Montreal·First Person

My father died during COVID-19's first wave, but he was long suffering in Quebec's care homes

The system for senior care is broken, and it was broken before the pandemic. Not just public long-term care homes, not just private residences.

We need more accountability, and a universal standard, in the long-term care system

Moira Davis with her father Stanley Pinnell in 2016. Pinnell died in April 2020 at a private care home in Montreal's West Island. (Submitted by Moira Davis)

This First Person article is the experience of Moira Davis, whose father was a resident at a Montreal long-term care home where 47 people died in the spring of 2020. For more information about CBC's First Person stories, please see the FAQ.

The system for senior care is broken, and it was broken before the pandemic. Not just public long-term care homes, not just private residences. There is a systematic breakdown in just about every care home in our country.

My father, Stanley Pinnell, was one of 47 residents who died at Résidence Herron in Montreal's West Island during the pandemic's first wave. Cause of death: possibly COVID-19, possibly not.

Herron was not the first care home for my father. In April 2016, he was placed in CHSLD Les Floralies LaSalle in Montreal after spending more than a month in hospital. Within five weeks, he was again hospitalized with a severe urinary tract infection, due to improper cleaning of his catheter.

Unable to find out what was going on over the phone, I travelled from Saskatchewan to Montreal in November of that year. Arriving at his care home, I saw that my father's room, not much bigger than a utility closet, directly faced the noisy dining room, and his bathroom was down the hall.

Staff would scream instructions to each other down the hallways. I do not know how my father was able to tolerate that.

I was cautioned by a Quebec placement counsellor not to put my dad in a public home, as he would go wherever the next bed was available — regardless how close he'd be to family. So I felt confident in choosing a private care home, knowing they were designated as a CHSLD. I was told this meant there was a minimum standard of care that my dad would receive.

As I toured private homes, Herron stood out. It was the only facility where I saw residents engaged among themselves: playing cards, knitting, sharing a cup of coffee. It really felt like this was a community.

But I soon discovered that while he had a nicer room in Herron, there were many other issues.

Communicating with medical staff was difficult, if not impossible. The nursing station phone was rarely answered, voicemails and emails rarely returned. Staff would often leave my father's phone out of reach, so when we called it would ring and ring and ring, and we'd get no answer.

In March 2018, my sister advised Herron that she wanted to move our dad to a care home in British Columbia. A request was made to Herron to provide the home in B.C. with proof that my father did not have tuberculosis. Several months went by before Herron finally complied, but my father's health had declined enough that a transfer across the country was no longer feasible. (Editor's note: the company that ran Résidence Herron, Katasa Group, did not respond when asked to comment on when this request was fulfilled.)

By September, my dad was legally blind, wheelchair-bound and unable to get in or out of bed without a lift. An independent foot-care specialist was hired to tend to my dad's feet every few months, as Herron staff were neither available nor trained to provide it.

My father's medical file notes that in March 2017, his weight was 150 pounds. On January 4, 2020, more than three months before his death, he weighed 124 pounds. At both weights, he was listed as malnourished.

Stanley Pinnell had stayed at two Quebec long-term care homes. His daughter, Moira Davis, says both homes lacked an adequate standard of care. (Submitted by Moira Davis)

My experience with both care homes was pretty much the same. Understaffed, hard to contact the medical team, no cohesive medical plan and no desire to create the best life possible for my father. Fearing my dad would be punished if we complained, a lot of what happened at Herron was never addressed or resolved.

Some staff were lovely, and truly cared for my father in any way they could. Unfortunately, they usually weren't in positions of power.

Something was wrong

Once family and visitors were barred from entering Herron in March 2020, I believe the situation began to unravel, quickly and badly. Once the first case of COVID-19 was announced at Herron on March 27, I contacted the Montreal Gazette. I knew something was wrong, but could not get anyone to tell me what was going on inside.

The regional health board failed miserably from the moment they arrived at Herron on March 29. Every resident had a contact information sheet in their binder at the nursing station, but the board said they couldn't reach us because they were locked out of the computer system.

Residents were still not fed or hydrated under the health board's watch for several days. Many of them died in that time, including my father.

Health-care staff work inside Résidence Herron on April 12, 2020. (Ivanoh Demers/Radio-Canada)

On Saturday, April 11, my sister received a phone call from someone at the health board, asking her if she knew about our father. She replied: "Like he's dead? Yes, I know." We had been informed three days earlier, but that was not noted in his chart.

We had asked repeatedly — verbally and in writing — that he be tested for COVID-19. But the person on the phone was now asking for our permission. By the time the funeral home was contacted, my father had already been cremated.

I was told several months later that someone at public health deemed it unnecessary to swab his room for COVID-19. Was it better to put on his death certificate "possible COVID-19," when it could very well have been starvation, dehydration or a combination of both?

A major overhaul is needed. Seniors need to be placed in homes near their families. For-profit and private care homes need to be dissolved so the same standard of care is available to all people, regardless of income. Patient advocates should be on every floor. The doctors at Herron, as well as the health board, should be investigated, as should any individual or agency who were previously aware of Herron's issues with staffing and equipment, and did nothing about it.

Forty-seven people died at Herron. The majority all alone. In the days prior to his death, my father's voice got weaker and weaker with each phone call. He faded out like a 1950s television screen, until his light was finally gone.

My father suffered under Herron's watch. Under the health board's watch. And while I believe the Quebec government is ultimately responsible for what transpired in its care homes, I will bear the guilt of ultimately moving him to a care home to be forever known as the one.

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Moira Davis was born and raised in Montreal, and now lives in Saskatchewan. She testified at the Quebec coroner's inquest into a private seniors' home where 47 people, including her father Stanley Pinnell, died during the first wave of COVID-19.