Definitions & Examples to Assist with the BSO Reporting Requirements
Included in L-SAAs
Reasons for Discharge from Long-Term Care Home
A Discharge incudes a refusal to readmit a resident* with any responsive behaviours back to
the LTC Home following an Emergency Department (ED) visit or a hospital admission.
Please do NOT count:
a) if resident expired (deceased); or
b) if resident was discharged from the BSO program; or
c) if resident was transferred to another LTC home (eg. to first choice home).
*Any resident of LTC home
Reasons for discharge from the LTC Home: only one ‘main reason’ should be recorded to
align with each discharge-- the sum of ‘main reasons’ should equal the total # of discharged
residents with responsive behaviours). Additional reasons or factors that contributed to the
need for the discharge may be optionally included in a different field.
Reason for Discharge
Definition and Examples
- Includes physical or verbal forms of aggression towards fellow
residents
- May have resulted in physical injury or pain to another resident
- Does not include sexualized behaviours
Resident-to-resident
aggression
- Examples of physical aggression include (but are not limited to):
kicking, choking, hitting, biting, spitting, pinching, scratching, hairpulling
- Examples of emotional and verbal aggression include (but are not
limited to): remarks, swearing, screaming, and shouting causing
alarm or fear
- Element(s) of the resident’s physical environment act(s) as a trigger
for behaviours and cannot be easily remedied and therefore lead to
the resident being discharged from the long-term care home
Environment is a trigger
- Examples of noise/overstimulation from surroundings include (but
are not limited to): noise from the kitchen/dining room, common
areas, overly bright spaces, sharing a room with another resident
Bed hold expired (i.e. time
in hospital exceeds
allowable time on leave)
- The resident remains in hospital longer than the allowed leave (eg.
60 days for psychiatric leave, 30 days for medical leave), so the
long-term care home bed must be given up
Reason for Discharge
Definition and Examples
- Includes physical or verbal forms of violence or aggression towards
staff
- May have resulted in physical injury, pain, claim of workplace
violence or WSIB-related claim
Violent behaviour towards
staff
Physician unwilling/ unable
to manage
- Examples of physical aggression include (but are not limited to):
kicking, choking, hitting, biting, spitting, pinching, scratching, hairpulling
- Examples of emotional and verbal aggression include (but are not
limited to): remarks, swearing, screaming, and shouting causing
alarm or fear
- Care and treatment options for the resident are beyond the
physician’s willingness or ability to continue to monitor and manage
- Unlawful conduct (as per the criminal code) that results in harm,
injury, or fear for safety that is not included in a category above
(does not matter if charges are laid or not)
High-risk/ criminal
behaviour
- Example: non-consensual sexual touching, sexualized behaviour or
remarks especially if history/record of sexual wrongdoing(s)
- Example: possession of a weapon, possession of illegal drugs
- Example: act of aggression/violence towards a family
member/visitor
- Example: domestic violence issues/concerns
Wandering/ risk of
elopement
- Resident wanders or exit seeks and a departure from the long-term
care home could represent a threat to the resident’s safety
Other
- Any reason for discharge that is not accurately described by any of
the reasons outlined above
Reasons for Implementing 1:1 Staffing
**One-to-one (1:1) staffing
 staffing ratio of one paid care provider to one resident
 time spent providing direct care (including supervision, monitoring) to a resident NOT
1:1 time spent with family members teaching gentle persuasive approach/triggers etc.
Reason for 1:1 Staffing
Definition and Examples
- 1:1 staffing implemented in response to fear/concerns for the safety
of long-term care home staff
Staff Safety—fear and
concerns
Resident Safety—
aggression towards other
resident(s)
- Example: to avoid injury and/or alleviate fear/concern of safety of
staff as a result of physical violence/aggression exhibited by the
resident towards staff
- 1:1 staffing implemented in response to fear/concerns for the safety
of other resident(s) of the long-term care home
- Example: to avoid injury and/or alleviate fear/concern for safety of
other resident(s) as a result of physical violence/aggression
exhibited by the resident towards other resident(s) of the home
- 1:1 staffing implemented in response to fear/concerns for the safety
of the resident related to risks of self-harm
Risk of self-harm (incl.
suicide, injury, addiction)
Family encouragement
“Buy time” to evaluate
options and formulate a
plan
An alternative to sending to
hospital
- Example: self-harm could include ingestion of non-palatable alcohol
sources (i.e. hand sanitizer), substance use/abuse, suicidal
ideation/risk of suicide, risk of injuring self
- 1:1 staffing implemented in response to persuasion or
encouragement from the family
- 1:1 staffing implemented as a method to “buy the time” necessary
to evaluate other options and/or formulate a plan for longer-term
solutions
-Example: time waiting for BSO team or family or care team to
determine effective strategies to manage responsive behaviours
- 1:1 staffing implemented in an attempt to manage and monitor
resident’s responsive behaviour in order to avoid sending resident to
the hospital
Reason for 1:1 Staffing
Definition and Examples
No access to extra room/
serenity room/ quiet room
- LTC home lacks the space to provide for separation of the resident
from what may be triggering the responsive behaviour
Wandering/ risk of
elopement
- 1:1 staffing implemented as resident wanders or exit seeks and a
departure from the long-term care home could represent a threat to
his/her safety
Protect from other
residents
(i.e. resident puts self at risk
of harm from others)
- 1:1 staffing implemented as resident is at risk of harm from others
-Example: 1:1 staffing implemented with Resident ‘A’ as he/she may
wander and enter another resident’s room or ‘personal space’ which
may be unwanted and could result in a risk of harm to Resident ‘A’.
- 1:1 staffing implemented in response to fear/concerns for the safety
of friends/family members visiting other residents
Visitor Safety—aggression
towards visitor(s)
Other
- Example: to avoid injury and/or alleviate fear/concern of safety of
visitor(s) as a result of physical violence/aggression exhibited by the
resident towards visitor(s)
- Any reason for implementing 1:1 staffing that is not accurately
described by any of the reasons outlined above
References & Guidance Documents
Long Term Care Home Act (2007) Section 24 (1) reporting Certain Matters to the Director
Long Term Care Home Act (2007) and O. Reg 79/10 Licensee Reporting
Frelick, K. (2010). Workplace Violence and Harassment: New Obligations for Long-Term Care
Homes. Accessed online April 29, 2016:
http://www.millerthomson.com/assets/files/article_attachments/Workplace_Violence_and_Harrassment
_New_Obligations_for_Long_Term_Care_Homes.pdf