Daughter wasn’t notified when mother was dying in Ontario care home
After Melanie Barker died alone in a long-term care home in London, Ont., earlier this year, it took nearly a month for her family to be notified of her death. Her family members want to know why.
Barker, 66, died on Feb. 12 at Mount Hope Centre for Long-Term Care, where she had been living for nearly a decade. According to family members, London police showed up at a former residence of one of Barker's children about 3½ weeks later to inform them of her death.
"This shouldn't have happened. It makes me so angry that she died alone and the body sat in the morgue for a month. There's no justification for that," her sister, Donna Barker, said from her home in Havelock, Ont.
According to Barker's long-term care records, provided to CBC News by the family, Barker's condition sharply worsened on Feb. 9 after choking during lunch. She died on Feb. 12, but the family says it wasn't notified until March 8.
In a statement to CBC News, St. Joseph's Healthcare London, which oversees Mount Hope Centre for Long-Term Care, said it couldn't comment on individual resident matters because of privacy legislation, but said it follows all proper procedures for notification of substitute decision makers and powers of attorney when a resident dies.
In this case, Barker's substitute decision maker was Ontario's Public Guardian and Trustee's office, which represented her wishes and best interests under the Health Care Consent Act (HCCA). Due to privacy rules, it said it couldn't speak about its role as substitute decision maker.
However, the office also acted as Barker's guardian of property since May 2010, making financial decisions on her behalf, as it does for nearly 4,550 Ontarians whose family members aren't able to be involved.
In a written response, the Ontario Ministry of the Attorney General said the Public Guardian and Trustee's office "makes reasonable efforts to identify family" in its role as a guardian of property but isn't mandated to search for family members.
Records show lack of family contact information
However, long-term care experts say both the care home and the Public Guardian and Trustee's office should have had family information on file.
Toronto-based lawyer Jane Meadus, who specializes in long-term care, said it was the home's responsibility to maintain family contact information and inform them of Barker's death.
"The home should have done it," Meadus said. "There's definitely requirements of the home to contact the family."
Barker's long-term care records reveal that as far back as September, a social worker made notes in her file flagging that there was no funeral plan in place and that family contact information was lacking.
"Resident's health has declined and does not currently have funeral arrangements listed," the notes say. "Continue to explore contacting family to identify a funeral home for resident when necessary."
On Feb. 11, the day before she died, a social worker wrote that an "exhaustive search" for family had been completed. According to the records, because staff were unable to contact next of kin, the home would have to "follow unclaimed resident policy at time of death."
Two immediate family member names appear on Barker's admission sheet. A phone number is listed for one of them and the file indicates that staff had contact information for the other family member. Barker's long-term care documents state that staff had previously "contacted those numbers, which were no longer in service."
Family members question how robust those efforts were.
"How much trying did they actually do?" Donna Barker said. "How hard would it be to go on to Facebook or even just Google? You can find someone if you really try."
A quick online search using Google and Facebook located both family members listed in the chart within minutes.
And yet, it wasn't until the care home engaged London police nearly a month later as a part of its procedure for unclaimed bodies if there is no known next of kin that a family member was tracked down via a former address on file. The home has not provided an explanation as to what happened between the time of Barker's death and the notification.
Donna Barker doesn't have regular access to a car, and as COVID-19 restrictions had eased, was planning to visit her sister when she learned of her death. She said had she known her sister was dying, she would have found a way to London.
"No matter how bad her life was, she had to know she was loved, not just abandoned," she said.
"To find out a month after — that really, really makes me angry that there was no contact because I had given them my number," Barker said. "I even watched the woman write it in her file."
A life of struggle
Melanie Barker's life was one of trauma and struggle, according to her sister.
"We were very badly abused as children," Donna Barker said. "Physically, emotionally, sexually…. And Melanie suffered, I think, the worst for it because she would withdraw."
She remembers her sister as smart and beautiful.
Barker married at 17 and had three children. She and her husband divorced in 1994 and Barker enrolled in Western University in London, Ont., where she obtained a sociology degree. She started a new relationship and had two more children.
When that relationship ended, her sister said she had a mental health crisis and ended up in psychiatric care before a physical illness forced her into long-term care.
Daughter called home in December
Melanie Barker's oldest daughter, Shelley Silverthorn, has mixed memories of her childhood in Gravenhurst, Ont. She says her mother was verbally and physically abusive but also took her to Toronto to watch musicals.
"'She was really, really super religious," said Silverthorn, who remembers her mother blasting Christian music in the house on Sundays.
"I think she was just trying to find something to hold onto that she could believe in in order to explain why her father did what he did to her and I think that was her coping mechanism."
Silverthorn had her own struggles: with addiction and the law. She estimates the last time she visited her mother was 2016.
"Getting clean has been hard on me because that's part of the reason why I didn't go see my mom. I was in no shape to even look after myself," she said.
In December 2021, Silverthorn said she called the care home to check in on her mother and gave them her number.
Silverthorn's name and number appear on her mother's long-term care documents but there is no mention of her familial relationship.
Silverthorn said her number was working when her mother died and she did not receive a call from the care home.
"I think she would have wanted us all there at the end," she said. "She may have not been the best mother throughout our lives, but she loved us … and she deserved at least that."
'Tragedy of errors'
Long-term and palliative care experts question whether the home and the Public Guardian and Trustee's office did their due diligence in maintaining family contact records.
"It's a tragedy of errors, really," said Dr. Samir Sinha, director of geriatrics at Mount Sinai Hospital in Toronto. "What boggles my mind is that efforts were made, there was information here [on Barker's chart]."
In his own practice, Sinha said his team members often find themselves conducting searches for next of kin, property searches, going through medical charts and contacting whoever is listed — even reaching out to pharmacists or concierges at last known addresses.
"The home can say, well, the documentation says that people did an exhaustive search and they followed the right checkboxes," Sinha said. "I would beg to differ and say if it's not documented, then it wasn't necessarily done. I'd like to know more about what did that exhaustive search entail?"
Sinha said it is unfortunate Barker's family members weren't given a chance to reconcile or say goodbye, but he suspects chronic underfunding of the long-term care system and poor staffing played a role.
"Sadly, I feel that there are probably a lot more people like Melanie Barker out there."
Both Sinha and Meadus question whether the Public Guardian and Trustee's office could have done more to help the care home with possible family contact information.
"It's unfortunate that the Public Guardian and Trustee hadn't maybe made some more effort." Meadus said.
Policies and procedures reviewed
St Joseph's said family contact information in a resident's chart is updated as needed and if it becomes aware of incorrect information, it asks the decision maker or the resident to provide updated information.
If there are any significant changes in a resident's health, including if the resident becomes acutely ill, their substitute decision maker or power of attorney is notified.
St Joseph's said it consistently reviews its policies and procedures and seeks opportunities to improve its care and services.
WATCH | Family wants to know why it wasn't told of woman's death in long-term care home:
She died in a nursing home, no one told her family for nearly a month
After Melanie Barker died alone in a long-term care home in London, Ont., it took nearly a month for her family to be notified of her death. CBC’s Katie Nicholson helps the family investigate why.
A 2017 memo from Ontario chief coroner Dirk Huyer offering guidance on unclaimed bodies in care homes states that it is the responsibility of the facility where the person died to conduct a next of kin search, and that ideally care homes would maintain up-to-date records on patients and residents. The office confirmed that is still the guidance.
The memo notes "it is important to facilitate timely and dignified disposition of deceased persons" and that when a next of kin search is not made a priority, "the condition of the body may deteriorate in a morgue over weeks to months."
For its part, the Ministry of Long-Term Care said it doesn't maintain statistics on when families are not immediately notified of a death, but it does track non-compliance when a care home fails to to notify the substitute decision maker or any other person designated by the resident of a serious injury or serious illness. It says there was only one case of this in Ontario in the last five years.
It also said the ministry would "conduct an inquiry or inspection upon receipt of a complaint related to a family member who was not notified of a resident death, if they were designated to receive that information."
A place to visit
On a recent walk through a London cemetery, Silverthorn looked for a place to hopefully inter her mother's remains to help alleviate her guilt over not being there when her mother died.
"I don't feel right about just throwing her ashes away. I want her to have some place to rest and to be at peace," she said, pausing near a spot where a dozen deer were grazing in the sun.
"I'd rather have her close by, so I can actually go visit her like I didn't when she was here, right?
"I think it'll bring me some peace and hopefully some relief from the guilt," she said. "I hope it gives her some peace, too. I think she needs that."
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