Mary Jo Bernard and Jodie Penwarden call for a review of practices and policies that contribute to hostile working and living conditions in long-term care facilities.

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Violence is on the rise in long-term care facilities. This is due to both an increase in ‘challenging behaviours’ on the part of residents and an increase in the number of front-line staff working alone due to staff shortages. Often, when workers are ill or injured (sometimes as a direct result of rushing through physical labour all day long), their shifts are not covered.

When there are not enough trained staff on the floor, the residents suffer. They sit in soiled clothing with their call bells ringing, they are rushed through unpleasant meal times, and they are pushed in a commode to their shower through common space in nothing but a towel. Meanwhile, staff become demoralized and the environment risks becoming hostile.

A case from O’Leary, Prince Edward Island, first reported in the spring of 2015, demonstrates how a culture of hostility in long-term care facilities can result in poor quality care.

During the summer of 2016, a resident care worker at a government-funded long-term care facility was fired by Health P.E.I after sharing a photo (which is described as a ‘head shot’) of a deceased resident via Snapchat. Health P.E.I. launched an investigation into the incident and learned a number of disturbing facts. The photo that was shared included an inappropriate caption and was forwarded to someone outside of the workplace. As well, over a period of months, the employee in question had shared numerous other photos of vulnerable residents while they were eating, sleeping, or receiving care after a bowel movement.

These unfortunate incidents conflict with practices and policies that long-term care employees are supposed to follow. For example, pending employment, each candidate is required to sign a pledge of confidentiality which includes a promise to protect the confidentiality of all residents. The distribution of photos to co-workers and to a person (or persons) outside the facility is clearly a violation of this pledge. It is also a clear violation of Prince Edward Island’s long-term care mission to provide residents with care that preserves and maintains their dignity and privacy.

Policy revision that is both specific (for example, strictly limiting cell phone use for employees in long-term care) and broad (continued education and course work for employees) is necessary to improve the care provided to long-term care residents. New ways of ensuring that candidates understand the pledges they are signing (and the promises they are making) are also important.

The problems related to respect in long-term care facilities are not just problems at the level of the individual, however. These problems are also systemic and cultural. Long-term care facilities in Canada require a culture change in order to more effectively prioritize fairness and social justice, and to maintain respect for all staff and residents in long-term care settings. The hostile working and living conditions found in so many of our long-term care facilities need to be addressed. Better pay, training, appropriate staffing ratios, and full-time hours would keep good workers on the job. In turn, this would improve the quality of care for residents. This will require smarter allocation of resources, not cutting funding to the system.

Meanwhile, facts about funding are disheartening. In Nova Scotia, for example, long-term care facilities are feeling the impact of back-to-back years of drastic budget cuts. As recently reported by Michael Gorman of the CBC, administrators at Oakwood Terrace in Dartmouth and Northwood in Bedford and Halifax have had to make serious cuts to staffing levels to try to stay within their allocated budgets. Oakwood Terrace lost $82,000 in funding in 2015 and another $86,000 in 2016. Northwood experienced a $360,000 budget cut in 2015 and another $600,000 was cut in 2016.

This reality will in no way help to ensure that residents in long-term care facilities receive the quality care they require. As witnessed in Prince Edward Island, the lack of respect experienced by long-term care workers risks being passed on down the line to the residents of long-term care facilities.

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Mary Jo Bernard is a first-year Masters student in Family Studies and Gerontology at Mount Saint Vincent University. @marbernard12

Jodie Penwarden is a final year Masters student in Family Studies and Gerontology at Mount Saint Vincent University. She has eight years of experience working with older adults in Alberta and Nova Scotia. @JodieLPWadden