InfoLAW: Long-Term Care

With the aging population, longer lifespans and the increasing complexity of care, the demand for longterm care (LTC) in Canada will increase and more nurses will be involved with caring for these patients. Nurses should be aware of the more prevalent risks of harm for this segment of our population.

Falls

Injuries sustained as a result of falls are one of the major reasons for admissions to LTC and transfer of patients from LTC to acute care hospitals for treatment of serious injuries. Seventy per cent of major injury-related hospitalizations for patients 65 years of age and older are as a result of unintentional falls.¹ Safer Healthcare Now! information indicates that 40% of admissions to LTC facilities are directly related to falls, almost half of elderly residents in LTC facilities fall every year, and serious injuries are sustained by a third of those who fall.² One such case involved an elderly LTC patient with dementia who fell from an elevated lift chair when it tipped over. The fall-related injuries contributed to her death.³

Over a 15 year period, 16% of incidents reported to the Canadian Nurses Protective Society (CNPS), involving LTC patients, related to falls. It appears that elderly patients can sustain serious injuries or even die as a result of the trauma sustained during a fall. Some falls were blamed on a lack of appropriate supervision, medication errors, and improper use of transfer equipment. In other cases, it was alleged that nurses failed to appropriately assess patients after a fall resulting in delays in diagnosing and treating fractures or other serious injuries. The patients’ inability to communicate due to their medical condition or a language barrier may also have played a part.

Medications

A Canadian Institute of Health Information study of drug claims by more than one million seniors gives a clear picture of the multiple medications taken by the elderly: 67% of people over 65 take five or more types of drugs; 21% take 10 or more; and 6% take 15 or more.⁴ The use of multiple medications increases the potential for medication errors and adverse reactions because of the interactions of these medications. As well, failure to appropriately monitor medications given to LTC patients can have negative consequences. For example, Haldol was ordered by a psychiatrist to manage the verbally-abusive behaviour of a patient in a nursing home. Because the medication was not effective, the patient’s primary physician increased the dosage, without consulting the psychiatrist, and did not monitor the effects of the increased dosage. The patient’s condition deteriorated and she developed tardive dyskinesia which rendered her completely spastic.⁵

The provision of inaccurate or incomplete medication information also increases the risk of medication errors when the elderly are admitted, discharged or transferred between healthcare facilities. To prevent near misses and adverse events in this area, Accreditation Canada has included medication reconciliation as a required organizational practice. Preventing adverse drug events through drug reconciliation is also one of the targeted interventions in the Safer Healthcare Now!⁶ program.

Abuse

Investigations by Alberta’s Protection for Persons in Care (PPC) office are an indication of the prevalence of emotional, physical and financial abuse suffered by the elderly under the care of healthcare providers. In one year, the PPC office received 447 reports of alleged abuse. The breakdown of these complaints was emotional harm (49%), failure to provide the necessities of life (27%), bodily harm (17%), unwanted sexual contact (3%), inappropriate medication administration (2%), and financial abuse (2%). Fifty-nine per cent of the victims of alleged abuse were over 65 and the largest age group involved in the abuse reports were between 81 and 90 years of age. Of these complaints, 82.8% of the alleged abusers were healthcare service providers.⁷

A finding of patient abuse against a healthcare provider or healthcare organization can lead to serious legal consequences. Healthcare providers involved in such activities may be disciplined by their employer and their professional licensing body, sued, fined⁸ and have criminal charges laid against them. For example, after being found responsible for physical and emotional abuse of residents in a nursing home, a registered nurse was terminated from her employment and had her nursing license revoked by her professional association.⁹ A personal support worker was recently sentenced to eight months in jail, after pleading guilty to charges of assaulting four vulnerable residents, all in their eighties and nineties who had Alzheimer’s disease or dementia.¹⁰ A civil lawsuit was also initiated against a nursing home because of the failure of the organization and its nursing staff to provide a safe environment for an elderly resident with Alzheimer’s disease who wandered into the room of a known combative resident, was thrown to the floor and fractured her hip. The court concluded that the nursing home and its staff failed to make the premises of the nursing home reasonably safe for its residents.¹¹

CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.

1. Canadian Institute for Health Information, National Trauma Registry 2009 Report: Major Injury in Canada (Includes 2007-2008 Data) (Ottawa, Ont.: Author, 2010).
2. Safer Healthcare Now! National Collaborative on Falls in Long-Term Care.
3. Office of the Chief Coroner for Ontario, Nineteenth Annual Report of the Geriatric and Long Term Care Review Committee to the Chief Coroner for the Province of Ontario, September 2009, pp. 16-20.
4. Canadian Institute for Health Information, Drug Use Among Seniors on Public Drug Programs in Canada, 2002 to 2008 (Ottawa, Ont.: Author, 2010).
5. Wells (Litigation Guardian of ) v Paramsothy (1996), 32 OR (3d) 452 (Div Ct (Gen Div)); leave to appeal to CA refused [1997] OJ no 671 (CA) (QL).
6. Safer Healthcare Now! National Medication Reconciliation in Long-Term Care Intervention.
7. Government of Alberta, Protection for Persons in Care 2008-09 Annual Report
8. For example, pursuant to s. 24(2) of Alberta’s Protection for Persons in Care Act, SA 2009, c P-29.1, individuals may be fined up to $10,000 and service providers up to $100,000.
9. Snider v Manitoba Assn of Registered Nurses, [2000] 4 WWR 130 (Man CA); leave to appeal to SCC refused, [2000] SCCA no 102 (QL).
10. R v Foubert, 2009 CanLII 64826 (Ont Sup Ct), [2009] OJ no 5024 (QL).
11. Stewart v Extendicare, [1986] 4 WWR 559 (Sask QB).

December 2010

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.