Our second study was entitled “Breaking Point: Violence Against Long-Term Care Staff”. It was published in March of this year.
Like the problem of violence against hospital staff, violence against long-term care staff is well documented in the scientific literature, and we know it's widespread, perhaps even more so than for hospital staff.
In January of 2019, OCHU/CUPE commissioned another poll. Some 1,200 long-term care workers responded. Eighty-five per cent were women. Almost half self-identified as indigenous, racialized, recent immigrant or visible minority.
The results were really alarming. According to the poll, 89% of personal support workers and 88% of registered practical nurses experienced physical violence on the job. Sixty-two per cent of PSWs and 51% of nurses experienced it at least once a week. Sixty-five per cent of female staff have been sexually harassed, and 44% have been sexually assaulted. Sixty-nine per cent of those identifying as a visible minority indicated that they have experienced related abuse. Seventy-five per cent believe they are unable to provide adequate care due to their workload and low staffing levels, and 53% said they never file incident reports.
The research we carried out reveals the day-to-day reality behind these numbers. We spoke at length with dozens of long-term care staff in communities across Ontario. We heard such comments as this, “On a daily basis, I am hit, punched, spat at, sworn at, slapped, bitten. I've had hot coffee thrown at me. I've gone home with burns on my hands.” Or there's this one, “I put his pajamas on and I went to tie them. Then I saw his fist. Oh my God! Here it comes. Pow, right in the mouth. It cracked all my teeth and broke my nose.”
They described feelings of stress, burnout, anxiety, depression and fear. They talked about how sexist comments and sexual touching leaves them feeling hurt, angry and demoralized. One told us this: “He groped me when I was bathing him. It bothered me for a very long time, but I didn't dare say anything because I was worried about my job. I was a single mom and I had to work.” Another one said this: “It's degrading. There are times that you just sit down in your car and cry.”
Violence against long-term care staff can be prevented. This has been proven in Scandinavian countries. The conditions under which staff are working and residents are being cared for in Ontario breed aggression. We learned that the system is at a breaking point and that the staff are at their breaking point.
Our system is underfunded and understaffed. It has been widely privatized. Efficiencies and time studies have reduced the people in care to little more than objects on a production line. Care is rushed. There is little time for making emotional connections with residents, and this contributes to their frustration, fear and confusion, which they then direct towards their caregivers.
Several issues stood out for us as significant barriers to dealing with the problem of violence in both the hospital and the long-term care settings. There's a systemic under-reporting of violent incidents, resulting in an underestimation of their prevalence. Some study participants said they feel unsupported by their supervisors and even blamed for the assaults that they do report.
The culture of silence around the issue of violence is a major barrier to acknowledging its existence and consequently addressing it; however, although the public has been kept in the dark about this issue, it is not a problem that is unknown within the health care community.
We recently conducted a search of published literature on MEDLINE, an online database of medical and scientific research papers, and discovered an extensive compilation. Over 1,000 articles on this issue have appeared in peer-reviewed academic journals since 2000.
One of the more recent articles was a U.S. study published by Dr. James Phillips in the New England Journal of Medicine. The author concluded, “Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored.”
The solutions that the article put forward, and those outlined in many other studies, provide the same solutions offered by the health care workers we talked to, so we cannot say that we don't know how to protect staff from violence. Prevention strategies are well documented and have been for almost two decades, but in many cases the recommended solutions remain un-implemented. As a result, violence continues to harm health care workers.
Clearly, some will require significant financial investments, such as hospital redesign and increased staffing. Others simply require a change in approach. We have learned that violence prevention measures currently in place appear to be piecemeal and inconsistent from one facility to the next. Universal protections need to be legislated.
Ontario hospitals are operating with less per capita funding than the rest of Canada, and Canada falls below many of the OECD countries. Staffing levels are correspondingly lower. Patient wait times are elevated. As well, there is a shortage of mental health beds.
These failings contribute to violence and need to be addressed.
After studying this issue and talking to victims we feel strongly that we can't allow the problem of violence against health care workers to remain hidden from the public. In broader society we encourage victims of physical, verbal and sexual assault to speak out about it and to seek out support, but if those victims are health care workers they're told to be quiet about it. This repressive and unsupportive practice can add further insult to injury and further psychological harm to already traumatized victims.
We would contend that those who attempt to silence the victims of abuse are themselves complicit in the abuse. Legislated whistle-blower protection for staff would eliminate the fear the study participants expressed about being—