Violence in long-term care facilities ‘normalized’ for workers: Study

‘They are being emotionally exploited to do the best they can’

Violence in long-term care facilities ‘normalized’ for workers: Study
Physical violence, verbal abuse, racial and sexual harassment, and sexual assault, were so widespread that they were being normalized, found a recent study. Shutterstock

By John Dujay

For nurse Sue Moore, the reality of violence in the workplace hit her smack in the face one day.

“My first black eye in my life came from a resident when I was a personal support worker (PSW) back about 2007,” said Moore, who has worked in the long-term care (LTC) industry around the Kingston, Ont., area for about 15 years, both as a PSW and a nurse.

“Workplace violence in long-term care (happens) on a daily basis; it happens verbally, sexually, physically, and it is grossly underreported. Workplace violence has a severe impact and has effects on the care we provide each day to our patients.”

What happens in the LTC facilities would not be tolerated in any other workplace, said Moore.

“If you were punched in the face by someone, but you were able to walk it off and carry on with your day in a professional manner, does that mean that you were not assaulted and that an act of violence did not occur? If it is expected that a worker reports a broken piece of equipment or other safety hazard immediately to ensure the safety of everyone in the workplace.”

‘Extreme’ problem

The problem is extreme, according to a recent study looking at Ontario LTC facilities. Researchers visited seven Ontario communities and conducted multiple group interviews with 56 staff members between 2016 and 2018.

“What we discovered was that physical violence, verbal abuse, racial and sexual harassment, and even sexual assault, was so widespread that it was being normalized  — it was just being treated as part of the job,” said Jim Brophy, researcher at the University of Windsor in Ontario and the University of Stirling in Scotland.

“We wondered, ‘Why aren’t people speaking out?’ Well, there was such fear that there would be reprisals if they said anything about it — either firings or reprimands or disciplines — that literally the public wasn’t being told.”

The staff are treading an emotionally challenging path, said the researchers.

“As the term caregiver suggests, their role is to care — physically and emotionally — for those in their charge. Unfortunately, they are inadequately equipped, due to budgetary constraints and other factors, to satisfactorily carry out their mandate. Yet they are being emotionally exploited to do the best they can anyway and to turn the other cheek to the insults and assaults hurled their way,” said the study Breaking Point: Violence Against Long-term Care Staff.

“They are expected to be caring and compassionate in their work no matter the dangers, but they themselves seem not to be entitled to care and compassion from their employers. On the contrary, they feel instead they are being blamed when they are assaulted.”


The study is backed up by a survey released in January that found 88 per cent of personal support workers and registered practical nurses experience physical violence in the workplace. Sixty-two per cent experience at least one incident each week, according to the poll of 1,223 front-line workers by the Ontario Council of Hospital Unions (OCHU) and the Canadian Union of Public Employees (CUPE).

And yet 53 per cent of respondents to a January survey do not file incident reports.

“Body maps” reveal abuse

The study involved the use of “body maps,” where participants marked out the places where they had been injured or assaulted on the silhouette of a body.

“Clusters of stickers were applied to the body maps in the groin, breast, and buttock areas, which represented groping, touching, grabbing, or sexual assault. The arms and face were also shown as common targets for slapping, grabbing, spitting, scratching, or wrenching. Stickers on the head represented blows resulting

in minor assaults to serious concussions,” said the study.

“Several participants in each group applied stickers in the cloud above the head representing stress, burnout, anxiety, depression, and fear, as well as the effects of racist, sexist, classist, or anti-immigrant comments.”


The body maps led to further discussions, with participants talking about how sexist and racist comments and sexual touching left them feeling hurt, angry, and demoralized — seemingly with no recourse.


“In addition to the lack of immediate or ongoing psychological supports from management, there were criticisms of the workers’ compensation system that failed to recognize their injuries or delayed accepting claims and making payments,” said the study.


“Participants talked about how the combination of violence, fear, stress, workload, disrespect, lack of compassionate support, as well as feeling professionally inadequate due to time constraints leads to physical and emotional exhaustion.”


For Moore, the results are not surprising.

“It is nothing to go into a room with a resident who potentially is aggressive; to get hit, punched, kicked or spit on. And to endure that so that that resident has received the appropriate care. But then you come out of the room and you’re injured but it’s not being reported. It is most certainly viewed as part of our job in long-term care.”

Possible solutions

A wide range of risk factors for the violence emerged during the discussions, said the researchers.


“Key among them — and widely agreed upon — were the increased acuity of residents,

understaffing, lack of security measures, a task-oriented organization of work that provides too little time not only for basic care but for resident-centred relational care, the physical environment, and inadequate training.”


So, what can be done? Employee enlightenment is the first place to start, according to Moore.

“There’s really no education provided to staff regarding resident-to-staff abuse. I think it’s important that the unions and employers work together so that we can provide the education to our staff members.”

Workers should be encouraged to report any incidents to managers, said co-author Margaret Keith, also a researcher at the universities of Windsor and Stirling.

“Health-care workers need to be able to report without feeling that they’re going to be blamed. If they report to the supervisor… and say that they’ve just been sexually assaulted, and the supervisor might say, ‘Well how did you approach this person? What did you say to them? What did you do got them so agitated?’ or ‘What did you do to invite that sort of attention?’” she said.

“This is a universal problem of people feeling that they were being blamed for the assaults against them.”

Supervisors also need to be made aware of the role they can play after an incident, said the researchers. Keith recalled a story about a female worker who was sexually assaulted in a shower room and managed to escape.

“She went to the supervisor, who just wanted to make sure physically that she was OK, and then said, ‘So, you need to go back to work, we’re short.’ And she said, ‘I can’t, I have to go home.’ This person needed to go to a sexual assault crisis centre, this person needed support for what had happened and wasn’t getting it,” she said.

Another problem is short staffing, said Moore.

“We have patients (who) are being offloaded from the mental health sector, from the acute sections of the hospital, and they’re coming to our long-term care sector. And our resources aren’t growing for that. We are chronically working short. You potentially have two front-line workers who have to take care of 30 people, along with one nurse,” he said.

“You add in people with more acute diagnosis, without adding those front-line resources, how can you care for those people?”

Other solutions offered by the report included: staff regularly working in pairs; a flagging system to warn of potentially violent residents; crisis intervention training; more residents’ family involvement; a safe room for employees to calm down; better training on the importance of reporting incidents; and greater public awareness and support.


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