Home­care work­ers plagued by vi­o­lence

Re­searcher says un­der­staffing can cause higher chance of abuse


All Ni­cole Lochrie knew about her next client was their ad­dress, ap­point­ment time and how long she had to be there.

“That’s very com­mon. I would say for 95 per cent of my new clients when I was work­ing in home­care, that was the sit­u­a­tion,” said Lochrie, a former London per­sonal sup­port worker (PSW) of five years.

Be­cause the client was un­able to speak due to her dis­abil­ity, Lochrie re­lied on the woman’s hus­band for in­struc­tions on what she needed to do.

Once she had put her client in bed, Lochrie said she felt the hus­band grab her from be­hind. “He at­tempted to as­sault me. He was grab­bing my chest. He forcibly put his tongue in my mouth . . . It got as far as to where he had my pants down” be­fore she man­aged to flee the house, Lochrie said.

Though re­search is lim­ited, ex­perts say PSWs face high rates of work­place vi­o­lence, some of which is re­lated to crit­i­cal lev­els of un­der­staffing in set­tings such as long-term care or com­mu­nity liv­ing res­i­dences.

There are no data avail­able on a pro­vin­cial or na­tional level to an­a­lyze the re­la­tion­ship be­tween a PSW’s work­ing con­di­tions and their health, ac­cord­ing to a study pub­lished in June 2017 in the BMC Health Ser­vices Re­search jour­nal.

A re­cent poll con­ducted for the On­tario Coun­cil of Hospi­tal Unions (OCHU) found 68 per cent of nurses and PSWs across the prov­ince have ex­pe­ri­enced phys­i­cal vi­o­lence at least once on the job over the past year.

Ta­mara Daly, a health ser­vices re­searcher and as­so­ciate pro­fes­sor at York Univer­sity, said PSWs face an in­creased like­li­hood of abuse in the work­place if a fa­cil­ity is un­der­staffed.

“If they are run off their feet and they don’t have enough time to pro­vide care . . . then you get higher in­ci­dences of hit­ting, punch­ing and scratch­ing di­rected to­wards work­ers,” she said, a con­clu­sion based on her re­search that cor­re­lated staffing lev­els to vi­o­lence against work­ers.

Daly and her team be­gan a study this fall to look at work­ing con­di­tions in long- term care, in­clud­ing the lev­els of vi­o­lence and in­jury for PSWs. The last time this study was done, about a decade ago, the re­searchers found that Cana­dian PSWs were six times more likely to face daily vi­o­lence com­pared to Nordic coun­tries.

This trans­lates to at least 40 per cent of PSWs in Canada ex­pe­ri­enc­ing vi­o­lence in the work­place on a daily ba­sis. Daly pre­dicts the vi­o­lence lev­els would be even higher to­day.

Den­mark, Fin­land and other Nordic coun­tries in­cluded in the study had a staffing ra­tio of three to four res­i­dents per worker dur­ing the day­light hours, but the ra­tios in Canada are at least dou­ble and some­times triple that, she said.

The prov­ince does not have a min­i­mum staffing stan­dard for long-term care and PSWs are fac­ing a greater bur­den of care as pa­tients with more com­plex health needs are tran­si­tioned out of hos­pi­tals, said Natalie Mehra, ex­ec­u­tive di­rec­tor of the On­tario Health Coali­tion.

“The gov­ern­ment has ap­proached the re­struc­tur­ing of health care from the per­spec­tive of try­ing to cut costs pre­dom­i­nantly, so that means a kind of cas­cad­ing down­load­ing from hos­pi­tals, to long-term care, to the com­mu­nity. From RNs (reg­is­tered nurses) and RPNs (reg­is­tered prac­ti­cal nurses), to per­sonal sup­port work­ers and un­reg­u­lated staff,” she said.

Though the bur­den of re­spon­si­bil­i­ties in the work­place is in­creas­ing for PSWs, some be­lieve a lack of com­mu­ni­ca­tion by em­ploy­ers in the work­place can put work­ers at risk. “Some­times we knew noth­ing about these res­i­dents that would come in,” said April Hill, a PSW of 12 years and rep­re­sen­ta­tive at the On­tario Per­sonal Sup­port Work­ers As­so­ci­a­tion (OPSWA). Hill said this in­for­ma­tion is im­por­tant for a PSW’s safety, es­pe­cially when car­ing for pa­tients with de­men­tia and ag­gres­sive Alzheimer’s dis­ease.

“If we don’t know they’re ag­gres­sive, next thing you know, we’re get­ting punched or slapped or kicked or hair pulled. There has even been sex­ual as­sault,” she said.

And a pro­fes­sional code of si­lence among work­ers means a lot of this client-to-worker abuse may never get re­ported, of­ten be­cause work­ers fear po­ten­tial ret­ri­bu­tion from their em­ploy­ers.

“When you’re us­ing fear tac­tics, a lot of peo­ple don’t want to say any­thing,” she said.

OPSWA of­fers whistle­blower pro­tec­tion to mem­bers of its as­so­ci­a­tion, ad­ver­tis­ing that they will re­port in­stances of abuse, whether di­rected to­ward PSWs or clients, on be­half of the PSW.

“With long-term care and home care, in­tim­i­da­tion is prob­a­bly the num­ber one used tac­tic with em­ploy­ers,” Lochrie said.

Fol­low­ing the in­ci­dent, Lochrie was or­dered off work by her doc­tor for four months af­ter suf­fer­ing from se­vere anx­i­ety and panic at­tacks. She was let go upon re­turn­ing to work.

“As much as these com­pa­nies ask you to be a whistle­blower and speak out, the mo­ment you do, you’re in hot wa­ter,” she said.

“The way that PSWs are treated, in my opin­ion, is crim­i­nal.”

In Septem­ber, the Min­istry of Labour launched a seven-month health-care-en­force­ment ini­tia­tive to ad­dress vi­o­lence and in­jury in health-care set­tings such as hos­pi­tals, long-term care and re­tire­ment homes, and fam­ily and com­mu­nity health cen­tres.

A spokesper­son said the min­istry does not ex­plic­itly track data re­lated to PSWs fac­ing work­place vi­o­lence, re­sult­ing in­juries or in­ci­dents, work re­fusals and com­plaints.


Ta­mara Daly and her re­search team are study­ing work­ing con­di­tions in long-term care, in­clud­ing the lev­els of vi­o­lence and in­jury for PSWs.

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