Canada's Hidden Crime

BY CLAUDIA CORNWALL

       From Canadian Reader's Digest May 2000

TOM KAMBEITZ, a retired Alberta farmer, had Alzheimer's disease, but he still walked two kilometres to church and back every Sunday until he was 91. In May 1999 the Garden View Lodge in Lethbridge, where he was living, decided they could no longer care for him, and at the age of 92 he was moved to a long-term care facility.

       His son Ernest was on vacation at the time. On his return, he immediately visited his dad. "The look of him broke my heart," he says. Tom had bruises all over his body. His nose was broken. Pus was draining out of his left eye. He had untreated cuts on his face, hands and head and had come down with a staph infection.

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       "I broke down and cried," says Kambeitz. "All my dad could do was sit there and drool. They had drugged him up to keep him calm. We couldn't make out anything he was saying, and he had been an articulate man before moving there."

       Staff at the facility said they had taken Tom's cane away because he was verbally aggressive. Without it, and under the influence of the drugs, he had become unsteady and had fallen several times.

       Kambeitz moved his dad to an auxiliary hospital, where the care was better. "But," he asks, "what about people who have no family and get abandoned in places like this?"

       Growing Problem. A 1991 report from the National Advisory Council on Aging states that "there are enough complaints and investigations of deaths and injuries in nursing homes, homes for the aged and even acute-care hospitals for us to know that the problem is real."

       Seniors in institutions may be handled roughly or be sexually molested. Sometimes they are the victims of fraud and theft. Often, the abuse takes the form of neglect. A surprising number of seniors do not even get enough food. The trend is worrisome, given that Canada's three million seniors represent 12 percent of the population. By 2021, the Council on Aging projects, one in five Canadians will be over 65.

       About 250,000 seniors live in institutions run by charities, municipalities, individuals or corporations. Nursing homes are licensed by the provincial and territorial ministries of health, which have standards for staffing levels, training, food preparation and medical care. The federal and provincial governments spend about $7 billion a year on these facilities. Governments also allow unsubsidized and unlicensed residences, which offer limited or no nursing. Like boarding houses, they are governed only by municipal bylaws, which do not regulate the care seniors receive.

       Says Christine Gordon, a coordinator with the Vancouver-based Coalition for People With Disabilities: "Abuse in institutions is often hidden. In many cases these facilities are simply not safe places for people to be, but we've not given much attention to that with research."

       Going Hungry. Eva Proskow of Edmonton lived in two nursing homes between May 1998 and February 1999, when she died at age 79. She had osteoporosis and a weak heart. She was supposed to have a low-salt diet, but her daughter, Irene Simpson, says the homes did not provide it. Proskow also had trouble swallowing. Simpson says that if she couldn't be at the home during mealtimes, her mother did not eat. "She needed things cut up for her, but the home didn't have enough staff to do that."

       When Proskow entered the nursing home, she weighed 130 pounds. When she died, she weighed less than 90.

       "Seniors die in hospitals every day from the effects of malnutrition," says Dr. Paul Saba, who works in the Department of Family Medicine at St. Mary's Hospital in Montreal. A 1998 Quebec study that looked at 16 nursing homes in Hull found that 74 percent of the 1,000 residents suffered moderate to severe malnutrition. A recent Ontario study found that 45 percent of seniors in a chronic-care hospital were undernourished.

       How can this be? Saba says doctors in Canada are not knowledgeable about malnutrition and may fail to recognize it in elderly patients until it is too late.

       Malnourished seniors are more likely to develop infections and are prone to bed sores. They are more likely to have hip fractures. And they experience more postoperative complications than do adequately nourished seniors.

       Neglected. Joan Kelmacki's mother, Mary, would leave pleading notes for her: "I don't like it here. I want to come home." When Kelma-cki read them, she was heartsick. She wondered if she had let her mom down by moving her into a long-term care facility in Thunder Bay. But at 80, her mother began to have blackouts, and the family doctor said she needed a nurse available 24 hours a day. Kelmacki found a 100-bed nursing home for her close by.

       Kelmacki visited every day. She hated to see her mom's independence and dignity being eroded. "She couldn't get to the bathroom on her own, and she was often forced to wait because staff were too busy to take her. She ended up wearing adult diapers."

       Nevertheless, one morning Kelmacki arrived to find her mother lying in a soiled bed. When Kelmacki asked for help, the staff told her they were too busy giving breakfast to other residents.

       Once, a nurse took her mother to the bathroom and left her alone while she went to her office to do paperwork. The nurse forgot about her; Kelmacki's mother fell, and another resident later found her crumpled on the floor. Her face was severely bruised and her mouth so sore she could no longer wear her dentures.

       Kelmacki asked about having her mother moved to another nursing home, but 200 people were already on its waiting list, so Kelmacki had to leave her mother where she was.

       Mary died in December 1996. To improve the home where her mom lived for 2-1/2 years, Kelmacki is working to establish a family council -- a watchdog organization for the residents.

       Dorothy Pringle, a professor of nursing at the University of Toronto, says, "In Ontario long-term care is brutally underfunded." Studies bear her out. Linda O'Brien-Pallas of the faculty of nursing at the University of Toronto looked at staffing levels in 22 nursing homes in Ontario in 1995. She found that on average, healthcare aides on the day shift were responsible for 19 residents, and at night for 39. As a result, residents received only 20 minutes of direct care during the day.

       Lax Enforcement. Charlie Tremblay took up golf after retiring from his job as a diamond driller. Until age 88 he was remarkably healthy. But then he began to suffer the effects of Alzheimer's disease. Forgetful and sometimes aggressive, he needed full-time care and moved into Garden Manor, an intermediate-care home with 29 beds, in Delta, B.C.

       His daughter Donalda Helferty was happy with the place at first; it was small and near her home. She found it easy to drop by and take her father out for a lunch of fish-and-chips or bring him to her house for dinner so he could spend time with his three grandchildren.

       Then one Sunday evening in May 1996, Tremblay became violent. When a nurse and care aide couldn't get him back to his room, they summoned Ernel Sarabia, the owner. To subdue Tremblay, Sarabia -- who has no training as a nurse or caregiver -- pushed him, and he fell, hitting his head on the floor. She warned the nurse and care aide not to say anything about her actions, even though she was asking them to break the law. British Columbia care facilities are required to report serious incidents such as a patient falling.

       The following week, Tremblay was admitted to hospital; he was having trouble eating and walking. "He ultimately died a painful death," says Helferty. "His doctor now thinks that he had a cerebral hemorrhage."

       In October 1996 Helferty learned from the coroner investigating Tremblay's death that Sarabia had a three-year history of noncompliance with government regulations. The Ministry of Health had closed Garden Manor to new admissions several times because of health and safety hazards. Helferty also learned that in 1993, when Sarabia had owned another home, she had been cited for several violations, such as not respecting the privacy of residents, collecting fees to which she was not entitled and not reporting serious incidents.Says Helferty: "I don't understand how the owner was able to get a licence to operate Garden Manor."

       After Charlie Tremblay died, the care aide who saw Sarabia push him reported the incident, and Sarabia was finally prohibited from operating a home in British Columbia.

       Helferty vows never to let something like this happen again. "My mother is nearly 90, and we've renovated our home so that she can come to live with us. I have never considered putting her in a home."

 
CONCERNED FRIENDS, a Toronto-based organization, reviews Ministry of Health reports on long-term care facilities in Ontario. In a four-month period in 1997, it found that of 207 annual reports completed by the ministry, over half the facilities -- 110 -- had violated one or more quality standards. Among other problems, they were dirty, hadn't kept proper medical records and hadn't provided a treatment or diet ordered by a doctor. More than 50 facilities were in violation of more than five quality standards. One had 26 violations. Yet not one was closed down.

       In the last ten years, Ontario's Ministry of Health has removed the licence of only one home: the Van Del Manor nursing home in Toronto. In September 1997 an inspector saw live cockroaches too numerous to count in the kitchen. Cupboards and other surfaces were dirty and covered with debris. The call-bell system was not working and hot water for the residents was scalding. Cups for dispensing medicine were not sterile. A month later the inspector returned to find the kitchen cupboards still filthy, the call bells not fixed, the medicine cups still not sterile. Nevertheless, the ministry allowed the home to stay open.

       John James Hayward, a 70-year-old veteran of the Korean War, lived in Van Del Manor for five years. "I went through hell at that place," he says. He remembers people being kept in their wheelchairs for hours and left to lie in their own urine and feces. "People used to cry all night, they were so unhappy there."

       When Van Del Manor finally lost its licence in 1998, it did not shut its doors. It became a retirement home, which does not need to comply with the provincial standards for nursing homes. The owner, Stella Pinnock, simply changed the name to the Birch Cliff Retirement Home and continued to house some of the same sick and elderly people as before.

       Tied Up. A 1999 report by the Canadian Institute for Health Information found that 30 percent of patients in Ontario chronic-care hospitals, who are mostly elderly, were restrained daily with vests or ties, or were put in a chair that prevented them from getting up. John Hirdes, one of the authors of the report, says that restraints are used much more frequently in Canada than in other countries. In the United States, 15 percent of patients in similar settings are restrained. In Denmark less than two percent are.

       Judy Lever, a nurse, geriatric specialist and author of Set Me Free, says: "We cavalierly put restraints on seniors because we think we're giving them safety. In fact, we're taking away the last bit of independence they have."

       Restraints are usually used to prevent patients from falling or injuring themselves. But they can lead to health problems such as incontinence and bed sores. Lever believes that restraints actually increase the risk of injury because patients often fight to free themselves.

 
WHAT MUST be done to improve Canada's care of seniors? Some suggestions from experts:

       • Make Sanctions Real. Ernie Lightman, author of a 1992 report about unregulated residential accommodation for seniors, says: "There have to be sanctions. If the home owner does not fear that his licence can be removed, there is no incentive to comply with the regulations."

       • Family Councils. Canada's first family council was started in 1992 at St. Vincent's Hospital in Vancouver. There are now 40 of them in British Columbia, and a pilot project to test the idea is under way in Ontario, as well.

       Similar to parent councils at schools, they are critically important when residents cannot speak up for themselves.

       When John Fee's wife moved into the Peace Arch Hospital, a long-term care facility in White Rock, B.C., in the spring of 1998, he was worried by the narrow corridors approaching the fire exits.

       He complained to the building manager and to the maintenance department of the hospital. But no changes were made until he involved the family council, which informed the local fire marshal. Improvements were made to the building to comply with fire regulations in the spring of 1999.

       Says Fee: "Even a good hospital needs to be pushed sometimes."

       • More Home Care. Lightman also says: "We should have more programs that enable people to remain in their own homes or in their children's homes for a longer time. There are people in nursing homes who don't need to be there.

       "If adequate home care was in place, they wouldn't have to go into institutions."

       • Better Training for Staff. Marie Beaulieu, director of the Masters of Ethics program at the University of Quebec at Rimouski, says: "A lot of people working in nursing homes don't have training in gerontology. They don't know what is normal aging or what is pathological, and they don't know how to work with older adults."

       • Be Vigilant. Lawyer Craig Paterson, a 25-year veteran of medical/health cases, says that residents and their attorneys have a right to see their care records. "If you're a patient in an institution, you need somebody to help you -- to make sure your toenails are being cut, that you're being given the correct medication in the right dosage, that you're getting physical therapy and exercise.

       "Caregivers have to be vigilant. If the staff know that the files are being reviewed, that will improve both the record keeping and the quality of care."

Is there a story you'd like to share concerning the quality of care an aging relative has received in a seniors home or care facility? To post your views, use the submission box in Join the Debate. Your comments may be used in a future issue of Reader's Digest magazine.

PHOTOS: (TOP) © AGE/FIRST LIGHT, (BOTTOM) © ADAM HINTON/STONE