'Righteous rage': Woodbridge families share pain, anger after COVID-19 crisis

Sienna says long-term care homes face staffing challenges

Yorkregion.com
June 24, 2020
Kim Zarzour

They were strangers until anger and grief brought them together.

Sons, daughters and grandchildren, passing each other in the nursing home hallways as they swept in and out to care for their loved ones, they exchanged a nod or a smile, but never a name or contact number.

Then the pandemic changed everything.

On the cool evening of June 14, they gathered outside Woodbridge Vista, the families whose elders had passed away, and, with the sun setting and the four-storey brick building looming behind them, they put aside their anger for a moment and focused on their loss.

Clinging to candles, photos and each other, they sang and prayed and shared life stories, their words sometimes drowned by the passing trains and traffic -- but still, it felt like a stolen moment of peace before battle.

“We must hold this vigil because what you are facing, what you are dealing with, is very difficult,” said Catherine Spada, a devout Catholic who led the service. Spada’s grandfather was a resident of the home before he passed May 26.

“There is a lot of righteous rage here. There are a lot of questions. There’s a lot of doubt of God right now. I pray this opens up some healing.”

This last-minute vigil was organized by Spada and Annalisa Crudo-Perri. The two met on Twitter after the Vista situation hit the news.

Crudo-Perri is the only one of five siblings who could face returning to this home after their mother, Marta Crudo, died May 27.

For the others in her family, it felt too painful.

For Annalisa, it felt necessary.

Marta moved into the home about two years ago.

Gregarious with an ever-present smile, she’d emigrated from L’Aquila, Italy at the age of 13, the first in her family to finish high school and complete college training. She was a bank teller, a pizzeria owner, the hub of her community and the rock and foundation for her large family.

When Marta died, it was in a swirl of confusion, in the midst of a COVID-19 outbreak in the nursing home, and the family felt very alone.

They’d been locked out of the facility for months, struggling to get someone to answer the Vista phone. When staff did respond, they assured Marta’s family that she did not have COVID-19, that she was doing well -- until she was not.

The family rushed her to hospital, but it was too late.

“The doctor said he couldn’t believe she was in such bad shape, that she could be so dehydrated and fighting so many infections and no one had paid any attention,” Annalisa said.

When Annalisa discovered that Vista had inadvertently shared other families email addresses in a recent communication about the outbreak, she reached out -- and in the flurry of emails that followed, they discovered they were not alone.

Catherine Spada offered to hold a vigil and share some words of comfort.

She spoke of the residents in this facility, many of them Italian immigrants, optimistic and hard-working, who travelled by ship and by plane to build a new life -- building hospitals, roads, and a country.

As she spoke, a school bus in the Vista parking lot unloaded Canadian Armed Forces personnel for their shift change. Stretchers wheeled in and out. An older resident peered from his upper floor window.

When the prayers and songs were over, the mourners huddled and talked about their shared stories, the shared pain that they could not be there to care and advocate for their loved ones, or witness their dying breaths.

'We weren’t getting the truth from anyone'

Never in her worst dreams could Lucia Fracassi have imagined that her dear mother would die of neglect, abandonment and loneliness.

But that, she said, is exactly what happened to Carmela Colalillo at the age of 89.

Fracassi is still reeling over the sudden death of her mother, who, up until the time she moved into a long-term-care home, appeared healthy, strong and vibrant.

When she helped Carmela move into Vista in December 2017, dementia presented some cognitive challenges, but otherwise, Fracassi said, she was in great health, med-free, pain-free, with no underlying conditions.

Her mother’s health changed almost immediately after she moved into the facility owned by Sienna Senior Living.

“It was one UTI infection after another, pneumonia after pneumonia. The entire time she was there was so stressful for us, trying to get her proper care.”

It got worse after pandemic lockdown, when she couldn’t be with her mom; getting information from staff about her condition was like “pulling teeth,” Fracassi said.

She called several times a day, she said, and the few times that they answered the call, staff would say “don’t worry, she’s doing good.”

On May 13, the home’s doctor called to say Carmela had vomited. He ordered a COVID-19 swabbing and a battery of other tests. But Fracassi said she never got the results of those tests, no matter how many times she asked the home.

Instead, she was simply told her mother was doing well.

“They’d just been telling us what we wanted to hear. We were all asking the right questions, but we weren’t getting the truth from anyone.”

Eleven days later, Fracassi spoke with Carmela’s doctor. He said her mother had taken a turn for the worse. Carmella was severely dehydrated, she had trouble breathing, her vital signs were not good. A few hours later, the home’s evening nurse reassured her, saying Carmella looked much better and was sleeping well. But that was quickly dispelled at 7:30 the next morning when Lucia was shocked to hear no one had checked on her mom.

At 9 a.m., the nurse manager called. Fracassi should come in immediately, she said. Carmela was nearing the end.

“When I saw her,” she recalls, “it was heart-wrenching.”

Carmela had lost a tremendous amount of weight. She lay in a fetal position with contusions on her knees and right elbows.

The room was stifling hot, and Carmela was sweating profusely.

Fracas and her husband sat at her bedside, swabbing her with cold compresses. No staff responded to their request for a refilled saline bag, Fracassi said, no one came to the room to help, no one asked if they needed anything or to see if Carmela was comfortable.

Fracassi whispered into her mother’s ear, “If you want to rest now Mommy, that’s OK. Daddy is on one side of you, God on the other.”

And then Carmela was gone.

Fracassi still doesn’t know how this happened. She has asked the home many times for Carmela’s medical records, she said, but no one has responded.

The doctor told her that cause of death was septic pneumonia, but she hasn’t seen anything in writing -- no coroner’s report or paperwork of any kind.

On June 11, Fracassi was advised that the Chief Coroner’s Office will investigate Carmela’s death. Fracassi is also listed as a plaintiff in a class-action lawsuit against Woodbridge Vista.

None of her allegations against the home have been proven in court.

Lucia said she is not looking for money, but answers, acknowledgement and, perhaps, change.

“In the end, we didn’t even get a card in the mail from the home. A simple condolence. How hard would that have been?

'He was nothing but skin and bones'

In a room just down the hall from Carmela, Pietro Bruccoleri, 82, was also faltering fast.

Rina Di Salvo and her sister Mary Bruccoleri had been reluctant to put their father in a nursing home, but because of his advanced dementia, they and their mother could no longer care for him on their own. In May 2019, they’d moved him to Vista.

It wasn’t their first choice, or even their second or third, and the facility was not as clean as they’d like, but it was just 10 minutes away from the home he’d lived in for 35 years -- the red brick house that was “Grand Central Station,” where the affable Pietro gardened and cooked and barbecued, gave everybody kisses and hugs and never let anyone leave empty-handed.

Today, the sisters struggle to understand how this “phenomenal cook,” who loved the human touch, died alone of malnourishment.

Until the lockdown, the sisters and their mother, Diega, visited every day. They fed him, groomed him, made sure he was cared for and had all the hugs and kisses he needed.

The last time they saw him, they say, he was eating “like a champ,” his face plump, cheeks rosy, “he even had quite the little gut.”

“Mary would cut his hair. I would clip his toenails, his fingernails. My mom was there every day, feeding my dad, and not only did she feed my dad, but when my dad finished eating, she would also help feed other residents. We looked after him as, as much as we could. And then, it all stopped,” Rina said.

“We didn't see him for three months. In the end, he was nothing but skin and bones.”

At the start of lockdown, the sisters say, they tried window visits, but because of his dementia, it didn’t mean anything to Pietro.

“He needed that physical connection,” Mary said. “We’re Italian, like, it’s what we do, touch each other, hug each other, kiss each other.

“We begged them so much to see him. We begged, begged, begged, even if it was just one of us for five minutes. But they said the only way they’d let us in is if my dad was end of life, we could go and say our goodbyes.”

That’s not how it happened, though.

In April, before COVID-19 hit the home, Pietro’s doctor gave the family the option to take him to the hospital for more care, Rina said.

“We were stopped by the director of care and the head nurse,” she said. “They told us they had everything in place to care for him.”

In mid-May, Mary said, she stopped by the home with a care package for her father: some pudding, fruit juice and a case of water.

“I put a note on it, to please give this water to my father because he did not like cold water. He always liked warm water. And I put ‘I love you dad’ on the note and I taped it onto the case of water.”

Pietro was tested five times for COVID-19, but each time the results were negative, Mary said. They continued to call the home regularly and were assured their father was doing well -- until May 29, when the home nurse called.

“She said, ‘We would like for you and the family to come to the nursing home.’” Mary recalls. “She didn't say anything else. And I knew. I started freaking out, crying.”

It took them 10 minutes to get there, another 20 minutes waiting for a nurse to let them in, but by the time they got to his room, Rina said, Pietro’s body was already stiff and cold.

“I lifted up the blanket to see his toenails. They were so long and disgusting. I looked at my father's hands. His nails were very dirty.

“His room was boiling hot. The gowns that we had to put on, they were sticking to our bodies.”

The fan they had brought him months ago was not turned on.

Mary looked around the room. The case of water she’d delivered weeks ago, with the hand-drawn heart and “I love you dad” note sat untouched.

“When I saw that, I cried. I was heartbroken.”

Later, cutting his hair to get him ready for the funeral, Mary noticed spots on the top of her father’s head. “I asked the funeral director what it was. She said ‘that’s dehydration’. We looked at my father's left ear, and there was a big black mark. I asked her what that was and she said the same thing.”

The coroner’s report said Pietro died of inanition. They had to look it up. It means exhaustion from lack of nourishment; starvation.

Pietro’s daughters are devastated, but their grief is overshadowed with anger.

They are pursuing legal action. York Regional Police is investigating their father’s death, Mary said, as is the Chief Coroner’s office.

“We understand that this is life and, sooner or later, you're going to lose a loved one,” Mary said. “But the way it happened is heartbreaking. They should not be making a profit on these vulnerable people. This is so wrong. This has to stop.”

'If I didn't see it with my own eyes, I would not have believed'

Luigi Marra is livid.

“They watched my father starve himself without lifting a finger.”

Until the coronavirus arrived in the home, Luigi said his father was healthy and quick-witted, receiving adequate care at Vista -- but only because he visited every day after work. His mother, sister and the grandsons visited constantly, too.

“There was no margin for error because we were always there.”

But what he saw happening with other residents, those whose families were not there, was “atrocious,” he said.

“If I didn’t see it with my own eyes, I would not have believed.”

He recounted residents sitting in soiled diapers, yelling for help, beepers going off for hours, an older man who lay where he fell, staff ignoring his calls for help, staff yelling at another older woman who was frantically searching for her family.

“My heart broke for the old lady. She was sobbing.”

Luigi said he sat beside her, telling her in Italian, ‘it’s going to be OK’.

“By the end, she was holding my hand, singing with me  That lady is gone now too.”

Luigi vowed to lodge a complaint to the ministry about the home, but not while his father was alive. Like many residents, he said, he was afraid of ramifications to his father’s care.

Then the lockdown.

Vincenzo, 80, complained on the phone that staff wasn’t helping him move; he was stuck in bed, or his chair, for up to 24 hours at a time.

Over time, Luigi said, his father grew depressed.

“He felt abandoned. His tone was weaker and he became delirious.”

“Make sure he eats,” Luigi would say to staff.

“We can’t force him,” they’d reply.

One day, Luigi’s son reached his grandfather on the phone. “Jordan, Vincenzo said, “I’m dying,” and then the call was abruptly cut off.

Two hours later, Vincenzo was dead.

He’d tested negative for COVID-19 all along, Luigi said, but when he raced to hospital to say goodbye, the hospital would not let him enter, insisting that Vista paperwork labelled him as positive.

By the time Vista confirmed that Vincenzo was negative and Luigi could be with him, his father had passed.

“I didn’t even have a chance to say goodbye.

“The place was a death trap. This is just coming to light now, but it’s been going on for years. It’s just brutal. These old people, they’re just a number. A means to the end.

“If they had let me in there, or my sons, he would still be with us today.”

“This happens more often than you’d know.”

Vivian Stamatopoulos, associate teaching professor at Ontario Tech University who specializes in family caregiving, said the stories coming out of Woodbridge Vista are an example of what’s happening in many long-term-care homes that are chronically understaffed.

“Research shows family is crucial to reduce staff burden and has an important effect on mortality, infection, hospitalization and medical error.”

Family help with feeding is crucial, she said, but families have also, historically, been a key source for reporting abuse.

The pandemic lockdown left residents alone in their rooms, without proper assessment by general practitioners unable to do normal rounds, falling victim to loneliness, depression and “confinement disease,” she said.

Yolanda, who worked at Vista, agrees.

A PSW for 15 years, she is reluctant to use her real name for fear of retribution from her employer.

Without much-needed family help, she said, Vista PSWs were floundering.

They wished they could provide better care, but they were run off their feet -- to the point where some were overwhelmed and simply left, she said.

“It was just rushing, feeding, toileting,” dealing with upset, lonely residents and upset, angry families, she said.

Housekeepers could not keep up with the garbage piling up in rooms, and PSWs had to ask the home for PPE supplies, gowns and masks, she said.

“When they did send some, it was just a little package that didn’t last long. They told us it was OK to wear the same stuff from one COVID room to another.”

In an emailed statement responding to the allegations, Sienna spokesperson Natalie Gokchenian said pandemic plans, infection control, and outbreak management policies and protocols are in place as part of normal operations.

“We have also ensured that we have adequate supplies of personal protective equipment available at each of our residences,” she said.

“It’s no secret that the seniors’ living sector has experienced staffing challenges for some time.”

The COVID-19 pandemic exacerbated these challenges, she said, as long-term-care workers are not permitted to work in more than one location and staff must stay home if they are suspected of having COVID-19.

Recruiting new staff during the pandemic has been “incredibly difficult,” she added.

To ease families concerns, Gokchenian said Sienna has made more effort to communicate with families and launched a six-point action plan to improve operations.

There's growing demand for systemic change.

In a letter issued to the Ford government earlier this month, the Ontario Justice Centre warned that locking out families -- and their crucial assistance and supervision -- compounded exponentially serious existing problems in long-term care.

The organization said it has been inundated with stories of elderly residents missing essential care from their loved ones, crying themselves to sleep, telling their children they want to die, feeling abandoned, never getting to say goodbye.

Families and advocates have launched several petitions fighting for better care in long-term homes and better access for essential family caregivers.

And June 24, the Ontario Health Coalition plans cross-country protests, saying the province is pushing through new laws to privatize home care, stifle class action lawsuits and has failed to take action on emergency staffing crisis in long-term care.

On June 11, the Ontario government announced the gradual resumption of visits to long-term-care homes -- but under ”strict health and safety guidelines,” giving homes leeway to tailor them to their own circumstances.

Stamatopoulos and other geriatric experts say this is not good enough.

The government announcement was “little more than a publicity stunt aimed at quelling the mounting public outcry against blanket visitation bans,” she said.

“If we learned anything from the tragic malnutrition death at a Woodbridge Vista Care Community, it’s that essential family caregivers need to get inside the facility to assure their loved ones are safe.”

For decades, Stamatopoulos said, reports, letters and lawsuits have pointed to problems in these homes.

“Imagine how bad it has become, now that the iron ring of secrecy is there. It is terrifying to families.”