Vivian Stamatopoulos, PhD1, Shannon Vettor, PhD1, and Emily Hladkowicz, PhD2
1Faculty of Social Sciences and Humanities, Ontario Tech University, Oshawa, ON;
2Acute Care Research Program, Ottawa Hospital Research Institute, Ottawa, ONDOI: https://doi.org/10.5770/cgj.29.930
ABSTRACT
Background
Ontario’s Fixing Long-Term Care Act, 2021 requires long-term care (LTC) licensees to immediately notify police of any alleged, suspected, or witnessed abuse, neglect, or other conduct that may constitute a criminal offence. This study examines compliance with mandatory police notification requirements using publicly available Ministry of Long-Term Care (MLTC) inspection reports.
Methods
We conducted a qualitative analysis with descriptive quantitative summaries of MLTC inspection reports issued in 2024. A 20% random sample of Ontario LTC homes was selected, and all associated inspection reports (N = 457) were retrieved. Using predefined keywords (“abuse,” “neglect,” “police”), relevant reports were identified (n = 193) and analyzed thematically to examine legislative compliance, documentation of police involvement, and enforcement responses.
Results
Twenty-one of 193 reports (10.8%) mentioned police and were the focus of our analysis. In 16 of 21 reports, there were accounts of abuse and/or neglect, including theft, fraud, and physical and sexual assault, but police were only notified and dispatched to an LTC home in 2 of the 16 reports (12.5%). The remaining 14/16 cases (87.5%) involved incidents of resident-involved abuse or neglect where police were not contacted. Four of 21 reports (19%) involved noncompliance pertaining to required qualifications and missing or falsified police record checks. The final report cited a prior, second-hand account of police involvement for alleged resident aggression.
Conclusion
This study provides the first review of compliance practices of LTC licensees in Ontario and their legal duty to report incidents of abuse, neglect, and other suspected criminal activity to police. Inconsistencies in documentation and variation in violations issued for comparable incidents suggest that these events are often addressed within regulatory or clinical frameworks, with limited documented engagement of criminal processes.
Key words: long-term care, police, mandatory reporting, inspection reports, abuse
Abuse of older adults in long-term care (LTC) is a serious, preventable human rights and public health concern.(1) Rates of abuse are higher in long-term care homes (LTCHs) than in the community, and the greater level of frailty, cognitive impairment, and dependence of LTC residents for activities of daily living increases their vulnerability and risk of abuse.(2–4)
During the coronavirus disease 2019 (COVID-19) pandemic, abuse and neglect in Canadian LTCHs intensified,(5,6) exposing systemic failures including profit-driven models, chronic understaffing, weak regulation, and limited accountability.(7) Reports of physical and emotional abuse, dehydration, malnutrition, untreated medical needs, and neglect documented by the Canadian Armed Forces deployed to LTCHs in Quebec and Ontario triggered investigations and urgent calls for reform.(8) In Ontario, provincial audits and the LTC COVID-19 Commission found that decades of policy favouring privatization and cost containment left LTCHs understaffed and unprepared for COVID-19, resulting in preventable suffering and loss of life.(9) The exclusion of family caregivers and confinement of non-symptomatic residents further breached LTC residents’ rights to participation in care, access to visitors, and substitute decision makers, and infringed upon their basic constitutional liberties.(10)
Historically, LTC in Canada has been governed primarily through provincial regulatory frameworks that emphasize administrative oversight rather than criminal enforcement. The increasing bureaucratization of LTC has been associated with excessive administrative and compliance checklists, which have been flagged as reducing time available for direct resident care while contributing to staff workload and burnout.(11,12) This study lends support to alleviating some of this administrative burden by more appropriately involving police forces to investigate crimes, which also addresses the chronic underreporting and limited prosecution of elder abuse in Canadian LTC homes.(13–15)
Under Ontario’s Fixing Long-Term Care Act, 2021 (FLTCA 2021),(16) police involvement is required for screening measures, including police record checks (i.e., vulnerable sector check, or VSC) for staff and volunteers, and/or when resident abuse or neglect is suspected to be a criminal offence. For the latter, licensees must report such incidents immediately, after which the police may investigate and lay charges (FLTCA 2021, s.105). The involvement of police in this role provides a key avenue for accountability beyond regulatory enforcement, as they have the legal authority to investigate, arrest, and lay criminal charges. However, police notification and/or police involvement is not automatic for all care issues, and despite isolated media reports, coroner’s inquests, public inquiries (e.g., the Wettlaufer inquiry),(17) and commissions that describe police involvement, these tend to be case-based rather than analytical or data-driven studies.
Although research on abuse and regulatory oversight in LTCHs is emerging,(18–21) no Canadian empirical studies examine the role of police in LTCHs, whether in abuse investigations, crisis response, or enforcement. The lack of empirical research in this area limits our ability to advocate for stronger criminal accountability mechanisms in LTCHs. To address this gap, this study analyzes publicly available LTC inspection reports in Ontario to examine whether documented incidents of abuse or neglect that potentially meet mandatory police reporting thresholds under Ontario’s FLTCA 2021 were reported to police as required.
Ontario’s FLTCA 2021 and its accompanying regulations (O. Reg. 246/22) establish mandatory standards for LTCHs and outline inspection and enforcement processes. Inspections may occur in response to complaints or reported incidents, as part of proactive compliance inspection programs, or as follow-up to previously identified noncompliance. Following each inspection, a report is issued documenting findings, including instances where no noncompliance is identified.
Section 105 of the FLTCA 2021, titled “Police Notification”, requires that “every licensee of a long-term care home shall ensure that the appropriate police service is immediately notified of any alleged, suspected or witnessed incident of abuse or neglect of a resident that the licensee suspects may constitute a criminal offence” (O. Reg. 246/22, s. 105, 390) (Appendix A). In this context, criminal misconduct is captured under the Criminal Code of Canada,(22) and includes a range of offences including physical or sexual assault, criminal negligence causing bodily harm, fraud, or theft.
When a licensee fails to immediately notify police of an eligible incident (see Appendix B for Glossary of Definitions of Abuse and Neglect), inspectors are to issue a written “Police Notification” violation. This noncompliance becomes part of the home’s public record and may result in escalated enforcement actions, including compliance orders, follow-up inspections, or administrative monetary penalties or AMPs (see Appendix C for a glossary of inspection and penalty types).
Using a qualitative document analysis approach(23) supplemented by quantitative descriptive summaries, this study conducted a document analysis of publicly available Ministry of Long-Term Care (MLTC) inspection reports to assess the extent to which LTC licensees complied with the mandatory police notification requirement set out in section 105 of the FLTCA 2021. Document analysis is a systematic procedure for evaluating printed or electronic materials to extract meaning, identify patterns, and develop empirical insights.(23)
A random sample of 20% (N = 138) of LTCHs in Ontario was drawn, with 8 excluded for lacking 2024 inspection reports, resulting in a final sample of 130 LTCHs. This sample size was selected to provide a feasible yet sufficiently large set of inspection reports to identify patterns in police notification-related violations while maintaining depth for qualitative analysis. In qualitative research, sample size is guided by information richness and thematic saturation rather than statistical representativeness.(24) Accordingly, this sample represents a large, information-rich dataset for focused document analysis. Descriptive statistics were used to summarize observed patterns and provide context, not to support statistical generalization. Of these, 75 (58%) were for-profit, 34 (26%) were not-for-profit, and 21 (16%) were publicly owned (e.g., municipal) LTCHs, which aligns with the provincial ownership breakdown of LTCHs in Ontario (i.e., 57% for-profit, 27% not-for-profit, and 16% publicly owned).(25) Next, a full list of inspection reports was extracted from the MLTC online administrative database (MLTC, 2024) for each of the 130 LTCHs, resulting in 457 unique inspection reports for the 2024 calendar year, spanning January 1, 2024 to December 31, 2024. We screened out any reports that did not include the keywords “abuse,” “neglect,” or “police”, leaving 214 reports. We then removed reports that found no noncompliance with the legislation (n = 21), leaving 193 reports. We then narrowed the sample to only those that mentioned police (also n = 21). A structured data extraction form was developed a priori and applied to all 21 reports to systematically extract report characteristics, details of alleged abuse and/or neglect, and documentation of police involvement as recorded in the inspection reports (e.g., “police contacted” or “police dispatched”). This systematic approach enabled a structured evaluation of compliance with mandatory reporting requirements.
Table 1 breaks down our sample of included LTCHs by ownership and inspection report tally.
TABLE 1 Sample by ownership breakdown and inspection report tally (N = 457)
NVivo 9 (Lumivero, Denver, CO, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) were used to store, code, and analyze the sample of 457 MLTC inspection reports. Reports were screened and selected using predefined keywords related to police involvement, abuse, and neglect. Both descriptive statistics and thematic analysis(26) were applied to the extracted data to characterize police notification practices across LTCHs in Ontario. Team members met weekly to review and refine codes in an iterative fashion, resolve discrepancies, revise the coding dictionary, and group refined codes into higher-level themes following thematic analysis procedures (see Figure 1 for detailed description of data collection and analysis).(26–28)
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FIGURE 1 Data Collection and Analysis Flow Diagram. MLTC = Ministry of Long-Term Care | ||
Of the 193 reports, police were mentioned in only 21 (10.8%). In 16 of 21 reports (76.2%), there were accounts of abuse and/or neglect, including theft, fraud, and physical and sexual assault. Despite the FLTCA 2021 requirement that licensees must immediately notify police of any potential criminal abuse or neglect involving residents, police were only notified and dispatched to an LTCH in two of the 16 reports (12.5%). One licensee immediately contacted police as required, and another contacted police the next day. In 14/16 cases (87.5%), incidents of resident-involved abuse or neglect were not reported to police. Four of 21 reports (19%) involved noncompliance pertaining to required qualifications and missing or falsified police record checks. The final report cited a prior, second-hand account of police involvement for alleged resident aggression.
Moreover, in only 10/193 reports (5.2%), a written “Police Notification” violation was issued (Table 2). In four of the 193 reports (2.1%) citing “neglect” or “abuse,” written notifications were issued specifically for “Prevention of Abuse and Neglect.” In all other reports, instances of abuse or neglect were cited in written notifications under different, often broader regulatory categories, such as “Duty to Protect,” “Resident’s Bill of Rights,” or “Reporting Certain Matters to Director.”
TABLE 2 LTC licensees levied with “Police Notification” (i.e., failure to notify) noncompliance
Table 3 includes the 21 inspection reports citing “abuse” and/or “neglect” and “police” and descriptive information.
TABLE 3 2024 MLTC inspection reports (N = 21) citing “abuse” and/or “neglect” and “police”
From the thematic analysis of these 21 reports, four themes developed: (i) records: screening measures and employee documentation, (ii) compliance with mandatory police reporting per Ontario’s FLTCA 2021, (iii) noncompliance with mandatory police reporting: “Police Notification” violation issued, and (iv) noncompliance with mandatory police reporting: no “Police Notification” violation issued.
Under the FLTCA 2021, LTC licensees must obtain a police record check within 6 months of onboarding any staff or volunteers to ensure suitability and resident safety (Appendix A). In our sample, 6 of 21 inspection reports (29%) cited violations related to missing or inadequate police record checks. Only two licensees contacted police to verify discrepancies in staffing documentation.
The remaining four licensees were issued written “Police Notification” violations for failing to notify police of missing police record checks (or VSCs). At LTCH-016, inspectors issued a written “Police Notification” violation upon arriving at an LTCH for a separate improper care allegation and finding “staff dressed in street clothes, wearing no identification, seated outside of various resident rooms. In the course of conversation, it was identified that these staff hired to conduct 1:1 monitoring of residents had not completed vulnerable sector checks.”
Four of the six screening violations (66.7%) involved private staffing agencies contracted to provide care or security services. In these cases, inspectors documented licensees hiring agency workers without required qualifications (Table 3: LTCH-010) or accepting falsified records from agencies or their workers (Table 3: LTCH-015; LTCH-019). In some cases (e.g., LTCH-009), screening violations were discovered only after agency staff were implicated in improper care, resident injuries, or abuse. In all, written notifications and/or compliance orders required licensees to implement new procedures for agency staff.
Although contracted agencies were the source of screening failures in four of six cases (66.7%), only one inspector identified the agency provided in their inspection report:
The home used an agency, …, for one-to-one staff. There were no records of screening measures for these staff in the home. DRC #108 said that they entrusted the agency to screen staff, and that there was no process implemented at the time for the home to review this information. It was discovered that all agency staff did not have a completed vulnerable sector check as required (LTCH-010).
Even when more serious compliance orders were imposed, details about follow-up enforcement or charges were often missing, even though the conduct described in the inspection reports may meet elements of Criminal Code offences such as fraud (s. 380), uttering forged documents (s. 368), forgery (s. 366), or falsifying employment records (s. 398).
Despite the FLTCA 2021 requirement that LTCHs immediately notify police of resident-involved abuse or neglect that may constitute a criminal offence, only one LTCH in our sample of 21 fully complied with this obligation.
Here, police were contacted following multiple incidents of sexual abuse by a resident designated “1:1 high intensity” (LTCH-014). In this incident, police were called after the resident in question entered another resident’s room and refused to open the door; however, “the residents opened the door before the police arrived” (p. 23).
Although 16 of 21 (76.2%) reports documented abuse or neglect that met the FLTCA 2021 threshold for mandatory police reporting, in only 10 of 193 reports (5.2%) were LTCHs issued “Police Notification” violations (Table 3). The 16 reports are unique inspection reports, as some of the inspection reports did come from the same LTCH (LTCH-006 and LTCH-010 each had two unique inspection reports).
Enforcement was inconsistent, both across LTCHs and within the same inspection, resulting in similar incidents being treated differently. Some LTCHs were issued “Police Notification” violations for resident-to-resident altercations or staff-to-resident abuse, while comparable or more severe cases involving staff-perpetuated resident abuse, financial exploitation, and other criminal-level neglect did not trigger this violation. Even for the LTCHs that did report eligible instances to police, delays in reporting led to “Police Notification” violations for some LTCHs.
Among case examples that illustrate these inconsistencies, LTCH-011 was issued a “Police Notification” violation for failing to report an incident of resident-to-resident abuse; however, a separate incident of staff-to-resident abuse in the same report did not result in a similar violation.
Similarly, LTCH-005 received a single “Police Notification” violation in a 68-page report documenting multiple incidents of serious abuse and neglect. The cited violation involved resident neglect leading to hospitalization that “could have been avoided with proper care” (p. 35). The same report described two other similar incidents—a resident who was hospitalized from neglect and died 9 days later, and another who fell out of a mechanical lift and was hospitalized with a significant injury—yet no “Police Notification” violations were issued for either of these incidents. The administrator for this LTCH also indicated to the MLTC inspector that “they were not aware of the requirement to report alleged neglect” (p. 35).
At LTCH-003, a verbal altercation between two residents was reported to police, but not until the day after the incident, thus triggering the “Police Notification” violation. Police were also dispatched to this LTCH to speak with the resident responsible, as this was their second alleged incident of verbal abuse.
At LTCH-009, failing to report alleged staff-to-resident physical abuse resulted in the “Police Notification” violation. However, in the same inspection, a separate incident was treated differently: police located a missing resident who had eloped from the LTCH and transported them to hospital with “sustained injuries,” yet this was classified only as a “Responsive Behaviours” violation (pp. 14, 16). The report does not say whether the LTCH notified police about the resident’s disappearance or where the resident was found. Despite the resident having “several documented attempts to elope prior to this incident” (p. 15) and despite the inspector noting several missed 30-minute safety checks in the Dementia Observation System (DOS) for this resident (p. 15), the home was not cited for failing to notify police of potential neglect leading to injury, nor did the inspector issue a more specific “Prevention of Abuse and Neglect” violation.
Inspection reports involving resident financial abuse also led to “Police Notification” violations for licensees failing to report these incidents to police. At LTCH-010, the inspector identified “misappropriation of resident monies by a staff member” (p. 20), yet police were not notified, and the report provides no details on the staff member and any resulting charges (pp. 14, 20).
At LTCH-013, a written “Police Notification” violation was issued because staff-to-resident physical abuse causing injury was not reported to police, and the same written notification was issued for a resident-to-resident altercation causing injury at LTCH-006. The latter incident also resulted in the largest AMP in our sample ($16,500). AMPs, intended as a more serious penalty for repeated noncompliance with compliance orders within a 3-year period, were disproportionately applied to resident-to-resident abuse. Of 457 inspection reports, three of the four AMPs issued involved resident-to-resident incidents.
The remaining inspection reports included alleged and verified instances of resident neglect, abuse, or other criminal conduct, but none resulted in violations for failing to comply with mandatory reporting requirements. Inspectors frequently issued unrelated or less-serious noncompliance findings despite clear indicators that mandatory reporting to police was required.
In one report (LTCH-006), the inspector went so far as to state that an incident of staff-to-resident physical abuse constituted “a criminal offence and police should have been called but were not” (p. 7–8), yet no written “Police Notification” violation was issued to the licensee.
In another report, multiple instances of improper care, unauthorized restraint use, and neglect resulting in serious skin and wound issues failed to trigger “Police Notification” violations. In one case, a newly admitted LTCH resident with a stage 1 pressure wound that deteriorated to stage 4 within a “few months” was neither reported to police nor issued the required violation. The incident was also classified as a “Skin and Wound Care” violation rather than “Prevention of Abuse and Neglect” (LTCH-017). Similarly, a verified incident of staff-resident neglect at LTCH-006 did not result in a written “Police Notification” violation and was further classified as a noncompliance under the “Residents’ Bill of Rights” rather than the “Prevention of Abuse and Neglect.”
Additional accounts of resident financial abuse also failed to produce the associated written violation for mandatory reporting. One report confirmed “financial abuse has occurred towards the resident” when an employee accepted “gifts or gratuities from residents” (LTCH-010, p. 21). Another verified case involved a staff member stealing cigarettes from a resident over a period of months (LTCH-009). A further report detailed the “misuse” of a resident’s personal TV and landline, resulting in $200.00 in unauthorized charges for “movies and international calls” (LTCH-020). Although the report described this last incident as a “failure to immediately report the alleged financial abuse to the Director,” the inspector issued a violation for “Reporting Certain Matters to Director,” with no mention of police or criminal charges.
At LTCH-004, police were notified of an incident of sexual abuse of a resident with a cognitive impairment; however, a 3-day delay in reporting the incident failed to produce a “Police Notification” violation despite other LTCHs in our sample being issued one for similar or shorter delays in reporting. Moreover, the delay in reporting was noted in the inspection report as due to “the close relation of the alleged abuser with the resident” (p. 2).
At one LTCH, the inspector issued a written violation under “involvement of resident etc.” instead of Police Notification”, even though the resident had explicitly requested that the police be called. In the report (LTCH-002), the inspector notes that “staff did not contact the police to report an allegation of assault as requested by the resident” (p. 2).
Across these reports, inspection reports rarely documented whether criminal charges were considered or whether matters were referred to police, even in cases describing conduct that could potentially engage Criminal Code offences such as fraud, assault, or failure to provide the necessaries of life. Across the reviewed inspection reports, documentation of police notification was infrequent and varied, and serious incidents were not consistently accompanied by documented police involvement.
Our study examined the extent to which LTC licensees in Ontario complied with the legal duty to immediately report alleged, suspected, or witnessed resident-involved abuse or neglect that may constitute a criminal offence. Results showed that licensees rarely (3 of 193 inspection reports) complied with mandatory police reporting requirements across a range of eligible incidents. Of the 457 inspection reports sampled for 2024, police were referenced in only 21 reports involving either falsified or missing staff and volunteer records and documentation (e.g., police record checks), or certain incidents of abuse and neglect. All 21 reports described events that should have triggered mandatory police notification; yet written violations for failing to notify police (i.e., “Police Notification”) were often absent, with no rationale provided. Absent was any discussion of whether police involvement was considered after the fact by either the licensee or the inspector. Notably, although staff-driven misconduct was more frequently identified in inspection reports, AMPs were more commonly issued in resident-to-resident incidents. This pattern raises questions about enforcement priorities, particularly where staff-related conduct may engage potential criminal liability. Taken together, these findings suggest that mandatory police notification requirements may be enforced inconsistently, raising concerns about transparency and accountability in cases involving potential criminal conduct. This gap reveals a disconnect between legislative mandates and the realities of enforcement practices in the LTC sector.
Our findings extend prior inspection-based research by examining what occurs after abuse, neglect, and other potentially criminal incidents are identified.(18–21) In multiple inspection reports describing incidents such as theft, fraud, assault, or neglect, documentation of police involvement was minimal or absent. This highlights a major gap between the detection of criminal harm and the enforcement of mandatory external reporting requirements, indicating that inspection-level identification does not reliably translate into law enforcement engagement.
Given that most LTC residents in Ontario live with significant cognitive and/or physical vulnerabilities and may not be able to report harm,(29) such findings raise serious concerns about their safety in LTCHs. Robust, transparent, and enforced reporting mechanisms are essential. That said, variability in inspection terminology and narrative detail, as well as the specific violations issued for often comparable incidents, echo longstanding criticisms of Ontario’s oversight, inspection, and enforcement regime in LTC. A 2023 investigation by Ontario’s provincial Ombudsman found that MLTC inspectors have, in certain cases, exercised discretion in a way that potentially delayed or avoided more serious penalties being issued to LTC licensees.(30) In our study, inspectors often categorized incidents under broad regulatory headings (e.g., “Duty to Protect,” “Resident’s Bill of Rights”) instead of using the more direct “Prevention of Abuse and Neglect” violation. It remains unclear whether police reports were triggered after inspection reports first flagged criminal incidents, and, if so, this raises additional questions about the role MLTC inspectors play in reporting crimes, should operators fail to do so per their legislated requirements.
This practice obscures the true prevalence and severity of abuse in LTC, minimizes the visibility of incidents that may warrant police intervention, and reduces the likelihood that licensees will face AMPs or other consequences. Standardized templates, mandatory fields indicating police notification, and uniform criteria for coding potentially criminal offences are needed to strengthen the reliability of inspection data and enable consistent detection of systemic risks. Future research should more directly examine inspection report quality and where improvements and standardizations may be warranted.
A second issue is chronic under-investment in staffing and training. Insufficient funding, inadequate staffing, and limited professional development for dementia care, behavioural management, and legal/ethical reporting obligations(31–33) mean staff may not recognize when incidents rise to the level of criminal offences or when they require mandatory reporting. This lack of clarity fosters conditions that lead to inconsistent understanding, application, and documentation of mandatory reporting violations, ultimately undermining resident safety.
Research shows that police frequently respond to older adults with complex medical and social needs, yet many do not feel knowledgeable about aging-related health.(34,35) These findings indicate that police may benefit from targeted education and training with respect to their interactions with older adults.(34,35) Interprofessional collaborations between police and healthcare providers (e.g., LTC staff) can strengthen these competencies and improve the identification and response to elder abuse.(34,36) Policing has largely been viewed as separate from healthcare, a factor that limits such collaborations.(37) However, integrated police–healthcare collaborations can clarify legal thresholds, evidentiary standards, and documentation requirements essential for successful investigations.(2,36) Specialized elder abuse units contribute trauma-informed, resident-centred investigative approaches, including communication techniques tailored for older adults living with cognitive impairment.(38–40) These initiatives are shown to increase staff confidence when engaging with police and enhance safety responses during high-risk incidents such as resident-to-resident aggression.(2)
Police engagement should be seen not as punitive, but as a safeguard that protects residents, supports staff in navigating legal and evidentiary requirements, and reinforces shared responsibility across care and justice systems. Constructive, cross-sector collaboration offers a path to enhance resident safety, strengthen public trust, and ensure that criminal acts in LTC are addressed appropriately.
Overall, these findings reveal an LTC oversight system in which legislative expectations are not matched by enforcement practices, where documentation is inconsistent and often incomplete, and where residents may be left unprotected due to uncertainty around when police notification and involvement are required. Addressing these issues will require additional training, government commitment, and regulatory reform, with a focus on resident safety, security, and protection in LTC. Appropriate police involvement can signal that elder abuse is a matter of public safety and criminal accountability, helping to address the widespread abuse and neglect that occurs in the LTC sector.
This study only analyzed a sample of Ontario LTCH inspection reports for the 2024 calendar year. Future studies can expand samples to include more LTCHs and/or from a wider time frame. An additional problem of underreporting of abuse in LTC, often linked to gaps in training,(19) is well documented and similarly observed in our study (e.g., LTCH-005). This issue of underreporting is compounded by the ambiguous wording of the FLTCA 2021, which specifies that only incidents of abuse and neglect that “may constitute a criminal offence” be reported to police. This study relies on publicly available inspection reports as an administrative data source. As such, findings are limited by the completeness, accuracy, and consistency of documentation within these reports.
Despite the FLTCA 2021 requiring Ontario LTC licensees to immediately report alleged, suspected, or witnessed incidents of abuse or neglect that may constitute a criminal offence, documentation of police involvement was infrequently and inconsistently reflected in our sample of 2024 MLTC inspection reports. Our findings suggest that incidents describing potentially criminal conduct were often managed and documented within regulatory frameworks, with limited indication or referral to law enforcement. The persistent underuse of police, even when incidents meet clear legal thresholds for offences, including theft, fraud, assault, or unlawful confinement, contributes to the perpetration and normalization of abuse in LTC. While tensions exist between calling for greater criminal accountability and avoiding an overly policed LTC environment, the failure to uphold mandatory reporting requirements suppresses avenues for accountability and upholds a well-documented cycle of abuse in this sector.
The authors would like to acknowledge Natalie Malyjasiak, Sharuya Mathavan, Anthoneil Newman, and Zainab Khalid for their diligent contributions to data collection during this research.
We have read and understood the Canadian Geriatrics Journal’s policy on conflicts of interest disclosure and declare that we have none.
This research did not receive external funding.
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Correspondence to: Vivian Stamatopoulos, PhD, Faculty of Social Sciences & Humanities, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, E-mail: vivian.stamatopoulos@ontariotechu.ca
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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited.
Canadian Geriatrics Journal, Vol. 29, No. 3, SEPTEMBER 2026