It's always a tough decision to put a loved one in a nursing home. For Sandra Croteau it was made even more difficult by the fact that her mother had recently died and her 58-year old developmentally disabled brother, Keith, had taken a turn for the worst.

"Him and my mom were very close and he just went downhill (after she died). He wouldn't eat, he wouldn't wash, his life skills were gone" she said.

After much thought, Sandra placed her brother in a long-term care facility in Sudbury, Ont. She found a room at Extendicare York, a home normally reserved for the frail and elderly, but she didn't have any other options.

"We didn't know what else to do" she said.

On January 24, 2007 Keith was brutally assaulted and killed by his roommate, Bryan Belliveau. Croteau discovered too late that her brother's roommate was a 55-year old man diagnosed with chronic schizophrenia, psychopathic personality disorder, who had a history of not complying with his medication. Years after the murder, Sandra Croteau also learned that Belliveau was on a suicide watch.

"He's on suicide watch and they were arguing and nobody comes? Who was watching him?" she said.

Sandra believes the long-term care system needs an overhaul so that this type of tragedy doesn't happen again: "The system failed my brother and also failed Bryan. He should not have been there either. " she said.

W5 asked Extendicare what changes have been made to make their homes safer since Croteau's murder. Rebecca Scott, Director, Communications and Government Relations at Extendicare Inc. responded by email.

"We are all deeply saddened by the tragic incident that occurred at Extendicare York in 2007," said Scott.

W5 asked Extendicare if they had increased staffing in their homes to prevent future tragedies. They wouldn't comment directly on staffing numbers but said they have taken steps to increase safety in the home.

"Since 2007, we have undertaken a number of initiatives to assist in preventing something like this from happening again," wrote Scott.

Common problem

Resident-to-resident abuse in long-term care is far more common than you might think. Through access to information, W5 obtained the number of resident-to-resident assaults in Ontario nursing homes. There were 1,788 incidents in 2010.

The statistics include everything from shoving and pushing to, choking, punching and even sexual assaults. With the help of a statistician, W5 analyzed the data and discovered that the rate of assault in long-term care is four times higher than in the population at large.

Pat Masters has first-hand knowledge of those statistics. Her father was assaulted by a fellow resident at The Perley and Rideau Veterans' Health Centre in Ottawa.

The person who attacked Pat's father wasn't a typical frail and elderly nursing home resident. Pat describes him as a man in his 70s who was diagnosed with aggressive dementia.

"He was a very physically fit individual. He had no weakness in how he walked. (He was) a very vigorous man," she said.

Experts argue that residents with aggressive behaviours should not be placed in care facilities alongside the frail elderly. However, with the closure of psychiatric hospitals and group homes, there really is nowhere else for these patients to go.

The CEO of the Perly and Rideau Veteran's Health Centre, Greg Fougere, acknowledges that resident-to-resident altercations can occur but, in an interview with W5, insisted that they are not a common event at his facility. However he does admit that nursing homes in general need more staff to deal with these new and challenging patients.

"We don't have enough staff to provide as much care as we would like to. And really our seniors deserve it," said Fougere.

In order to ensure her father's safety at the Veteran's Health Centre Pat is now paying an extra $63,000 a year for a personal support worker to take care of him. She's one of the lucky few that can afford it.

"I'm happy and able to do it. What about those people who aren't able to do it? What do they do?"