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Nursing home rationed diapers while residents suffered rashes, infections

A scathing complaint filed against top-level staff at an Alberta nursing home alleges administrators locked up diapers to limit their use while incontinent residents sat in urine-soaked pads, suffering from severe bladder and yeast infections, painful skin rashes and open wounds.

Extendicare Athabasca passed its audit last spring, Alberta government says

Don Bryan says the treatment his mother received at an Extendicare nursing home in Athabasca, Alta., was 'despicable.' She suffered constant bladder and yeast infections. (Craig Ryan/CBC)

A scathing complaint filed against top-level staff at an Alberta nursing home alleges administrators locked up diapers to limit their use while incontinent residents sat in urine-soaked pads, suffering from severe bladder and yeast infections, painful skin rashes and open wounds.

The allegation is just one of many in a complaint filed in December 2018 with the College and Association of Registered Nurses of Alberta (CARNA), claiming that senior staff at Athabasca Extendicare — a facility 145 kilometres north of Edmonton — did not deliver proper care and hygiene to 50 residents and that the home was constantly understaffed.

"It's just despicable," said Don Bryan, whose mother Sheila endured repeated bladder infections, yeast infections and skin rashes while at the home between December 2014 and November 2018, when she died at age 83.

"You don't treat elderly people that way," he said. "That's just so wrong."

Bryan, along with a resident, two former health-care aides and a nurse who resigned filed three complaints with CARNA, in December 2018. 

Their complaints — obtained by Go Public — take issue with the inner workings of the for-profit nursing home, which former staff say came at the expense of quality care.

Extendicare disagrees with a number of the allegations and said in a statement that "each resident's room is equipped with the required [incontinent] products and staff regularly restock them as needed and without limitation."

The Markham, Ont.-based company also said its Athabasca home is regularly audited and was "fully compliant" with provincial standards in the last audit of March 2019.

Diapers rationed, locked away

The longest, most disturbing complaint was filed by a nurse who worked at Athabasca Extendicare from April 2016 to March 2018 and then quit, Natalie Shipanoff.

She alleges the home rationed diapers — limiting most residents to three during the day and one at night. 

"Pads were a constant source of contention," Shipanoff wrote, saying the director of care often wanted to know why so many were being used.

The director of care told staff, in a September 2017 email seen by Go Public, she was changing the access code to the room storing incontinent pads.

"The new code is not to be shared with HCA's [health-care aides]," the director of care wrote, because "product removal was being abused." 

From then on, HCAs would have to track down a nurse — who may not be available for hours, wrote Shipanoff — to unlock the stash of diapers. 

"What is the HCA supposed to do when the resident is full of feces and they do not have a clean pad to put the resident in?" wrote Shipanoff. 

Statistics from the Canadian Institute for Health Information indicate that from 2017 to 2018 the home had a reported urinary tract infection rate of 7.5 per cent, much higher than the national average of 4.3 per cent.

Melanie Benard, the director of policy and advocacy at the Canadian Health Coalition, says it's "hard to imagine" there would be abuse of diapers at the home.

"Using these kinds of products that are really just used for basic hygiene and keeping patients safe clean and comfortable."

What's needed, she says, are national standards to ensure a level of care is met at all long-term care homes.

"There are minimal standards across the country," she says. "And sadly even those minimal requirements are often not being met." 

Former staff at Extendicare Athabasca say it was frustrating to see residents suffering from painful skin and bladder infections. (Craig Ryan/CBC)

In support of Shipanoff's complaint, a former HCA writes that the facility ran out of incontinent products "multiple times" and that a diaper change "didn't happen until the pad was 80% or more wet or soiled with feces."

CBC News is not identifying her because she fears employment repercussions in the health-care field.

"It's really frustrating when you're going to go change a client and you realize you have no pads," she told Go Public.

"It makes you feel horrible," she said. "Like you're just neglecting that person."

She says trying to get Extendicare Athabasca to give certain residents more diapers "was like jumping through hoops" — requiring months of documentation about how someone is soaking through their pads, requiring bed changes or wetting their wheelchairs.

Extendicare head office declined an interview request from Go Public. Instead, the company — which operates 96 homes in Ontario, Manitoba, Saskatchewan and Alberta — said in a statement it follows "well-established procedures to ensure that incontinence products are always available to our residents."

A spokesperson also wrote that the director of care was "impelled to adjust the distribution process to address a personnel issue" for a brief time and later reinstated the "existing distribution process."

The spokesperson did not explain the current procedures for obtaining diapers.

The statement also said the Athabasca home "is highly rated by residents, their families and government regulatory agencies."

Bryan, seen here with his mother Sheila Bryan, says it was 'very tough' to watch her suffer. (Submitted by Yvonne Cumbleton)

Shipanoff also alleges HCAs were told to only use one diaper wipe when changing a resident, to save money, and that many suffered from painful health problems she attributed to poor hygiene. 

She says staff were shown how to fold a 8x10-inch wipe to get 16 different surfaces to clean a resident and describes "fungal infections (yeast infections) of the skin, especially in the groins and perineum that were being left untreated for long periods."

She describes "red, raw and sore" skin, chronic and "foul-smelling" rash and "open areas near anus from intense scratching." 

In an email to her supervisor, included in the complaint, Shipanoff says 20 out of 50 residents at Extendicare Athabasca have fungal infections.

In part, she blames the home's practice of not washing residents with soap and water during a diaper change.

"Can you imagine being incontinent of stool, with an indwelling catheter, and never being washed with soap?" she asks in her complaint. "It's disgusting."

In her complaint, Shipanoff says she and HCAs were so concerned that they resorted to giving residents secret washes with soap and water while on the night shift.

Extendicare did not address these allegations when Go Public asked for comment.

Chronic under-staffing

All five people involved in the complaints to CARNA also describe under-staffing at Extendicare Athabasca.

The former HCA writes that many shifts were short by one or two staffers and that overtime was "very seldom approved." 

That meant "basic care would get overlooked, call bells couldn't be answered in a timely manner and baths were skipped."

Extendicare did not address questions about under-staffing affecting patient care, but said it's "not possible" to profit by reducing staff at long-term care homes in Alberta, which are partly funded by Alberta Health Services (AHS).

"If a provider does not provide the mandated hours of care, AHS recovers the unused funds," the company said. 

Bryan kept a detailed journal of his mother’s care at Extendicare Athabasca. (Craig Ryan/CBC)

In a separate dispute, Extendicare Athabasca was recently found to have violated both a collective agreement and the province's Nursing Homes Act for not having a registered nurse on duty at all times. 

Extendicare had argued in arbitration that recruiting nurses in the region was difficult, and suggested that having one at the home 24 hours a day was not necessary, as long as one was on call.

The company was ordered in December to pay $5,000 to the United Nurses of Alberta to account for lost union dues.

A spokesperson for Alberta's Ministry of Health said in a statement that a number of patient complaints prompted an investigation at Extendicare Athabasca in September 2018.

Among other things, it found "some opportunities for quality improvement," including a review of the home's "supplies practices and possible association with skin breakdown."

The spokesperson said the nursing home passed a January 2019 audit, but there were several issues of "non-compliance," including prevention and control of infection and medication management. Those issues were resolved by the next audit, two months later.

Bryan says he's anxious to see the results of the complaint he filed, and that he's been told a decision will be coming shortly. But he says it won't change the haunting memories of his mother's care.

"Just the fact that … she had to suffer through all that stuff," he said. "Nobody should go through that. Nobody."

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Erica Johnson

Investigative reporter

Erica Johnson is an award-winning investigative journalist. She hosted CBC's consumer program Marketplace for 15 years, investigating everything from dirty hospitals to fraudulent financial advisors. As co-host of the CBC news segment Go Public, Erica continues to expose wrongdoing and hold corporations and governments to account.

With files from Enza Uda


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