PSW bites a special constable; conditional discharge, still works as PSW

My late father was blessed with terrific PSWs

Personal Support Workers provide the most intimate of care for our loved ones. They deliver services to residents unable to carry out their own activities of Daily Living (ADLs); toileting, changing adult incontinent products, bathing, in institutions, private homes, retirement homes.

A call-to-arms has risen to protect seniors from elder abuse, yet the most simplest of solutions, to register and monitor the behaviour of PSWs goes unheeded. As long at four years ago, at a conference call between those of us acting a Family Council chairs for long-term care, many of us begged that PSWs be registered, trained, and supervised. Currently, there is no standard training. We train early childhood educators and demand they have their ECE two-year course, while PSWs working in profit and non-profits do not have similar requirements.

My dear friend, paraplegic with spinal stenosis.
I wrote about her in my book, as well as my parents.

PSWs are free to go from agency to agency, without their actions being tracked. The good ones often end up with the better paying jobs in hospitals. But all of them are part of those delivering services, subsidized by taxpayers in retirement homes, long-term care and delivering home care to seniors in these institutions and in their homes.

This PSW, with a history of alcohol abuse and violence, does not belong on the registry of PSWs, nor should he be working with people.

Judge grants would-be nurse a conditional discharge Ottawa Citizen
Ontario Court Justice Heather Perkins-McVey gave Mario Laliberté a conditional discharge and placed him on probation for a year after he admitted to biting a special constable while drunk. He was arrested Nov 29, 2010, for causing a disturbance and he bit through the officer's glove.
The judge, Justice Heather Perkins.McVey, an alcoholic who had received a discharge for a similar incident involving a security guard, said he had been abused as a child.

These ladies were wonderful with Dad.

Laliberté asked for leniency because one day he hoped to become a nurse and a criminal record would make it impossible for this. Why would a PSW be able to work with frail seniors, with those who have dementia, and the ensuing behavioural issues?

The four A's of dementia: anger, agitation, anxiety, apathy, demand we have highly trained workers who understand aging, dementia, and have anger management training. [Gentle Persuasive Approaches in Dementia Care.]


This violence goes both ways, but the focus is on seniors who are abused.
Man, 87, dies after Winnipeg care home assault

The accused, Joe McLeod, had previously been jailed for allegedly assaulting his wife.

All residents and all workers must be protected. This means that staff must be highly trained. The training varies, home to home, agency to agency.
But the pattern is that PSWs escape being charged if homes decline to charge them and fire them instead.
This case:

Worker charged in patient assault

30 Jun 2011 – A personal support worker at the Perley and Rideau Veterans Health Centre has been charged

is all the more frightening, since the worker was simply fired before charges were laid, after the incident in late May. Perley residents are at their most vulnerable, unable to communicate.

This PSW had been there for 21 years. Rey Lozada, 58, may well have burned out. Staff, family, friends must be vigilant in looking for signs.

While most abuse occurs at the hands of people residents know, the benefits of having a loved one in an institution with strict guidelines regarding staff and staff training, as well as whistleblower protocols, is enormous. It was a fellow PSW who reported the abuse.

In other stories:

 with assaulting a 90-year-old patient.

Hospital worker charged with sexually assaulting patient

www.torontosun.com/news/torontoandgta/2011/02/.../17331441.ht... 

18 Feb 2011 – A 45-year-old male personal support worker at a hospital in Durham Region is accused of groping a patient.

Personal support worker charged with sexual assault 

www.vancouverite.com/.../personal-support-worker-charged-with-s... 

21 Feb 2011 – A Scarborough personal support worker at the Rouge Valley Ajax Pickering... week with sexually assaulting a 22-year-old male patient recovering from surgery. ...Hospital was charged last week with sexually assaulting a

WOMAN ON TRIAL FOR ASSAULT OF ‘VIOLENT’ 75-YEAR-OLD IN NURSING HOME

By Kelly Patterson, Ottawa Citizen March 29, 2011

The PSW has been convicted, with a suspended sentence. This means, at least, that she has a record and cannot work with vulnerable people. 

Nurse Practitioners and Midwives

I have long celebrated both.

 It was thirty years ago, when pregnant with my first child, that OB/GYNs were fighting the accreditation of midwives. Now, they are an acceptable part of a practice. They have hospital privileges, and provide intense support, and home care.
For low-risk births, these professional midwives provide pre- and postpartum information and counselling on breastfeeding, as well as caregiving, something OB/GYNs often do not understand.

A recent US-based study tells us that many prefer Nurse Practitioners (NP) over physicians.
In general, the findings indicated that NPs spend more time with patients, listen more closely, provide more feedback, show more respect for patients' opinions, and the like. Note: Researchers point out that physicians scored well on the survey--an average global score of 7.2 out of 10. In comparison, however, NPs earned an global average of 9.8.



While this study is simply an opinion poll, it reflects the service received by US patients.
In fact, the Ontario movement to create Family Health Teams, seems to be the way to streamline services.

What does a patient want from a nurse?

The kind of service midwives provide.I hope that physicians will come to accept working in a fully-integrated healthcare system.

Dr. Brian Goldman, of White Coat Black Art, ER physician, book author, radio host, tweeted:

Study: Patients prefer NPs over physicians: MDs who don't realize it are like frogs in a pot of slowly heated water.

This will not replace physicians, but it will ease up the healthcare system. If we have NPs who can make house calls, to provide better homecare to frail seniors, this will add to the Aging at Home strategies.

I hope that GPs will realize what they do NOT know about geriatrics, we have far too few geriatricians in Canada.
We have many more nurses trained in palliative care and pain management.

Our Nurse Practitioners, caring for seniors in an integrated Family Health Team practice, provide much-need, personal care that a busy physician cannot provide.

To get an appointment is much easier with the NP. I had a precancerous skin issue. I visited my NP every two weeks to have it zapped. I didn't have to wait months to have it taken care of, I could make appointments as the treatment (liquid nitrogen) was a 10-minute procedure.

To learn more:
- read the Medscape Medical News story
- check out The Clinical Advisor's take

Food safety in retirement homes

In institutions, salads are few and far between.

This home was inspected and, again, had problems. Family members are wise to check out performances in such retirement homes.
In my late father's LTC home, fruit was never offered. Many cannot eat it, but others can.
His private retirement home was terrific, but cost a lot. Many cannot afford a retirement home.

If they have issues with handling food according to acceptable standards, what are they doing in terms of medical practices?

Choosing LTC vs. retirement homes, e.g., food handling

Inspection: Jun 28, 2011

Overall Result: Not In Compliance

Compliance Category	Description	Finding
Critical Food Safety	Food protected from potential contamination and adulteration	Corrected During Inspection

This home was inspected previously. The DAY BEFORE.

ROSEMOUNT RETIREMENT CENTRE, 25 ROSEMOUNT AVE, Ottawa,Ontario

Inspection: Jun 27, 2011

Overall Result: Not In Compliance

Compliance Category	Description	Finding
Critical Food Safety	Food is held at 4°C (40°F) or less	Not In Compliance
Critical Food Safety	Food is frozen at -18°C (0°F) or less	Not In Compliance
Critical General Food Safety	Thermometers used to verify food preparation and storage temperatures;	Not In Compliance
Critical Food Safety	Food protected from potential contamination and adulteration	Corrected During Inspection
Non-critical Sanitation, Design and Maintenance	Food contact surfaces properly designed, constructed, installed and maintained	Not In Compliance
Non-critical Sanitation, Design and Maintenance	Sanitize test kit / thermometer readily available for verifying dishwashing and sanitizing temperatures	Not In Compliance
Non-critical Sanitation, Design and Maintenance	General housekeeping is satisfactory	Not In Compliance

They hadn't been inspected in nearly two years.

Inspection: Dec 10, 2009

Overall Result: In Compliance

This premises was found to be in compliance with the Ontario Food Premises Regulation.

Inspection: Sept 14, 2009

Overall Result: In Compliance

This premises was found to be in compliance with the Ontario Food Premises Regulation.

Dad's LTC dinner

Inspection: Aug 17, 2009

Overall Result: In Compliance

This premises was found to be in compliance with the Ontario Food Premises Regulation.

LHIN Responsibilities

The LHIN’s mandate with respect to these responsibilities relates to

• community engagement, planning, funding and accountability.  

The LHIN coordinates 135 services providers. They work with hospitals, LTC, ccac, community mental health & addiction, community health centres, community support and support and services agencies. They are resp. for community engagement with the public, professionals, and coordinating services.The agency I volunteer with does: Meals on Wheels, tranportations, foot care, diners' clubs, home help, home maintenance, grief support groups, resources library, hospice, friendly visiting in hospitals alone. To increase the responsibility of hospitals to turn around and supervise this work, esp. after Every Patient Matters personal experiences, frightens me. It would be the cart leading the horse.
This mandate is carried out in
a region that has a broad diversity of geography, language and culture, and
involves 135 service providers.
Through this mandate the LHIN’s vision is to build engaged and healthy
communities and to demonstrate values of accountability, responsiveness,
respect, integrity, innovation and respect.

The Old Boys Network in Texas Medicine

This American Life featured a show about the Old Boys who live and work in red-neck, small town Kermit, Texas. It is a familiar thread man's inhumanity towards women.
It is about the incompetent male doctors, a crooked male lawyer, vs. female nurses - who chose to speak truth to power, following proper protocol, and ended up arrested. It is shocking.

The nurses, well-respected Anne Mitchell and Vickilynn Galle, thought they were protected, but faced a legal charge and the possibility of $10,000 fine and 10 years in jail.

It demonstrates how a doctor let go from larger town, Odessa, Texas, where no one spoke truth to power, allowed this doctor to move to another state, with limitations on his license, yet the Texas Medical Board failed to follow through in order to protect all its US citizens.
The story begs the question, how well do we monitor foreign-trained medical staff in North America?
Also, when doctors move to another province or state, how well are they followed? Where is the accountability to the citizens of the country?

A doctor who manages to work in two small towns, despite questions about his competence. Eventually Arafiles, the doctor, received notice from the Texas Medical Board that he was under investigation. The sheriff, a friend of said doctor, managed to find the names of the nurses, which were supposed to be confidential, and went after them in a shocking example of a travesty of justice.

The story has a good ending, although the grief these women suffered for outing a doctor taking patients off of thyroid medicine and putting them on non-FDA-approved concoctions that the doctor has others (in sort of a Ponzi scheme) sell privately. The nurses were charged with 'misuse of information', after reporting the medical treatment of their patients, were awarded $750,000 after they sued. Their accusers were charged with misuse of information, by taking confidential documents, including patient records, to go after the nurses.

To get more of the full story:

 OLD BOYS NETWORK

Originally aired 06.03.2011

Stories about standing up to the man—or, really, the men. Nurses at a small Texas hospital report a well-connected doctor for dangerous medical practices, and find themselves under arrest. Plus...how political operators in Chicago get to be judges.

ACT ONE. MESSING WITH THE BULL.

In a small west Texas town called Kermit, two nurses were accused of harassment after they complained to the medical board that a doctor was putting patients in danger. The nurses were fired and then arrested, facing ten years in prison. Reporter Saul Elbein found that a group of powerful men in Kermit went to extreme and sometimes ridiculous lengths to try to bring down these nurses. Saul wrote a version of this story for the Texas Observer.

Intent To Harm

The new doctor in town was friendly, popular—and dangerous. Especially to the nurses who reported his bizarre treatments 

BEFORE EVERYTHING HAPPENED, NURSE ANNE MITCHELL SAYS KERMIT [Texas] had a good little hospital. “We had an excellent nursing staff. We had great doctors. We provided very, very good care.”

In 2008, when the trouble began, Winkler County Memorial Hospital was the pride of Kermit, one of the few new buildings and success stories in town. This flat, dusty burg of 5,000, 35 miles west of Odessa, is a ramshackle prairie town sprawling along Highway 18 in a motley collection of cinderblock and prefab siding. In the center of town, surrounded by a well-kept lawn and shuttered storefronts, sits a stately Depression-era courthouse. From any vantage point, you can see the face of Kermit the Frog, staring down at you from the water tower.

OMEGA--Journal of Death and Dying

OMEGA--Journal of Death and Dying
	Issue:	Volume 63, Number 2 / 2011
	Pages:	141 - 160
	URL:	Linking Options

Coping with the Ultimate Deprivation: Narrative Themes in a Parental Bereavement Support Group Laura R. Umphrey A1 and Joanne Cacciatore A2 A1  Northern Arizona University, Flagstaff A2  Arizona State University, Phoenix Abstract: Support groups are often used to help individuals cope with challenging and unusual life circumstances through narration. Yet, little is known about specific meta-communication within a support group setting and in what ways these interactions may benefit participants. This study uncovers narrative themes that were expressed during a series of support group meetings specific to bereaved parents. Three central narratives were revealed in the analysis including the death story narrative, coping/negotiating narrative, and connecting through communication with others narrative. This research underscores the vital outlet that the support group serves for participants and the communicative means by which subjective healing can occur.

CARP online poll on elder abuse: lacks validity, reliability

I eschew online surveys and polls. They are inaccurate. They are wrong. It violates all of the scientific protocols for statistical reliability, validity, and we read media quoting them all the time.
In order for the study to be reliable, you need a true sample of the population. CARP surveying its members is not valid. These are people who have paid money to belong to this lobby group. And their opinions are just that - not data. NICE is conducting a better, reliable and valid survey, supervised by social scientists: Defining and measuring elder abuse.

Myths of Elder abuse abound. Personally, we need more people in more private homes to watch for such abuse. Those situated in long-term care, especially those with great staff, do monitor each other.

I would believe, from MY work in eldercare, that there are more caregivers, paid and unpaid, who are abused, than the opposite.
How to help aging, abusive parents
Is this valid? The question, have you EVER experienced abuse is misleading. Elder abuse occurs when you are elderly. Those answering can respond from any experience, at any age.

Elder Abuse Poll Elder abuse can include physical abuse, such as beatings, sexual abuse, such as molesting, verbal abuse, such as cursing and swearing, financial abuse, including fraud and misappropriation of funds and neglect of the basic necessities of life. Have you personally ever experienced ANY of these forms of elder abuse? Yes 80 Votes 6.9 % No 1079 Votes 93.1 % Total 1159 Votes Which type of abuse did you suffer? Physical abuse 7 Votes 0.6 % Sexual abuse 3 Votes 0.3 % Verbal/psychological abuse 38 Votes 3.3 % Financial abuse 16 Votes 1.4 % Neglect 5 Votes 0.4 % OTHER ABUSE 1 Vote 0.1 % MORE THAN ONE KIND OF ABUSE 18 Votes 1.6 % NEVER BEEN ABUSED 1069 Votes 92.4 % Total 1157 Votes

Firstly, do you notice the above chart: 93.1% have not experienced abuse in Q. 1, yet in Q. 2, suddenly 92.4%, a difference in 10 votes, haven't been abused. Many more of my clients have engaged in self-neglect, rather than elder abuse.

Secondly, this doesn't have construct validity.  Can you say you've been verbally abused?
I can. I have been shoved by a large, angry parent while doing hall duty as a teacher. I've had parents yell at me. I've been yelled at by angry kids. But until the verbal abuse is persistent, it is not abuse. Angry clients with dementia have yelled at me, including my late father, but that isn't verbal/psychological abuse.

Thirdly, elder or child abuse is wrong. Neglect is wrong. But abuse is very different from understanding how seniors ought to be cared for, neglecting someone may mean they didn't have the education or knowledge to do so in the first place. With 70-year-olds caring for 90-somethings, they do the best they can.  Many more understand raising a child. Much fewer understand caring for failing seniors. They need footcare, and often dental care. Many die from aspiration pneumonia. There are those who do not visit a dentist. Is this abuse or neglect?

 Medscheck to ensure the medications are being taken correctly, and they aren't taking too many. Visit your pharmacist for Medscheck. In Ontario the government pays for a pharmacist to check in with you and your medications. Polypharmacy is a terrible issue with some seniors. 


Many seniors fail to use mobility devices, walkers, wheelchairs, and have a fall. This is predictable, and the statistics show how falls hurt many and result in unrecoverable hospital stays.
Does this mean we charge the caregiver with neglect - because they didn't force their spouse/aging parent to use said device?

Next question:

Who was the person who inflicted the abuse?
Professional caregiver in an institution	6 Votes	0.5 %
Professional caregiver in the home	1 Vote	0.1 %
Family caregiver - spouse	18 Votes	1.6 %
Family caregiver - child	20 Votes	1.7 %
Family caregiver - other	9 Votes	0.8 %
Trusted advisor (lawyer, accountant, etc)	5 Votes	0.4 %
Friend	3 Votes	0.3 %
Acquaintance	13 Votes	1.1 %
Stranger	13 Votes	1.1 %
NEVER BEEN ABUSED	1069 Votes	92.4 %
Total	1157 Votes

Easy on a webpage to complain about family caregivers. I've yelled at my kids; they've yelled at me. That isn't abuse, either. In the above table, at this point, 47 people say they've been abused by a caregiver. It seems as if, if we can believe these stats, that we have to look to the home to ensure the safety of our seniors.

Also, rather than spending millions of dollars on more studies, let's provide more professional homecare, more people in the home, more respite for caregivers, would relieve the stress of caregiving. And it is stressful. As a stay-at-home mom in the 70s/80s, I found it difficult.
As a caregiver in my 50s, it was even worse with my father's brain tumour and resulting dementia. He didn't understand that he didn't understand numeracy principles anymore and couldn't DO his banking. He allowed the bank manager to take his paperwork back and forth from his house to the bank herself. He would have claimed I was financially abusive, as he didn't understand numbers anymore.

My mother, while fighting cancer, had radiation, chemo, and was not herself. She was verbally abusive to me; constantly undermining my authority, refusing to accept CCAC home care while I was living next door and working full time,. Who was abusing whom? She wasn't in her right mind. I knew that. She didn't know what she didn't understand any more.

Next...we have had awareness programs.

Experts on elder abuse have made a number of recommendations. Which ONE of the following do you think would do the most to prevent elder abuse? Developing and implementing a National Strategy on Elder Abuse 116 Votes 10.0 % Promoting and funding research on elder abuse 12 Votes 1.0 % Coordination and dissemination of elder abuse resources 35 Votes 3.0 % Development of a national public awareness program on detecting elder abuse 294 Votes 25.4 % Ongoing support and coordination of groups working to prevent elder abuse 114 Votes 9.9 % Developing a National Centre for Forensic Investigation of Elder Abuse 14 Votes 1.2 % Working with the Justice Ministry, RCMP, Health Canada to coordinate response 59 Votes 5.1 % Funding for a national volunteer agency to promote more awareness and research 14 Votes 1.2 % NONE OF THESE WILL WORK, NEED REAL ACTION, NOT MORE STUDY 356 Votes 30.8 % DON’T KNOW 143 Votes 12.4 % Total 1157 Votes

These people answering the request for an opinion seem to disagree with themselves.

Generally, three kinds of abuse are recognized by society - child abuse, spousal abuse and elder abuse. Which of these do YOU think is the most abhorrent? Child abuse 270 Votes 23.3 % Spousal abuse 22 Votes 1.9 % Elder abuse 16 Votes 1.4 % ALL EQUALLY ABHORRENT 826 Votes 71.4 % DON’T KNOW 23 Votes 2.0 % Total 1157 Votes

Which of these do you think SOCIETY thinks is the most abhorrent? Child abuse 888 Votes 76.8 % Spousal abuse 24 Votes 2.1 % Elder abuse 8 Votes 0.7 % ALL EQUALLY ABHORRENT 186 Votes 16.1 % DON’T KNOW 51 Votes 4.4 % Total 1157 Votes

In fact, abuse is abuse, it should be the police who become involved. It is professional caregivers who can monitor.
Responding to Elder Abuse and Neglect:
The Challenge for Health Care and Social Service Workers

In many cases, 60/40, it is a male response on-line: how many men are caregivers, or in a position to understand abuse? 

What is your gender? Male 671 Votes 58.0 % Female 486 Votes 42.0 % Total 1157 Votes