‘I’m so sorry, I hurt your mother.’ Broken leg the beginning of irreversible decline for 93-year-old nursing home resident

It was payback time.
Just as Martina and Noella feared, the fallout for lodging a complaint over their mother’s care with the administrator of Versa-Care Hamilton had immediate consequences. Staff froze them out and stopped speaking to them. They had clearly broken an unwritten rule.
The first time Martina got in an elevator with one of the aides, her hello was met with silence. After that, it became routine. These were the front-line workers looking after her mother. The daughters worried her care would suffer when they weren’t around.
So when Central Park Lodges announced it was taking applications for a beautiful new 150-bed facility, called Ridgeview Long Term Care Centre, in nearby Stoney Creek, the sisters jumped at the chance.
The new home was built with money from the health ministry.
It was part of a major expansion of long-term-care beds by the former Progressive Conservative government.
The building was lovely, the rooms were big — and the staff seemed so much happier.
When Natalie moved there in January 2002, her daughters thought their problems were solved.
By the summer, Martina started to notice a new problem — her mother’s food.
Natalie, now 93, couldn’t chew and needed her food pureed or minced so it was easy to swallow. It is a very common request at nursing homes and easy to accommodate.
But Martina kept finding her mother staring helplessly at pork chops or heavy uncut meat on her plate.
Natalie’s weight was starting to slip off her body. Her skin hung from her arms. She had entered Versa-Care Hamilton in 1999 weighing 130 pounds.
Now, three years later, Martina figured she was well below 100.
Martina went to the charge nurse, telling her the food was wrong for her mother and she was losing weight. “I’ll take care of it,” the nurse said. Some days the home served the same thick meats and some days the food was cut into small pieces, but it was rarely pureed so that Natalie could eat it easily.
Martina said staff claimed Natalie chose the heavier meals, since residents are required to get two choices of meals in nursing homes. But, Martina tried to reason, she has Alzheimer’s so she really doesn’t know what she’s choosing.
Natalie’s children brought soup and other easily swallowed foods from home. They asked the dining staff to feed it to her but weren’t sure they did.
Ministry compliance advisers would later find Ridgeview guilty of serious violations in a review of its dietary practices. In early 2003, the advisers issued a series of citations against the home for breaking nursing home standards — including a violation for neglecting to monitor the food and fluid intake of residents who are at risk of nutritional deficiencies.
But the ministry’s action came too late for Natalie.
The summer of 2002 was a difficult time for Natalie’s children.
Noella, who had been fighting leukemia for four years, was recovering from a bout of pneumonia that had nearly killed her. One of their brothers had died unexpectedly in the spring, and Martina was busy trying to help out.
In late July, she missed visiting her mother for a few days. When she walked back into the home, a young aide-in-training named Tammie Brown ran up to her and said, “I’m so sorry, I hurt your mother!
“I was pushing her in the wheelchair and I forgot to put the flaps down for her feet and her leg got caught underneath,” Tammie explained.
The accident had happened a few days earlier, Martina recalls. It was Natalie’s left leg that was injured.
Tammie was upset over the accident, and in an interview with the Star, said she asked the nurses if they were going to x-ray Natalie’s leg or take her to the hospital. They didn’t immediately do either.
Martina knew right away the injury would be bad. Her mother had serious problems with her left leg, along with pins in her knee, all originating from a car accident many years ago. The nursing home was well aware of this.
In her room, Natalie was lying in her bed. The senior nurse on duty came in immediately, and gave Martina a much different version of the accident. “It was your mother’s fault,” the nurse said. “She was being difficult, and kept putting her feet down on the floor. And, on Sunday, she cried all night long.”
“Why didn’t you call me?” Martina asked
“Oh,” said the nurse, “you wanted me to call you?”
Alone in the room, Martina pulled back her mother’s blanket. The pin had always protruded slightly from her knee but now it was sticking out so far that just a thin layer of tissue held it inside her flesh. There’s something very wrong here, she thought.
The staff said she hadn’t complained much since Sunday, but they had been putting ice on it and thought it was better.
In a letter to the Star, Ridgeview says Natalie was given a “pain reliever” along with an ice pack on the first day.
On the second day, according to spokesperson Mary Nestor, her doctor was contacted and Natalie was given an x-ray. It showed a fracture.
On the third day after the accident, Natalie was taken to see an orthopedic specialist, Nestor wrote.
Natalie was taken to the Henderson Hospital in Hamilton. Noella was with her at the hospital.
The x-ray highlighted a break straight across her bone, just under her knee. She was put in a slip-on leg brace and sent back to Ridgeview.
Hospital records dated July 31, 2002, show an entirely different version of the accident from the one the charge nurse gave Martina — although the blame was still laid on Natalie. “She had an injury to the tibia (shinbone) when her foot caught in the toilet,” read a doctor’s report.
That didn’t make sense to Martina. A few months earlier, when she had taken her mother home for a visit, she couldn’t even raise her feet high enough to walk up the steps. Martina had to lift them, while her husband held Natalie from behind. It would have been impossible for Natalie to raise her foot high enough to put it in the toilet, Martina believed.
Back at the nursing home, Martina talked privately to Brown.
Martina asked if she got into trouble for telling her the cause of Natalie’s accident. The young woman lowered her head and tears rolled down her face. “I almost lost my job,” Martina recalled her saying.
Still on a training program with the Toronto School of Business, Brown was nervous about her status within the home. She said, in an interview, that the nurses chastised her, telling her it was okay to talk to the families but she shouldn’t be so forthright.
They said she should have let the director of care or the head nurse tell the family what caused the accident.
By the end of August, it became clear that Natalie was having a difficult time recovering from her broken leg. Her leg brace was too big. They got a smaller brace but she kept taking it off. It became increasingly difficult for her to move, and since her left leg no longer offered any support, Natalie started rolling out of bed at night.
She developed another problem. In constant pain, despite medication, she started eating and drinking less and began to shrink.
Martina figured her weight dropped to 80 pounds.
Martina kept trying to feed her and was heartened to see that when she gave her mother drinks, she gulped them down like a thirsty child.
Natalie now spent most of her day sitting in one of two positions — upright in her wheelchair, or lying on her back in bed. Experts say residents in her condition — stationary, dehydrated and malnourished — need to be repositioned every two hours so the pressure of their own body weight doesn’t create toxic bedsores.
Nursing home staff should have known this — Natalie’s children did not.
WHAT CENTRAL PARK SAYS
Natalie Babineau received care from two nursing homes, both owned by Central Park Lodges. The Star approached the company one month ago, and in a telephone interview with chief spokesperson Mary Nestor, detailed allegations raised by Babineau’s family. Nestor agreed to answer questions but cancelled a face-to-face interview. She has since provided responses by letter and telephone.
THE BIG PICTURE
Natalie Babineau was one of 65,000 elderly people in Ontario’s 544 nursing homes.
93 per cent need supervision to reduce chance of injuries.
84 per cent need assistance to move about.
A Star investigation reveals:
A sampling of problems flagged in inspection reports: