Guest post: What must a long-term care home do to protect my loved one?
by Family Councils Ontario
By Lisa Feldstein (Lawyer practicing Family Health Law™ at Lisa Feldstein Law Office) and Niki Fragiadakis
The recent guilty plea of Elizabeth Wettlaufer has brought national attention to the vulnerability of residents in long-term care to elder abuse. Wettlaufer was a registered nurse who worked in long-term care homes in Woodstock and London, Ontario. She admitted to the assault and murder of a number of nursing home residents she was responsible for between 2007-2014. Her crimes went undetected until she confessed to a Toronto psychiatrist in 2016.
Many are left wondering, how could this have happened undetected?
Wettlaufer had been investigated previously by the College of Nurses of Ontario (“CNO”) on two separate occasions, one of those being in 2014 after she was fired from a long-term care home in Woodstock for a medication error. The CNO stated that, based on the evidence at the time, there was no need to conduct an official investigation. Because there was no official investigation, the matter stayed private and Wettlaufer was able to find employment at a London, Ontario nursing home. The last murder took place after the investigation by the CNO.
Responses to the Tragedy
In response to public outcry, the Government of Ontario launched an inquiry on August 1, 2017 appointing Justice Eileen Gillese to address concerns about the health and safety of residents of long-term care homes. A final report will be delivered to the Attorney General by July 31, 2019 and will be made available to the public. The mandate of the inquiry is said to include a review of accountability measures in place to ensure the objectives of the Long-Term Care Homes Act are met and provide recommendations to improve the protection and safety of residents.
The CEO of the Registered Nurses Association of Ontario is advocating for termination of nurses to be publicly posted and disclosed to future employers if patient safety is at risk.
There are reportedly at least two lawsuits being brought against the long-term care homes where the deaths took place.
Duty of Long-Term Care Homes
Under the Long-Term Care Homes Act, the operators of long-term care homes are responsible for protecting residents from abuse and must have a zero tolerance policy on abuse or neglect.
The policies of long-term care providers must include:
- That abuse and neglect are not to be tolerated;
- What constitutes abuse and neglect;
- A program for preventing abuse and neglect;
- An explanation of the duty to make mandatory reports;
- Procedures for investigating and responding to alleged, suspected or witnessed abuse and neglect of residents;
- The consequences for those who abuse or neglect residents;
- Procedures and interventions to assist and support residents who have been abused or neglected or allegedly abused or neglected; and
- Training and retraining requirements for all staff, including
- training on the power imbalances between staff and residents and the potential for abuse and neglect by those in a position of trust, power and responsibility for resident care; and
- situations that may lead to abuse and neglect and how to avoid such situations.
Rights of a Substitute Decision-Maker
Some of the most vulnerable seniors are those with dementia and other cognitive impairments. In such cases, residents’ substitute decision-makers and any other person specified by the resident, have the following rights under the law:
- To be notified immediately upon the home becoming aware of alleged, suspected or witnessed incident of abuse or neglect of the resident that has resulted in a physical injury or pain to the resident or that causes distress to the resident that could potentially be detrimental to the resident’s health or well-being
- To be notified within 12 hours upon the home becoming aware of any other alleged, suspected or witnessed incident of abuse or neglect
- To be notified of the results of an investigation immediately upon its completion
- The long-term care home must ensure that the appropriate police force is immediately notified of any alleged, suspected or witnessed incident of abuse or neglect of a resident that may constitute a criminal offence
Working Together to Keep Residents Safe
A common response to this horrifying story is, how did this happen and how can it be avoided in the future? While the public inquiry should answer those questions, in the mean time there are steps family members and family councils can take to help keep residents safe:
- Review the long-term care home’s policy on abuse and neglect and ensure it contains the mandatory items outlined above
- Develop presentations for residents and family members to learn about the abuse/neglect policy of the long-term care home
- Ensure that a portion of family council meetings take place without staff present to allow for open discussion of concerns
- Family members are free to make reports to long-term care homes, the College of Nurses of Ontario and the Ministry of Health and Long-Term Care if they witness an incident
- Keep an eye out and speak up for residents without frequent visitors, as they are more vulnerable to abuse and neglect
- Create a culture of information-sharing
- If something suspicious or unfortunate happens to a resident, ask questions, review the chart and don’t assume the cause is old age
- Perform your own evaluation –members of Family Council may have noticed gaps that would permit abuse or neglect to go undetected. Councils can discuss potential improvements and raise these concerns and ideas as a united voice to the home.
Family and friends are the eyes and ears of long-term care homes and can work together to help keep their loved ones and other residents safe from abuse or neglect.