January 28, 2018
Dementia is among the most devastating health conditions associated with growing older, with Alzheimer’s disease being the most prevalent cause. Over the past several decades, as the ability of families to cope with the many stresses of dementia caregiving have mounted, long-term care facilities in Ontario and across the world have become the places we look to in order to best meet the needs of affected patients and to give their families respite. This is hard, grinding work as patients with dementia need assistance in nearly all activities that the rest of us might effortlessly take for granted.
Along with the cognitive deficits of dementia, in which patients are forgetful, have difficulty communicating, cannot adequately organize themselves or problem-solve effectively, nearly all get confused navigating familiar surroundings. At mid to later stages of severity, these individuals need help dressing, bathing, eating and having their daily care needs met. While the work is demanding of all of us who have dedicated our careers to this field, it is also immensely rewarding and of great benefit to families —that is why we do it.
One of the greatest challenges in caring for patients with dementia is that the disorder often results in changes in behaviour and emotional control. This is very troublesome and has to be addressed when patients are cared for in their own homes by family members as well as by staff in long-term care facilities. People affected with dementia can get easily excited or upset, be verbally abusive to others, resist care, are suspicious, and at times, might engage in violent behaviour. Occasionally this aggression can be predicted and prevented, but often it is remarkably impulsive and occurs very suddenly. At present, we do not have medications that adequately prevent aggression without also so thoroughly tranquilizing individuals that they cannot safely move about, communicate, or meaningfully engage in social, recreational or other activities that support quality of life. As a society we have rightly chosen to avoid limiting the freedom of movement of affected patients living in long-term care homes —we do not think it is morally right to physically restrain or lock up in seclusion our loved ones who are suffering from terrible brain diseases that cause them to behave in ways they would likely never choose.
Some believe that more staffing would solve the issue of assaultive behaviour. The reality is that we have very limited useful data to tell us the extent to which increased staffing levels for dementia care would reduce the occurrence of resident-to-resident violence and by what amount. We do know it would likely be impossible to completely eliminate the risk if patients with dementia continue to live together in congregate care settings, such as the contemporary long-term care home.
The CBC Marketplace episode titled Crying Out For Care, which first aired on January 26, 2018, highlights a serious public health challenge that will grow in importance as the global population ages. We want to talk about this issue, but it must be in a responsible, thoughtful way that informs the public. As a society, as well as focusing on care, we must also focus public efforts on brain health and invest resources into the prevention, diagnosis and treatment of brain diseases like Alzheimer’s. Eradicating these threats to our well-being should be a major priority.
The episode included some upsetting footage taken of an altercation between two residents on a long-term care floor at Baycrest approximately five years ago. I recognize that many viewers may be upset by this episode, and rightly so. We are disturbed and saddened by this case. It is unfortunate that the CBC has chosen to approach a very serious public health issue by emphasizing this uncommonly tragic event.
Regardless of how the CBC has reported this, the outcome of the altercation that took place between the two residents in 2013 was particularly tragic, and we recognize the pain and anger the family must feel and our sympathies go out to them.
While we do not generally share information regarding specific residents publicly, we do so here because certain information shared in the broadcast mischaracterized actions taken by Baycrest. I would like to clarify the following:
Baycrest did not keep the existence of the video hidden from the family, and upon receiving a request to view the video – four months after the incident – we immediately took steps to respond.
We embrace transparency and disclosure with families and residents. The incident occurred in the very early hours of the morning and the family was notified of the altercation later that same morning. A Ministry of Health and Long-Term Care critical incident report, which outlined the altercation, was filed the same day.
I fundamentally believe in the dedication of our staff and their skills. This particular incident does not take away from the great work our staff does every day to provide for our clients.
We at Baycrest are committed to providing all our clients with the best possible care experience and have worked tirelessly to be a recognized global leader in geriatric care, research, education and innovation.
William E. Reichman, M.D.
Former President, American Association for Geriatric Psychiatry and the Geriatric Mental Health Foundation
President-Elect, International Psychogeriatric Association
President and Chief Executive Officer, Baycrest Health Sciences