The Role of the Union in Abuse Prevention: Current Situation, Future Possibilities Marcy Cohen Research and Policy Planner, HEU

Who are the members of HEU? About half of our members work in direct patient care Most of the workers in long term care are in HEU Identity of the union closely tied by the LTC organizing drive in 1970’s that linked “poor working to poor caring conditions” The union is committed to working in coalition with community and seniors groups in advocating for better care

Multiple Roles: The duty to represent our members Representing individual members who have been accused of abuse Encouraging members to report abuse Developing strategies to address systemic abuse

An informal Survey of the Servicing Reps When a member is accused of abuse he/she is sent home while the management conducts an investigation It is the responsibility of the Servicing Rep to represent that worker There are workers, who have been fired, based on evidence that they are unsuitable to work with the elderly There are also cases where people are burnt out, and others where the individual reports themselves

Related Issues Care Aides and LPNs learn about resident abuse and the reporting requirements in the public college programs – but this training is not mandated Regular in-services are not provided Many managers do not know how to conduct an investigation. They could also use more training and support (CDNA, 2004) Some servicing reps do remind members of their duty to report, but not all. Also need training

Systemic Abuse; Normalized Neglect There are LTC facilities where there have been on-going concerns raised by our members that took years to resolve The majority of our members working in LTC are very concerned about situation of residents who are alone and do not have family to advocate on their behalf Concerns about neglect and lack of respect raised by our members during the consultation on the regulations for the Community Care and Assisted Living Act

Individual Risk Factors Not suited to work with frail elderly or dementia population Alcoholism Depression Family problems, history of abuse LEARNED REPSONSE TO STRESS

Systemic Risk Factors Organization Cultures and professional inaction key in hiding abuse (Pring, 2005) External Oversight Key: Inspection and Regulation relevant in tackling abuse (Clough and Manthorpe, 2004) Mandated staffing levels Mandated staff training

Prevention at the Facility Level Care Aides encouraged to have input at meetings and to be involved in care planning Information clearly conveyed on a resident’s history of aggression Teamwork cultivated and flexibility supported Promoting an organization culture that supports good care Engaged Environment

Prevention at the Facility Level (continued) Values are modeled in all relationships especially by managers in their dealing with staff Training acknowledges rather than idealizes working conditions Clear and realistic expectations of staff Substantive Philosophy of Care

Prevention at the Facility Level (continued) Appropriate staffing Clean and fair policies On-going training and staff development Concrete Policies and Practices

Prevention at the System Level Increased transparency in complaints process Regular surprise inspections More proactive role in investigating abuse Training and staff requirements written into the regulations Strengthen Licensing Regulations & Enforcement

Lessons from the US Very strong consumer movement in response to private delivery system – National Citizen’s Coalition for Nursing Home Reform, Federal legislation requiring state level advocates (systemic) and local advocates (for residents in LTC) – Significant research linking staffing levels and training to quality care – Report to Congress on Appropriate Staffing Levels (2001)

Lessons from the US (continued) Regular public reporting on the licensing violations related to improper use of restraint, lack of respect for personal autonomy and privacy, poor quality care, etc The California Website a partnership between a Foundation and the University of San Franciscowww.calnhs.org

Other Forms of Oversight Mandatory family councils and independent advocate – Ontario Ombudsman – Alberta Accreditation Process

Future Directions for HEU Provincial Policy table mandated in bargaining that will focus on training requirements and standards for Care Aides, and staffing and quality care issues in LTC Increased focus within the Union on licensing process and enforcement Possibilities of partnering in the development of training on abuse prevention for HEU reps and members