Norma Silverstein's voice wavers when she recalls the odour coming from the bedsore that caused her elderly father to go into sepsis last fall.

She said doctors in hospital told her the 93-year-old might not recover from the wound, which developed last fall during his time at Harbourstone Enhanced Care Ltd. in Sydney, N.S.

John Ferguson had been experiencing a degeneration of the spine and had lost his ability to walk.

"He was vulnerable ... he was belted in a chair for about eight hours a day. When asked to put him in bed for an afternoon nap, they told me it was too much trouble. Now if that isn't a case of abuse and neglect?" Silverstein said from her home in Albert Bridge, N.S.

Whether Ferguson's treatment constituted abuse is still being investigated by the Department of Health and Wellness.

Last November, Silverstein reported the case under Nova Scotia's Protection of Persons in Care Act — legislation meant as an extra safeguard for people being cared for in hospitals, residential care facilities and nursing homes. Her father's case is one of nine investigations from 2017 that remain open.

Read the individual reports here:

Click on the individual home and scroll down to open the incident reports for each facility where there was confirmed cases of abuse:

Spike in abuse cases

New documents obtained by CBC News under freedom of information legislation show a spike in reported and substantiated cases of abuse under the act in 2017, with 42 confirmed incidents, up from an average of 28 the previous two years.

Over a three-year period starting in 2015, there were a total of 102 findings of abuse by the Health Department. On average, that's 13 cases of abuse for every 1,000 beds.

Of those 102 cases, 63 — that's more than 60 percent — involved physical or emotional abuse.

The redacted reports obtained don't make it clear whether the perpetrators in those cases were staff members or residents.

There were 17 cases of neglect, which the province defines as a failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent.

In 13 instances, residents were found to have sexually abused other residents. In four cases, investigators determined staff sexually abused people in their care.

Perry Sankarsingh, the senior executive director of client services and contract management with the Health Department, said the higher number of cases in 2017 might be attributed, in part, to people being more likely to file complaints about their loved one's care.

"We do know that general awareness of the [Protection of Persons in Care Act] legislation is increasing, we know that consumers and patients are becoming more sophisticated and more able and willing to exercise their rights."

Sankarsingh said there is an increased effort nowadays to care for people in their own homes as long as possible. By the time those patients enter facilities, they tend to be sicker and require a greater level of care.

"I think there is an ongoing debate as to whether the long-term care sector is appropriately resourced to meet that shifting set of needs," he said.

Perry Sankarsingh is the senior executive director for client services and contract management at the Department of Health and Wellness. (CBC)

In Ferguson's case, investigators determined in their preliminary report that staff at Harbourstone "reported there was nothing they would do differently in providing care."

According to the preliminary report provided to CBC News by Silverstein, the investigation under the Protection of Persons in Care Act did find gaps in documentation of Ferguson's care. There was no evidence he was referred to the facility's wound-care specialist, nor was there any sign a registered nurse assessed his bedsore.

"If I had known half of what I know now, I would've fought it. I really would have. - Norma Silverstein





The wound on Ferguson's buttocks was considered a stage 2 pressure ulcer on Oct. 5, meaning his skin was blistering or peeling. A physician examined him on Oct. 18 and referred him to hospital a week later on Oct. 25 because it had worsened. That day, Silverstein said she learned her father had a fever and a wound about eight centimetres in diameter on his buttocks.

She brought her mother, his wife of 70 years, to his bedside.

"That was very unsettling for everybody to bring a 91-year-old woman into the emergency room to say goodbye to her husband, with no prior notice that there as anything serious wrong with him," she said.

Silverstein received the preliminary report nearly two weeks after her father died in January. She said Ferguson never fully recovered from the wound, though he had been moved out of hospital and into another care home before he entered palliative care.

Under the Protection of Persons in Care Act, staff must respond within 24 hours when someone lodges a complaint. (CBC)

She still wonders why she didn't learn of the multiple bedsores on her father's body when they were first documented in June, and why it took so long for him to receive treatment.

"If I had known half of what I know now, I would've fought it. I really would have. There's no doubt in my mind."

There are approximately 7,900 long-term care beds across Nova Scotia in a range of homes, from government-run, to for-profit and non-for-profit facilities. Some facilities have hundreds of residents, others just a few.

There are dozens of homes that had no reported incidents of abuse in the three-year period CBC News examined.

John Ferguson died after entering palliative care in January 2018. (CBC)

The Health Department does not analyze the information collected by the 10-member team that inspects homes across the provinces and investigates reports of abuse under the Protection of Persons in Care Act.

Sankarsingh, who oversees that team, said the department doesn't yet have the ability to look at trends that contribute to abuse.

"We don't capture data in a way that lends itself to analysis easily. So there is some work that we have to do to be able to get there," he said, adding the department started using a new electronic records system two years ago that may make the process easier.

Harbourstone is one of 34 seniors facilities owned by Shannex in Nova Scotia, New Brunswick and Ontario. (Google Maps)

In several reports obtained by CBC News, there were references to facilities being short-staffed when abuse occurred.

At the beginning of September, Health Minister Randy Delorey appointed an expert advisory panel to look at ways to improve long-term care. The three-member advisory group will focus on staffing levels, safety and wound care.

Under provincial legislation, people who violate the Protection of Persons in Care Act can face a fine up to $2,000. Corporations can face up to $30,000.

Silverstein said she'd like to see the law enforced in Nova Scotia but she also thinks an arms-length organization should be in charge of investigating complaints instead of the Health Department.

"It just doesn't seem reasonable to me the way it's done," she said.

"I guess Heath and Wellness just investigates itself and who holds them accountable? Can you go to the RCMP or the regional police and get them to enforce that law? I don't know. They [Health and Wellness] never had the decency to even get back to me."

She and her husband, Robert, have established Families for Quality Eldercare — a foundation with the goal of improving care for seniors.

Among the group's initiatives is fundraising to buy technology that helps rotate patients in order to prevent bedsores. They hope to team up with one nursing home at a time to help that facility improve its services.

Families put their trust in homes and residents deserve better treatment, she said.

Silverstein said she feels betrayed by what happened to her father, whom she described as a stoic man who went through a great deal of pain in his final months.

"You believe your loved one is going to be cared for properly and when it doesn't turn out that way ... it's heartbreaking," she said.

"I could've accepted him coming to the hospital with a heart attack or a stroke or a bad fall even, but to me, dying of a bedsore is dying of neglect. And that's very hard to take."

With files from Jack Julian and Susan Allen

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