Alarms ring at nursing homes

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Violence has become all too common at Norway’s 942 nursing homes, most of them publicly owned and operated. They house around 40,000 elderly Norwegians, 80 percent of whom suffer from severe dementia but can still be physically strong. That’s resulting in widespread violence that’s been charted and reported by newspaper Aftenposten for the first time.

Only a small percentage of the elderly obtain long-term care in a nursing home, with the vast majority now receiving assistance in their homes instead. That means only the most frail and those suffering the most severe dementia are now living in nursing homes, and violence among them is now much more widespread than most politicians realized. PHOTO: Husbanken

The shocking reality of daily life at Norwegian nursing homes was laid bare first in a 16-page report in Aftenposten’s weekly magazine A-magasinet on Friday, and then followed up throughout the weekend. Aftenposten’s team of reporters uncovered at least 13,000 reports of nursing home violence last year alone, with strong indications that many incidents go unreported.

They’re not cases of staff being violent towards residents, but rather the nursing homes’ confused, frustrated and often angry residents harassing and physically attacking staff and, occasionally, fellow residents. Around half of the violent episodes charted by Aftenposten involve residents hitting, kicking and even grabbing nurses and attendants by the throat. “I have to explain to my husband why I come home from work with black-and-blue marks on my arms,” one nurse with 10 years of experience in nursing homes told Aftenposten.

Others have thrown items at nursing home staff, screamed, spit and hurled obscenities at them, or made threats. In one case, a male resident who’d been displaying highly aggressive behaviour was given a sedative to calm him down but it didn’t work. He grabbed a nursing assistant by the throat, dragged her into his room and locked the door, before asking her: “Are you scared now?” She managed to escape and when she returned with another nurse, the man smashed his window and threatened them with jagged pieces of glass. He’d sunk into deep psychose and staff, realizing he could be dangerous, had to keep him confined to his room until more help was summoned.

Violence from north to south
No staff members or nursing homes were identified in Aftenposten’s reports, but they’re located from Troms in the north to Rogaland and Østfold in the south. Since nursing homes are run by municipal governments, not the state, reports of so-called avvik (abnormal incidents) had to be collected and compiled from all over the country. Even though Norway is a highly digitalized society, reporting procedures were found to vary widely, with some still submitted on paper. Many regions had relatively few reports registered, but Aftenposten was told that’s often because violent episodes occur on a daily basis and therefore are not considered “abnormal” any longer.

Some nursing homes, including one in the county of Møre og Romsdal, have offered self-defense training to staff so they’ll be better able to respond to physical attacks and even “humanely” lay an attacker on the floor after a struggle. Another nursing home in Trondheim has hired security guards to protect both employees and other residents from unruly and aggresive dementia patients.

Inadequate care
Top politicians have reacted with both shock and admissions that Norway’s health care and welfare sectors haven’t kept up with the demands of an ageing population. “This shows that we have a long way to go before we have adequate care for dementia in Norway,” Sveinung Stensland, the ruling Conservative Party’s spokesperson on health care policy, told Aftenposten. Others, including Member of Parliament Karin Andersen of the Socialist Party (SV), claimed that “we have known there are massive violations of the elderly’s human rights and that nurses have days that are much too tough. We’ve taken this up in Parliament many times.”

There’s nonetheless been a chronic shortage of nursing home capacity for many years, meaning that now only the most frail and those suffering the most advanced dementia actually “win” a nursing home room. There have been many cases of Norwegians well into their 90s who are denied nursing home residence, because it’s less costly to offer them help at home instead.

Many prefer to stay in their own homes for as long as possible, often with additional help from family, neighbours, younger friends or privately paid personally assistants. Aftenposten’s editor-in-chief Espen Egil Hansen stressed that the reports “are not meant to frighten” either the elderly or their families away from nursing home care, “but the reality can be frightening.”

Need for more competence in dealing with dementia
Bettina Husebø, leader of a center for elder care at the University of Bergen, noted that “the reality can be even worse than described” in Aftenposten. “Those who work at nursing homes are so used to this that they don’t report it,” Husebø told Aftenposten. Others are calling for far more instruction at nursing schools about dealing with dementia, anxiety and depression among the elderly.

“It’s clear that the nurses need more professional, fundamental competence when they have to handle such complex challenges in a nursing home,” Sylvi Listhaug, the government minister in charge of public health and elder care, told Aftenposten on Monday. She said she was “shocked” by the reports, and that it was “hugely important” that also nursing assistants especially in Norway’s outlying areas receive more training and knowledge about how to handle residents with severe dementia.

The head of the national nurses’ association, Lill Sverresdatter Larsen, also called for more personnel at local nursing homes who have more formal health care education and training.

None of the nursing home employees attacked or harassed by elderly residents has reported violent residents to the police. “I’ve been bitten, spit at and clawed, but these are sick patients who wouldn’t have behaved as they did if they were healthy,” one nurse told Aftenposten. Another said that despite the violence and frequent sexual harassment, she still enjoys her work and finds it meaningful.

“I thrive with the elderly,” she told Aftenposten. “Every person I meet on the job has his or her own story.” She and her colleagues also do their best to protect other patients from the unruly ones.

“I know my patients, and also know that some can’t understand what they do,” said another. Unlike prison guards in Norway who’ve recently sought permission to wear masks to protect them spitting, nursing home staff interviewed said they don’t want that: “It would frighten the elderly.”

newsinenglish.no/Nina Berglund