Purpose
Violence in Long-term care homes has become common for Canadian frontline workers. About 46% of Canadian frontline workers reported experiencing violence daily in their line of duty, which implies that this is an important topic of study (Banerjee et al., 2012). In addition, violence in long-term care has significantly impacted service delivery in these facilities leading to poor health outcomes. The main purpose of this study is to evaluate the current policies within the healthcare system regarding violence in long-term care, evaluate their effectiveness and provide recommendations on what should be done to help in the situation.
Background
History, previous policy links, details, amendments/changes
Admission of patients in care homes has faced dramatic changes over the last few decades. Many people required these services in Canada and had insufficient homes; thus, the government was forced to implement policies that encouraged only those with high risk to be admitted to the homes. In Ontario, the admission of new residents was changed in 2010 and required individuals with high to very high cognitive or physical challenges to be admitted to the facilities (Brophy et al., 2019). This made the Long-term care homes saturated with people with high cognitive disabilities and mental health problems, increasing the likeliness of aggressive behavior toward the healthcare providers.
Literature review
Introduction
While there has been much research on violence in Long-term care homes regarding patient-to-patient or healthcare-provider-to-patient, there has been little research regarding patient-to-healthcare violence. Canadian healthcare workers in Long-term care homes experience six times more daily physical violence than their Scandinavian counterparts. There has been much controversy on what causes this, whereby some research highlights the difference in policies. Others insist on patient characteristics such as increasing levels of dementia which increases the possibility of aggressiveness and substance use disorders, structural challenges such as staff shortage, and a culture of acceptance (Casey, 2019). Another study by Brophy et al. (2019) has provided similar reasons, including personal effects, resident acuity, understaffing, lack of security measures, and inadequate training.
However, some measures have been taken to control situations of violence in Long-term care facilities. It requires the healthcare providers to put measures that help enhance their workers’ safety in line with the Joint Health and Safety Committee and put them in writing. In addition, employees should be provided with training programs on their actions when patients get violent with them (Casey, 2019). These policies have reduced the violence cases; nonetheless, they are still not fully effective in helping to calm down the situation.
Purpose
This study focuses on providing realistic and implementable strategies that can be used to help in reducing the number of patient-healthcare provider violence in Long-term care homes. 90% of frontline healthcare workers have experienced at least one type of violence from a patient, ranging from spitting, punching, poking, hitting, kicking, or being pushed (Banerjee et al., 2012). This shows that violence in long-term care homes is a serious concern that requires intervention. The paper will provide strategies and recommendations that can be used to address these issues, hence improving the quality of care provided and the safety of the service providers.
According to the currently done research, one of the main causes of violence in Long-term home care facilities in Canada is the privatization of the sector. Privatization of Canadian Long-term home facilities and lack of government involvement has hindered the implementation of major policies in the sector. This is because most privatized homes are based on making profits at the expense of healthcare safety. For instance, most long-term private homes have insufficient staff because they are saving on the cost of operation to reap more benefits. Government involvement in Scandinavian home care has significantly reduced violence-based cases because of the various policies, such as the maximum number of patients per room to enhance safety.
Another major theme was the invisibility of violence, whereby most Canadian Long-term care homes disadvantaged their employees from reporting violence. One method they use to discourage is long paperwork which lengthens the process to discourage employees from reporting violent activities (Banerjee et al., 2012). In addition, the caregivers can be blamed for the violence by being told that they should act professionally with the patients and their relatives. When people do not report violence, it leads to the normalization of violence from patients to caregivers.
The evidence above shows that Canadian Long-term home care needs some amendments in the policies and structure. These amendments should be based on increasing the security of the caregivers, shortening the reporting procedures, and ensuring realistic actions against violent patients. In addition, there should be policies on the number of patients per room, the number of patients a caregiver should attend to, and how to ensure that caregiver welfare is considered.
Current Situation
Various policies have been implemented to avoid patient violence in Canadian care homes. The introduction of the Occupational Health and Safety Act requires every Long-term care home to have a workplace violence program with measures and procedures to avoid and control violence in the facility. Some caregivers fear reporting acts of violence because the system lacks confidentiality (Government of Ontario, 2022). Some communication challenges include a lack of a confidential way to report violent residents and residents not wearing identifiers so they cannot be recognized.
A SWOT analysis of the current system demonstrates that current system has a strong policy regarding violence in Long-term care homes. However, the main weakness is the implementation because of various structural dynamics which discourage the execution of these policies, such as lack of confidentiality and lengthy reporting processes. The country can use the data collected from the high number of violence cases in Canada to seek the underlying problems and causes, which, when well used, can be an opportunity to revolutionize the system. Nonetheless, the system faces the threat of having highly uncontrollable violence cases in Long-term home care if no action is taken.
Recommendations
The government has provided various recommendations, which include moving care homes from the management of local government to the federal government. However, this has not been actualized because the federal government requires funding. It has adopted some policies, such as ensuring that every caregiver has to be trained on managing violence and that every care home facility has written safety measures. In addition, it has carried out a pilot survey by implementing Scandinavian policies in four states (Casey, 2019). The government can adopt some policies from the Scandinavian countries and implement them across the country to prevent violence (Casey, 2019). I suggest that the government should create public awareness of the violence caregivers experience and amend the criminal code to ensure that residents who harm caregivers are sentenced. In addition, the government should provide funding to help research and implement best practices against home care violence. Some other policies that can be adopted include providing an online application platform for raising matters, issuing warnings to residents who are found abusing caregivers, and a safety plan such as escorting employees after work.
Next Steps
The federal government should intervene in situations of violence in Long-term home care. It should have more legislation based on the issue of protecting caregivers from violent residents. For instance, violent residents can be denied admission into normal Long-term care homes and taken to a special unit that will be created for these types of residents. In addition, more studies should be conducted on Scandinavian Long-term home care policies and how they have helped reduce violence and implement the same policies in Canada to help contain the situation.
References
Banerjee, A., Daly, T., Armstrong, P., Szebehely, M., Armstrong, H., & Lafrance, S. (2012). Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia. Social Science & Medicine, 74(3), 390–398.
Brophy, J., Keith, M., & Hurley, M. (2019). Breaking point: Violence against long-term care staff. New solutions: A Journal of Environmental and Occupational Health Policy, 29(1), 10–35.
Casey, B. (2019). Violence facing health care workers in Canada: Report of the Standing Committee on Health.
Government of Ontario. (2022). Workplace violence prevention in health care: A guide to the law for hospitals, long-term care homes, and home care. Ontario.ca.