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Shocking neglect of elderly
Exclusive study reveals inadequate care is widespread
At least one third of 544 homes have history of injury, abuse
"More
than 7,500 complaints were filed with the provincial health ministry
over the past five years"
MOIRA WELSH
TORONTO STAR
Elderly residents of many Ontario long-term-care homes are living in
a state of neglect.
They are left in feces-filled diapers or urine-soaked clothing.
They suffer from untreated
bedsores that eat down to the bone. They
go hungry.
They are injured. Some are abused.
Some die alone, ignored by well meaning but overworked staff in
many of the 544 homes across the province.
A detailed analysis of three separate provincial databases
obtained by the Star shows there's a deep crisis in the nursing-home
system — a system that receives $2.1 billion a year in government
funding to help care for 65,000 Ontario seniors.
Taken together, the data reveals widespread neglect and
inadequate care.
One database is filled with heart-wrenching complaints made by
families. Another reveals injuries and abuse. The third, comprised
of inspection records, details a litany of homes with substandard
care.
Over the past few days, Star readers learned the tragic story of
Natalie Babineau. The three-day series detailed how the 93-year-old
mother of 10 suffered a broken leg and ultimately died because a
gangrenous bedsore was not treated properly.
Her daughters called the conditions in her nursing home
"deplorable."
Government inspectors, who visit each home once a year, unearthed
evidence of poor care in four out of five, the Star found.
The Star's research also shows many homes — at least a third —
have a history of serious complaints and injury or abuse reports
filed to the ministry.
Problems uncovered during the investigation include:
 A 72-year-old diabetic man from
Strathroy, near London, was so neglected that an
infected toe rotted
and his foot had to be amputated.
An elderly man in obvious distress died
alone, sitting in a wheelchair beside the nurse's station in a
Windsor nursing home. Nobody comforted him.
Seniors in homes in Toronto and across
the province were found to be malnourished, dehydrated and living in
desperate conditions.
Leaders in the nursing-home field agree there are serious and
persistent problems. They are demanding immediate changes from
Queen's Park. Topping their wish list are more dollars for staffing
and better government enforcement.
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Here's what they say:
"People in our homes are at risk," says Karen Sullivan, executive
director of the Ontario Long Term Care Association, which represents
mostly for-profit nursing homes. "People are at risk of waiting to
go to the toilet, or falling because they tried to go on their own
... they are not getting the care when they need the care."
"The neglect of the elderly is a very significant problem in
Ontario," says Lois Dent, spokesperson for Concerned Friends, the
chief advocacy group for nursing-home residents.
"These are supposed to be homes where elderly people end their
lives in a compassionate way. It is unacceptable that there should
be any kind of neglect or abuse. It is a disgrace for Ontario," Dent
says.
"I wonder how much worse it has to get before we see the
situation addressed," says Donna Rubin, head of the Ontario
Association of Non-Profit Homes and Services for Seniors.
"It is a crisis," says Joy Richards, vice-president and chief
nursing officer at Toronto's Baycrest Centre for Geriatric Care,
regarded as one of the best homes in the province. Richards blames
inadequate staffing — a direct result, she says, of government
funding shortfalls.
The provincial health ministry acknowledges there are problems.
"The ministry is aware that improvements need to be made," says
Mary Kardos Burton, assistant deputy health minister. Burton plans
to make a series of proposals (such as a better enforcement program)
to the new Liberal government.
The homes researched by the Star fit into three separate
categories: for-profit nursing homes, non-profit municipal homes for
the aged, and charitable institutions. Unlike non-government
regulated retirement homes, all are governed by ministry rules. For
the purposes of this story, they are all referred to as nursing
homes.
Complaint records obtained by the Star show families are angry
and upset.
More than 7,500 complaints were filed with the provincial health
ministry over the past five years, with each family that complains
making an average of two complaints highlighting different problems.
The Star's investigation found these are just the tip of the
iceberg, for several reasons.
Many incidents go unreported, often because the family fears
retribution or because the family is not aware of the incident. Many
that are reported are not included in the ministry's data management
system, from which the Star obtained the records (for example, if a
family member complains to the home, not the ministry).
Fewer than one person out of 100 with a problem will ever file a
complaint, says Charmaine Spencer, a lawyer and gerontology
researcher with Simon Fraser University in British Columbia.
"There
is a tremendous fear among residents and families of nursing homes
to complain about their care,"
Spencer says.
That apprehension was borne out by dozens of interviews with
families and seniors' advocates.
Analysis of the complaints shows that inadequate care and neglect
are the biggest problems — 57 per cent of the complaints filed
against homes relate to these concerns.
Problems cited include:
Going hungry, because there is not
enough staff to help the resident eat.
Being ignored when calling for help.
Unexplained bruises, untreated bedsores,
urine-soaked clothing, feces under fingernails at dinner time.
Being left alone in a wheelchair all
day, every day.
Other complaints relate to infection control, dirty living
conditions and some physical, sexual and verbal assaults, many of
which are resident on resident.
How many complaints and serious incidents (such as injury
reports) are too many? In doing its research, the Star learned that
the ministry of health has no standards for this.
However, the Star found that one third of the homes had
particularly high numbers — a total of more than 40 serious
incidents and complaints over the five-year period. More than 10 per
cent of the homes had over 100 incidents and complaints in the same
period.
In addition to complaints and serious incident reports, the Star
reviewed and analyzed the government's own inspection records from
the year 2002.
These show inspectors routinely find serious problems with homes
that fail to meet requirements for a safe and healthy environment.
Inspectors found homes not providing the care they agreed to
provide; homes with dirty, unsafe conditions; homes with poor
infection control; and homes that did not provide adequate training
for staff.
Inspectors found four out of five homes had some form of quality
of care problem, and issued directives or recommendations for
improvement as a result. Over one in three homes had more than 10
problems in the past year.
It became clear during the investigation that families must lobby
constantly to ensure their loved ones get good care. Some hire, at
significant expense, private caregivers. Others quit their jobs to
provide the care the home advertises it will give.
Why is this happening in Canada's richest province?
Nursing homes are chronically underfunded and short-staffed. In a
comparison with jurisdictions across Europe and North America, a
2001 Ontario government study concluded the province has the lowest
levels of daily personal care — lower even than Mississippi. In
addition, residents are being admitted older and sicker than ever
before. In the last decade, the number of medically fragile
residents, with conditions like Alzheimer's, Parkinson's disease or
dementia, has increased by over 17 per cent, creating the demand for
chronic care in homes that don't have the time and trained staff to
respond. And hospitals, which have the expertise, are stretched to
the limits and can no longer provide long-term care.
Adding to the pressure is Canada's graying population. By 2011 —
when the first baby boomers hit retirement age — the number of
Ontario residents aged 80 and older will nearly double.
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The people relying on nursing homes are our parents, grandparents
and great grandparents. They survived the Great Depression, fought
in World War II and then quietly worked hard, raised their children
and paid their taxes.
"The seniors in this country did so much for us, but they are not
getting what we should be giving to them," says Janet Holtrust, a
front-line worker at Versa-Care Centre in Uxbridge. "They are such a
vulnerable group of people. They are like children. Do you think we
would ever allow children to live like this?"
Irene Campbell-Taylor is a clinical neuroscientist and a PhD,
known for her work in swallowing and eating problems of the elderly.
She has spent 25 years working with doctors and dieticians in
Ontario nursing homes, and is appalled by what she sees as
deteriorating conditions over the last five years.
"What I have seen is a vicious circle of malnutrition,
dehydration and neglect," Campbell-Taylor says. "If residents
experience any of those, then they are at huge risk of developing
infections, like pressure ulcers (bedsores), that lead to
excruciating pain and then death.
"I have seen this happen over and over. Residents aren't fed
properly, they get dehydrated, they don't get the proper care, like
baths, they develop pressure ulcers that become gangrenous and then
they die. We are killing off our elderly."
Currently, there is no guarantee of a minimum standard of care in
an Ontario nursing home. The province had one —2.25 hours of daily
care per person, per day — but that requirement was dropped after
the former Conservative government took power.
The Tory government also dropped the regulation for a weekly
bath, and the requirement that a registered nurse be on site 24
hours a day to dispense medication. Problems exist everywhere, even
in facilities like the Baycrest Centre — a home renowned for its
care.
Al Gorlick, 81, is a retired pharmacist who pays $24,000 a year
on room and care for his 79-year-old wife, Sarah, at Baycrest. It
costs him another $40,000 a year for a private caregiver, who does
the job the home doesn't have time to do.
Gorlick is part of an increasing trend — families who spend
upwards of $60,000 a year on both the home and private "companions,"
or quit their full-time jobs to do the bathing, walking, toileting
and feeding work themselves.
Sarah — "Sorcy" as Gorlick lovingly calls her — has Alzheimer's.
"At my wife's dining room table there are four people and three
of them have caregivers, paid for privately in excess of $40,000 a
year," Gorlick says. "If you don't have an attendant, you will sit
in a chair all day.
"The staff here range from excellent to good. None are bad. The
reason why the Baycrest workers, as understaffed as they are, can
possibly cope is because there are so many sitters and companions
working there.
"Without them, the place would be chaos," Gorlick says.
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`We're so rushed
caring for them that we're not treating them like humans. It's
like an assembly line.'
Dorothy Algar, nursing-home worker
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Baycrest's Richards says workers throughout the industry are
demoralized, which has a direct impact on how they treat residents.
"When caregivers are burned out, they disconnect," says the
home's chief nursing officer. "They don't have the energy to go back
one more time. I'm not excusing the behaviour. I think it is
deplorable and needs to be addressed. I think what we are seeing is
caregivers who are so burned out they can't attend to the clients'
needs anymore.
"We have a term for it in the industry. It's called compassion
fatigue."
Baycrest has higher staffing levels than most since it can tap
into extra money from its fundraising foundation.
The annual government funding for nursing homes is $2.1 billion.
That is up by $330 million from three years ago, and works out to
about $117 per resident per day. Funding for prisoners in Ontario's
jails is about $140 a day.
The industry has welcomed the increases, but critics say a big
chunk of the money was eaten up by much needed pay increases, pay
equity settlements and the purchases of supplies, such as diapers.
The ministry claims nearly 2,400 full-time jobs were created, but
the nursing-home sector says more staff is desperately needed.
Karen Sullivan, whose mostly for-profit association represents 80
per cent of the homes across the province, says another $420
million is needed to catch up to the daily hours of care provided by
Saskatchewan in 1999.
"We're not where we need to be but we feel that we've moved
forward," Sullivan says. However, "if you don't continue to get
increases, you can slip back pretty quickly."
Several front-line workers risked their jobs to speak with the
Star. They believe that speaking out can only improve the lives of
the elderly.
"Residents are being neglected," says Holtrust, of Versa-Care
Centre in Uxbridge.
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Holtrust says she's seen no real improvements in care, despite
the funding increase.
"They are just not getting what they need. We look after war
veterans here. It truly breaks my heart to think what they did for
us, and what we're doing for them."
A typical day is chaotic.
"People aren't being taken to the bathroom as quickly as they'd
like. They aren't given enough time for meals. We are on really
tight time constraints and we'll be in the middle of feeding a lot
of people when someone else wants to use the bathroom.
"The ministry says you're not supposed to leave people who need
to use the bathroom. The ministry also says you're not supposed to
let someone's meal get cold. So you say, `I'll be back in a minute,'
and take Charlie to the washroom. But it never takes just a couple
of minutes and when you come back, the other man's lunch will be
cold so you take it down to the kitchen to heat it up and when you
come back, someone else needs to use the washroom.
"I'm 35 years old," says Holtrust. "And I'm so tired I'm ready to
retire."
Holtrust's home is operated by Central Care Corp., commonly known
as Central Park Lodges. It is Ontario's largest nursing-home chain.
Central Park has 7,000 residents and gets the most tax dollars —
over $100 million a year — to operate over 60 facilities across the
province.
Senior spokesperson Mary Nestor has told the Star her company has
a system for fixing problems rapidly when they arise. Problems that
do occur, she said, are "the exceptions to the overall high
standards we successfully maintain."
Another worker who spoke to the Star is Dorothy Algar, a
health-care aide at a small private chain called Community Nursing
Home in Port Perry.
Algar says she's seen an alarming increase in pressure ulcers
that can eat deep holes into the skin. She blames staff shortages.
"I can honestly say that in the last 10 years, I have never seen
so many ulcers as I'm seeing now," Algar says. "Now we have sores so
big you can put your fist up inside of them."
People who sit in wheelchairs or lie in bed for long periods of
time are particularly susceptible to pressure ulcers. The painful
bedsores are caused by unrelieved pressure in particularly bony
areas of the body, along with malnutrition and dehydration.
Nursing-home workers are supposed to reposition immobile
residents every two hours to relieve the pressure on the body.
"Nobody has time to reposition," says Algar, who stresses that
her home works hard to give good care and brings in extra supplies,
like special mattresses, to deal with bedsores. "When you have
somebody who is just starting to get the sores, a bath can make all
the difference for their circulation. We just don't have time to do
that.
"We're working short so often, we get snappy, our tempers go.
Some residents cry when they ring the buzzer for help. They say,
`I'm so sorry.' God forbid they just want to tell you a story,
that's not going to happen. There is such a sense of loneliness to
their lives. We're so rushed caring for them that we're not treating
them like humans. It's like an assembly line."
Everyone in the industry agrees that front-line workers have a
tough job. It is dirty, often back-breaking work. Many of the nurses
and aides do it because they want to care for the elderly. Most are
paid roughly $16 an hour for a job that keeps them running from the
moment they punch in.
Training is an issue. There is no educational or training
requirement laid down by the ministry for personal care workers in
homes, although some facilities insist on a three- to five-month
training program at a community college. Veteran employees worry
that new workers are ill-equipped to do a proper job.
Families interviewed for this story say they were shocked to
discover the substandard care.
Brenda Carson witnessed her mother, Margaret, wither away in two
southern Ontario nursing homes. She died on Aug. 20.
Margaret, 81, a World War II veteran with England's Auxiliary
Territorial Service who moved here with her Canadian husband, lived
for one "horrible" month in Versa-Care Lambeth, a Central Park
Lodges home, says Carson.
She says her mother was placed on a floor that smelled of urine,
with residents who had serious behavioural problems.
The family removed her, and she spent her final three months in
Caressant Care in Arthur, Ont. That home, her daughter says, missed
signs of pneumonia and ignored a swollen leg.
"There is an awful lot of guilt about having put your own mother
into a place like this — how can I ever forgive myself for having
done this to her?" says Carson, communications director of the
Hearing Foundation of Canada.
"My whole feeling about nursing-home care now is, never put
anybody you care about in those places. They are horrible. They
won't be looked after, their needs won't be met, they won't be
stimulated, they won't be helped, and they will be ignored.
"If I had to advocate for my mother every time I went there,
which was every week, then they should have told me that up front.
Tell me there isn't enough staff to look after all the health
problems. Tell me that I am responsible for doing that, because I
assumed that since she was going into care, that is what she would
be getting — care. But that wasn't the case. The case was — ignore
it for as long as possible."
Lara Riehl, administrator of Caressant Care Arthur, says Margaret
Carson's issues were "dealt with appropriately." She said Carson
might have taken her concerns to the front-line staff, but never
brought them to the home's top management.
Nestor says Versa-Care Lambeth, the Central Park Lodges home
where Carson first stayed, tries to keep residents with similar
cognitive abilities together but can't always accomplish that. The
chain's spokesperson also says the home works hard to control urine
odours, which can be more intense at certain times of the day.
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Alyn Kemp, 72, a diabetic who lives at the municipally run
Strathmere Lodge in Strathroy, says staff ignored his infected toe
for a year until it rotted, leaving his right foot so badly infected
it had to be amputated.
"I am legally blind, so I couldn't see it. I have bad
circulation, so I couldn't feel it. But one day I went to the
television room, put my feet up — and I could smell it," says Kemp,
an articulate man who once worked as a bank manager in Grand Bend.
"Before my foot came off, they had been changing the dressing
every day for a year. I kept asking them, `How does it look?'
Usually they said it looks fine. One nurse said it was gruesome. But
they left it until it rotted.
"I feel like I was forgotten. They just ignored me. My greatest
fear now is going completely blind in here. Then I can't fend for
myself.
"I don't want to be vulnerable in here. I've watched ladies call
for someone to take them to the washroom. The workers are too busy
and no one comes. Then the ladies start crying, saying, `I've got to
go, I've got to go.'
"They try to hold on as long as they can, but you can see that
their clothes are soaking wet. It's a terrible thing to watch a lady
cry because she's had to wet herself."
Strathmere administrator Larry Hill says privacy issues prevent
him from fully discussing Kemp's story, but denies he was neglected.
"He was receiving ongoing medical care for his diabetes as well
as nursing care," he says.
"In some respects, it is a question his physician would have to
answer as to why more aggressive action wasn't taken. Nurses act on
doctors' orders."
Hill also contests Kemp's observations about urine-soaked
clothing. "Our staff is very compassionate," he says.
In addition to complaints and ministry inspection reports, a
third and different level of government scrutiny is called the
"unusual occurrence reports," filed by the homes. These reports
detail an incident and propose an action plan, if any, to fix the
problem.
In a five-year period ending March 31, 2003, 13,574 such reports
are listed on the data the government released. However, the Star
has learned from the ministry that this represents only about half
of the reports in that time period (last year's provincial auditor's
report criticized the ministry for not keeping track of the reports
and the ministry vowed to improve).
The majority of the reports were for injuries that required a
visit to the emergency ward, or admission at the hospital.
According to the data that was released, 68 per cent of the
reports were injury related. Ten per cent involved abuse, 3 per cent
missing persons, less than 1 per cent accidental death, with the
remainder made up of medical error, fraud and a series of
unspecified occurrences.
While some accidents can't be avoided, advocates for the elderly
say many are the result of understaffing, poor training, or simply
bad care.
Vera Muza, 79, broke her spine and numerous other bones after she
was dropped from a broken chair lift at Meadow Park Long Term Care
Centre in London on May 13, 2002.
Sandra Fysh, Meadow Park's new administrator, said she couldn't
comment on the case due to resulting legal action.
Muza spent months in the hospital and, according to a lawsuit
filed by her daughter, Ohla Muza, died the following September as a
result of complications from the fall.
Meadow Park filed 79 injury reports for the five-year period, one
of the highest numbers of injuries in the province.
Lois Dent, of the Concerned Friends advocacy group, believes the
lack of interest in how the elderly are treated reflects a
deep-rooted ageism.
"Everyone says it doesn't matter because they are going to get
sick and die anyway. But why should they spend the end of their
lives in such terrible pain? It doesn't have to be that way. Being
able to die a good death is really important."
Neuroscientist Irene Campbell-Taylor believes the future is grim.
"The state of long-term care is such that the baby boomer
generation should be very afraid. Especially if they don't have
family, because if you don't have an advocate — you are doomed." |
