed cases of abuse. I'll write more about this in the future.

2. Comparing facility size (number of residents) and frequency of abuse - this is quite striking. I'll dig into it more in a future post.

3. Comparing abuse data at nursing homes vs residential care facilities. Nursing home residents require a higher level of care and are often in much bigger facilities. They are abused at a much higher rate.

My information is approximate and intended to convey trends. I'd welcome anyone checking my information and sending edits if needed. I'm happy to make corrections if mistakes are found. Thank you for reading.

Abusing Vulnerable People - How Wrong Is It?

Abusing vulnerable people - how wrong is it? Seems like a no brainer question. I think most people will agree that abusing vulnerable people is very, very wrong. If so, our system of consequences and deterrents doesn't reflect society's values. Please tell me if I've got it wrong.

Warning - there is a photograph of a pressure injury later in this post. It is disturbing. I included it because preventable and treatable suffering of vulnerable people is kept out of view, literally and figuratively. It kept me complacent. 

Background

You've read about my mother's abuse - days of intermittent screaming in pain and asking for help, badly cut legs from thrashing in pain and more. Staff closed her door so they wouldn't hear her as loudly and did nothing. They didn't call a doctor or call me and they didn't assess or treat her new pain. My complaint to Protection of Persons in Care was determined to be founded. 

Consequences and deterrents - The consequences are that her long term care facility was told to follow their existing policies related to the incident.

I’ve respectfully and repeatedly asked Truro Police Services to clarify why there isn’t a criminal investigation but I don’t get answers. 

In trying to understand our legal system’s tolerance for suffering among helpless people (after all it’s explicitly prohibited in the Animal Protection Act, but excludes humans) I’ve begun to look at other cases.  Unfortunately it isn’t difficult to find examples. Pressure injuries, as noted below,  are very painful and can lead to infection and even death. 

In the News - Pain Among Society's Most Vulnerable

CBC wrote an article in 2019 outlining a tragic pressure injury case. Here are excerpts from the article:

"Dorothy Dunnington wonders if anyone will ever be held accountable for a massive bone-deep pressure ulcer that became infected and led to her sister's death at the age of 40."

"Eight weeks prior to her death, she was rushed to hospital at her family's urging and treated for a bone infection as well as septic shock, pneumonia, a urinary tract infection and severe dehydration."

Consequences and deterrents - Halifax Regional Police found there was no criminal wrongdoing and they closed their investigation into whether there was negligence at Shannex's Parkstone Enhanced Care home in Halifax, where Chrissy Dunnington had lived. 

In case the Halifax Police findings weren't chilling enough regarding Chrissy Dunnington's experience at  Shannex's Parkstone, Medical examiner Matthew Bowes wrote in a letter to police that he found no evidence that her death was the result of circumstances that included negligence. Other medical experts seem to disagree, saying the type of wound she had was preventable.

Shannex's Parkstone, a for profit long term care facility has had 7 proven incidents of abuse from 2018, the year of the incident, to 2023 according to Protection of Persons in Care. Several of Shannex's other long term care facilities have multiple confirmed abuse cases in this time period. Many long term care facilities have no cases of abuse in this time period. 

A Reward? - Not only are there no legal consequences, Shannex received a $120 million sole-sourced contract from our provincial government for a care facility in Nova Scotia in June, 2024. Government contracts could be a powerful incentive and deterrent tool in reducing abuse. Hopefully the public will learn more about how this was the best use of our tax dollars.

The extreme pain of pressure injuries is a national problem. Here are some examples from other provinces:

1. A Quebec man who requested and received assisted suicide after developing a bone deep pressure injury (bedsore) in hospital in 2024 in Quebec is described here.

Consequences and deterrents - I didn't find any.

2. An Ontario man's terrible suffering and subsequent death in 2022 related to a preventable pressure injury (bedsore) is described here, including the very disturbing photograph below.

Consequences and deterrents - I didn't find any.

It's a Start

I'll note that in 2021 Nova Scotia did fund a pressure injury reduction strategy, approximately $665,000 per year (I'm unaware of the current budget), to provide staff training and wound management specialists. There has been a modest reduction in reported pressure injuries in Nova Scotia. You can view the data here. 

Closing Thoughts

Our legal system doesn't criminalize* even extreme pressure injuries in a long term care setting, despite the severe suffering and expert opinion that approximately 95% are preventable. (*I'm unable to find examples of criminal charges. There could be some.)

Unmanaged pain, pressure injuries and other abuses in long term care remain very hidden in our society. 

There were 43 confirmed abuse cases in long term care and hospitals in Nova Scotia in the 2022/2023 fiscal year. Did you know they were occurring at this frequency? I didn't. There are various factors that contribute to keeping abuse out of sight that I'll write about in a future post.

I haven't touched on the issues that many people blame for abuse, for example under staffing and lack of training. I'll leave those topics to others although I may touch on them in the future.

Resources

Find  Nova Scotia long term care and hospital abuse data by scrolling to the lower section of this page and clicking on the year you'd like to view.

Find the Nova Scotia College of Nurses complaints record page here. Click the 'Has Complaint Comment' box and then 'Search'.

Find your Nova Scotia MLA's email address and phone number here.

The information in this blog may have mistakes and reflects my opinion except as noted. I'm happy to correct any mistakes you may note. Thank you for reading.

Introduction

Hi there, 

My mother Margaret Macomber had a very bad experience during her two week stay in long term care in Nova Scotia. This blog will chronicle my journey in seeking justice for her memory and paths for better outcomes for others in the future.

My mother's incident was investigated by Protection of Persons In Care, a provincial government service within the Department of Health and Wellness. The investigation determined multiple failures in her care as she experienced prolonged, extreme pain (screaming in pain), new to her, without assistance or notification to her doctor or family. 

Unfortunately many of us have family members who have experienced neglect or abuse in long term care. A quick google search reveals horror stories. Despite the appearance of preventative measures it continues. 

I'm not an expert in long term care but I have time, my background as a municipal planner lends related skills, and I can be kind of relentless 😬. I hope you'll join me and share your thoughts in exploring why abuse and neglect in long term care continues and how we can do better. 

A final note for today's post - there are many groups doing wonderful work for seniors in Nova Scotia. There are also many great resources online. As I develop my blog I'll add links to some of these that you might find useful. 

Carol 

Mom wearing one of our Five Fires Equestrian Centre hats ❤️