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One challenge in understanding the extent to which people in health care are injured at work is that injuries tend to be underreported. Generally the data used to measure health care worker injury is through workers’ compensation claims. A study of Canadian health care workers found that of 2,500 health care workers who experienced an injury, less than half filed a workers’ compensation claim.

Recent data from Alberta shows that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the mining and petroleum industry.

A study of health care worker injuries in three British Columbia health regions from 2004 to 2005 found that injury rates are particularly high for those providing direct patient care – and highest among nursing or care aides (known as health care aides in Alberta, and personal support workers in Ontario).

83% of health care worker injuries were musculoskeletal in nature.

However, there have been efforts to mechanize some of the dangerous aspects of health care. Musculoskeletal injuries are the leading category of occupational injury for health care workers.

Evidence suggests that this is the case – a 2009 British study of over 40,000 workplace injury claims found that 89% were made by women, and 11% by men.

Gert Erasmus, senior provincial director of workplace health and safety for Alberta Health Services says that “health care is a people intensive business – combine that with physically demanding jobs and an aging workforce.”

The Canadian Federation of Nurses’ Unions notes nurses retire around the age of 56 – compared to the average Canadian worker at 62.

Experts also point to the changing work environments for many health care workers. There is a worldwide trend towards moving health care services out of hospitals into patients’ homes. Thease are uncharted waters for workplace safety and prevention of injury. Little is known about how often workers in peoples’ homes are injured and the kinds of injuries they are sustaining.

Gert Erasmus notes the tremendous insecurity of providing health care inside patients’ homes. “They [health care workers in homes] work in an environment that is not controlled at all, which is fundamentally different than most industries and workplaces.” In this environment, workers are more likely to be alone, lacking back up from colleagues, and the help of aids such as mechanical lifts.

Miranda Ferrier, President of the Ontario Personal Support Worker Association says that each time a personal support worker enters a new patient’s home – they enter into the unknown. “You are lucky if you know anything about a client when you go into the home” she says.

in 1979, 225 of every 100,000 Canadian deaths could have been avoided by preventing a disease or injury. By 2008, the rate had fallen to 119 per 100,000 deaths — a drop of 47 per cent

Improvements in getting people timely and effective healthcare also helped to reduce untimely deaths. The rate for this measure dropped by 56 per cent in three decades, from 149 per 100,000 Canadians in 1979 to 66 per 100,000 in 2008.

the drop in preventable deaths was largely due to fewer people dying from circulatory diseases, including heart disease

gains in cancer survival rates, which are improving all the time, and policy changes to boost public safety and reduce injury, such as seatbelt laws and other driving legislation, have been the other big factors

Canada ranked third lowest in preventable death rates, coming behind Japan and France

large differences between socioeconomic groups. Specifically, the rate of preventable deaths for people living in the least affluent neighbourhoods was double that of people living in the most affluent neighbourhoods

we have three recommendations

Patient-centred care, inter-professional care and comprehensive care are all things that deserve and require additional investment and attention.

We need a pan-Canadian human resources for health observatory function to provide evidence and data on which to plan. Our workforce science in Canada is at a very primitive stage, and we are lurching from one crisis in one locality or one specialty to another.

The second recommendation

Our third recommendation

Canada needs an injury prevention strategy to elevate in the public's attention and bring resources to bear to reduce needless injuries in our life. The reason for this is that injuries cause a lot of loss of life, disability, long-lasting disability and painful disability, and they cost a lot of money.

Jean-François LaRue, Director General, Labour Market Integration, Human Resources and Skills Development Canada

foreign credential recognition

Marc LeBrun, Director General, Canada Student Loans, Human Resources and Skills Development Canada

Canada student loan forgiveness for family physicians, nurses and nurse practitioners, as introduced in Budget 2011

Robert Shearer, Acting Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Health Canada

in 2004 the federal government committed to the following: accelerating and expanding the assessment and integration of internationally trained health care graduates across the country; targeting efforts in support of Aboriginal communities and official language minority communities to increase the supply of health care professionals in these communities; implementing measures to reduce the financial burden on students in specific health education programs, in collaboration with our colleagues in other federal departments; and participating in HHR planning with interested jurisdictions

Canada does not have a single national health human resources plan

Health Canada plays a leadership role in HHR by supporting a range of targeted projects and initiatives of national significance.

Pan-Canadian Health Human Resource Strategy

Internationally Educated Health Professionals Initiative

Health Canada supports collaborative efforts as co-chairs of the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources known as ACHDHR. This committee was created by the conference of deputy ministers of health back in 2002, to link issues of primary health care, service delivery and HHR.

ACHDHR will be providing a written brief

The federal government also participates on ACHDHR as a jurisdiction that directly employs health care providers and has responsibility for the funding and delivery of certain health care services for populations under federal responsibility, such as First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces and the Royal Canadian Mounted Police.

Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada

Dr. Brian Conway, President, Société Santé en français

account for over a million Canadians who need access to quality health services in their own language.

Acadian and francophone communities outside Quebec

Senator Eggleton

I am interested in the injury prevention idea. We hear of it from time to time. Do you have some specific thoughts on what an injury prevention program or strategy might look like and how it might fit in with the health accord? One of the things the Health Accord brought about in 2004 was the federal government saying to the provinces, “If you do this and you do that we will give you money here and there.” Maybe we should be doing that here. Maybe we should ask the federal government to provide an incentive for the provinces to be able to do something. It would be interesting if you could come up with a vision of what that strategy might look like.

Home care provided by the province is typically capped at 21 hours a week

why someone hurt driving a gas-guzzling vehicle receives greater compensation than someone biking or engaging in a sport. In Australia, a national commission tasked with that question has produced a proposal for a National Injury Insurance Scheme designed to cover the lifetime care and support needs of people who get a catastrophic injury, however it happens.

Long-term-care insurance is expensive, relative to the odds of needing it. Long-term-disability insurance is more affordable, but it typically only replaces lost income. Critical-illness coverage will provide people with a lump-sum payment should they develop any of a list of diseases or disabilities. (About $120 a month allows $200,000 of coverage.)

The report details vulnerabilities in the system and the costs of inaction: Emotional abuse, bullying, and even physical threats are often accepted as “normal” conditions of the health care workplace.  Production and cost pressures in health care have reduced intimate, personal caregiving to a series of demanding tasks performed under severe time constraints, detracting from what should be joyful and meaningful work. More full-time employee workdays are lost in health care each year (due to illness or injury) than in industries such as mining, machinery manufacturing, and construction.

An elderly woman with a broken thighbone in a Pickering nursing home suffered for days without treatment.

A Brantford home was so short staffed that residents frequently missed their weekly baths.

Eight years after an Ontario government promise to revolutionize nursing home care, the elderly are still suffering neglect and abuse.

The Star’s investigation draws from material uncovered by a new inspection system created by the Ministry of Health and Long-Term Care in July 2010. It has since investigated 2,993 complaints and critical incidents, like broken bones or assaults. We analyzed more than 1,500 of those inspection reports and found at least 350 cases of neglect where residents were left in soaking diapers, suffered untreated injuries, bedsores, dehydration, weight loss or were put at risk from outdated care plans that ignored changing medical needs. Other reports, scrutinized for Thursday’s story, focused on abuse. Today the Star probes the issue of neglectful treatment of home residents. The reports reveal that many families have no idea what their loved ones are subjected to. Inspectors found that some homes do not disclose problems to the ministry or police.

Diaper shortages can be found in many of Ontario’s 627 homes, said Sharleen Stewart president of the union representing front-line nursing home staff. “Our members tell us the shortages leave residents with rashes and sores,” said Stewart, of the Service Employees International Union, which represents 50,000 Ontario health care workers, including 22,000 nursing home employees.

Last November a ministry inspector wrote, “Five different nursing staff members working the day shift from all home areas… indicated they are only provided with one (diaper) per (eight hour) shift for the resident and frequently have to go to another home area to try and borrow products.”

The report also described a resident with an open sore whose diaper was soaked in the morning. Since staff could not find a replacement, the resident was only given a paper insert to keep urine from the senior’s wound.

Two months later, in January 2011, the ministry was back at the same home, this time investigating a complaint from a family who said their loved one was wearing the same diaper from the previous day and it was “heavily soiled.”

Ko dismissed allegations that a Revera home in north Etobicoke rations diapers. But one current and one former resident of Westside Long Term Care on Albion Rd. told the Star residents are only given one diaper per eight-hour shift.

She praised the staff, saying they scramble to find an extra diaper if one’s needed. “They’re embarrassed that I’m embarrassed.”

Two employees at Westside said the home locks up diapers and staff have to sign them out. The workers at Westside spoke on the condition of anonymity, saying they are afraid of being fired. One worker said she is so worried about leaving residents in wet diapers that she places towels and plastic garbage bags under them to prevent urine from soaking their bed sheets.

Revera was “shocked” to hear allegations that makeshift diapers were being used and she has both launched an investigation and is conducting educational sessions for staff

Westside workers say their bosses warn staff they will be fired if they tell residents’ families the home is rationing diapers. Whistleblower protection in Ontario homes only helps staff who divulge problems to their nursing home supervisors or the health ministry. It does not protect the jobs of workers who warn residents’ families that their relatives are being neglected, complain to their union or speak to the media.

The new inspection report system often hides bad care from public scrutiny. The public report is often stripped of details. A private version for the home’s management, on the other hand, gives precise information about each violation. It took Lorraine Henderson 11 months to obtain copies of these private reports through access to information legislation.

The Star’s analysis of inspection reports found more than 50 cases in which elderly residents fell and got injured, many times when they were left unassisted by caregivers or dropped from mechanical lifts.

The initial evaluation is done by one of three “non-physician experts,” which is the clinic’s name for the trained, certified athletic therapists

The 208 patients who required an orthopedic surgeon were operated on within four months of diagnosis, five months earlier than patients outside of the clinic

reduction in the need for MRIs since the program began to 7.5 per cent from 30 per cent

the Bone and Joint Clinical Network, which is overseeing the project on behalf of AHS

This clinic has the ability to provide timely diagnosis and treatment for up to 200 patients a month

it’s only being used by an average of 95 patients a month

sees it being applied effectively to other types of musculoskeletal injuries

Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities.

For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices [1], which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.

If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate.

"a hidden national scandal."

Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities.

In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.

Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis [2] found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.

"father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."

"We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."

A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.

Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.

State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so

there has to be a professional, independent review process

a public, 74-bed facility

As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses.

Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.

Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.

Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.

Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.

Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.

"Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."

"Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."

a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.

"It was a horrible place,"

investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores

prompted Medicare inspectors to start citing nursing homes for care-related deaths and to undergo additional elder-abuse training.

Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases

They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.

A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."

staffing in homes is a constant challenge. Being a caregiver is a low-paying, thankless kind of job. (at one time you could make more money flipping burgers than caring for our elderly- priorities anyone??) With all the new Medicare cuts, pharmacy companies who continue to overcharge facilities for services, insurance companies who won’t be regulated, our long-term facilities are in for a world of hurt- which will affect the loved ones we care for. Medicare cuts mean staffing cuts- there are no nurse/patient ratios here- meaning you may have one nurse for up to 50 residents. Scary? You bet it is!!  Better staffing, better care, everyone wins.

Lets not just blame the caregivers. Healthcare and business do not mix. When a business is trying to make money, they will not put the needs of patients and people first. To provide actual staffing (good-competant care with proper patient to caregiver ratios) the facilities would not make money.

hree weeks later, Shippobotham died due to complications from his injuries, his family said.

Susan Eng, vice-president of advocacy for the Canadian Association of Retired Persons, said she’s troubled by the spate of fatal attacks on residents at nursing homes by other residents, usually suffering from dementia.

Just weeks after that incident, William May, an 85-year-old resident at the Polson Residential Care facility in Vernon, B.C., died after allegedly being assaulted by his 94-year-old roommate.

oth cases are now being reviewed to see if they warrant an inquest or deeper examination by a death review panel, says the British Columbia Coroners Service. A pair of attacks in the Toronto area last year triggered similar alarms. Francisco DaSilva, 87, was found dead at the Castleview Wychwood Towers nursing home in November with “obvious injuries to the head,” police said. His roommate, 81-year-old Francesco Greco, was charged with second-degree murder. Earlier in March, 72-year-old Joycelyn Dickson was found dead at the Wexford Residence long-term care facility, allegedly beaten with a cane. Another resident, 72-year-old Peter Brooks, was charged with second-degree murder.

The homicides prompted the Ontario Nurses’ Association to call on the province to act on key recommendations from a previous inquest – held in 2005 into the deaths of two residents at the Casa Verde nursing home in Toronto.