Physical and verbal abuse against workers in long-term care have largely become normalized according to a new study by Canadian researchers.

Stirling University and Windsor University experts came to their conclusions after conducting group interviews with almost 60 LTC workers across seven facilities. They found that violence is a “significant” risk factor in skilled care, with many incidents going unreported for fear of reprisals.

Authors believe the results of the study — funded by two healthcare worker unions — are meaningful for providers in American and elsewhere.

“The health and wellbeing of healthcare staff reflects the health of the system itself,” co-author James Brophy, Ph.D.,  an adjunct professor with the University of Windsor, said in a statement. “There is widespread recognition that the public healthcare system in Canada — as in other countries around the world — is facing a deepening crisis, with working and residential care conditions at breaking point.”

Violence in nursing homes is often caused by resident fear, confusion and agitation, the research found. Other underlying causes included understaffing, work being organized in a task-driven fashion, inappropriate resident placement, and a lack of time for social and emotional care.

The study, published in New Solutions Monday, also identifies some of the common barriers to preventing workplace violence, such as insufficient training and resources, systematic underfunding, limited public awareness, and a lack of recognition of the problem’s pervasiveness.

A second and related poll of LTC workers estimated that 88% of personal support workers and registered practical nurses experienced physical violence on the job.