Family searching for answers after mother dies at Midland long-term care home

Donna Saunders, 74, was healthy when she entered Hillcrest Village in Midland, according to her family. She died two months later due to complications from an infection.

Her son Jamie Baxter is devastated and searching for answers.

“None of it makes sense to us,” said Jamie. “Our mother went there healthy and died of a bedsore a month later.”

Investigations, completed internally and by the Ministry of Long-Term Care, found no wrongdoing on the part of Hillcrest Village.

“I believe that we looked into their concerns as fully as we could. I am very sorry that they don’t seem happy with those results from ourselves and our medical director,” said Jonathan Ens, assistant administrator at Hillcrest Village.

In January 2020, Saunders and her daughter, Tammie Baxter, moved from London to Barrie. That April, Saunders had her kidney removed and ended up having a bad reaction to painkillers, was bedridden for months and lost her ability to walk.

Due to fear of COVID-19, the family decided Tammie would care for Saunders at home. She looked after Saunders, with the help of a nurse, from June 2020 to February 2021 before the family decided to place her in Hillcrest.

“We applied to put her in long-term care with the goal of getting her help with rehabilitation, so she could get back on her feet again,” said Jamie.

Saunders entered Hillcrest on Feb. 12, 2021.

On March 6, Saunders was sent to Georgian Bay General Hospital (GBGH) to get treatment for a urinary tract infection (UTI). While in hospital, a doctor notified the family of a concerning bedsore.

“We were shocked,” said Jamie, who noted that there was “no significant sign of bedsores when she entered Hillcrest.”

According to Jamie, Saunders was sent back to Hillcrest on March 10 with “complete instructions on how to properly care for the bedsores,” according to Jamie.

Two weeks later, on March 24, Tammie went to Hillcrest to visit her mother.

“(She) immediately called me on FaceTime and said things didn’t look right. She was very concerned,” said Jamie.

Later that night, the family got a call notifying them that Saunders was going to be sent to GBGH.

The family soon learned the bedsore had progressed to approximately 10 millimetres deep, and Saunders was septic. She was placed in palliative care and died April 10.

Jamie immediately filed a complaint with the Ministry of Long-Term Care, which prompted an investigation.

An inspection report, dated July 9 and sent to the family, found two minor unrelated infractions. Jamie said he isn’t satisfied with this report and the fact the investigation took place June 21–25, more than two months after his mother’s death.

“I fully understand that the ministry can only investigate whether the home was in compliance with legislation, but if legislation isn’t strong enough to prevent a healthy woman dying from a bedsore a month later, then there’s something wrong with the legislation,” said Jamie.

Ens confirmed investigations into Saunders’ death did take place.

“The findings were that there was not any negligent care,” said Ens. “With everybody, we do our best to care for them, (but) a lot of our residents that come in are very compromised in their health status.”

From 2019 to 2021, the ministry conducted eight investigations at Hillcrest Village related to critical incidents and complaints, including one involving Saunders. These investigations resulted in seven written notifications for noncompliance; six were related to resident care plans, and one involved infection-prevention protocols. Three investigations found no infractions.

The family told the Mirror they have reached out to Ontario’s Ombudsman for assistance.