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Had Dianne Lynch not been stuck in business meetings all day, she would never have missed the hysterical call one morning a few weeks ago from her ailing mother, bedridden and alone in her nursing-home room.

The frantic 73-year-old woman, only a few years ago a formidable mother, had been lying in a soiled, sodden diaper for hours, trapped in her bed by raised bars, with the nurses and support workers tending to dozens of other seniors on her nursing-home floor.

When an alarmed Ms. Lynch rushed to the home nine hours later, she discovered her mother sobbing, lying in the same diaper, her sheets in disarray from thrashing around. Only then did the red-faced nurses remove the diaper, revealing the weeping sores of an angry rash. The prescribed cream that was to be ordered from the pharmacy three days before was nowhere to be found.

Ms. Lynch was livid. This was not the first time she had confronted stark evidence of her mother's neglect at the Leisureworld nursing home in Scarborough, where the older woman has lived since suffering a series of strokes four years ago. But after years of watching her capable mother diminish, she no longer considered the home safe and is making arrangements to remove her.

"I can't let this continue," says Ms. Lynch, 44, a Toronto accountant. "Mom's been through so much. She used to rule the roost. ...

"I'm sorry, but this has changed her psychologically and it's not because of anything but that environment. I want her back. I want her back before she's gone forever."

The six-storey Leisureworld Caregiving Centre in the well-heeled Scarborough Bluffs neighbourhood of Toronto, home to 299 people considered too sick, feeble or mentally infirm to care for themselves, is no stranger to trouble. Under watch by Ontario's Ministry of Health and Long-Term Care, it was slapped with 37 violations of provincial nursing-home standards during its annual inspection last year (the average number for Ontario's 621 nursing homes was about three) and the admission of new residents was frozen in April for six weeks after the "unusual death" of a resident.

Add to this a lengthy record of complaints and a report of serious occurrences, both obtained through provincial freedom-of-information laws, that paint the picture of an institution where frail residents are vulnerable to sloppy care and repeated physical abuse, usually by disturbed roommates.

It was newspaper accounts of checkered nursing homes that prompted an emotional Ontario Health Minister George Smitherman to proclaim a "revolution" in the long-term-care industry nearly four years ago. Since then, the province has launched surprise inspections; started a complaints line; mounted a website; funded more nurses to be hired and homes to be built; and passed new legislation last month that protects whistle-blowers and fixes a time limit on formerly indefinite bed licences.

Despite the new Ontario legislation, both people in the industry and its critics say little has changed. Problems persist. Some critics say the province remains lenient, if not downright cozy, with the nursing-home industry. Others counter that with regulations still to be drafted, it is too early in the life of the new legislation to tell.

Whichever the case, some nursing homes remain a far cry from the places most Ontarians would choose for ailing parents in their twilight years - never mind for themselves in a few short decades.

The case for change

"I will die in my reclining chair before I will ever come back to a nursing home," declares Maggie Nash, sitting in her wheelchair in the Leisureworld lobby, flamboyant next to the drab surroundings in a colourful, flowing skirt. A sharp-witted 66-year-old whose body after four heart attacks, emphysema and severe arthritis is nowhere near as agile as her mind, she was moving to her own apartment by the end of July, one of the lucky few to find subsidized, supportive seniors' housing. "But for those of us totally dependent on a government pension," she says, "this is as good as it gets."

The list of complaints against Leisureworld Scarborough dates back seven years and runs 19 pages. In the past year alone, the dozen complaints verified by a government investigator include fears about infection control after staff were never informed about a patient testing positive for hepatitis; a resident placed in diapers though not incontinent; a resident experiencing multiple falls without staff responding or alerting family, and unexplained bruises. In one especially graphic case, a family member found maggots in the feet of a resident who did not get the twice-weekly showers.

"It's the cumulative effect of all of these daily things that makes life in these places so awful," says Patricia Spindel, a professor of family and community social service at the University of Guelph-Humber.

Leisureworld chief executive officer David Cutler believes that some of the complaints are just isolated incidents and that a combination of government underfunding for staffing and onerous paperwork requirements lie behind some of the home's reported breaches.

"With more staffing, we'd be able to do more for our residents. Our focus is to deliver services and make sure people get the care they need and deserve. ... The majority of those findings, I'm predicting, relate to lack of documentation. You're faced with the challenge: Deliver the service or deliver the documentation."

In the realm of infection control, Mr. Cutler insists that the home has stringent policies in place and has never suffered an infection outbreak. And he denies that anyone in the home is needlessly wearing a diaper. As for maggots in the feet, the afflicted resident, he says, was a former street person who shunned efforts to change his dressings. "We don't know if the person came in with eggs already in the wounds and then they developed, but it's well documented this was a person who refused treatment," he says.

According to Mr. Smitherman's parliamentary secretary, Monique Smith, admissions were frozen after the nursing home reported the "unusual death" of a resident placed in restraints. Police are still investigating. Ministry inspectors discovered three breaches of standards around the use of restraints. Once admissions were reinstated in late May, the nursing home was allowed no more than three new residents a week. Soon after, she says, inspectors found the home "wasn't coping well" and admissions were cut back to one a week. "We have put those protections in place," says Ms. Smith. "Is there more work to do? Absolutely."

Even before the recent death, government documents reveal many records of serious occurrences at the home, with incidents of assaults against residents reported nearly every month - including one allegation of an assault by a staff member last year.

Elderly residents hunched over walkers and in wheelchairs are living cheek by jowl with seniors suffering dementia. Many seniors sleep in dormitory-style rooms; 60 residents on every floor vie for two elevators to reach the first-floor dining room at meal times. In this volatile mix, tempers flare. "My mom's been injured a lot," Ms. Lynch says. " ... She's had bloody noses. ... She's always thinking she's going to get hit or hurt. She's expecting it."

Troubling political climate

Ontario has embraced nursing homes as an answer for a swelling population surviving into old age with the sickness that can go with it. Since 2000, the province has spent hundreds of millions of dollars to fund thousands of new beds. In the past five years, the government's nursing-home budget has soared by 39 per cent, to $2.86-billion a year. More of that public funding is flowing to private nursing homes run by for-profit businesses and sometimes multinational corporate owners reporting handsome profits - thanks in most part to government subsidies and bed licences awarded for 15 years or longer.

The Leisureworld Scarborough facility is one of a chain of 19 nursing homes under the Leisureworld brand that was sold to a subsidiary of the giant Australian-owned Macquarie Bank for close to $465-million two years ago. (None of the other homes has run amiss of regulators.) Now owned jointly by a Singapore-based investment fund and a Canadian income trust with a Toronto Stock Exchange listing, it has seen its revenue climb 11 per cent last year, to $172-million.

Nursing-home operators collect an average of $132.32 a day from the Ontario government for each bed. At this rate, Leisureworld pockets about $14.4-million a year in government funding, not including money the province chips in for rent for all its 76,000 nursing-home residents. (Residents pay a portion of rent.)

Many companies pocket more to defray the capital costs for beds in institutions built or renovated since former premier Mike Harris announced the awarding of 20,000 new licences for nursing-home beds in 1998. While not-for-profit churches and charities had dominated the nursing-care industry before then, it is the for-profit companies with ready access to bank financing that have snapped up the majority of those new licences. Licences, once awarded, become instant assets to be pledged as collateral for bank loans and bought and sold to other operators.

In the past, critics drew a link between the awarding of licences and the fat political contributions of companies like Leisureworld - which handed the Ontario Conservative Party more than $10,000 over the two years after the bed announcement was made. (The Liberals got $2,500 in the same time period.) Now, with 58 per cent of homes in private hands, the Ontario government funds more for-profit companies to run long-term-care facilities than does any other province.

The awarding of new beds - and the political donations - have dwindled. Last year, 256 licences for new beds were handed out, all to for-profit companies, and bids are tendered for 1,760 this year. As with other nursing-home chains, Leisureworld's political contributions have dropped. Yet some feel ties between the industry and its regulator appear to remain.

It's all about the optics

Aghast at the open sores of her mother's diaper rash, Ms. Lynch says she turned to the sheepish nurses and demanded to know why her mother had been abandoned.

She says a nurse blamed her mother for drinking too much water, complaining that the elderly woman - who has worn a diaper only since returning from hospital following an illness that has left her temporarily confined in bed - routinely requested her diaper be changed every three or four hours. "That may be," Ms. Lynch retorted. "But how often do you go to the bathroom?"

The next day, Ms. Lynch returned to the nursing home accompanied by a worker from the local Community Care Access Centre, the government-funded agency that finds nursing home beds for seniors assessed as needing them.

Notified of the visit, nursing home staff had roused Ms. Lynch's mother out of bed and dressed her for the first time since she returned from hospital. Sitting in a chair, she looked to her daughter a little more like her old spunky self.

"My goodness, but my mother looked good," Ms. Lynch says with a hint of irony. "She was washed, she was shampooed, she had three kinds of juice and pop. ... And I just thought, 'Nice show.' "

In bed with the regulators?

Despite dwindling political donations from for-profit companies, ties between the industry and its regulator appear to remain. The past few years have seen a stream of Health Ministry bureaucrats jumping sides to for-profit nursing-home companies and a few industry senior managers assuming government posts.

Until recently, Astrida Plorins, the former director of the ministry's operations support branch, was Leisureworld's director of operations, but has left the company. Paul Tuttle, president of Extendicare (Canada) Inc., another big, publicly traded nursing-home corporation, used to be director of long-term-care facilities for the Ontario ministry. He replaced Shelly Jamieson, who became deputy minister in Ontario's Transportation Ministry.

Former premier Mike Harris is on the board of Chartwell Seniors Housing Real Estate Investment Trust. And former premier Bill Davis recently stepped down as a trustee of giant nursing-home operator Retirement Residences Real Estate Income Trust.

Critics say this is evidence of a congenial relationship between the industry and the ministry regulating it, hence the government's gentle hand in dealing with homes flouting the law.

"There's just far too much back and forth between the ministry and the nursing homes," says Amani Oakley, a Toronto lawyer who is one of the few to represent family members suing nursing homes where seniors have been injured or died. "It is a policing relationship. It should not be a buddy-buddy relationship."

Leisureworld chief executive officer David Cutler flatly denies the allegations of close corporate ties with the government. "And if it were true, why would the government go after Leisureworld Scarborough?"

Margaret Philp

Unmet standards of care

After serious problems with care in nursing homes came to light a few years ago, Ontario's Ministry of Health and Long-Term Care started reporting on its website (http://www.health.gov.on.ca) the standard violations, verified complaints and possible sanctions at the 621 nursing homes it funds. Critics have charged that http://www.health.gov.on.ca should provide more information, including full annual inspection reports. Leisureworld Caregiving Centre in Scarborough has been inspected several times over the past year. Here are some of the unmet standards and criteria the ministry identified:

Prompt action to address incidents of offensive odour;

Routine inspection of feet and trimming of nails;

Food and fluid intake monitored for those at nutritional risk;

Skin problems receive care to promote healing.

Margaret Philp