Violence Prevention Initiative Respect Aging: Preventing Violence against Older Persons Section 1: RECOGNITION Module 3: Violence against older persons in Residential Care Facilities Violence Prevention Initiative

Agenda Welcome Brainstorming Learning together: Violence against older persons in residential care facilities Small group activity Reporting back to whole group Wrap-up / Evaluation

 “residential care facilities” What is an institution? A set of organized beliefs and rules that establish how a society will try to meet its basic social needs…  “residential care facilities” An institution is a set of organized beliefs and rules that establish how a society will try to meet its basic social needs. Major social institutions include family, school ,peer groups, mass media and government. Residential care facilities are also examples of an institution and for the purpose of this training we will be focusing on residential care facilities, where care is provided in a residence or institution that is not the client’s original primary residence/home.

Residential care facilities in NL Personal care homes Long-term care homes Long-term beds in hospitals Seniors’ residences / Retirement homes Community care homes Cooperative apartments Alternate family care homes Assisted living residences Congregate housing In this session, we mostly look at the first two models of residential care facilities.

Personal care homes Private For-profit Licensed Minimal care No on-site health services 95 homes 4000 beds Private; for-profit Licensed, regulated and monitored by Regional Health Authorities Provide minimal levels of care For people who do not need on-site health services There are 95 personal care homes across the province with more than 4000 beds

Long-term care homes Public Accredited Regional Health Authorities Long-term nursing Higher-level care needs 2800 beds Public Accredited facilities Operated by Regional Health Authorities Provide long-term nursing care for residents with higher-level care needs 2800 beds available provincially.

Who is most affected by violence in residential care facilities? 1. Women There are two groups who are most affected by violence in residential care facilities. The first group is women. Ask participants: “Why do you think that is so?” Women live longer, so there are more older women than older men in residential care Women = approximately 63% of individuals aged 80+ in NL* Source * Statistics Canada. (2013, July). Population by Broad Age Groups and Sex, 2011 Counts for Females, for Canada, Provinces and Territories. Retrieved from: http://www12.statcan.gc.ca/census-recensement/2011/dp-pd/hlt-fst/as-sa/Pages/highlight.cfm?TabID=1&Lang=E&Asc=0&PRCode=01&OrderBy=6&Sex=3&View=1&tableID=21&queryID=1

Who is most affected by violence in residential care facilities? 2. Residents in long-term care The second group that is most affected by violence in residential care is residents in long-term care. Ask participants: “Why do you think that is so?” Often depend on others for care and support Least able to protect themselves They are the most elderly seniors More frail, have more complex needs

Types of violence in residential care facilities Physical violence Psychological violence Emotional violence Verbal abuse Sexual violence Financial abuse Neglect Spiritual violence Cultural violence The nine types of violence that were described in Modules 1 and 2 are also found in residential care facilities.

Other forms of violence in residential care facilities Failure to respect basic rights Psychological neglect Excessive use of restraints Imposing care when unwarranted Taking belongings without permission Not respecting dietary preferences Besides the nine types, there are two other forms of violence that occur in residential care facilities. The first is “failure to respect basic rights”. Ask the group for some examples of these forms of violence.

Other forms of violence in residential care facilities Systemic violence Rules and policies which have a negative impact on residents Practices that have become “the norm” Inadequate training, insensitivity, lack of awareness Systemic violence is the second type of violence that can occur in residential care facilities. Ask participants for examples of each of these kinds of systemic violence.

Why does violence occur in residential care facilities? Isolation Ageism Systemic problems There are three primary reasons why violence occurs in residential care facilities. Isolation. Isolation may occur because of: Physical distance from family/friends Children moving away Location of facility Ageism: Involves stereotypes or prejudices against older persons because they are old These stereotypes can lead to discrimination: treating older persons as “lesser” persons or inconveniences Systemic problems include: Failure to deal with violence Fear of reporting incidents Lack of clarity about reporting incidents Lack of education & training Poor wages, working conditions Ask participants if they have any examples or stories about isolation, ageism, or systemic problems in residential care facilities.

Rights of older persons Same rights as all adults Operational Standards Residential care should… be violence-free provide dignity and respect Residents of residential care facilities have all the same rights as other adults. Operational Standards are provincial guidelines for residential care facilities that are violence-free and that provide residents with dignity and respect There are two kinds of Operational Standards in this province: Operational Standards for Personal Care Homes Operational Standards for Long-term Care Homes Point out the websites where the Operational Standards can be found (see page 50 in the Manual or handouts). (www.health.gov.nl.ca)

Promising practices Residential care facilities can act on those things that prevent people from speaking out, such as: Not knowing how to report an incident Fear of retaliation for reporting Fear of getting evicted for doing something against the rules Worry about getting someone fired

More promising practices Increase awareness about ageism and violence against residents Train staff Encourage a culture of respect and compassion Avoid labels Provide advocates for residents Ask participants what else institutions or residential care facilities can do to promote a safe, violence-free environment.

ALERT!!! If you witness or suspect violence Staff or volunteers: tell your supervisor Residents, family or friends: contact your Regional Health Authority Immediate danger: call local police or 911 where available Point out the phone numbers of the Regional Health Authorities (Manual, page 52) Eastern Regional Health Authority (Rural Avalon) 709-786-5245 Eastern Regional Health Authority (St. John’s Region) 709-752-4885 Eastern Regional Health Authority (Bonavista, Clarenville, Burin Peninsula) 709-466-5707 Central Regional Health Authority 709-651-6340 Western Regional Health Authority 709-634-5551, ext. 226 Labrador-Grenfell Regional Health Authority 709-454-0372

BE PREPARED! Take reports of violence seriously Learn about reporting procedures in residential care homes in your region Know your legal obligations to report violence Show participants the “Contact Information for Reporting” Tool on page 53 of the Manual or handout.