Op-ed: Reducing Resident on Resident Aggression in British Columbia

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BCCPA Director of Research and Policy Michael Kary.

January 5, 2016

Lately in the media we have seen increased coverage of high profile cases dealing with incidents of resident on resident aggression in British Columbia care homes. A recent incident in Kamloops, for example, was followed by the BC Coroner’s office noting that it was the third time in the past two years that it had declared a death a homicide at an Interior Health Authority care home.[i]

While such incidents are indeed tragic it is still important to recognize that these are still largely isolated events. Unfortunately, however, these isolated events are becoming more common and will likely continue to rise with increasing levels of dementia an affliction which currently effects 70,000 BC residents and is expected to increase to 105,000 by 2025. In BC over 60% of residents in long term care also have some form of dementia. [ii]

Similar to other jurisdictions across Canada, many seniors in BC who have dementia also exhibit some level of aggressive behavior. As outlined in a 2015 Ontario report it highlights that nearly half (46%) of residents living in long term care in that province exhibit some form of aggressive behavior related to their dementia or mental health condition while more than one in five (22.2%) exhibits severe or very severe aggressive behavior. [iii]

Ontario’s provincial coroner also recently highlighted that increasing levels aggression in care homes in that province are placing other residents and staff at risk. [iv]   The Ontario coroner’s report, which recommended the provincial government convene an expert panel to address resident-on-resident violence in long-term care, reviewed 13 homicides over the past two years most of which occurred in care homes with one senior, usually suffering from dementia, assaulting another. [v]

aggresionWith increasing levels of dementia, the issue will only become more prevalent across Canada, including BC, unless immediate action is taken. As such the BC Care Providers Association (BCCPA), believes it should be addressed as part of any future discussions on a national dementia strategy, which the new federal Liberal government has committed to work with provinces on. [vi] Legal changes may also be required as frontal temporal dementia (FTD), for example, poses specific challenges for the criminal-justice system including cases related to resident on resident aggression. [vii]

The BCCPA also advocates exploring new programs and care models to address this issue. An example of an effective program in Canada is Behavioral Supports Ontario (BSO) established in 2012.  As part of this program, which has received almost $60 million in government funding, BSO staff take specialized training to gently approach and redirect residents with challenging behaviors. Staff also work with care teams to reduce aggressive or challenging behaviors. Initial results show BSO has been successful, including one care home which has reduced antipsychotic medication use in half while lowering rates of agitation, restlessness and conflict. [viii]

The Care to Chat speaker event in November featured Dementia Village founder Eloy van Hal.

The Care to Chat speaker event in November featured Dementia Village founder Eloy van Hal.

In order to increase public awareness, the BCCPA hosted its first Care to Chat event specifically on the issue resident on resident aggression in November of 2013 with Suzanne Anton, the current BC Minister of Justice and Attorney General.[ix] More recently in November of 2015 the BCCPA hosted an event with Eloy Van Hal of the Netherland’s Dementia Village (DeHogeweyk). DeHogeweyk, which is home to approximately 150 seniors living with severe cases of dementia, encourages residents who might otherwise remain in a more confined environment and exhibit aggressive tenancies, to roam around the confines of the village, enjoying everyday pleasures such as shopping, cooking and going to the movies. [x]   By reducing the residents’ risk of danger through security measures, the village also provides residents an opportunity to maintain as much of a normal life as possible. [xi]  Along with decreasing levels of stress and anxiety including the use of antipsychotics, the Netherland’s dementia village has also resulted in reductions in the overall levels of aggression and violence. [xii]

In addition to exploring new programs and dementia care models, the BCCPA intends to continue to promote tools such as its anti-psychotic best practice guide released in 2013 to help empower long term care staff to lower aggression. [xiii]  It will also work further with stakeholders including its partner organization SafeCare BC, whose mandate is to reduce worker injury rates in long term care and which has implemented a workshop training program with the Alzheimer Society of BC to better train front-line staff dealing with residents living with dementia.[xiv]

Increasing public awareness through the sharing of best practices and events such as Care to Chat as well as dementia training programs are critical as is finding joint practical solutions to deal with this issue. In particular, this is why the BCCPA also strongly recommends that the Ministry of Health work with Attorney General of BC, Health Authorities and stakeholders from the sector to develop a provincial strategy on resident on resident aggression that balances the need to protect residents with the need to ensure seniors can live with dignity and have a high quality of life.  It is only through such collaborative action and specific initiatives that this critical issue can truly be addressed.

[i] CBC News. Kamloops Seniors Village care home death ruled a homicide. Mike Laanela. Nov 03, 2015. Accessed at: http://www.cbc.ca/news/canada/british-columbia/kamloops-seniors-village-homicide-emily-houston-1.3301659

[ii] BC Ministry of Health. Primary and Community Care in BC. February 2015. Accessed at: http://www.health.gov.bc.ca/library/publications/year/2015/primary-and-community-care-policy-paper.pdf

[iii] Ontario Long Term Care Association. This is Long-Term Care 2015.November 23, 2015. Accessed at: http://bluetoad.com/publication/?i=281415.

[iv] Office of the Chief Coroner for Ontario. Geriatric and Long-Term Care Review Committee 2013-14 Annual Report. October 2015. Accessed at: http://www.mcscs.jus.gov.on.ca/english/DeathInvestigations/office_coroner/PublicationsandReports/GLTC/2013-14Report/GLTCRC_201314.html

[v] Toronto Star. Coroner’s report warns of violence in nursing homes. Theresa Boyle. November 17, 2015. Accessed at: http://www.thestar.com/life/health_wellness/2015/11/17/coroners-report-warns-of-violence-in-nursing-homes.html

[vi] Liberal Party of Canada Response Letter to Canadian Alliance for Long Term Care. October 2015. Accessed at: http://www.caltc.ca/pdf/Response%20from%20Liberal%20Party.pdf

[viii] Ontario Long Term Care Association. This is Long-Term Care 2015.November 23, 2015. Accessed at: http://bluetoad.com/publication/?i=281415.

[ix] BCCPA. November 8, 2013. Inaugural Care to Chat Speaker Session a Success! Accessed at: http://bccare.ca/speaker-series-success/

[x] Jenkins, C., and Smythe, A. (2013) “Reflections on a visit to a dementia care village.” Nursing Older People, RCN Publishing Company, 6 (25).

[xi]  BC Care Providers Association (BCCPA). Gagan Lidhran. October 7, 2015. Accessed at: http://bccare.ca/op-ed-exploring-dementia-villages-and-other-care-models-in-canada/

[xii] Global News. Estefania Duran A special ‘neighborhood for people with dementia. November 25, 2015. Accessed at http://globalnews.ca/news/2362492/a-special-neighbourhood-for-people-with-dementia/

[xiii] BCCPA. June 2013 Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care  Accessed at: http://bccare.ca/new-anti-psychotic-best-practices-guide-now-online/

[xiv] Creating Connections: Working with People with Dementia. SafeCare BC. http://safecarebc.ca/creating-connections-working-people-dementia-abbotsford/