Family demands changes to nursing home regulations after N.B. senior served 'eviction notice'

It's been a month since her mother died, and Susan Steels still can't understand why her life ended the way it did.

Pauline Breen was 83 years old and suffering from vascular dementia. A resident of Loch Lomond Villa in Saint John, she had survived the isolation imposed on all long-term care homes during the COVID-19 pandemic, only to be suddenly discharged from the nursing home on May 22 for reasons her family still struggles to comprehend.

"We were told, go find a bed, but we don't know how to navigate that. So we did just start cold-calling and trying to figure out what we were going to do with Mom because she was being evicted," Steels said.

Her daughters insist their mother was effectively evicted as punishment for their questioning of the care she was receiving at the New Brunswick home.

A letter from Loch Lomond Villa CEO Cindy Donovan sent to Breen's older daughter, Patti Kleinke, on April 27 makes clear the nursing home was discharging their mother not because of Breen's behaviour or condition but because of a perceived lack of respect from her daughters.

"We are writing to advise that due to the lack of trust you have expressed in our care and as an organization, we are hereby giving you ... notice of our intention to discharge Mrs. Breen in 15 days."

The letter provides no further explanation or justification for the discharge, and offers no means of appeal for the family. Any further inquiries are directed to the Loch Lomond Villa's lawyer, James O'Connell.

CBC tried to contact O'Connell for comment but did not receive a response. 

Mother looked worse after lockdown

Pauline Breen moved into the Loch Lomond Villa on Oct. 3, 2019. Aside from being a nursing home, it serves as a highly regarded teaching and research centre for geriatric care. 

A comment on Breen's admitting form written by the admitting nurse called Breen "a lovely lady" who would fit in well. Breen's daughters felt certain their mother was in good hands.  

Then COVID-19 hit. Family access to loved ones was prohibited until the danger from the pandemic had subsided.

Loch Lomond Villa closed its doors to family and visitors on March 20, 2020. When nursing homes reopened to family visits and Steels and her sisters were finally able to see their mother again on Nov. 1, they were shocked.

"I can't even explain how devastated we were when they opened the doors after not seeing Mom for eight months," said  Steels. "She looked like she was just a broken soul. Like she was in detention for eight months."

Breen had lost nearly a third of her weight, had to be lifted into a wheelchair  and seemed disoriented. 

"It broke our hearts. It absolutely shattered us."

Breen's daughters are familiar with the professional and educational standards required when caring for the elderly. Kleinke and Pam Pastirik are both registered nurses, while Steels is a social worker who specializes in geriatric care. 

Their immediate concern was that Breen was ill with a serious underlying condition. They met with Villa staff and asked about their mother's care plan and what was being done to alleviate her condition.

Steels said they were the kinds of questions "that any family member that loved their mother would ask."

"They weren't out of line, just simple, basic questions... I guess asking questions, they interpreted that we didn't trust their care."

The letter of discharge from the Villa hit the family like a thunderclap.

"We had no idea this was going on," said Pastirik. "The front-line workers were amazing. We were floored when we got this eviction notice."

Wait list for beds

With just 15 days to find their mother a new nursing home, they had no time to waste. New Brunswick has about 70 nursing homes, with a backlog of about 700 people waiting for beds.

The family was able to negotiate a few extra days to find a bed for their mother. She was second on a wait list for a bed at the Saint John Shannex, and the daughters hoped the Villa would keep her until a bed became available. 

But Breen was discharged without warning on May 22 and sent by ambulance, in her pyjamas, to the Saint John Regional Hospital, where she would have to wait until a nursing home bed became available.

In a statement to the media issued after CBC News broadcast several stories about the Breens and the ethics of nursing home discharges, Loch Lomond Villa CEO Cindy Donovan said discharges against the will of the resident are "an extremely rare occurrence" and that there have only been two such occasions in the past 20 years at Loch Lomond Villa.

"While we cannot comment on the specifics of individual cases for privacy reasons, we understand that sometimes our home is not always the right fit for those in our care. That is why our policy, that both parties agree to, is to allow either party — the organization, or the resident, to terminate their agreement with 15 days' written notice."

The New Brunswick Nursing Home Act gives administrators wide leeway when it comes to removing or discharging residents.

The act states, "If for any reason an operator intends to discharge a resident, the operator shall give at least 15 days' notice of that intention to the resident and to his or her next of kin or legal representative."

'I've never heard of that'

This provision of the act surprised Dr. Samir Sinha, one of the country's leading experts in the care of older adults.

"I've never heard that in all my years of practice in Ontario or anywhere else in Canada," said Sinha, director of geriatrics for the Sinai Health system and the University Health Network in Toronto.

He warns the threat of discharge if a resident or their family members are deemed troublesome by nursing home administrators is powerful in a province where nursing home beds are already in short supply.

"We know that for those who are living in long-term care homes, 90 per cent of them have cognitive impairment. Sixty per cent have dementia. So many of them cannot fight for themselves. They're often relying on their family members and friends to do that for them.

"The fear [is] that if you are the squeaky wheel ... you are going to suffer the consequences by getting worse care or be asked to leave."

Seniors' advocate has 'significant concerns'

This hasn't escaped the notice of New Brunswick's seniors' advocate.

Norman Bosse declined an interview with CBC News, but offered this statement expressing his concern about nursing home discharges.

"Back in June 2019, I made official recommendations to the Department of Social Development to remedy the lack of fulsome protection from discharge from special care homes. Residents of special care homes have significantly fewer protections against eviction than any member of the public has in a rental situation," he wrote.

"Our Office is now looking at the standards in nursing homes. I have significant concerns about the level of protection from discharge of nursing home residents and the procedural fairness of discharge."

When she arrived at the Saint John Regional, Pauline Breen was accepted as a "social admission," meaning her admission was not due to a medical condition. That would soon change.

Medical tests her daughter had been requesting at the Loch Lomond Villa were performed by hospital staff. Breen was diagnosed with end-stage terminal cancer. Six days later, she was transferred to Bobby's Hospice, where she died on June 6, surrounded by family.

"All of the questions we had turned out to be true," said Steels.

Seeking to add protections

While Breen's fight has ended, her daughters are pressing on, demanding the province alter Section 17.1 of the Nursing Home Act to give discharged seniors more time to find alternate accommodation, and to add protections for seniors and their families from reprisals.

"We want protections for families who speak up for frail seniors," said Steels, "so they don't wind up evicted like my mother."

Social Development Minister Bruce Fitch told CBC News he has directed staff in his department to review the rules in the act.

"I've asked the department to take a look at it, and if there's changes after we do the consultation and due diligence, I'm more than happy to bring that forward," Fitch said.

Dr. Samir Sinha is blunt in his assessment of the rules in New Brunswick.  

"Discharging someone to a hospital because there's nowhere else for a vulnerable person to live is just completely unacceptable," he said. "It's just something that we would not allow to occur and frankly violates the rights of residents."