Isobel Mackenzie, Seniors Advocate for BC, released a report today in Victoria focused on the issue of resident to resident aggression in BC’s care homes. The report examined 422 incidents of aggression leading to harm between residents in care homes in the province last year, most of which occurred in facilities with a high proportion of residents with complex care needs.
“When we started this review, our intent was to see where patterns emerge when it comes to this critical issue,” said Mackenzie. “What we found was that, although many of these incidents follow no obvious pattern, there are still some particular commonalities that we feel are important to scrutinize further,” Mackenzie added.
While conducting research for this report, the Office of the Seniors Advocate reviewed over 400 individual incident reports. The Office also compared data regarding overall characteristics of facilities, including medication use, incidence of dementia, and funded care hours. Data pertaining to residents’ overall health status were also examined.
“The first thing that emerged when we started to look at the data is the striking inconsistency of how information is collected and tracked on this issue,” said Mackenzie. “There are different definitions of aggression, different incident reporting forms, and different protocols regarding follow-up, which makes getting a clear picture of what’s really going on in our residential care facilities challenging.”
Key findings of the report focus on “high-incident” reporting facilities, where four or more incidents of resident to resident aggression occurred in the last year. Overwhelmingly, residents in these facilities have higher care needs, including more diagnosed aggression behaviors, psychiatric diagnoses, and higher rates of antipsychotic drug use. The report finds that there were slightly less funded direct care hours in high-incident facilities versus other facilities. “While we would expect more complex residents translates to more care hours, unfortunately we don’t see this and this concerns me,” said Mackenzie.
“Even in facilities with the most complex residents and highest incidence of aggression some fall below the minimum provincial guideline of an average of 3.36 care hours per resident per day and we must look more closely at what appropriate care hours are in these facilities. I know the Minister of Health shares my concern and he has called for a systemic provincial review of care hours.”
Additional findings include:
One third of incidents occurred in residents’ rooms, while the remainder occurred in shared areas, such as the dining room
Incident-reporting facilities tend to be larger and have a higher proportion of singe occupant rooms, and a lower proportion of multi-bed rooms.
Most incidents occurred between 4 p.m. and 8 p.m.
41% of aggressors and 53% of victims were 85 or older; 59% of residents in long term care are 85 or older
Males were the aggressor in 61% of incidents, while females were the victim in 69% of incidents. Both the aggressor and victim were more likely to be female as age increased, likely due to the overall proportion of female residents increasing with age
Only 37% of incident reports carried details about the circumstances leading up to the incident
40% of incidents involved hitting another resident
Half of facilities surveyed for this report indicated they have indoor or outdoor walking circuits that help redirect residents with escalating behavior
There is no single, standardized incident report form used for the reporting of incidents across Health Authorities
The report recommends that resident to resident aggression be defined and tracked the same way across all residential care facilities and at a provincial level. In addition, the OSA recommends a review of the adequacy of staffing for residents with more complex needs, specifically during busy times like dinner hours, when there is a noted spike in incidents.
It also recommends more comprehensive training for staff in relation to dealing with aggressive behaviors that includes standardized follow-up protocol. As well, the OSA recommends all facilities adopt strategies and design features that are known to be effective in mitigating aggressive behaviours including exploring the use of locking systems for private rooms to mitigate wandering behaviours.
The Office of the Seniors Advocate is an independent office of the provincial government with a mandate of monitoring seniors’ services and publicly reporting on systemic issues affecting seniors. The office also provides information and referral: Toll-free 1.877.952.3181.
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