By Martin Green

It seems as though hardly a week passes by without there being a story in the news about an elderly person with Dementia or Alzheimer’s disease wandering away from a retirement home, long-term care facility or family home.  More often than not, these stories have tragic endings.

The population is aging more rapidly now as the “baby boomer” or “Silver Tsunami” generation hits their 60’s and 70’s.  Just as society had to prepare and respond to the boomer generation in the 50’s by building schools, it now has to respond by building Long-term care facilities, (LTC’s).

According to the World Health Organization, (WHO) approximately 35.6 million people around the globe are currently living with dementia. This number is expected to double by 2030 and more than triple by 2050.  It is estimated that 80 per cent of LTC Home residents have dementia, 60 per cent have serious mental illness 70 per cent of older individuals in LTC homes have behavioural problems, 30 per cent have severe issues.  Right now in Canada, there are now more people over the age of 65 then under 15.

In addition to the problem of patient/resident elopement from LTC facilities is resident violence.  There have been numerous incidents where residents have attacked and seriously injured or killed other residents.  In most cases, charges are not laid against the attacker due to their Dementia.

In response to an incident that occurred in Toronto in June 2001, the Office of the Chief Coroner in Ontario held an inquest into the death of two residents at the hands of a third resident. Both the residents were deceased from severe head injuries at the scene. The resident was arrested and charged with double homicide. At his arraignment hearing he was sent to a Psychiatric Hospital for assessment, but died from a stroke while being assessed.

The jury heard evidence from 43 witnesses and had 85 exhibits submitted during an inquest of 34 days. The jury deliberated over 9 days.   The Coroner’s jury reviewed the gruesome details surrounding the deaths, and made 85 recommendations.  Not one of those recommendations mentioned security.

The “Guide to the Long-Term Care Homes Act, 2007” in Ontario does mention security.  It states that it is a “Fundamental Principle” that a Home is ….to be operated so that it is a place where its residents may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.  Unfortunately, the guide does not address how individual homes are to provide security.

What can we do to improve security and to reduce and mitigate risk?

Risk Management – Definition

A systematic reduction in the extent of exposure to a risk and/or the likelihood of its occurrence. Also called risk reduction.

Risk Acceptance – understanding that there is a risk, but that the risks do not have a high possibility of occurring.  On the other hand, it also means that you understand that there is a risk of occurrence, but that is the nature of the business you are in.

Risk Avoidance – the action that avoids any exposure to the risk whatsoever. Risk avoidance is usually the most expensive of all risk mitigation options.  It also means that we chose not to do or be in this type of business.

Risk Limitation – This strategy limits a company’s exposure by taking some action. An example of risk limitation would be a company accepting that an event may occur and avoiding their exposure by having regular training, strong and robust policies – Patient lift devices is an example

Risk Transference – is the involvement of handing risk off to a willing third party.  However, that does not eliminate repercussions to your facility in the event of an incident.

CPTED Principles – Crime Prevention Through Environment Design, (CPTED) is a proactive design philosophy built around a core set of principles that is based on the belief that the proper design and effective use of the built environment can lead to a reduction in the fear and incidence of crime as well as an improvement in the quality of life.

How hard is it for someone to get into your facility and enter the room of a resident, and equally important, how hard is it for someone to get out?  As we move closer to a secure area the harder it should be to get to it.  The main entrance of a LTC is a danger zone as it is the primary entry exit point and is often unattended, unmonitored or unsupervised.

There are three primary goals in protecting residents in a LTC; reduce incidents of Violence; stop unauthorized entry, (theft); stop unauthorized exit, (elopement).

The International Association for Healthcare Security and Safety, (IAHSS) has developed the IAHSS Healthcare Security Industry Guidelines and the Design Guidelines.   These guidelines are written for all levels of experience and for all types and sizes of Healthcare Facilities, (HCF’s). These are very valuable resources for those people that are responsible for security regardless of their level of experience in the industry.  Additionally, the IAHSS has developed the Long Term Care Safety & Security Management Guide.

The IAHSS guidelines are applicable to ALL Healthcare facilities regardless of their size, type, or location.  These Guidelines are very useful for all levels of security management as well, from the seasoned Security Director in a large facility, to a person who wears many hats in a smaller facility.

Recently, IAHSS conducted a survey of Long-Term Care facilities across North America.  The survey identified 4 top areas of concern

• Resident aggression/violence
• Public aggression/violence
• Theft from residents and staff
• Elopement/wandering

Looking specifically at applications for LTC’s the Industry Guidelines are divided into eight different categories, but the one category that is most applicable to LTC’s is the first section which focuses on “Program Administration”

The Program Administration section is further divided into nine sub-categories.  Of the nine subcategories, the three most applicable are Security Management Plan; Security Administrator; Security Risk Assessments

Every facility should have a Security Management Plan.   This has to be based on a Risk Assessment.  Current Best practices recommend that a Threat Risk Assessment, (TRA) should be conducted annually by a qualified security professional.  It is recommended that the initial or original TRA be conducted by an external person.  This provides for a fresh perspective or new set of eyes to examine your facility and your program and to help identify areas for improvement.

Program Administration – there must be someone in your facility that has a clearly defined role and job responsibility for Security.  Many facilities may not have a security manager, security department or program, you still have a person that has over-all responsibility.  If you don’t have the required specialized knowledge it is incumbent on you to engage security expertise.  When you are seeking outside expertise, ensure that it is from a qualified professional who has specific training and experience in Healthcare Security. There are many companies and individuals that promote themselves as healthcare security “experts”.  When selecting a consultant look for a direct background in Healthcare.  Look closely at their background, their experience; their education and credentials.  A “Certified Healthcare Protection Administrator”, (CHPA) designation is highly desirable.  A CHPA will have the industry specific knowledge that is required to provide an accurate assessment.

By taking the necessary steps to ensure that your facility has a viable security plan, you lower the risk of resident elopement, resident violence while at the same time providing a safer facility for your residents and staff.

Martin Green is the Manager, Security, Telecommunications & Emergency Preparedness at Baycrest Health Sciences in Toronto, Ontario.  He is also the current President of the International Association for Healthcare Security & Safety, (IAHSS).  www.iahss.org