Residents at long-term care facilities in Nova Scotia were physically, emotionally or sexually abused or not provided adequate care in at least 46 confirmed cases over a two-year period, a CBC News investigation has learned.

At least half of those cases involve abuse by a staff member. Physical and emotional abuse, or a combination of the two, were the most common type of confirmed abuse during the period examined, 2015 and 2016. On seven occasions, staff failed to provide adequate food, medical care or other necessities of life. There was one case of sexual abuse by a staff member.

Reports about the incidents obtained by CBC News under the Freedom of Information Act were heavily redacted, but some of the directives from the province to the facilities in question are not.

They include orders to train staff on recognizing "escalating situations," signs of abuse and the duty to report allegations. In some cases, there are orders to train staff on dealing with patients with dementia, answering call bells in a "safe and appropriate time frame," treating wounds properly and doing routine checks to be sure residents are safe.

Medicating inappropriately

Only one report provided enough detail to give a glimpse of understanding about the incident.

At Glen Haven Manor in New Glasgow in 2015, staff inappropriately drugged residents in an attempt to control their behaviour.

"Several staff reported that … medications were administered to certain residents because they were too disruptive to other residents on the unit," states the report.

Staff at the facility told provincial investigators they followed the practice of administering those medications "as soon as a resident started to escalate, as the medication may not be effective once a resident's agitation increases."

Some of the medications "did not have a documented intended use from the physician" for those residents.

Staff at Glen Haven Manor in New Glasgow drugged patients inappropriately, according to reports filed by the Health Department. (Google Street View)

Staff said they were unaware of resources available to deal with challenging behaviours, the documents state.

But the facility's director, Lisa Smith, said that doesn't mean alternatives don't exist at the home.

"Although staff reported they were unaware of the resources — or I think they also commented that they'd never used internal programs for managing responsive behaviours — that doesn't mean that the programs or resources weren't available," she said.

Smith refused to provide information about how many residents were inappropriately drugged, what kind of medication was used or how long the abuse was going on. She did say she takes allegations of abuse and neglect very seriously. The staff member involved is no longer employed by Glen Haven Manor.

Protection for Persons in Care

The 46 allegations were investigated under the province's Protection for Persons in Care Act (PPCA), which came into effect 10 years ago as an extra safeguard for people receiving care in hospitals, residential care facilities and nursing homes. The legislation stipulates that facilities have a duty to report all allegations of abuse, although the documents received by CBC News indicate that doesn't always happen.

Bob Lafferty, manager of compliance and investigations for the Protection of Persons in Care, has a team of nine investigators. (Brian Mackay/CBC)

Bob Lafferty, manager of investigation and compliance for the PPCA, says his team of nine investigators responds to all complaints within 24 hours, but not all inquiries turn into investigations.

Over a four-year period there were approximately 800 complaints under the PPCA, including allegations of misconduct by staff and residents, but only 20 per cent of them resulted in investigations.

Anonymous phone call

Ellen Rudderham-Gaudet believes an investigation should have taken place into an incident involving her mother. Both of her parents lived at Saint Vincent's Nursing Home in Halifax for three years.

Rudderham-Gaudet said she and her brother received an anonymous phone call from someone claiming to work at the nursing home telling them to ask questions about an incident involving "very rough handling" of her mother.

Ellen Rudderham-Gaudet made several reports under Nova Scotia's Protection for Persons in Care Act. (Brian Mackay/CBC)

She questioned staff and says she was told something did happen, but that the nurse who made the anonymous call had exaggerated what she observed. Rudderham-Gaudet reported the incident under the PPCA.

"They never investigated. They never followed up. They never called me back," said Rudderham-Gaudet, who has since obtained her own records through the Freedom of Information Act in an effort to determine how her complaint was handled. She remains unsatisfied.

Betty Rudderham, Ellen Rudderham-Gaudet's mother, lived at Saint Vincent's Nursing Home in Halifax for three years. (Submitted)

Donna Hopkinson kept detailed daily journals of what took place during the five years her mother was at Saint Vincent's. She once got a call from a nurse apologizing for giving her mother a double dose of blood pressure medication. Hopkinson says the error wasn't documented. She also reported under the PPCA.

Donna Hopkinson kept detailed daily journals of what took place during the five years her mother was at Saint Vincent’s Nursing Home in Halifax. (Brian Mackay/CBC)

"I got five minutes on the phone with him to describe what had happened," she says. "They had said that my letter did not meet the definition of abuse and that the investigation was closed."

Maxine Major, Donna Hopkinson's mother, was at Saint Vincent's Nursing Home for five years. (Submitted)

Abuse, as defined by the legislation, does include neglect and failing to provide adequate care.

"Any time a family member has a concern, especially over something as serious as a medication error, we would thoroughly investigate and if necessary make any corrections," says Angela Berrette, Saint Vincent's executive director.

Neither Saint Vincent incident is included in the 46 reports examined by CBC, nor were they confirmed by the PPCA.

Response to every call

Lafferty maintains his team takes every call seriously, and while not every call warrants an investigation, each results in an inquiry, which involves contacting the complainant, validating the information and determining its credibility.

In order to proceed with a full-fledged investigation, Lafferty's team needs some kind of evidence, such as a corroborating witness, video or documentation.

"We're really probing in because we don't close the file until we're confident that it either doesn't fit within our definition of abuse or that it's been resolved," Lafferty said.

When an investigation does take place under the PPCA, the government issues improvement directives to the facility, at which point the home has 10 days to respond with an action plan. The facility is then monitored until the government is satisfied the directives have been met.

If the abuse involves a professional, the matter is also referred to a licensing body, and to police in the case of criminal behaviour.

'It's disheartening'

Gary MacLeod also has concerns with the act and the response of investigators. He's the chair of Advocates for the Care of the Elderly, a group that formed in 2006 following members' own experiences with family members in care.

"I've had people come to me with their loved one black and blue in the face and they'll go through the motions of doing their job but they're not really doing their job if no one is ever held accountable or there's no resolution for the families. It's disheartening," he says.

Gary Macleod became the chairperson for the Advocates for the Care of the Elderly following a negative experience with his mother while she was in care. (Eric Woolliscroft/CBC)

MacLeod says nursing homes are understaffed, which he believes leads to a great deal of the neglect, but so, too, is the Protection for Persons in Care team, he says.

"There should be more money poured into it, at least having somebody like a hall monitor, going down through the hallways of the facilities to make sure that patients are safe and that they're being cared for and that no abuse is happening."

Lafferty says he has enough investigators and points out there are also other avenues which aim to protect people in care. Long-term care facilities licensed by the Department of Health and Wellness are subject to at least two inspections a year in which inspectors show up unannounced and engage with staff, residents and their family members.

'Don't abandon your loved ones'

Rudderham-Gaudet successfully applied to move her parents from Saint Vincent's to the South Cumberland Community Care Centre in Parrsboro. Her mother has since died, but she says her father continues to receive excellent care.

Meanwhile, she continues to search for answers about her reporting under the Protection for Persons in Care Act and has this message for others:

"For God's sake, don't abandon your loved ones in a nursing home. I mean, be there for them, be an advocate, ask questions."