‘Degraded and helpless’: Spike in reported abuse in continuing care homes

Residents can be seen in a long-term care home in this undated photo.

Injury, neglect, malnourishment, death: Documents show increased reports of abuse against seniors in Alberta’s publicly funded long-term care and supportive living facilities.

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The Protection for Persons in Care (PPC) program responds to allegations of abuse in Alberta’s hospitals, nursing homes, lodges, homeless shelters, addiction and rehabilitation centres, programs for persons with developmental disabilities, and related care and support services.

In 2023-24, PPC employees investigated hundreds of reports of abuse. According to its annual report, investigators determined 157 of these allegations were founded — three times more than the previous year.

Sixty-eight of these cases of abuse occurred in long-term care facilities and 26 in assisted or supportive living centres.

Allegations include physical, emotional, and sexual abuse, but the most common type of abuse – half of all founded incidents – are those categorized as a “failure to provide the necessities of life,” when serious bodily harm results from a service provider not giving a client adequate food, medical attention, or otherwise neglecting a client’s needs.

Three continuing care clients died after service providers failed to adequately assess and monitor their medical conditions and deteriorating health, details contained in PPC decision summaries reveal.

In several cases, service providers failed to help the client eat, resulting in significant weight loss and hospitalization.

Across the spectrum of maltreatment documented in PPC decision reports, seniors expressed that they felt unheard, ignored, disrespected, and in the words of one client, “degraded and helpless.”

The “inevitable outcome” of policy and business choices

Rebecca Graff-McRae, research manager at the Parkland Institute, has spent years studying problems within Alberta’s continuing care system. The apparent decline in quality of care in some facilities and increasing harm to residents indicated in the PPC reports aren’t shocking findings, she says, “this is the inevitable outcome of continuing to make the same mistakes.”

“It’s inevitable when you don’t take the necessary steps (to address issues). And not taking the necessary steps is a choice. It’s a policy choice. It’s a political choice. And it’s increasingly a business choice.”

The disparity between seniors' care needs and staffing levels has been regularly cited as a cause of harm in nursing homes.

A 2021 survey conducted by the Parkland Institute, 90 per cent of long-term care workers said their site was short-staffed at least occasionally, and less than half said they had enough time to meet clients' care needs. Around 40 per cent of respondents identified actual harm to residents from delayed assistance with meals and injuries resulting from inadequate staffing.

Though the crisis in seniors' facilities caused by the pandemic elicited studies, inquiries, and recommendations, the solutions they offered haven’t been implemented, funded, or enforced, Graff-McRae said.

A 2021 report from MNP, commissioned by Alberta Health, recommended increasing staffing hours and consistency of staffing to improve the quality of care clients receive.

Alberta’s Auditor General also recommended in 2023 that the province implement a system to “mitigate risk to safe, quality resident care from insufficient staffing.”

High levels of burnout that followed the COVID-19 pandemic have further decimated the workforce and caused an exodus of experienced staff, Graff-McRae said.

Throughout her past research, new employees entering the industry often described being overwhelmed by the demanding working conditions: having to work through breaks, being expected to work after your shift has ended or come in when you are sick, and not having the supplies, support, and resources to provide the level of care people deserve.

“That’s really promoting this cycle of turnover within a lot of facilities, particularly the ones that aren’t offering additional incentives and stable conditions,” she said.

“I’ve heard from operators that they have to recruit 50 per cent of their staff every year. That really creates abysmal results for people,” said Lori Sigurdson, Alberta NDP critic for seniors issues, continuing care, and home care.

“When you’re a vulnerable senior and you’re in a continuing care facility, people need to be familiar with you and understand the things that you need and have some sensitivity to that,” she said.

Not having staff who are familiar with patients' medical needs increases the likelihood of mistakes and accidents, as well as contributing to agitation and confusion for residents with dementia or memory challenges.

Underfunding, short-staffing leading to inadequate care

A fundamental factor behind issues in continuing care is underfunding, Sigurdson said. Because the unit cost of care paid to operators by the government aren’t enough, “operators are trying to make ends meet,” and in turn are understaffing facilities.

Graff-McRae said there is also an “increasing commodification of care, particularly within private for-profit facilities,” that is driving problems in the industry.

“These (for-profit) facilities get the same amount of funding to provide care, and so if they’re making a certain amount of profit over and above that, it’s either that they’re paying less for staffing, or that they’re cutting costs in other ways.”

Provincial inspections have identified several facilities in recent years that weren’t regularly changing bedding or performing necessary cleaning. Graff-McRae said she has also heard of facilities rationing incontinence products and other items.

“That’s a profit measure, and not one about human quality of life, or human dignity.”

The Minister of Health’s office said in a statement it recognizes a strong workforce is essential to a well-functioning continuing care system and has committed $112 million in the last year to address staffing challenges and provides various grants to support mental health initiatives for continuing care workers.

“To improve oversight for the continuing care system, Alberta’s continuing care legislation brings together multiple pieces of outdated and fragmented legislation — some of which was 35 years old — into one updated and streamlined framework. The legislation and standards outlined in the Act are robust, safeguarding resident safety and ensuring operators and providers meet the highest standards or care and accommodation,” the minister’s office said.

The updated Continuing Care Act came into force in April 2024.

Nurses concerned over changes to minimum care requirements

Among the changes to the act is the elimination of a requirement that care home operators provide 1.9 hours of nursing and personal care per day, 22 per cent of which had to be performed by a Registered Nurse or Registered Psychiatric Nurse.

Heather Smith, president of the United Nurses of Alberta, said that the removal of this standard of care increases risk of harm for seniors in care homes, and makes it harder to hold facility operators accountable.

“The changes have really diminished the ability for the public to have any assurance of minimum standards in terms of minimum amounts of care, or in terms of who’s providing that care,” Smith said.

The minister’s office said that while there are now no staffing hour mandates for continuing care operators, they are funded to provide an average of 3.62 worked care hours per resident day, “which means that, in practice, residents are actually receiving more hours of care.”

Brett McKay, The St. Albert Gazette