The family of an elderly woman who fell and broke her hip in a Vancouver nursing home has complained that she was left alone and in pain while staff failed to acknowledge her injuries or get medical attention.

"She was in pain … and her leg was visibly crooked," said granddaughter Alexandra Ziebeil. "I phoned my mom and told her I had to call 911. She had to go to the hospital."

Erna Luttmer, 95, who has severe dementia, had been a resident at Yaletown House, a not-for-profit long-term care facility, for 12 years.

In February, Ziebeil arrived at the home and said she found her grandmother in distress.

"I mentioned to the care aide that something was wrong with my grandma — and that's when they told me she had fallen earlier in the day," said Ziebeil. "The minute [the care aide] touched her leg, my grandma screamed out in pain — so I knew something was wrong."

Nurse did assessment

"Apparently the nurse in the nursing home had assessed her, and she kept telling me that everything was fine," said Ziebeil.

Granddaughter Alexandra Ziebeil, left, says she is happy to see Erna Luttmer, 95, living in the family home instead of Yaletown House. (CBC)After Ziebeil called 911, she said paramedics arrived and pointed to swelling from an injury, but she said the nurse continued to insist Luttmer's leg was just fat.

At St. Paul's Hospital, doctors found serious hip and leg fractures and Luttmer was rushed into emergency surgery.

Her family later concluded she had fallen on the floor while trying to get into her wheelchair, without proper assistance.

"My grandma was a 'two-person assist,'" said Ziebeil. "She was supposed to have two people with her — helping her — and she didn't."

After Luttmer fell, Ziebeil said staff used a crane-like device to lift her into the wheelchair, and the family believes that may have made her injuries worse.

"It wasn't just that her leg was broken, but it had been broken and shifted and it was two inches shorter than the other leg," said Ziebeil.

"Who knows how long it would have taken them before they finally admitted something was wrong and called the hospital?"

Family had several concerns

Luttmer's daughter, Frauke Owen, said she believed Yaletown House staff sometimes left residents unattended for too long, too often. She had hired private caregivers to be with her mother all day, but Luttmer's companion hadn't arrived the morning she fell.

Frauke Owen, left, and daughter Alexandra Ziebeil have several complaints about how Erna Luttmer was treated in the nursing home. (CBC)Owen has since filed complaints with the health authority's licensing office and the provincial nursing regulatory body about her mother's treatment.

CBC News asked Yaletown House for an interview, but the executive director declined.

It is one of 54 long-term care facilities licensed by Vancouver Coastal Health. VCH spokesperson Anna Marie D'Angelo refused to talk about the Luttmer case, citing privacy.

D'Angelo said Yaletown House has reported 29 falls by elderly residents to the health authority since January 2009. She said ambulances are not always called when a resident falls, instead a nurse may "monitor" the injury for 24 hours.

Hospital not always needed: health authority

"It's not necessarily done right at the specific time, because it can be quite traumatic for a frail elderly person to go directly to hospital," said D'Angelo.

Yaletown House is a non-profit, long-term care facility in downtown Vancouver for seniors with complex needs. (CBC)"They might be uncomfortable — they might not be. So they are assessed and monitored. Usually, within a 24-hour period you're going to be able to know what the extent of the injury is."

"My mother didn't have a voice," said Owen. "She was just totally dependent and at the mercy of those people that I should trust to take care of her. And she wasn't taken care of."

Owen suspects staff may be reluctant to call for medical help, because they then have to file an incident report, which can reflect badly on them.

"This is the horrifying thing. If we wouldn't have been there when my mother fell we wouldn't know the outcome. She could have had big medical complications."

"I think they are afraid," said Ziebeil. "They don't want to be blamed for anything. If they report every single fall, they don't want their numbers to go up."

D'Angelo insisted staff did not, and would not, cover up or fail to report serious incidents.

"We take great issue with those kind of allegations," said D'Angelo, adding if anyone tried to do that, other staff could report them — and they would be protected under whistleblower laws.

"Your licence could be removed if you were found not complying with these kinds of regulations," said D'Angelo.

Doctors orders not followed: family

After her mother recovered from hip surgery, Owen said the surgeon gave orders for her to walk as much as possible.

Vancouver Coastal Health spokesperson Anna Marie D'Angelo, left, tells the CBC's Kathy Tomlinson that ambulances are not always called immediately when elderly residents fall because a trip to hospital can be needlessly traumatic. (CBC)However, when Luttmer got back to Yaletown House, Owen said the facility's physiotherapist suggested she stay in bed. The family hired its own therapist to work with her and she is now up walking.

"If we weren't there to make her walk and get her quality of life back — like she has now — what would have happened to her?" Owen asked.

"If it were left up to them, my grandma would have never walked again," said Ziebeil.

Owen said the last straw came when Yaletown House moved her mother to a new, unfamiliar room, in the middle of the night, against the family's wishes.

"We expressed concerns several times in meetings with management and we were told several times if you don't like it here, leave," said Ziebeil.

In August, the family pulled Luttmer out of the facility. She is now cared for at Owen's home, with help from private caregivers.

Elder law group cites strained system

"I think what we are seeing is cracks in the system," said Laura Watts, director of the Canadian Centre for Elder Law Studies.

Watts said she often hears from relatives like Luttmer's, who are shocked by what they see in long-term care — and who have become distrustful of a system under increasing strain.

"We are hearing reports of people being left alone for long periods of time. We are hearing reports of falls and danger. We see people are being left without proper toileting," said Watts.

"We see facilities putting restriction on how often people can be toileted — something I think none of us wants."

Erna Luttmer lived in the same room in Yaletown House for 12 years. (Courtesy of Alexandra Ziebeil)She is not surprised to hear families complain that facilities try to downplay problems.

"In all institutions, there is a great concern with looking like you are not doing a good job, and having ramifications coming back and investigations. And, in some cases, people may try to cover things up."

Watts believes the real solution would be a big shift to home care. Owen said taking her mother home was one of the best decisions she's made.

"My mother is safe here — she's looked after. But it's not just about my mother. It's about the rest of them that are still in there," said Owen. "I feel horrible for leaving the rest."