Today’s blog was written by Melissa Miller of Howie, Sacks & Henry LLP

Imagine that you have a loved one in a retirement home and it’s been an unusually long time since you heard from them, or you cannot get a hold of them in the usual way. You finally pay a visit and find out that your loved one had a fall in their room and has been left there for days. They are alive, but not responsive. Help is called, but there is permanent damage, or they do not recover and die. It’s an awfully terrifying thing to imagine and, unfortunately, not uncommon.

I have seen this scenario played out in a number of different ways. In one case, a man was left after falling on his coffee table for two days. He ended up with a myriad of complications from being left for so long and ended up in hospital for months, followed by a brief period in long-term care before he died. In another case, a man fell in his bathroom and was left for 36 hours. He had fallen on his dominant arm, allowing “rhabdomyolysis” to set in (which is essentially a permanent version of your foot falling asleep – it is permanent nerve damage). He lost the use of his dominant arm permanently and had a massive decline in his dementia. In yet another example, a woman fell in her room, missed her medications and meals for three days, before she was found and suffered acute kidney failure due to extreme dehydration, dying within days. Truly anyone’s worst nightmare and the opposite of what many envision for their Golden Years.

So how does something like this happen in a place that is supposed to be safe – a place where people are literally buying peace of mind?

The answer is that it’s the perfect storm of resident independence and unchecked balances – the gap in the system where a resident is independent enough to basically only be renting a room, but not so independent that they are still living in their own home. The fall is usually precipitated by some other factor: onset of flu or COVID, stroke or some other cause of loss of balance. Finally, the resident fell through the cracks in the home and the staff simply never noticed they were missing or there was no policy to check on them.

In essence, this should never happen and the fact that it does, even once, is a harsh reminder of our vulnerability as we age, and how diligent we must be to prevent such an event as much as possible. But how?

Planning for Retirement Home Living

When choosing a retirement home, it is important to get past the “chandelier effect” of seeing the nicely decorated lobby and common areas. Ask to tour some of the rooms, and have your loved one speak with some of the other residents if they are able. And ask some hard questions when you meet with the admissions team:

• Do they have a policy on “wellness checks” (i.e. do they check on the resident if a meal or activity is missed)?
• If so, what is their policy? (i.e. do they check on the resident after one missed meal or several? Do they merely call the resident or physically go check on them?)
• Do they have a policy about leaves of absence? How are absences recorded/checked?
• If they do not have any of these policies as part of their normal admission package, can a service be added?
• If there is an outbreak in the home, what steps do they take to check on residents more frequently (i.e. temperature checks, meals in rooms)

In short, how does the home ensure that while someone is living independently (and perhaps not engaging with any of the “a la carte” services for care), they are still keeping tabs on the residents?

Retirement homes are completely private (and expensive) and often people think, “you get what you pay for”. While that can be true, none of these homes are immune to the situation described above. Many think it is obvious that a retirement home keeps tabs on residents, but many residents live very independently and come and go as they please. This is why it is critical that you have a very good understanding of what is and is not possible at the admissions stage.

Monitoring Care in a Retirement Home

Once your loved on is in the home, there are things that can be done to keep tabs on them or checks in place. Fall pendants are a good place to start. If worn correctly (and consistently), these pendants are meant to capture a sudden change in elevation, like a fall, and notify help (either staff, family or emergency services). These pendants do not prevent a fall, obviously, but can save critical time in responding to a fall.

There is no substitute for in person visits, but it may not always be practically possible, given the very busy lives of families with loved ones in a retirement home. “Granny cams” are a good alternative. Not all are created equal. There are many iterations these days of cameras – from those that only turn on when there is movement in the room, to those that are interactive with two-way conversations. Some offer recording of video, while others are just meant to act as an “eye” in the room. However, a granny cam can also feel like an invasion of privacy, especially if your loved one is very independent, so this may not be the right fit.

Another great way to check in with a loved one is to know their routine and schedule. Most homes offer a calendar of events that residents must sign up for. There are usually set mealtimes. Most residents get into a groove of what works for them and most of us are creatures of habit. The more familiarity you have with a loved one’s schedule, the more likely you will be to notice if they veer from that schedule. If they do break routine and you are unable to reach them, it’s best to check in on them in person as soon as possible.

Difficult Conversations

Ultimately none of these suggestions will work if your loved one is not compliant with wearing a pendant, is unwilling to share their routine/schedule and/or does not want tabs to be kept. Many seniors feel as if they have already lost much of their independence by moving to a retirement home and wish to maintain what they have – which often means not discussing difficult topics with their families. There is no sugar coating a conversation with a loved one about why their whereabouts is so important, which is why having conversations early and directly are critical. The idea is that you want to be a part of the process (not control it!) so they can maintain independence, not lose it entirely. The above suggestions are meant to be a form of empowerment and control, rather than a system of monitoring one’s every move. It’s a balance between safety and security, and independence.