Senior hospitalized with multiple infections suffered neglect in care home, children allege

An Alberta senior with dementia who was admitted to hospital with multiple serious infections suffered medical neglect at her nursing home, her children allege.

Patricia Knebel, 74, was admitted to hospital on Christmas Day, nine months after she moved into the Barrhead Continuing Care Centre in Barrhead, 120 kilometres northwest of Edmonton.

Family members allege that the care centre, which is operated by Alberta Health Services, failed to monitor and meet Knebel’s most basic health needs.

Alberta Health Services is investigating the family’s allegations. The family met with AHS management on Jan. 19 and Jan. 23 to detail their concerns.

Critics say Knebel’s case illustrates the urgent need for government to fix systemic issues with staffing and resident care in Alberta’s continuing-care facilities.

“They need to be held accountable,” said Bobi-Jo Knebel, one of Patricia’s four children and her designated decision-maker. “We want better for Mom and for the other residents.”

Her children say Knebel, who is non-verbal, was suffering from thrush (a yeast infection in the mouth), a vaginal yeast infection, a urinary tract infection, a kidney infection and a blood infection.

Her catheter was blocked, she had a fever and was diagnosed with dehydration, they allege.

Bobi-Jo said doctors told the family they believed that the urinary tract infection had gone untreated for so long that it had made Knebel septic.

Her medical status in hospital is detailed in the formal complaint under review by health officials.

“She had a plugged catheter that gave her a UTI. She also had a kidney infection and she was septic. So from all the infections, it was now in her blood,” Bobi-Jo said. “On top of that, she had pneumonia and that was giving her heart failure,” she said.

“She was riddled with infections, which just kept compounding.”

Knebel remains in hospital in Barrhead.

Kari-An Knebel, a former nurse, can’t fathom how her mother became so ill while in care or how the progression of her infections went undetected by facility staff.

“Even if I wasn’t in the health industry, she was sunken and yellow. She was so dehydrated and full of infection,” she said. “Something needs to change.”

In a statement to CBC, Alberta Health Services said it has launched an internal investigation.

“Any allegations of misconduct or neglect are thoroughly investigated and reviewed,” AHS said.

“We have an ethical, moral and professional responsibility to care for residents with respect and to ensure their well-being.”

AHS declined to provide further comment, citing patient privacy.

Knebel’s family has filed a complaint with Alberta’s Protection for Persons in Care office, asking the province to investigate. PPC investigators conduct impartial investigations under the Protection for Persons in Care Act.

Correspondence with the family, shared with CBC, shows the PPC office has launched an additional investigation.

Health Minister Adriana LaGrange and Alberta Health officials declined to comment.

Sandra Azocar, a health-care advocate and a vice-president with the Alberta Union of Provincial Employees, said the family’s allegations are disturbing but not surprising. Alberta’s care facilities are chronically understaffed and quality-of-care oversight is weak, she said.

Alberta Health would not tell CBC how many care complaints are made in Alberta each year but Azocar said she has heard similar allegations of medical neglect from patient families across the province.

“This is an unfortunate human consequence of a system that has been persistently faced with some serious problems when it comes to the quality of care that seniors, disabled Albertans and vulnerable Albertans are receiving,” Azocar said.

“It speaks very loudly to staffing shortages and working conditions.”

Knebel’s children are speaking out in the hopes of improving oversight at the Barrhead facility and reforming a continuing-care system they believe is broken.

“My poor mom, sitting there alone in her room, suffering,” said Andria Knebel, another daughter.

“When was the last time they took her temperature? When did she start getting sick?

“It terrifies me for when I’m older … There are so many that are in the homes that don’t have people to advocate, that don’t have families.”

Knebel had been a passionate botanist and active community member before she was diagnosed in 2016 with early onset Alzheimer’s.

She lived with Bobi-Jo and her family until she suffered two seizures and fractured both arms in a fall last April. She was admitted to hospital. A gastrostomy tube was inserted through her belly into her stomach to supplement her intake of food, fluid and medication.

The same month, she was moved into the Barrhead care centre. The facility has 100 long-term care spaces, designed for individuals with complex, unpredictable medical needs who require 24-hour assessment and treatment.

Daughter got call on Christmas morning

Bobi-Jo said the family had hoped to take Knebel home for a visit on Christmas Day. But she was told in a call from the care centre that day that her mother had suffered multiple seizures in her room.

Nurses promised to call the doctor and ensure her mother was monitored, Bobi-Jo said.

She rushed to the facility and found her mother alone in her room.

“She’s in her wheelchair. The door is closed and she’s shaking,” she said. “Her eyes are rolling back and forth in her head. She’s sweating. I touch her, she’s burning up…she does not look good.

“Even not being a nurse, I could see that there was something clearly wrong.”

Bobi-Jo said she decided to call an ambulance herself and her mother was admitted to hospital.

She worries about the long-term impact on her mother’s health.

“I don’t even know the outcomes yet,” Bobi-Jo said. “Is this going to take more time away from us?”

In medical charting notes obtained by the family, facility staff wrote that Knebel was diaphoretic — sweating excessively — that morning and that she had suffered multiple seizures in her wheelchair that afternoon.

The notes indicate Knebel was being monitored “as per physician instruction.” Her stability as a patient was recorded as “medium risk” and it was noted that 911 was called at her daughter’s request.

Charting notes from Dec. 22 indicate she had been exhibiting signs of a vaginal infection, and that anti-fungal medications were being administered, but she was considered stable.

Charting notes from Dec. 20 indicate that her feeding tube had fallen out and was not immediately replaced because the worker on shift was “not comfortable” inserting a new one.

Repeated complaints

During the nine months she spent at the nursing home, Knebel’s children told CBC they grew increasingly concerned about the facility’s ability to provide proper care.

A series of emails with site managers detail a string of complaints dating back to May. The family’s formal complaint to the province also details their allegations.

Bobi-Jo alleges that her mother suffered a fall, that her lips were often cracked and bleeding, and that her medications were changed without her being informed.

The family alleges that, on numerous occasions, facility staff failed to provide adequate and timely hygiene care to Knebel.

In July, according to the family’s formal complaint, staff failed to take action for days when open sores appeared on Knebel’s face.

Bobi-Jo said the rash was tested, days later, after she urged facility staff to call the doctor. The tests came back positive for a staph infection and shingles.

The family further alleges that Knebel was provided inadequate hydration, including through her feeding tube, and that staff failing to adequately document the fluid intake and output.

Bobi-Jo alleges that the gastrostomy tube was not changed for months, even after it became visibly dirty. A photograph provided by the family shows a tube ringed with black.

After weeks of waiting for the facility to acquire replacement tubes, the family ordered their own, her children allege. The family provided CBC with email correspondence with site staff, detailing their order in October.

‘All too common’

Chris Gallaway, executive director of Friends of Medicare, said staff in Alberta’s continuing care centres are overworked and underpaid.

Decades of underfunding and chronic understaffing have spelled disaster for the system, Gallaway said.

“This is all too common in continuing care and long-term care in our province,” he said of Knebel’s case. “People fall through the cracks when you’re consistently short staffed.”

While systemic issues in long-term care existed before the COVID-19 pandemic, Alberta failed to learn from the dangerous gaps uncovered during the public health crisis, he said.

He pointed to a series of damning reports from Alberta’s auditor general detailing worker burnout and inadequate care early in the pandemic.

The province needs to legislate minimum hours for daily care, regulate staffing ratios and enact long-awaited continuing care regulations, Gallaway said.

“We know there’s structural issues and we know we could solve them if there was a political will.”

In February 2023, the Alberta government tabled Bill 11, the Continuing Care Act – legislation it said would make oversight of continuing care more consistent. The bill has been passed but not been put into force. Alberta Health would not comment on a timeline for when the regulations will be implemented.

Azocar said regulatory changes should include regular site inspections and ensuring the details of patient-care investigations are made public. She said the province should also re-establish the office of the seniors’ advocate to act as an independent watchdog.

“We need to address the problem at the root,” she said. “If we don’t start addressing those issues, then situations like this will continue to happen.”