Secrecy around long-term care home abuse puts residents at risk, advocate says

Secrecy around abuse investigations in Nova Scotia's nursing homes puts residents at further risk, according to an advocate for the elderly. 

"The public eye is very important in these places because, you've got to remember, the residents who live there very often can't speak up for themselves," said Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly.

"We have to do everything we can to make sure that we are protecting them as much as possible."

CBC News has obtained abuse investigation reports prepared by Nova Scotia's Department of Health and Wellness under the province's Protection of Persons in Care Act.

Unlike Alberta, Manitoba and Ontario, where investigation reports are automatically released to the public, CBC News had to file two rounds of freedom of information requests to obtain the records.

The first request revealed 46 confirmed cases of abuse in 2015 and 2016. The second batch of documents show that a total of 63 confirmed cases of abuse occurred in 36 of the province's long-term care facilities between 2015 and mid-2017. 

The most common types of abuse were physical and emotional, accounting for nearly seven in 10 cases.

There were also: eight cases of sex abuse perpetrated by patients; seven instances of failure to provide care; two cases of sex abuse by staff members and two cases of inappropriate use of medication.

According to the Health Department, complete reports are provided to the resident involved and immediate family members, as well as to administrators of the long-term care facility.

The reports obtained by CBC News, however, are almost completely redacted, omitting all details about the incidents.

In many cases, directives issued by the department to the care homes were also greyed out.

Abuse cases can be complicated: advocate

But Meadus said keeping those directives secret puts other residents and their loved ones at a disadvantage.

"How does the public or the resident know whether or not a home is complying, if they don't know what they're supposed to comply with?" she said.

Most people don't know the complexities of what constitutes abuse, she said, adding that even cases of physical abuse can be complicated.

"It doesn't [always] mean that they're being punched or slapped," she said. "In fact, it could be something else that people may not be aware is dangerous or problematic."

Meadus points to a case of physical abuse that occurred at Haliburton Place, a long-term care facility on the second floor of the Hants Community Hospital.

The two-page summary of facts obtained by CBC is greyed out except for a copy of a policy for using physical restraints on patients. Meadus said inappropriate restraint can take many forms.

"We've seen people … wrapped up with blankets in beds so they don't move, sort of like a cocoon. We've seen people tied up with ropes. We've seen people tied with all sorts of things," she said.

Hiding these details mean visitors to the facility won't know when to object, Meadus said, "because unfortunately the public is very unlikely to understand how long-term care homes were actually supposed to work."

Meadus also said she believes all residents of a facility where sexual abuse takes place have a right to be informed about the details of that abuse.

"Is it a person who has dementia that is acting out sexually and perhaps touching people? Or is it, in fact, a sexual predator who is residing in that home? You don't know," she said.

"If you had a loved one in that home, that's a piece of information that you'd want to know."

Secrecy in the system benefits the facility managers and the government, Meadus said.

"I think the homes are being protected," she said. "I think the ministry, the government is being protected. Because if people really understood what is happening there may be a bigger outcry about these issues."

Public reports promised but no timeline in place

The provincial government has said it plans to publicize investigation reports made under the Protection of Persons in Care Act (PPCA), which covers hospitals as well as long-term care facilities, but there's currently no timeline for when those reports will begin to be released.

"We need to ensure we do not breach resident confidentiality, and it is important that we balance transparency with the need to protect the privacy of the individuals involved," said Health Department spokesperson Tracy Barron.

The investigation reports prepared under the PPCA are meant only for people directly involved, Barron said.

"The report is designed to be shared among a small number of parties who are entitled to know at least the high-level details of an incident/investigation," Barron said. "When the report is shared outside of that circle of individuals, privacy issues arise, and some information must be redacted."

The privacy protections apply to staff members named in the reports as much as to residents, she added.

In Ontario, investigation reports are published online and also must be posted in a public area of the facility in question.