Staff at Extendicare nursing home abused woman before her death from dehydration, says report

An elderly woman who died from dehydration and a urinary tract infection — caused by sitting in wet diapers — was abused by staff at an Alberta nursing home who admitted they were too overworked to care for her properly, according to a scathing government report. 

Josephine Ewashko had been a resident at Extendicare Viking in Viking, Alta. — southeast of Edmonton — since 2016. 

She was rushed to hospital in November 2018 and died two weeks later, just shy of her 80th birthday. 

"Sometimes I feel like a hitman, because we were paying to have our mother killed," said her son, Dana Ewashko.

"It's sickening, is what it is," he said. "If somebody doesn't get enough water? Somebody doesn't get changed? They didn't do their job."

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Shortly after his mother's death, he complained to Alberta's office of Protection for Persons in Care (PPC) , which recently issued a report, obtained by Go Public, describing Josephine's slow deterioration due to the staff's neglect.

As a result, says the report, she experienced "serious bodily harm" leading to her death.

"I used to work in the financial world and for a lot less than a life we would have our licenses stripped if we … didn't follow protocol," said Dana, 57. "Doesn't seem like the health industry has any consequences to something like this."

Markham, Ont.-based ​​​​​​Extendicare — one of the three largest nursing home chains in the country, with 96 homes in four provinces — has not been fined in this case.

Alberta and Nova Scotia are the only two provinces in the country where regulators can issue fines when nursing home operators don't meet standards of care, although Go Public has learned that neither province has ever done this.

A prominent seniors' advocate says financial penalties are the swiftest way to ensure nursing home operators keep residents safe, and she's urging other provinces and territories to grant regulators the ability to hit nursing home operators in the pocketbook when they fail in their duties.

"We need to ensure that there is a quick and unequivocal system in place to bring operators into compliance," B.C.'s seniors' advocate Isobel Mackenzie told Go Public. "And I think that's fines — a monetary penalty." .

Repeated bladder infections

Dana says in the months leading up to his mother's death, he and other family members spoke to Extendicare Viking staff many times about her repeated bladder infections, which he says exacerbated her dementia symptoms.

"Her cognitive ability was greatly affected. She would sleep a lot — even fall asleep mid-sentence sometimes," he said. "It was a lack of care."

He recalls helping his mother out of her wheelchair three months before she died and looking at its seat cushion.

"It looked kind of an odd shade of black," he said. "I reached down and touched it and it was soaked in urine. It was as though you took a sponge out of the tub." 

He says when he and other family members asked staff to help their mother get to the bathroom, or change her foul-smelling diaper, it would often be hours before a nurse or aide responded.

'Extremely dehydrated'

Another nagging concern for the family — that Josephine's water glass was often several feet away from her wheelchair.

"She couldn't reach it," said Dana. "We always thought Mother was thirsty."

Family members raised their concerns two months before Josephine's death, in an October 2018 meeting with nursing home staff. They later learned those concerns were never recorded in their mother's care program. 

"The nurse said he was just too busy to do that type of paperwork," Dana told Go Public. 

A month later, his mother became increasingly weak, was often incoherent and slept for long periods of time. On Nov. 22, 2018, he insisted that she be transferred to hospital.

The PPC investigation into Josephine's death found: 

• She was "barely responsive" upon arrival at the hospital.
• She was "extremely dehydrated."
• Blood work detected "critically high sodium levels" — an indication of dehydration and kidney disease.
• The skin in her mouth "was sloughing off due to dryness."

The report also noted that, in the weeks leading up to her death, a computer system at Extendicare Viking issued a dozen alerts, noting changes in her condition —  but none was reviewed by a nurse or care aide. Among other things, the alerts signalled:

•  "New or worsening lethargy." 
•  "New or worsening disorganized speech."
•  "New or worsening altered perception."

The report does not include any details of interviews with managers, but a nurse told investigators: "We often don't have time to read [the alerts] or review charting."

Another nurse said: "We are supposed to check the alerts … but this is difficult [due to workload]."

Two aides also said they didn't have time to check the alerts.

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Josephine's family doctor had concerns she put in a letter last February to Alberta's Ministry of Health.

"I do believe …  that Josephine's needs were neglected, not on purpose but due to staff shortages and lack in experience," wrote Dr. Marna Hagan, who went on to say that her concerns about staffing were not new. 

"This is not the first time I feel there was a lack in care and experience," at the Viking location, wrote Hagan. "Shortage of staff and experience is lacking."

The province's investigation also reported concerns about staffing and training, noting that employees needed better education about nutrition, hydration and monitoring infections. 

It also directed the facility to develop policies that ensure staff review and respond to computer alerts. It gave the facility until Feb. 29 to comply. If it doesn't, it could potentially face fines. 

Dana points out that Extendicare is a for-profit business that answers to shareholders. It is partly funded by Alberta Health Services (AHS).

"They're caring about their profits … I don't think you can have profit and care in the same sentence," he says, adding that Extendicare's CEO received total annual compensation of about $4 million last year. 

According to AHS, there were 273 allegations of abuse at seniors' homes it funds between April 2018 and March 2019. Most were determined to be unfounded, but many still prompted suggestions for improved care. 

'Pretty shocking'

Extendicare's head office declined a request for an interview with Go Public, and would not comment on Josephine's case. 

Instead, a spokesperson for the Viking facility wrote that it is "very sorry" about her death and that she is "dearly missed by the team and residents."

Spokesperson Darlene Thibault also said Extendicare Viking has "taken steps to address the situation" and is working "to provide the highest quality of care, dignity and safety to our residents."

Thibault would not elaborate on what has been done to ensure other residents aren't neglected, and would not address concerns that the home is not adequately staffed.

• Read Extendicare's statements to Go Public

Outside of Alberta and Nova Scotia, the only options available to regulators when nursing home operators put residents at risk is to shut down the home — rarely done, as it can displace hundreds of people — or put it under government management — a lengthy and rare procedure, though it was recently done to three homes owned by Retirement Concepts in Victoria, B.C. 

"It's very frustrating," said Mackenzie, the seniors' advocate, who says it's time to introduce financial penalties across the country so nursing homes don't just focus on the bottom line. 

"You need to ensure in publicly funded nursing homes that the contracted operators are operating in the public interest," she said. 

She points out that publicly funded nursing homes in the U.S. have been subject to fines since 2002.

"Just because something is unpopular with some people doesn't mean it isn't the right thing to do," said Mackenzie. "And we have to remember that our duty is to the protection of the people who we have entrusted to that care home."

Dana says it's hard to deal with the grief of knowing his mother's death may have been preventable, and that Extendicare didn't pay a financial price.

"People go to jail for treating their pets in the same way," he said. "It's pretty shocking that nothing [no fine] has happened."