Documents reveal another 2 nursing home deaths due to pushing

Newly released coroner's reports have revealed two previously unreported deaths of Nova Scotia nursing home residents injured when they were pushed down by residents with dementia.

The cases, obtained through a freedom of information request to the medical examiner, bring the number of such deaths since 2008 to 11 in the province.

"Those numbers are concerning," said Eilon Caspi, a gerontologist who has researched resident-on-resident nursing home abuse for 25 years in Canada and the United States.

"Would we accept a few deaths a year if we were talking about toddlers in a child care setting?"

No public notification

The two newly revealed deaths, both since Jan. 1 last year, are the latest examples of such fatalities occurring without the Health Department or police notifying the public.

A third death during that period did become public: the case of 79-year-old Gordon Birchell was reported last year to The Canadian Press by a family friend and later confirmed by the RCMP.

Last year, The Canadian Press published reports of eight deaths since 2008 and found five had never been revealed to the public either by police or the province, and that one case wasn't investigated by the Health Department until the public revelations.

The latest cases occurred at Harbour View Haven in Lunenburg, while the other was at the Shannex Orchard facility in Kentville, with no police news releases in either case to inform the public that homicide investigations were launched and later dropped.

The heavily edited reports say that in one case, "the decedent was found on the floor by nursing home staff after suffering a fall ... another client was seen pushing decedent causing (name redacted) to fall."

In another case, the person who died was "pushed by another resident ... fell on the floor striking (name redacted)."

'Dementia related' deaths

Dr. Matthew Bowes, the chief medical examiner, said in an email he's reviewed the cases and based on comments from investigators he believes all of the cases are "dementia related," adding he isn't authorized to review the medical records of the people who pushed the residents.

Neither home returned calls and emails requesting further information.

Caspi said the continuing flow of pushing deaths shouldn't be regarded as normal or unavoidable: "This is devastating for family members."

Caspi has followed some of the deaths in Nova Scotia, and in an academic journal article he quoted from the case of Dorothy Stultz, who died when a male resident with dementia pushed her to the ground in 2012.

After the case was publicized, Stultz's daughter criticized the province for failing to investigate it.

More staffing, better programs needed

The toll of pushing deaths has quietly continued since last year's revelations, along with public criticism of the nursing home system's oversight of people who have aggressive outbursts.

Birchell's wife told The Canadian Press she personally witnessed the attack on her husband by an elderly woman with dementia, and said it came after previous incidents of the same resident going after her spouse.

Caspi said research suggests higher staffing levels and improved programs at nursing homes can help reduce resident-on-resident abuse, as leaving residents alone and without activity can increase their aggression.

He added that pre-assessments of residents need to be thorough and updated in order to assist staff in taking preventive steps to avoid mixing people inappropriately.

"We need to raise awareness and train staff to minimize this," he said.

Coaching from consultants

Mary MacDonald, executive director of risk mitigation in continuing care in Nova Scotia, said the province has 11 consultants who are experts on challenging behaviour who can coach and train facility staff.

Nursing home staff can also receive in-service training on the ways chronic illnesses affect behaviour in the elderly, dementia care and non-violent intervention, said MacDonald.

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She said she was unaware of how many staff in the licensed homes have received this training.

"These incidents are extremely tragic and they're all taken very, very seriously. We follow up with corrective action," she said during an interview.

However, Caspi said he's concerned Nova Scotia doesn't have an open reporting system where deaths and followup actions are described to the public.

'There's a lot at stake'

He cites the Ontario system, where the geriatric long-term care review committee at the Office of the Chief Coroner provides annual listings of deaths. These include brief descriptions that don't remove references to the root causes such as the dementia of the patient.

"If we're not learning from these incidents and then similar incidents occur in similar circumstances, it's a major missed opportunity for prevention," said the Minneapolis-based dementia behaviour specialist.

"There's a lot at stake for these elders and their family members. This needs to be looked at closely with a panel of experts."

Tracy Barron, a media spokesperson for the Health Department, said it isn't yet at a stage where it will notify the public about the deaths.

"Protocols around the reporting of deaths in long-term care facilities and how to balance privacy and accountability are being considered," she said in an email.