Nursing home residents at risk: W5 investigation reveals startling national statistics
Sandie Rinaldo, CTV W5
Published Saturday, February 9, 2013 7:00AM EST
Last Updated Thursday, March 14, 2013 12:25PM EDT
The photographs are shocking. They show 68-year-old Frank Piccolo with massive bruises, scratches, gouges, and multiple abrasions to his face, head and shoulders.
Unable to move or shout for help, Frank, who suffered from Parkinson’s and dementia, sat frozen in his wheelchair, while being hit violently and repeatedly over the head and face with a wooden activity board.
A resident of the Extendicare Lakeside Long Term Care Facility in Toronto, Piccolo was discovered by on-duty staff shortly after the attack on Feb. 18, 2012, slumped over the chair in his room, and drenched in his own blood. Blood was splattered all over the walls, floor and ceiling.
His attacker, another resident with dementia, was an elderly woman who was known to staff to have aggressive episodes, who had entered his room that night not once but twice.
The first time, she yelled and scratched Frank’s arm and shoulder before being taken back to her room by staff.
After 8 p.m., she returned to Frank’s room, and shortly afterward staff discovered him bloodied. His room resembled a scene from a horror film. The woman was found washing blood off her hands, Frank’s blood.
Not an isolated incident
A ground-breaking W5 investigation into resident-on-resident abuse in long-term care homes has found that these attacks are far more common than ever thought: more than 10,000 “incidents” across Canada in one year.
The data was obtained after W5 filed access to information requests about resident-on-resident attacks with 38 provincial and regional health authorities. Hundreds of documents came back, detailing everything from pushing and slapping to extreme violence such as that suffered by Frank Piccolo.
The 10,000-plus figure astounds experts.
Meanwhile, it seems that in Ontario, at least, few penalties have been imposed on facilities found not to have adequately protected a resident from abuse.
Under the province’s Long-Term Care Homes Act, the Ministry of Health has the power to order improvements in a facility, and can take over its management or even shut it down.
But there is no provision for criminal charges. And, in case after case reviewed by W5, the most that had been done was to require homes in violation of the act to submit a “plan of correction to ensure that residents are protected from abuse by anyone” and to ensure that they are not neglected.
So, families like the Piccolos complain there is no real penalty, and no justice.
Theresa Piccolo, Frank’s wife, said that she is shocked by the violence inflicted on her husband in a place that was supposed to care for him. “We had no idea anything like this could possibly happen.”
“We wanted my father to be safe and to have to rely on another place to make him safe was very difficult,” recalled Christina McCarthy, Frank’s daughter, of the decision to place him in Extendicare Lakeside after his dementia progressed to where he could no longer care for himself and the family could not cope with his daily needs.
McCarthy documented her father’s injuries and took the photos that showed his horrendous injuries.
“I wanted people to see what had happened. It was a horrible sight. He had a bandaged head. He was bleeding and no one wants to see their parents like that.”
Above the law
After the attack, Toronto Police were called to investigate. Occurrence report 4259155, obtained by W5, describes the scene: an employee of the nursing home found Frank Piccolo “in the room seated in his chair, covered in blood and suffering from trauma to the head and face. In front of room 2118 (staff) found another resident, standing with blood on (her) face, hands and clothing.”
Attending police recommended that the attacker be kept under supervision and that Piccolo be protected in future.
Despite the clear evidence of assault, police chose not to lay any charges. The occurrence report status is marked: “No Further Action.”
In a letter to Frank Piccolo’s wife, Supt. Mario Di Tommaso, Unit Commander of 14 Division, whose detectives investigated the attack explained: “The suspect in this case would not have been mentally fit to stand trial. The age, nature of illness, mobility and current capacity of both your husband and suspect were major contributing factors for this decision.”
In a subsequent interview Di Tomasso told W5: “There is culpability with the person that is committing the assault, but in my view there is some sort of responsibility on in terms of the home as well. But that home has a duty under the Long Term Care Act to provide a safe environment. “
But, according to Supt. Di Tommaso, whether or not the home had failed to provide that “safe environment” was not an issue for police to investigate. “That is the exclusive jurisdiction of the Ministry of Health. They oversee long term care homes, not the police.”
He further explained in his letter to Theresa Piccolo: “There is no evidence at this time that would cause the investigators to form reasonable grounds to believe that the facility was involved in any criminal behaviour.”
Not willing to leave it at that, Theresa Piccolo called the Ministry of Health and Long Term Care. She demanded an investigation, going so far as to send the photographs of her husband, black and blue, to Health Minister Deb Matthews.
For its part the Ministry did investigate. In an inspection report, dated April 2, 2012, a Ministry inspector found that "Lakeside had violated the Ontario Long Term Care Act" and had failed in its “duty to protect” Frank Piccolo.
The investigation also found that the nursing home had known for weeks that Frank’s attacker was aggressive and still left her unsupervised.
“Resident was admitted to (Extendicare Lakeside) in January 2012,” wrote Nicole Ranger, the Ministry inspector of Frank Piccolo’s attacker, “and since the admission to the home, resident had several behavioural incidents that required assessments and interventions.”
Ranger’s report goes on to list several occasions where the woman’s behaviour was “physically and verbally aggressive towards staff and other residents”:
- “hit and splashed a cup of juice” over another resident’s care-giver
- pushed another resident
- struck an RPN with a plastic cup thrown at the nurse, “resulting in a large swollen area on the RPN’s forehead”
- threw another cup of juice at the home’s Pharmacist
- chased staff out of her room and back to the nursing station
- was verbally aggressive to staff and another resident at dinner
- poured water on other residents while they were lying in their beds
“There was no assessment for the behaviours noted for resident. There was (sic) no interventions implemented, no strategies developed to respond to resident’s behaviours prior to the incidents.”
The ministry found that “the licensee did not protect (Frank Piccolo) from abuse by anyone . . . The licensee is requested to prepare a written plan of correction for achieving compliance to ensure that residents are protected from abuse by anyone and shall ensure that residents are not neglected by the licensee or staff, to be implemented voluntarily.”
“The nursing home was entirely, completely negligent and they did not keep my husband safe as they are required to do according to the Long Term Care Act”, said Theresa, adding that she wants someone held accountable for what happened.
W5’s investigation found that what happened to Frank Piccolo is not an isolated incident.
In Burnaby, B.C., siblings Karleen and Ron Harkness hoped Normanna, a long term care facility, would be the ideal home for their 73-year-old mother, Elsie Rogers.
She was admitted to Normanna because of her dementia yet she was still very physically mobile.
Karleen Harkness told W5: “She was a person that was very, very active, extremely active and always on the go. And to see her reduced to just a shell was unbearable.”
On June 3, 2006, Rogers was rushed to Burnaby Hospital for an emergency operation. Her hip was shattered and her doctor noted on Elsie’s hospital records that “she will not have independent mobility.” A once-active woman would now spend her final years confined to a wheelchair.
“When I received the phone call (about the hospital admittance) they did not tell me what the accident was about,” said Ron Harkness in an interview with W5. “And I was led to believe that it was a simple case of maybe she tripped or maybe, you know, it was an accident.”
After the family started canvassing the staff, it was revealed that another resident had pushed Elsie Rogers to the floor and, much to the siblings’ surprise, there had even been previous altercations with that same man.
After W5 obtained Elsie’s medical records, we learned that on earlier occasions the other resident was “angry and threatened to give it to her good”, “pushed her” repeatedly and “punched her in the stomach.”
“As soon as the first incident happened they should have been aware,” said Ron Harkness.
“And it should have never happened ever – ever – ever,” added Karleen Harkness “They broke her. And they broke more than just her ability to walk. They broke her spirit. She was a phenomenal woman and she didn’t deserve that violence.”
The siblings believe what happened to their mother was a crime. Karleen doesn’t understand why these attacks weren’t prevented.
“Someone has to take accountability. I mean we put someone that we love more than anything –into an area that we thought she would be safe in. I blame the nursing home. “
Normanna’s Director of Care, Sue Hundal, told W5 that these altercations don’t happen every day but all care facilities have to deal with aggressive behaviours and manage them.
In response to concerns raised by Elsie’s family, Hundal said, “I know that the incident happened and it happened, but at the same time we do look at the incident and try to say okay, what can we do better so it doesn’t happen again.”
Elsie’s attacker was eventually moved out of Normanna. Hundal told W5 his altercations with Elsie were partly to blame for his relocation but because of his aggressive tendencies “he wasn’t the right fit” for their long term care home.
Ron Harkness believes nursing home residents across the country are not adequately protected. “I am so sure that the incident that has happened with our mother is happening in nursing homes across the country at this very moment”
So just how common are these assaults?
Statistics obtained by W5 reveal that there were more than 10,000 resident-on-resident incidents reported at long term care homes across Canada in one year.
The data was obtained after W5 filed access to information requests with 38 provincial and regional health authorities, seeking statistics about resident-on-resident attacks. What came back were hundreds of pages of documents, detailing everything from incidents of verbal threats, pushing and slapping, to punching, choking, sexual assaults and even homicide.
The reports were taken to the University of Toronto’s Institute for Life Course and Aging for analysis.
“I can say in Canada we’ve never had a study on abuse in any institution, let alone on resident-to-resident,” said Lynn McDonald, the director of the Institute. “In fact, when CTV came to me I thought ‘Oh, my goodness; this is the most data I’ve ever seen on this particular issue.’
“I was really surprised to see how high that is,” said McDonald, who believes the actual numbers are even significantly higher due to under-reporting of incidents. “You wouldn’t want to live in a place where you’re afraid someone is going to come in your room and hit you or hurt you. You and I wouldn’t want that. Why should anybody in a nursing home?”
When W5 showed McDonald photos of Frank Piccolo's assault, she said: “She could have killed him. Extendicare should be held responsible legally. They should be charged.”
Promise to improve
W5 asked for comment from Extendicare, a for-profit nursing home chain that operates 243 seniors care centres in North America, including Lakeside.
In an interview, Tracey Mulcahy, regional director for Extendicare in Ontario, stressed that safety of seniors in their care is paramount. “Absolutely, beyond a shadow of a doubt, it’s our responsibility to ensure their safety.”
Mulcahy also stressed that resident-to-resident assaults were a sector problem and not one that was unique to an Extendicare home.
Staff at long term care homes and advocates for seniors believe a major contributing factor is the ratio of staff to residents. Despite claims from many homes that the average day-time ratio is one staff for every eight patients, personal care workers interviewed for this story claim that ratio is rarely met.
“You could be one PSW [personal support worker] on a floor of 25, and if two residents start going at it, what do you do?“ said Miranda Ferrier, President of the Ontario Personal Support Workers’ Association.
Ontario’s Long-Term Care Homes Act does not spell out required or optimal personal support worker-to-residents ratios.
Ferrier noted that in her experience many aggressive acts occur at night. It’s called "sundowning."
“I can remember standing at the nursing station,” she said of an incident at a home where she had worked. “In one part I had a wanderer down one hallway and I had a man down the other hallway that was screaming and hollering at the top of his lungs.”
Extendicare has promised to do better in the future and has drafted a voluntary plan of action including an increase in registered staff. After the assault, the centre also installed video surveillance in the unit where Frank lived.
Shown the pictures of Frank Piccolo’s injuries, Mulcahy was appalled and promised action: “It’s dreadful, it’s disturbing and that’s why we work so hard as a sector on prevention. We need to avoid incidents like this. We need to take this and move forward. We need to speak to the Minister of Health. We need to speak to our local health integration units, and what can we do to prevent this from happening?”
W5 asked Ontario Health Minister Deb Matthews about the Piccolo’s sense that no one is taking responsibility for Frank’s assault.
“You know, it’s absolutely heartbreaking and absolutely unacceptable,” Matthews replied. “This is one of those very, very rare cases, and it’s a reminder that we must always continue to do better. But these (cases) would be thoroughly, thoroughly investigated and appropriate steps taken.”
But Frank Piccolo’s wife, Theresa, isn’t waiting for Extendicare, the police, or government. She is determined to ensure her husband’s tragedy isn’t an “invisible crime.”
Theresa doesn’t blame Frank’s attacker, or the staff. She blames Extendicare and has taken her story to the street, picketing in front of Extendicare’s Lakeside Long Term Care Facility, hoping no one else suffers the way her family has.
As for Frank Piccolo, he moved back to the home after being treated in hospital for his painful injuries. His attacker was moved back to her room right across the hall. Three months after he was brutally assaulted, Frank Piccolo died. His family believes he just gave up.