“IF I TOOK MY JACKET off right now, you would see my arms covered in bruises,” Lori Love answers when asked about the violence she is forced to deal with every day at work. “There isn't a day that I go into work where I’m not hit and called filthy names.”
Police officer? Bouncer?
No, Lori is a personal support worker (PSW) at Leacock Care Centre in Orillia, Ontario. The perpetrators are not hardened criminals or drunken louts but “harmless” elderly ladies and men.
As more and more seniors enter long term care during the final phases of their life, many of them are arriving suffering from various forms of dementia. Care homes are not adequately prepared to handle the influx of seniors with serious mental health needs. Staff do not have the proper training. As a consequence, caregivers are daily confronted at work with a risk that no one should have to face: violence on the job.
IMAGINE GOING TO WORK EVERY day knowing that there’s a good chance you will be slapped, punched, kicked, bit, shoved, spat on, or called names. Yet that’s the reality for many healthcare workers today.
Lori isn’t only covered in bruises. She’s also suffering from a long term injury following an incident that occurred two years ago.
“There was a gentleman I was taking care of and the floor cleaners came in to wax his floor,” says Lori. “They moved around his furniture and when they finished the floor, they didn’t put it back where it belonged. He got really upset and the situation escalated very quickly. Next thing I remember I was being pushed full force by him. He threw me backward and sent me flying over top of the bed, into the heat register, and dislocated my shoulder. I was off for a week and wore a sling for three months.”
Although it’s been two years since the incident, Lori says her shoulder still gives her trouble.
“These kinds of situations really mess with your head,” she says. “I was shaking uncontrollably and trying to keep myself together, but being injured like that scared the life out of me. It’s really sad when all you’re doing is your job and trying to take care of residents, but instead you get thrown into a violent situation.”
Although some residents are violent and aggressive on a daily basis, she says others are mostly calm but will occasionally catch you off guard.
“Some residents give you a thousand signs before they ever strike,” says Lori. “You know that you need to be extra careful with them or take a fellow staff member with you when you go into their room.”
She recalls an incident that occurred with one of her fellow members who was standing near a table folding towels. A resident ran up to her from behind and punched her in the back in her kidneys.
“Those types of situations you can never fully prepare for,” says Lori. “And they’re truly terrifying.”
SO FAR, THE RESPONSE of the Ontario government is limited to issuing a report with 23 recommendations. This is a long way from the increase in staffing requested by CLAC, other unions, and patient advocacy groups.
“Healthcare workers have the right to do their jobs in a safe environment, free of violence,” according to the report. “Preventing and mitigating workplace violence in hospitals requires a multi-faceted approach. Everyone—hospital administrators, nurses, other health care workers and the public—must understand that workplace violence is not part of the job and must not be tolerated. One incident of workplace violence is one too many.”
The healthcare sector makes up 11.7 percent of Ontario’s labour force. It’s also the largest sector impacted by violence in the workplace.
Violence claims make up 9.4 percent of the lost-time staff injuries suffered by caregivers in the province’s long term care homes.
Ontario has begun implementing the report’s 23 recommendations in three phases. The first phase, which is underway, focuses on nurses in hospitals. The second phase will focus on all hospital workers and those in long term care homes, and the third phase will focus on the broader healthcare sector.
A few of the recommendations designed to make healthcare facilities safe places to work include providing more support for patients with known aggressive or violent behaviour, creating and implementing standard forms and processes to create care plans that include worker safety, and creating consistent communication protocols between facilities so everyone is on the same page.
Although the recommendations sound great on paper, violence against healthcare workers continues to worsen. Lori's been a PSW at Leacock Care Centre for 13 years and has served her fellow Local 304 members as a steward and is also on the bargaining committee. This is her second career. As glad as she is about the new rules that may be implemented soon, she says they have come too late for her.
“I’m not young anymore,” she says. I’m getting too old to go into work every day and be hit and punched. I am happy changes are coming for the younger girls, and the new ones that will be entering the field. Their workplaces will hopefully become safer once the recommendations are fully implemented.”
SARA FRANCIS IS A PSW and Local 302 member working at Salvation Army’s Eventide Nursing Home in Niagara Falls for the last eight years. Like Lori, she serves her fellow members as a steward and member of the bargaining committee. And like Lori, she’s also been physically and verbally assaulted.
“We’re hit, we’re spat on, we’re kicked, and we have things thrown at us,” she says. “I’m constantly playing dodgeball while simultaneously trying to get my everyday tasks done. The last three or four years, it’s gotten really, really bad.”
Sara is not waiting for the report’s recommendations to be implemented to take action. She decided to take it upon herself to implement changes in her workplace. She collaborated with Michael Reid, her CLAC representative, to convince the nursing home to provide employees with education on mental health issues and how to deal with residents that have them.
“We have nowhere to place residents with mental health needs,” says Sara. “We’re getting them into long term care, but we don’t have any psychiatric help. A general practitioner takes care of them, but I don’t believe any of us have the full knowledge required to deal with them.”
Sara says she reports violent incidents up to 10 times in a shift, whether it’s someone shouting at her or someone physically hurting her. Like many caregivers, she easily rhymes off a number of violent incidents that have taken place.
“One of my colleagues worked with a gentleman who grabbed her arm and broke both bones,” says Sara. “He just grabbed and squeezed as hard as he could. Another colleague came out the other day and her whole shirt was ripped apart. Another went into a resident’s room to do a nighttime brief change and rolled the resident onto her side. The lady grabbed her metal foot rest off her wheelchair and came back and smacked my colleague so hard in the head that she was sent home. She was off for quite a while. She caused major damage.”
The most traumatic thing that ever happened to Sara herself personally was when she bent over to help a resident put on her shoes—a task she performs many times each day for a number of residents.
“She grabbed me by my shirt and started slamming me back and forth on the edge of the bed,” says Sara. “She then grabbed me by the top of my head, and while I was trying to free myself, she began punching me in the face. I panicked. I had a co-worker with me and she panicked too and couldn't help me. I managed to pull her hands out of my hair, and she took my hair with her. I put her back to bed and walked out.
“My first thought after was, ‘Wow, I cannot believe that just happened!’ I was in shock for days, and that incident flashes back in my head every time I help someone put their shoes on.”
To cope with violent situations, Sara and her fellow members have begun refusing to deal with patients that are at high risk of being violent unless a registered staff goes with them into the room. Going in pairs helps deescalate situations and provides extra help when needed. When a violent incident does happen, they take a break to destress.
“We take a five-minute breather to calm down, chart what happened, breathe,” says Sara. “If I go back into a room where I just got pushed, naturally my senses will be heightened. My voice and my body reactions will be heightened, and that’s going to cause the resident to get even more agitated—which is the last thing we want. The break in between really helps us both.
“Usually, it’s the same people who are a danger because their behaviour does lead from their mental illness. So you know when you go into a room that you have to be on high alert. You know every day is going to be a fight with that resident.
“To avoid a violent reaction, I try to talk to them as low and as calm as possible, and I try to work as fast possible without rushing them. Or we find distractions. One man, he will punch you in the face, so we give him his glasses while we put on his seatbelt. If he’s doing this, he can’t punch you. You never want to get close enough to let them get you.”
RHONDA GOW AND HER CO-WORKERS at Cedarvale Lodge Retirement and Care Community in Keswick, Ontario, have developed some best practices too for handling violence from residents. Rhonda has been a PSW going on 28 years. She is Local 304 member and also serves as a steward as well as treasurer of the Local 304 Board.
“Any given day, you can be confronted by a resident who’s dealing with different issues, stress issues, behavioural issues—whatever is going on in their day,” she says. “You have to be careful when you enter a room. And every day it’s different. We’re never sure exactly what the resident’s mental state is at that moment, so when you approach them, you have to be careful. You could be bit, punched, kicked, smacked. I’ve had chairs thrown at me. I’ve had a lift thrown at me. I’ve had my hair pulled. I’ve been spat in the face.”
Rhonda and her fellow members meet every morning for a “ten at ten” session. Together, they review how to handle situations that may arise during the day and discuss any incidents that happened the day before and how to prevent them in the future.
The incident that sparked concern for Rhonda was when she had a chair thrown at her.
“A new resident was trying to exit the building and go home,” she says. “He wanted to be with his wife and his family. He was a new person to my team and he was throwing chairs and pushing the lift down the hallway yelling and screaming.
“We called a code white and had a number of staff intervene. I was in a nearby room providing care and when I came out into the hallway, I stepped out into the middle of the whole episode. He was very angry, very upset, swinging at everything. He broke the lift, broke the chair, but when he turned around and saw me, he stopped. He identified me as his wife, and that’s what deescalated the whole episode.
“The funny thing is that the whole situation escalated in the first place because he identified me as his wife. He had watched me do up another male resident’s belt, so in his eyes I was up to no good!”
Despite physical incidents like this, Rhonda says she is abused verbally more often than physically.
“You would think that’s better,” she says. “But personally, being verbally abused and being called unthinkable things daily breaks me down way more often than being physically abused ever could.”
To prevent further incidents, the management team at Cedarvale has been paying more attention to assessing residents before they bring them into the home. Behavioural teams come in and give staff tips on how to prevent certain incidents from repeating in the future.
But Rhonda says it doesn’t help much.
“I think all staff need to be trained to deal with violent and aggressive situations,” she says. “Your front-line workers are the best staff to have trained so they are armed with more information and techniques to deescalate situations. Having a team come in later, after the situation is done to give you cues, doesn’t help much. We’re also often short on staff, which doesn’t help the situation at all.”
FACING THE DAILY THREAT OF VIOLENCE at work is not something any worker should have to contend with; yet for many healthcare workers, it’s become a grim reality.
“Things are not getting better,” says Michael Reid, CLAC representative. “It is a very objective fact that things are getting worse and the government ‘initiative’ is just fine sounding words that can’t possibly address the core problem: you can’t rush patients with dementia through their care and expect them not to get violent.”
If Sara could change one thing about her job, to help decrease the violence and the overall atmosphere of the nursing home, she says she would hire psychiatric help and extra staff.
She currently has around eight minutes per resident to help them brush their teeth, get washed, and get dressed.
“You're so quick in the room,” she says. “You’re in and out as fast as possible to get the next resident done."
She thinks that being rushed to do so much in so little time contributes to making residents already struggling to cope with dementia more combative.
Not having the time to care is a recurrent theme for caregivers in long term care homes across the country. And it’s in part to blame for the increasing prevalence of violence by residents against those who do their best to care for them.
Lori doesn’t blame the residents.
“It’s not their fault,” she says. “I don’t know anyone who blames them, but violence and verbal abuse can’t be looked at as the norm, as just an accepted part of the job. It’s not normal—not for them, not for us. Something has to be done. It can't continue like this.”
How You Can Help
Please support our long term care members by calling your Member of Parliament and asking them to increase staffing in long term care homes. For further information on how you can help, please contact your steward or representative.
Hazards of the Job
Healthcare workers suffer more injuries on the job than workers in any other sector—more than manufacturing, construction, and retail, the next three highest sectors. In 2015, 41,111 healthcare workers suffered a lost-time injury in Canada.
In Ontario, workers in long term care homes suffered 1,701 lost-time injuries in 2014. Here’s how they were injured.
Contact with/struck by object - 8.1%
Exposures - 29.2%
Falls - 14.2%
Machinery - 0.8%
MSD client handling - 21.3%
MSD other - 14.7%
Not classified - 1.9%
Motor vehicle accidents - 0.4%
Workplace violence: 9.4%
Sources: labour.gov.on.ca, WSIB Enterprise Information Warehouse (EIW) Claim Cost Analysis Schema, Association of Workers’ Compensation Boards of Canada (awcbc.org)
Thick Skin
Long term care homes aren’t the only places where workers regularly face violence. Steve Wolkowski is a Local 503 member and security officer at St. Joseph’s Healthcare Hamilton. For 27 years, he’s dealt with a lot of scary situations and has lived to tell the story.
As a security officer at a busy hospital, what does a typical shift look like?
Before the shift starts, we’ll have a debrief session where we find out what’s going on in the hospital’s different areas. Many issues that might have occurred on the previous shift may require follow-up with the new shift. When we are paged or if we receive an emergency code (see page 33), we respond accordingly. When we are not paged, we patrol areas of the hospital to ensure it is a safe and secure environment.
What kind of safety issues do you have to deal with?
Lately, the issue of sharp-edged objects has taken the forefront, and various types of knives. I just had my first encounter with a gun—it was a pellet gun but it looked real and in any case, precautions must be taken. I’ve dealt with kicking, punching, grabbing, and spitting patients, and sometimes feces and other liquids have been thrown as well. Although it’s not a daily occurrence, sometimes we encounter various types of violence during the day. I’m never alone in any given situation; we have a team that are all very well-trained and work together to minimize and deter patients from acting out.
How do you deal with violent patients?
As a team, we assess the situation at hand and make a plan of action. If the patient is too out-ofcontrol, the doctor may give an order for medication that will help them calm down, in which case security may be required to hold them down physically to allow the nurse to give an injection, or use other forms of restraints. Rarely, there are situations that require extra outside assistance, but if they arise, we will call the local police department, who are better equipped to handle extreme violent situations. Our protective equipment is limited to handcuffs as a form of control and are only used when absolutely necessary.
What’s the scariest situation you’ve ever been in?
A year ago, a male came into the triage area, sat down, stabbed himself with a knife in both shoulders, and started yelling that he wanted to be treated immediately. That was really shocking to me.
Do you ever get verbally abused? Does it ever get to you?
Over the years, I think I have heard every sort of verbal abuse. I don’t let it get to me because I always consider that the abusive person may be going through their own difficult situations and need help. I definitely toughened up in the first couple years working at the hospital and have developed a thick skin to help deal with the situations that arise.
Codes and Colours
Code blue! Code blue! We’ve all heard that particular emergency code blaring over hospital PAs in TV medical dramas. But there are more codes and colours than blue used in emergency facilities around the world. Here are 10 standard emergency response codes used in Ontario hospitals.
Code black: bomb threat/suspicious object
Code blue: cardiac arrest/medical emergency
Code aqua: Flood
Code brown: Hazardous spill
Code green: evacuation
Code orange: disaster
Code purple: hostage taking/gang activity
Code red: fire
Code white: violent/behavioural situation
Code yellow: missing person (amber for missing child)