HR Resources Database

HR Resources Database March 2008

The downside of work in Canadian long-term care facilities


A new study led by York University researchers reveals that a staggering number of Canadians working in long-term care facilities suffer violence on the job.

The study found that 43 per cent of personal support workers endure physical violence at work on a daily basis, while another 25 per cent face such violence every week. Most of the workers are women, and many are immigrants or from marginalized racial groups.

"What we found is disturbing," says Pat Armstrong (left), a professor in York's Department of Sociology, Faculty of Arts, and study co-author. "Canada's levels of violence towards long-term care workers are significantly higher than the other countries we looked at. The situation is out of control, as one respondent put it."

Workers at 71 unionized long-term care facilities in Manitoba, Ontario and Nova Scotia were surveyed about their experiences of physical violence, unwanted sexual attention, and racial comments. They were nearly seven times more likely to experience such daily violence than workers in Denmark, Finland, Norway and Sweden.

"Most studies will compare our situation with that of the US," says Armstrong, who holds the CHSRF/CIHR Chair in Health Sciences & Nursing Research. "We felt it was more relevant to compare ourselves with countries that have a public healthcare infrastructure. When we do this, we realize just how behind we really are."

The physical violence experienced by care workers typically includes being slapped or hit with an object. It frequently involves being pinched, bitten, having one's hair pulled, being poked or spit on. Having one's wrists painfully twisted is also common. One survey respondent noted: "I've been punched in the face several times. I've been punched in the jaw several times. Getting hit. Having your wrists twisted. Pulling and shoving at you. I mean that's a day-to-day thing. Violence is an everyday occurrence."

Armstrong says most violent incidents go unreported. "Workers are afraid to report violent incidents, fearing that they will be blamed. Or they simply don't have the time to do so. Alarmingly, workers inform us that they are expected to take such abuse. They are told to 'lighten up'," she says.

The study also establishes a correlation between levels of violence and heavy workloads placed on staff. The main difference between Canada and the four Nordic countries is staffing levels. "Most of the violence occurs during daily care activities, which involve intimate acts and sharing of personal space. If such care is rushed, or worse, if it is forced - for instance, when residents are required to get up, get dressed, or bathe before they are ready - this may leave residents feeling threatened, fearful or overwhelmed and prone to retaliate violently," says Armstrong.

Unwanted sexual attention was also commonly experienced by personal support workers surveyed. Approximately one third (30.1 per cent) said they experienced unwanted sexual attention on a daily or weekly basis.

Armstrong notes that 95 per cent of personal support workers are women. "Violence in long-term care is not just a worker's issue. It's a women's issue. When we speak of violence against personal support workers, we are in effect speaking of violence against women."

The research forms part of a larger comparative project investigating working conditions in long-term care facilities across Canada and the Nordic countries of Demark, Finland, Norway and Sweden. To facilitate comparisons between countries, the survey was designed in coordination with Nordic partners to ensure that largely identical questions were asked in both the Nordic and Canadian context. Five major health-care unions aided in the distribution of the survey.

The study, "Out of Control: Violence against Personal Support Workers in Long-Term Care", is authored by: York PhD candidate Albert Banerjee, Department of Sociology, Faculty of Arts; York Professor Tamara Daly, School of Health Policy & Management, Faculty of Health; Professor Hugh Armstrong, School of Social Work, Carleton University; York Professor Pat Armstrong, CHSRF/CIHR Chair in Health Services & Nursing Research, Department of Sociology in York's Faculty of Arts; Stirling LaFrance, York master's candidate, Department of Sociology, Faculty of Arts; and Professor Marta Szebehely, Department of Social Work, Stockholm University.

The study will be published as part of a forthcoming book on long-term residential care.


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