(Above Chart: Combined numbers from Coroners, CMEs and media reports; 2012 and 2013 omitted due to incomplete data for Ontario, Manitoba and Alberta.)
There have been at least 60 nursing home homicides across Canada in the last 12 years.
The tragic stories behind the statistics include a son strangling his mother in a mercy killing, an altercation involving a man visiting his wife in a nursing home and residents dying in fires deliberately set by othersother residents.
But the prevailing trend revealed by W5鈥檚 research into homicides and suspicious deaths in nursing homes points to a crisis in how our society cares for people living with dementia.
The challenge of counting nursing home homicides across Canada arose after the Ontario coroner鈥檚 office told us that there had been 25 homicides in the province鈥檚 long-term care facilities (LTCs) between 2001 and 2011. That number was shocking, because we, journalists who have been covering the topic during those years, could only recall a handful.
So W5 contacted the Coroners and Chief Medical Examiners (CMEs) in every province and territory to see what numbers they kept.
While providing numbers, the coroners and CMEs repeated an important caveat: they do not establish culpability. When a coroner says 鈥渉omicide鈥� it鈥檚 not a determination of guilt, it鈥檚 a constitution of fact that the actions of one person resulted in the death of another. Accidents are not included.
When all the data was in, six provinces combined reported 53 homicides for various periods between 1990 and August 2013; four provinces reported zero, so did the three territories.
Next, a team of researchers scoured media archives and on-line coroner reports for nursing home murders. We found reports of 42 deaths that fit the nursing home homicide criteria. Twenty-five corresponded with the time periods covered by the coroners and 17 fell outside those timeframes. These 17, combined with the coroners鈥� 53, brought the total to 70.
The earliest was from 1987, when an 86-year-old man died after being attacked with a cane in an Edmonton home. We found seven homicides in the 1990s, but the majority of LTC murders have occurred since 2001: at least 60.
That total is likely higher, because Ontario has not provided numbers for 2012 and 2013, while Alberta and Manitoba don鈥檛 have this year鈥檚 numbers available yet. British Columbia provided numbers for 2012 and 2013 only.
Media coverage
Around half of all nursing home homicides make headlines. In Ontario, for example, we found media reports for only 13 of the 25 homicides the coroner told us had occurred in 2001-2011. We only found reports for 2 of 5 homicides that happened in Manitoba, 1 of 5 in Nova Scotia, 1 of 2 in Alberta.
Dr. Roger Skinner, chair of the Ontario Coroner鈥檚 Geriatric & Long Term Review Committee, said he is 鈥渘ot surprised that most of these cases do not come to the attention of the media.鈥�
鈥淎lthough they are homicides by the coroner's definition, they generally do not result in charges and families often do not wish to pursue the matter,鈥� Skinner explained.
Trends
We asked Ontario鈥檚 Dr. Skinner, who previously worked on the front lines of senior鈥檚 care as a clinician in a psycho-geriatric unit, to explain why the number of LTC homicides is so high in Ontario that it accounts for half of the nation鈥檚 total.
鈥淚 am skeptical that the numbers in other jurisdictions are significantly different. I suspect that the difference is one of definition and reporting,鈥� he explained.
The prevalent cause of death, in coroner parlance, is the 鈥減ush-fall interaction鈥� between two residents living with dementia.
鈥淭he majority of cases involve one or two individuals who suffer from dementia with aggressive behaviours. Usually there鈥檚 an escalation of that behaviour prior to the incident. Most of the incidents involve initially a verbal altercation and then a physical altercation in which one individual is pushed and falls and either suffers a fracture like a fractured hip or suffers a head injury鈥� The individuals usually share some living space, either they鈥檙e roommates or they share common space like a bathroom or a hallway,鈥� said Skinner describing LTC homicides in Ontario.
A review of the 42 homicides from media reports shows that trend across the country. Indeed, Skinner鈥檚 description of the most common form of nursing home homicide fits the tragic circumstances that led to the death of Frank Alexander, the focus of W5鈥檚 investigation Deadly Care.
Skinner said the overall number of homicides in Ontario is in the range of 4 to 10 a year. He says that number has been relatively stable in the last few years, but anecdotally, the number of actual incidents seems to be on the rise.
This tragic reality is not surprising given the projections of the number of Canadians living with dementia and forecasts for nursing home populations. The Alzheimer鈥檚 Society of Canada estimates there are 747,000 Canadians living with dementia today, a number that鈥檚 expected to reach 1.4 million by 2031. Experts project that the number of nursing home residents will double from 260,000 in 2005 to more than half a million by 2031 鈥� if the same level of institutionalization is maintained.
The search for solutions to the prevalent models of long-term care is being spearheaded by individuals and organizations like the Alzheimer鈥檚 Society who are calling for change in the culture of long-term care.
Research team: Steve Bandera, Kelly Butler, Leanne Dufault, Anne Gentleman, Tamara Huggins, Chris Kapalowski, Litsa Sourtzis
