Canada’s hidden crime: nursing home abuse

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.

“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.

<P align=&uot;jusify”>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.

Joan Kelmacki’s mother, Mary, would leave pleading notes for her: "I don’t like it here. I want to come home." When Kelmacki read them, she was heartsick. She wondered if she had let her mom down by moving her into a longterm 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 two and a half 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.

Next: A look at lax enforcement of existing rules, and a checklist for improvements for senior care in Canada.

Reprinted by permission from the Canadian Reader’s Digest Magazine
copyright © 1999 The Reader’s Digest Association (Canada) Ltd., Montreal