MIDDLETON, N.S. — After 87-year-old Dorothy Stultz died following a shove from another resident in her nursing home, her daughter says she expected the Nova Scotia Health Department would try to learn from the tragedy.
More than four years later, Debbie Stultz-Giffin says she was upset to learn no provincial inquiry ever occurred, even though she says the push contributed to her mother's death on March 1, 2012.
"It's shocking that the information never left the facility and got to the higher ups where it could have been more closely looked at," she said during an interview.
Stultz suffered a fractured hip in the incident, and the loss of mobility over several weeks led to a fatal blood clot.
The case at Mountain Lea Lodge in Bridgetown was one of five since 2008 that were never publicly reported, despite the medical examiner ruling the deaths were the "result of violence" — with autopsies describing pushes or shoves leading to falls. There were a total of eight deaths, three of which were made public through Halifax police news releases.
The chief executive of the facility says staff have been receiving training in recognizing and de-escalating aggression, but for Stultz-Giffin the case raises questions about staffing levels and safety awareness.
It's also one case among a steady flow of long-term care deaths across Canada that coroners define as "homicides," though police usually find no legal culpability. In Ontario, the chief coroner's office documented 13 homicides in the province's long-term care homes in 2013-14.
Experts like Dr. Gloria Gutman, the founder of Simon Fraser University's gerontology research centre, says the wave of dementia-induced aggression is colliding with a trend towards older and more frail residents. In addition, facilities are asked to use minimum levels of chemical and chair restraints out of respect for the residents.
Gutman says that means provinces need to carefully study cases where things go wrong.
"At the minimum there should be an incident report that is filed," she said in an interview.
In Dorothy Stultz's case — and in two other of the Nova Scotia deaths — no inquiry was carried out under the Protection of Persons in Care legislation, according to the Health Department.
Bob Lafferty, the department's director of investigations, says he first became aware of the Mountain Lea Lodge death when he read The Canadian Press report that documented the deaths.
"We were never informed of that incident at Mountain Lea. Once we did get informed of it through this process (the article) we've been in touch with the facility...about their duty and responsibility to report those incidents to us," he said in an interview.
Looking over photos of her mother, Stultz-Giffin says breaking the silence on the issue is a crucial first step.
"I think my mother would be quite saddened that her death wasn't more openly discussed, that it wasn't looked at ... under a microscope," said Stultz-Giffin, adding that Dorothy Stultz was a community-minded woman who herself cared for the elderly before Alzheimer's caused her physical decline.
The daughter says that small details from the days and moments before the push can provide insights.
For example, Stultz-Giffin said her mother loved to sit on a particular couch in the common area, and be held by another resident who was a former nurse.
She says she believes when that couch was removed, due to urine soaking through its covers, it prompted her mother to try to sit next to a male resident who reacted violently.
"There's a huge lesson to be learned from what happens when you disturb an environment that a person with Alzheimer's comes to expect," she said.
She says she also has questions about staffing levels on the secure dementia unit that afternoon and what risk assessment was done on the resident who pushed Dorothy.
Joyce d'Entremont, the chief executive of the non-profit Mountain Lea Lodge since last May, says she can't discuss the case, adding that she and the Health Department are following up with a review.
"We take every measure to keep our residents safe. ... We talk to the families. We have an inter-professional, inter-disciplinary care plan meeting shortly after all new residents come into the facility so we know if there have been prior acts of aggression," she said.
She says if the home feels it cannot manage a resident it can consult with a challenging behaviour co-ordinator from the Health Department and if necessary can move a resident.
The administrator also said the home is now diligent in reporting cases.
The Health Department says Protection of Persons in Care investigations were carried out in four of the other seven deaths. In one case a critical incident report was filed, and in two others there was no report filed.
Health Minister Leo Glavine says he finds it "upsetting" to hear that no inquiry was carried out in the Stultz case, and says his department will still carry out some form of review, which will include recommendations.
He also said the province is considering how to ensure the coroner's findings on deaths are viewed and taken into account by the Health Department in the future.
The minister also said he doesn't think a $3.1-million budget cut to long-term care will increase the risks of further safety incidents.
"There is a requirement of nursing time per patient and continuing care assistants per patient and none of that is impacted by this," he said.
But Stultz-Giffin says she hopes her mother's death will help prompt a deeper look at staffing levels and programming to help reduce behavioural problems.
"They are our most vulnerable population and we should do everything in our power to protect those people," she said.
