Ensuring Safe Haven – Long Term Care legislation

Elder abuse in long term care settings has been identified as an important social problem. The Long Term Care Homes Act, 2007 and its proposed regulations attempt to address some of the important issues that have been raised by researchers. While there are some areas that the Act or the regulation fails to cover, overall, it does an adequate job in addressing the key issues surrounding elder abuse in institutions.

Three important reasons why elder abuse may arise in LTC settings identified by researchers involve the institutional processes, the staff and the residents themselves. The institutional processes of the LTC facilities can make residents more vulnerable. This stems from a variety of factors, including poor understanding of what constitutes abuse and neglect, reluctance to report due to fear of reprisal, unclear policies and procedures for reporting or investigating abusive incidents, and their inadequate documentation.

The legislation addresses these issues under its section on Abuse and Neglect that requires a policy on zero tolerance which clearly sets out what constitutes abuse and neglect to ensure that all staff are familiar with what is considered to be abuse of residents – a key recommendation made by researchers for reducing the risk of elder abuse.

S. 20 (d) of the Act requires an explanation of the mandatory reporting duty, to counteract reluctance to report. The Act responds to researchers’ recommendation for comprehensive investigation procedures to be developed and initiated promptly for resident abuse by specifying procedures for investigating and responding to such incidents. S. 19 of the regulation requires that every incident of resident abuse or neglect be analyzed promptly and an evaluation be made at least annually to determine the effectiveness of the policy.

Together, the Act and the regulation seem to address most of the factors that contribute to increased risk of abuse for those in long term care facilities that arise from the characteristics of the facilities.

Staff issues may contribute to increased incidence of abuse, which includes low job satisfaction, frequent thoughts of quitting, high staff burnout, and low levels of education and job experience. Research has found that providing regular in-service education for staff about the aging process, and conflict-resolution training will contribute towards lowering the incidence of abuse. To address some of these issues, the Act provides for staff qualifications (s.73), screening (s.75), and training (s.76). It fails to account for factors such as job satisfaction and thoughts of quitting, but these may be gaps that the law cannot fill. It may be up to individual facilities to implement programs to encourage staff and recognize and reward their good performance. They may also endorse a policy to ensure regular rotation of staff off heavy or difficult resident assignment groups.

Characteristics of the residents may make them more vulnerable to abuse, which include residents who display more aggressive behaviours and conflict with staff, suffer from diseases or disabilities, and those unaware of their rights or fearful of reporting abuse.

The legislation does not address these issues in setting out its policy to promote zero tolerance of abuse. It may be useful to more closely monitor staff caring for residents displaying these characteristics, and programs educating residents on their rights. However, encouraging such programs may be up to the facilities to implement.