Gender plays an important role in how staff prevent, respond to, and experience violent situations in long-term residential care (LTRC), yet gender has received limited attention in research and policy on violence in LTRC and in dementia care more broadly.

This is despite evidence that violence is primarily directed at staff and residents who identify as women, while men residing in LTRC are more likely to act violently. The current lack of attention to gender-based violence in LTRC results in violence prevention policies overlooking the gendered relations that shape violent interactions and their interpretation.

Observational and interview data are analyzed in this article to examine the implementation of innovative non-forced care (NFC) policies in Canada. Such policies respond to issues of violence and prohibit forcing care upon long-term care residents without consent. We examine alignments between NFC and person-centered care, and suggest that NFC, in practice, is more akin to a harm-reduction approach to violence prevention. We describe structural factors contributing to a top-down, paradigmatic shift that reshaped care provision. NFC policies do not necessarily imply a complete absence of force, and acknowledging how workers’ navigate ethical dilemmas can encourage higher standards of care.

In long-term residential care (LTRC), sometimes staff provide involuntary care—care that residents refuse or resist—which can cause harm to both staff and residents. In this analysis, we explored how and when staff provide involuntary care, when they accept or see this practice as necessary and when they reject this practice. Data included interviews with staff, families, and residents working and living in LTRC as well as observations in two Canadian provinces. The acceptability of involuntary care was influenced by the potential of harm toward staff rather than the potential for harm to residents. This is apparent through the rationale given for what kind of force is acceptable in care, and what kind of force is not. The potential for staff injury and risk of being reprimanded by management are frequently factors in whether or not to proceed in providing care that the resident has not consented to. Staff narratives about the use of involuntary care reflect a lack of both interpersonal and organizational safety that undermines the autonomy and dignity of those for which they provide care.

Violence is pervasive within home and residential long-term care, affecting older adults, family carers and paid care workers. As part of the Safe Places for Aging and Care Study, we conducted a document analysis to examine provincial and regional strategies for preventing and addressing violence in home care and residential long-term care in Manitoba and Nova Scotia. In total, we analyzed 51 documents from both provinces (legal documents, provincial policy documents, regional policy documents and reports) using qualitative content analysis. This presentation will provide an overview of major policy responses to violence in home care and residential long-term care and critically reflect on how violence and violence prevention is constructed within policy documents. The presentation will conclude with recommendations for policy development and outline our plans for future research.

Presenters:

Dr. Sheila Novek, PhD

Postdoctoral Fellow, Safe Places for Aging and Care

Dr. Rachel Herron

Department of Geography and Environment, Brandon University

Nov. 18th, 2021 from 12:00 to 13:00 CT