The Role of the Union in Abuse Prevention: Current Situation, Future Possibilities

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The Role of the Union in Abuse Prevention
Current Situation, Future Possibilities

• Marcy Cohen
• Research and Policy Planner, HEU

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Who are the members of HEU?

• About half of our members work in direct patient
  care
• Most of the workers in long term care are in HEU
• Identity of the union closely tied by the LTC
  organizing drive in 1970s that linked poor
  working to poor caring conditions
• The union is committed to working in coalition
  with community and seniors groups in advocating
  for better care

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Multiple Roles The duty to represent our members

• Representing individual members who have been
  accused of abuse
• Encouraging members to report abuse
• Developing strategies to address systemic abuse

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An informal Survey of the Servicing Reps

• When a member is accused of abuse he/she is sent
  home while the management conducts an
  investigation
• It is the responsibility of the Servicing Rep to
  represent that worker
• There are workers, who have been fired, based on
  evidence that they are unsuitable to work with
  the elderly
• There are also cases where people are burnt out,
  and others where the individual reports themselves

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Related Issues

• Care Aides and LPNs learn about resident abuse
  and the reporting requirements in the public
  college programs but this training is not
  mandated
• Regular in-services are not provided
• Many managers do not know how to conduct an
  investigation. They could also use more training
  and support (CDNA, 2004)
• Some servicing reps do remind members of their
  duty to report, but not all. Also need training

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Systemic Abuse Normalized Neglect

• There are LTC facilities where there have been
  on-going concerns raised by our members that took
  years to resolve
• The majority of our members working in LTC are
  very concerned about situation of residents who
  are alone and do not have family to advocate on
  their behalf
• Concerns about neglect and lack of respect raised
  by our members during the consultation on the
  regulations for the Community Care and Assisted
  Living Act

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Individual Risk Factors

• Not suited to work with frail elderly or dementia
  population
• Alcoholism
• Depression
• Family problems, history of abuse
• LEARNED REPSONSE TO STRESS

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Systemic Risk Factors

• Organization Cultures and professional inaction
  key in hiding abuse (Pring, 2005)
• External Oversight Key Inspection and Regulation
  relevant in tackling abuse (Clough and Manthorpe,
  2004)
• Mandated staffing levels
• Mandated staff training

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Prevention at the Facility Level
Promoting an organization culture that supports
good care
Engaged Environment

• Care Aides encouraged to have input at meetings
  and to be involved in care planning
• Information clearly conveyed on a residents
  history of aggression
• Teamwork cultivated and flexibility supported

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Prevention at the Facility Level (continued)
Substantive Philosophy of Care

• Values are modeled in all relationships
  especially by managers in their dealing with
  staff
• Training acknowledges rather than idealizes
  working conditions
• Clear and realistic expectations of staff

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Prevention at the Facility Level (continued)
Concrete Policies and Practices

• Appropriate staffing
• Clean and fair policies
• On-going training and staff development

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Prevention at the System Level
Strengthen Licensing Regulations Enforcement

• Increased transparency in complaints process
• Regular surprise inspections
• More proactive role in investigating abuse
• Training and staff requirements written into the
  regulations

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Lessons from the US

• Very strong consumer movement in response to
  private delivery system National Citizens
  Coalition for Nursing Home Reform, www.nccnhr.org
• Federal legislation requiring state level
  advocates (systemic) and local advocates (for
  residents in LTC)
• Significant research linking staffing levels and
  training to quality care Report to Congress on
  Appropriate Staffing Levels (2001)

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Lessons from the US(continued)

• Regular public reporting on the licensing
  violations related to improper use of restraint,
  lack of respect for personal autonomy and
  privacy, poor quality care, etc
• The California Website www.calnhs.org a
  partnership between a Foundation and the
  University of San Francisco

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Other Forms of Oversight

• Mandatory family councils and independent
  advocate Ontario
• Ombudsman Alberta
• Accreditation Process

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Future Directions for HEU

• Provincial Policy table mandated in bargaining
  that will focus on training requirements and
  standards for Care Aides, and staffing and
  quality care issues in LTC
• Increased focus within the Union on licensing
  process and enforcement
• Possibilities of partnering in the development of
  training on abuse prevention for HEU reps and
  members