Violent Nova Scotia nursing home deaths need more disclosure, says union

Eight residents of nursing homes in Nova Scotia havedied since 2008 due to violence from other residents, according togovernment records five more than were previously revealed,raising questions about why most of the deaths were never publiclydisclosed.

• Nova Scotia nursing home deaths by numbers, circumstance

The list of death reports provided through freedom of informationincludes deaths at six homes at locations around the province, withsome having multiple incidents.

Documents obtained through the freedom of information law aresubstantially redacted and offer only scant details about theincidents, such as a witness calling out "Hey, hey, hey" beforeobserving a 71-year-old man fatally push an 81-year-old lastSeptember at Parkstone Enhanced Care residence in Halifax.

Public needs to know

Another report from May 2009 at Glen Haven home in New Glasgowsays, "medical records...describe an altercation at the home duringwhich the deceased was pushed."

For licensed practical nurse Rhonda Church, who has worked in theprovince's nursing homes for 35 years, the previous lack ofdisclosure of five of eight cases is a problem.

"We need the public to know exactly why and how these things arehappening in our long-term health care facilities," said Church inan interview during a Nova Scotia Nurses Union meeting last week.

She says the public should also be told what staffing levelswere, what exactly the resident mix was on the unit, and whatinformation staff were receiving to help prevent escalation ofaggression caused by dementia or mental illnesses.

'People need to understand there are risks'

Janet Hazelton, the president of the Nova Scotia Nurses Union,argues that without public disclosure similar to the annualreports prepared for Ontario's chief coroner citizens don't knowthe extent of a problem.

"I think people need to understand there are risks. Some ofthose cases, when it's resident-to-resident (violence) it's oftenbecause of a lack of staff," she said.

Dr. Matthew Bowes, the province's chief medical examiner, sayswhen death is determined to be the "result of violence" under theFatalities Inquiries Act it is referred to police as a potentialhomicide and it is up to police to announce details.

Eight incidents since 2008

The list of deaths includes two incidents at Mountain Lea Lodgein the Annapolis Valley in March 2012 and August 2008; one at GlenHaven Manor in New Glasgow in May 2009; one at the Harbour ViewHaven in Lunenburg in July 2011; one at the Harbourstone EnhancedCare in Sydney last September; one in Arborstone Nursing Home in
Halifax in October 2011; and two at the Parkstone Enhanced Care inHalifax.

Halifax police news releases informed the public of the two casesat Parkstone, where sudden pushes led to deaths in 2013 and lastSeptember, and a death at Arborstone, where a resident fellbackwards after being pushed.

No further investigation, no release issued

In the other five cases, the relevant police forces say theydecided not to proceed with investigations, meaning no release wasissued and the stories never surfaced.

Bowes says it is likely the aggressors are people withdementia-related aggression, but adds he cannot be certain becausehis governing legislation doesn't allow him to release the medicalcondition of the people who cause the death.

Asked if a public inquiry should be recommended in any of thesedeaths, similar to well publicized inquests undertaken by theOntario and Manitoba coroners' offices, the medical examiner said itdoesn't appear to be necessary in Nova Scotia.

"If a public system is reasonably diligent, I don't think hardabout a judicial inquiry. I only think hard about it if they
(government) are completely ignorant or in denial about an issue,"he said.

"Our health care system does have an awareness of falls of theelderly as an issue, whether accidental or homicidal I suppose."

Incidentsmaynot always be violent

Bob Lafferty, director of monitoring and evaluation in the healthdepartment, said his department doesn't publicly release deathsbecause there doesn't appear to be an intent to kill.

"Often times these cases may not be violent. They (residents)push them (other residents) out of way and ... it may not be a levelof violence," he said.

His agency carries out an internal inquiry under the Protectionof Person in Care Act, however when provided through a freedom ofinformation request most details are removed.

Lack of public discussion

Short summaries in the reports obtained through freedom ofinformation say underlying problems at the facilities played a rolein the deaths, such as a lack of details in care plans and a failureto make use of the challenging behaviour expert the province hasmade available.

Hazelton argues the lack of public discussion adds to a lack ofmomentum for reforms that other provinces are already exploring orfunding.

Shesaystheprovinceandnursinghomesshouldmovemorequicklyonrecommendationssuchasthoseputforward by the CommunityGoverned Organizations task force last fall, a group that includednurses, representatives from the province, the Alzheimer Society,and nursing homes.

It called for additional training to the front-line staff on waysto identify aggression and de-escalate outbursts, and comments thataccess to the training is "not equitable due to limitedresources."

Figuring out why it happens is key

Meanwhile, high-profile public inquests and recommendations froma committee formed by the Ontario chief coroner has helped fuel somesteps, says Candace Chartier, chief executive of the Ontario LongTerm Care Association.

She said she's pleased the Liberal government's last budget willprovide $10 million a year for three years for programs that canhelp reduce aggression and other behavioural problems.

"I favour a system of transparency. The more we know aboutwhat's happening in long term care, the more we can learn about whyit happened," she said."It puts more eyes on the issues."