Why opioid crisis may be contributing to more injuries for long-term care workers

A broken arm, a smashed nose. Strains and sprains.

These are just a few of the injuries being inflicted on health-care staff by younger, stronger and more aggressive patients living in long-term care and residential care facilities across the province.

Part of the problem, according to the the Nova Scotia Nurses' Union, is the opioid epidemic, which has led to a rise in overdoses that cause brain injuries.

"The more that we have a drug crisis in this province, and in other provinces, we're going to expect to see this," said Janet Hazelton, president of the nurses' union.

"Sometimes when people have a drug problem and they overdose a couple times, many times they end up having a significant brain injury, so we think that is going to increase because it's increasing nationally."  

Those injuries can damage a person's cognitive ability and make it so they can no longer take care of themselves, forcing them into an institution. 

Due to the shortage of beds in the province, some of these younger people are being placed in long-term care facilities and into adult residential care for people with mental or physical disabilities.  

"The challenge is they are able-bodied men and women that are quite strong and some of our health-care workers … don't necessarily have the ability to defend themselves," said Hazelton. 

Many of those residents lack the ability to control their emotions and can lash out, said Hazelton. But they have the strength to do serious damage in comparison to elderly residents in long-term care. 

"The most serious one that I heard about involved a broken nose and a fractured eye socket," said Jenna Brookfield, a national representative with the Canadian Union of Public Employees. 

CUPE represents about 12,000 workers in the health-care system. Many are continuing care assistants and licensed practical nurses who work in long-term care or residential-care facilities.

More mental-health resources needed, says union

The person who broke the worker's nose and fractured the bone around their eye was a former bodybuilder who suffered a traumatic brain injury and was in care.

"So this person was very physically strong and unfortunately no longer had the ability to regulate their own behaviour," said Brookfield.

She said more specialized units need to be created for these patients and more mental-health resources need to be made available. 

Both unions say the provincial government needs to free up money to allow facilities to hire more workers to help manage more aggressive patients.  

"We know that the staffing in long-term care isn't adequate as it is, and to expect the same staffing level to look after these individuals with more challenges is just not appropriate," said Hazelton. 

It's not clear how many of these younger aggressive patients are in the system. Hazelton estimates their could be hundreds, while Brookfield said her members generally have files related to seven or eight individuals.

CUPE members receive about 12-24 serious injuries, like broken bones, in encounters with younger people in care each year.

The nurses' union doesn't know how often its members are seriously injured. But Hazelton said staff can be attacked daily and end up with minor injuries.

"It's estimated that a health-care workplace is three times more likely to experience violence than other workplaces," stated a report released by the Nova Scotia Health Authority last week.

Data gathered by CBC News shows that as of Oct. 2018, the health authority ran 10 of the 136 long-term care facilities in the province. The majority of the others are run by independent groups.   

The Workers' Compensation Board of Nova Scotia tracks the number of injuries in workplaces, and even tracks injuries caused by violence. 

Board does not record ages

However, the board does not record the age of people who caused the injuries.

From 2015-18, there was an average of 46 time-loss claims due to violence in nursing homes.

Special care homes, like residential care facilities, had an average of 31 time-loss claims for the same period, according to the WCB.

Still both unions say the injuries caused by violence are on the rise. 

Hazelton said part of the reason the numbers don't reflect that is because many health-care workers only report an injury if it causes them to miss work, even though the injury might still be significant.

She said the nurses' union is trying to change that and encourages all health-care workers to report any injuries.  

Not everyone is seeing a jump in injuries caused by young people in facilities. Sheila Peck is one of them. 

She's president of the Continuing Care Association of Nova Scotia. It's made up of more than 50 facilities that provide long-term care and support services to the elderly, people with mental-health challenges and those with mental or physical disabilities.

Peck said she has no doubt health-care workers are being hurt, but her membership hasn't heard much about it, and it wasn't a big issue at their conference last month. 

"That was not a big concern at the time," she said. "You're going to have your one-offs, just like you do in schools and in jails, and in home care. People in long-term care normally feel safe because there is always somebody around."

But more resources would help, Peck said. She said it would be helpful to have more behavioural counsellors and psychologists available to help talk people through their problems.

She also has high hopes that a new position called a long-term care assistant will help ease some strain on the system. That new position is expected to roll out a little later this year.          

Della Boyle, director of finance at the Townsview Estates residential care facility in Truro, N.S., agrees with Peck. She hasn't heard of an increase in violence.  

"It's important to keep our staff safe," she said. "It's a very rewarding job when you are doing it and it's sad to hear the incidents that are going on.

"We have to let the staff know out there that 92 per cent of the time everything is great." 

Province evaluating

Nova Scotia's Minister of Health Randy Delorey said his department is looking into these workplace injuries and is evaluating what can be done to better protect staff. 

He said the needs of younger adults in long-term care facilities are different than elderly patients.

"We're just looking to understand the problems, Step 1, and what types of variances or differences that may be required in either care or other aspects of the operation."     

Depending on what the department discovers, modifications could be made to the system, said Delorey. But there's no timeline.

In the meantime, the province isn't putting up any more money for new staff.

Something needs to be done quickly, according to Brookfield. She said some of her members are considering quitting because of their injuries. 

"Quite honestly sometimes after a severe assault someone does not want to go back and work in that environment so they look for alternate employment," she said.  

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