And she's angered and bewildered by a system that prevents families from learning dirty secrets the government knows about nursing homes entrusted with their relatives' final days.

"Had I known about the home's problems, I would have taken my mother out, brought her home and cared for her as best as I could," says Patershuk, 65. "It's a tragedy."

The story of Patershuk's mother, Natalie Babineau, was profiled last week in the Star, detailing how the 93-year-old mother of 10 spent the last four years of her life in two Hamilton-area nursing homes. Babineau suffered poor care in one home and ultimately died in a second, after a gangrenous bedsore ate down to her tailbone.

The Star investigation shows Versa-Care Hamilton, where Babineau lived for three years, had systemic problems.

During the time she lived there, the home received 53 complaints from families, many of them serious. And government inspectors documented problems ranging from poor nutrition, to safety hazards and improper care.

In Ontario, families seeking a home for a loved one have no way of knowing whether a nursing home has a history of substandard care.

Even though the health ministry, which oversees the long-term-care system, collects thousands of complaint, violation, injury and abuse records about Ontario's 544 nursing homes, the public has very limited access to the data. Complaint and injury reports and rates, for example, are kept secret. Even the nursing homes don't know the extent of the complaints against them.

Yesterday, the Star revealed that problems of neglect and inadequate care are widespread in homes, based on an analysis of three separate provincial databases: complaints, injury and abuse incidents, and inspection records.

Today, the Star investigation turns to the health ministry, which is supposed to act as watchdog over Ontario's 65,000 nursing home residents.

Bottom line? The health ministry is failing to protect the elderly. The Star investigation found:

Ontario has no standard for rating a home's care.

The ministry waits too long to take action against troubled homes.

It keeps vital information on complaints, injuries and abuse but doesn't share the results.

"The system is not accountable nor is it transparent," says Lois Dent, spokesperson for Concerned Friends, Ontario's chief advocacy group for nursing home residents.

"It's very hard for families to know what is going on inside the homes. Once they're in there and they discover what's happening, they become afraid to speak out, they fear repercussions."

The only real public information is the yearly inspection report, which nursing homes are required to post in an easily accessible area. Not all homes do this and only the current report must be made available.

But that's not real disclosure, says Dent. "Families should be able to look at a history of inspections, going back for years. If you look at a series of them, you can see a pattern of care."

Versa-Care Hamilton, where Natalie Babineau lived, is owned by Central Care Corp., more commonly known as Central Park Lodges, the largest nursing home company in Ontario.

Spokesperson Mary Nestor would not comment on the Hamilton facility's high level of complaints and violations. (The Star looked at rates of complaints, factoring in number of beds, and found the Hamilton home was in the top 20 for complaints in Ontario.)

In one of several letters to the Star, Nestor wrote:

"We have an internal quality management system to continuously monitor quality of care in all of our homes. This is over and above the annual reviews undertaken by the Ministry of Health and Long-Term Care. Our goal is to identify where issues may be emerging and put measures in place to deal with them proactively."

While Ontario has little transparency, other jurisdictions are much more transparent.

Web sites run by many American states provide a detailed breakdown of nursing homes, listing the number of inspection violations, the number of residents with bedsores, residents who lost weight, who were left in bed for most of the day or placed in physical restraints.

Karen Sullivan, executive director of the Ontario Long Term Care Association, calls that kind of disclosure "an idea whose time has come."

"Those kind of things are being considered much more seriously now. They are advocated more by organizations like ours. I think we are at the cusp of that."

Nestor, Central Care's spokesperson, says that until she was contacted by the Star, she had no idea the ministry kept a database detailing vastly more complaints against homes in her chain than she believed existed.

For example, The Star's research showed that Central Care's Riverside Long Term Care Centre in Windsor has 129 complaints filed against it over a five-year period. All of the complaints are for specific issues, such as lack of showers or toileting assistance. Some families filed several complaints on different problems.

"This comes as a surprise and a shock to me," Nestor said. Her records show the ministry only had 50 complaints on file, a figure she said is based on the number of times the ministry visited the home.

"I have absolutely zero idea of the numbers ... I would like to know what it is that people are complaining about ... so we could do proactive work in our homes to address these things," said Nestor, a former long-term-care bureaucrat in the health ministry who left in 1999 to join Central Care.

Nursing home critics say the operators should know the problems going on inside. But Nestor called the hidden complaints a "disappointment about the transparency of the system and the missed opportunities to address the issues."

Health ministry officials told the Star they have not investigated Windsor's Riverside, a tiny 64-bed facility, for additional enforcement measures based on its complaint number, nor on the high number of reports for abuse (which are typically resident against resident) and injuries filed by the home.

Here's how the complaint system works:

Families are encouraged to first take their problem to the home. If administrators don't respond, they can call or write the ministry with specifics of the allegation against the home.

Ontario's complaint investigation process is shrouded in secrecy, in part to protect the complainants' anonymity, because many families are terrified of retribution. Homes are rarely told the specific types of complaints that inspectors are checking on their surprise visits and they only get written information when the investigator finds a violation.

The ministry dispatches an inspector, called a "compliance adviser." The inspector goes to the home. He or she does not reveal the identity of the complainant and probably tells the home very little about the complaint. The inspector usually pulls a handful of records, and may or may not question residents or staff.

Complaint records show the investigation findings: "verified," "not verified" or, when the inspector can't make a decision, "unable to verify."

If the complaint doesn't result in a violation, then no action is taken.

The provincial auditor attacked the health ministry's enforcement a year ago, criticizing it for not tracking injury rates, incidents of abuse and complaints. The auditor said the ministry needed to do this to identify "systemic" issues.

One year later, the Star found that little has changed. The ministry told the auditor it was going to develop a "risk-assessment" tool so that a specific number of complaints or injuries would automatically trigger a tough ministry response.

Today, the government is still mulling over that tool.

"Their compliance program has barely got off the ground," said Donna Rubin, CEO for the Ontario Association for Non-Profit Homes and Services for Seniors.

When the Star presented its findings to the provincial health ministry, a top official said she is aware improvements need to be made. Mary Kardos Burton, an assistant deputy minister, says risk management in nursing homes is a priority.

"I think that better targeting is something that we are clearly moving towards. I think that we need to make better use of the information that we have."

Since 2000, she says, more than 40 new nursing home inspectors have been hired, bringing the total to 64. At the same time, the number of long-term-care beds in the province has grown from 57,000 in 2000 to the current 65,000.

Sullivan, of the Ontario Long Term Care Association, said the ministry has to kick-start its enforcement program and target bad homes.

One of the worst examples of the ministry failing to take action is the troubled saga of the Royal Crest Lifecare chain of 11 homes in central Ontario.

Nine of those homes were allowed to operate unchecked for at least four years, while the ministry collected 630 complaints and at least 186 violations for terrible care and living conditions. The government finally cracked down on three of the homes just weeks before Royal Crest was petitioned into bankruptcy last October.

Royal Crest's Oakville home was taken over by the ministry last July, a rare step for any home. When Extendicare Canada was contracted as manager, it found the residents were living in extreme neglect.

Bankruptcy documents describe their lives:

"Residents were found soaked to their shoulders with urine; left for long periods on bedpans, beds that were soiled with feces and urine, and residents who were not washed when their dirty diapers were changed. It found bed mattresses were rotting from urine, wheelchairs were soiled, one resident's sling was soaked with urine."

Angela McLellan, a union rep for the Royal Crest's Strathaven nursing home in Bowmanville, said the former management paid little attention to ministry inspectors despite years of bad inspections.

"They felt like they had nothing to fear," McLellan said.

At Strathaven, the kitchen ran out of food on weekends, sewage bubbled up from the dining room floor drain and residents were given diapers that were so cheap, their urine and feces leaked on to their skin, causing such irritation that they developed open sores.

In Strathaven's 2002 inspection report, ministry compliance advisers found 31 different violations of standards and made another 13 recommendations to solve other problems. Ministry inspection reports dating back to 1999 detailed dozens of violations, bad care and living conditions.

Among the 2002 findings, no action was taken to protect residents from hazardous conditions and a filthy kitchen and baking area. Residents' care plans didn't reflect their individual needs, and there was a shortage of diaper pads.

All of this was documented in inspection reports. Yet residents at Strathaven did not benefit from government protection.

The bankruptcy receiver brought the change.

"It's day and night now," said McLellan, "We have supplies now. Staff used to spend their own money to buy residents supplies (like soap and cream). Now we have diapers that don't fall apart when the residents are wearing them. It is amazingly better."

One overwhelming conclusion from the Star data was that tougher enforcement gives results.

Regions of the province where ministry inspectors act tough — write up homes for violations of the long-term-care standards — had lower levels of complaints. The Star found that Toronto, the region with the lowest complaints, had the toughest inspection reports. The southwest region, with the most complaints, had the weakest inspection reports. There are seven ministry regions.

Enforcement means:

Suspension of admissions.

Withholding or reducing government operating subsidies.

A proposal to suspend and revoke a licence.

Takeover of a facility by the ministry to ensure the health and safety of residents.

A softer "pre-enforcement" approach includes the options of increased scrutiny by the ministry, voluntary suspension of admissions or formal warnings regarding the consequences of non-compliance.

Leisureworld's Scarborough facility, on Midland Ave., faced the soft side of the ministry's hand earlier this year.

Last February, the home voluntarily suspended its new resident admissions for about two months.

Inspection records show that, since the year 2000, ministry investigators documented more than 60 different violations of long-term-care standards. In 2000, inspectors noted that residents' responses to medications weren't monitored, weights weren't measured and residents' care plans didn't reflect their needs.

Two years later, on a special visit during increased scrutiny, inspectors found residents who went for nearly five hours without being toileted or changed in position. (Repositioning helps to prevent bedsores.) Another resident was left slumped over a 90-degree angle from breakfast until lunch. Other high-risk residents weren't given fluids to keep them hydrated.

"Yes, there were problems," said Leisureworld's chief operating officer David Cutler. "Was it fixed as quickly as the snap of a finger? No. Is it being fixed? Most definitely. Are we paying attention? Absolutely. Tons of corporate resources and help are going into that home."

The ministry cleared the Scarborough facility last April, meaning the home is now out of the enforcement stage.

The association representing long-term-care homes says enforcement would be much more effective if the government analyzed the huge volume of information it collects for care problems.

"It would be hard to find a sector that puts more in and gets less out," says association executive director Sullivan. She believes the industry needs to be accountable and open. She has some ideas on how to achieve that:

A universal family satisfaction survey.

A Web site that explains long-term care and gives some information on homes.

Information kits that tell homes and families the steps behind enforcement so they know what it means. (The ministry created these kits before the provincial election was called.)

Data analysis of all the ministry's information, such as complaints, inspections, and abuse and injury reports, to target the worst offenders.

"And," says Sullivan, "if that includes surprise inspections, that's fine with us."

The element of surprise is key to good investigations. Yet the ministry gives homes up to a month's notice for their annual inspections — the one opportunity a year for the ministry to take a hard look at the care homes give to the elderly.

It also allows homes to cheat at inspection time. The industry term for it is called "staffing up." It means bringing in extra workers to present the image of a smooth-running operation instead of a home struggling to overcome the shortfall of government funding.

Janet Holtrust, a front-line worker with Versa-Care Centre in Uxbridge, said her home responds to that advance notice by bringing in extra staff, in particular, registered nurses, to make sure that the care records are up to date, a ministry requirement.

"They also bring in extra staff on the floor to tidy, clean and get things in shipshape for compliance," said Holtrust, who has worked at the home for 15 years. "Then, during the week of compliance, we consistently have at least two or three extra staff on the floor giving care.

"I think the home should just leave the staffing at its normal levels and let them see what they are going to see. They would see a lot of stuff that we are not supposed to do, things that we don't get done. Paperwork doesn't get done. It takes a lot longer to get patients up in the morning, get them dressed for the day. There are not as many staff to feed residents, so meals are dragged out and then resident treatments are not being done.