When Maureen McCartney’s mother, Margaret, moved into a long term care home, she thought it was a perfect fit.
Woodhall Park Care Community is just down the street from Maureen’s Brampton home, and she and her sister could visit their mom every day.
But, Maureen says, Woodhall Park staff twice failed to contact her when her 88-year-old mother was injured in falls in the final month of her life.
Margaret McCartney died Nov. 27, 2015.
A post-mortem report by the Ontario Forensic Pathology Service states that Margaret had fallen twice in the “last few weeks” before her death.
The coroner found multiple signs of recent injury, including a “faint pink abrasion, covered with a bandage,” on her left forearm and contusions on her right knee, left foot and right wrist.
The report does not indicate that these injuries contributed to Margaret’s death.
“I went to visit her in the morning (after the first fall.) Her arm was split right open. There was so much blood it was incredible,” said Maureen McCartney.
“I was upset that I hadn’t been called.”
Kathy Pearsall, spokesperson for the Concerned Friends of Ontario Citizens in Care Facilities advocacy group, says residents’ families are often left out of the loop by long term care homes when their loved ones fall.
“A family may not be called because the staff may not think it’s that serious,” she said.
“Well, you know, it (shouldn’t be) their decision to make.”
Under Ontario’s Long-Term Care Homes Act, a home must ensure that any person “designated by the resident are promptly notified of a serious injury or serious illness of the resident, in accordance with any instructions provided by the person or persons who are to be so notified.”
But, said Pearsall, this leaves too much room for subjectivity, and staff don’t always make the right call.
Front line personnel at long term care homes should be trained to report all resident falls to family members, said Pearsall.
“I had a case where a woman fell three times but there was no injury and the staff said we’re not going to bother,” she said.
“Sometimes, by the time the family is called, it’s too far gone,” Pearsall adds.
“The falls are cumulative.”
In a report from June 9, 2016, Ministry of Health and Long Term Care inspectors determined that Woodhall Park staff had “failed to ensure that the care set out in the plan of care was provided to (a) resident as specified in the plan.”
The report does not include any names, referring only to Resident #003, but Maureen McCartney has identified #003 as her mother.
Resident #003’s plan of care, which directs health professionals on a patient’s treatment, required assistance from two caregivers using a lift when being transferred.
On an unspecified date in 2015, a single personal support worker transferred #003 manually, without a lift, the report says.
Resident #003 “sustained an injury during transfer.”
When contacted by the Star, Woodhall Park executive director Kerri Judge said she could not confirm the identity of Resident #003 because of privacy concerns.
“We have a deep ethical obligation to protect resident health information, and respectfully we cannot comment further,” she said.
Judge added that Maureen McCartney’s account of not being informed when her mother fell contained “several inaccuracies,” but would not indicate what those inaccuracies were, again citing resident privacy issues.
For its “non-compliance” with the Long Term Care Homes Act, Ministry inspectors issued Woodhall Park a “written notification” and a “voluntary plan of correction.”
Any time a care home is found not to have complied with the Long Term Care Homes Act, inspectors issue a written notification of non-compliance. Depending on the severity of the infraction and the home’s history, inspectors may require the home to create a “voluntary plan of correction” to fix its problems, or issue the home a compliance order, mandating that it fix its problems.
If a home is unable or unwilling to make the necessary changes, the ministry may cease the home’s admissions, reduce or withhold funding to the home, or revoke the home’s licence.
David Jensen, spokesperson for the Ministry of Health and Long Term Care said the province intends to introduce changes, including stiffer penalties, in early 2017.
Maureen McCartney says her mother fell and injured her arm around Nov. 10, 2015.
But, she says, staff did not call her to tell her about her mother’s accident.
After that incident, Maureen says, her mother’s plan of care, which directs health professionals on a patient’s treatment, was updated to require that she be assisted by two staff using a lift device when being “transferred.”
Just weeks later, around Nov. 24, staff failed to comply with that plan of care, and Margaret had another fall, says Maureen.
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