2023-11-04 05:21:34
“She slipped through all the meshes”
“It’s like she fell through all the cracks. She provided all her needs. And his needs were not understood. She was really misunderstood, this lady,” laments coroner Julie-Kim Godin in an interview with The Press.
Rema Kessler killed herself in her bath on February 15, 2022. Her body was found the next day in her apartment in a residence for independent seniors in Montreal, ironically by a home help she had hired privately through encounter unsuitable services and delays of several months. His friend Maureen Adelman was immediately notified by telephone. She heard the news with dismay. “She was a fighter. An extremely lively, intelligent woman with very strong opinions, she describes. Why did she have to go this far? »
PHOTO MARTIN TREMBLAY, THE PRESS
Let coroner Julie-Kim Godin
His story, “really sad”, underlines Me Godin, is unfortunately not anecdotal.
“I can’t make a diagnosis. [du système de santé], but it is certain that we are seeing more and more vulnerable people who do not have access to home service care and who end up having an accident and dying from the risk for which they were waiting for service . Or otherwise, the absence of services can lead to distress and people give up or commit suicide,” the coroner said in an interview.
This is the second scenario that Rema Kessler experienced.
As he grew older, his health became precarious. She had vision and balance problems. She was taking medication for mental health conditions. She was weak and tired. She was at odds with her family and had had to stop her social activities since the COVID-19 pandemic. She felt very alone.
Over the years, the octogenarian has often asked for help. She has interacted with several medical and psychosocial organizations and stakeholders: family doctor, CLSC, Department of Support for the Autonomy of Elderly People (SAPA), nurse, Info-Social line. She was followed at the CLSC Côte-des-Neiges.
The woman notably requested services to ease her daily life and manage her finances and psychological help.
Sometimes several months passed before she received a response. What was ultimately offered to him did not suit his needs, the coroner found.
An example: Mme Kessler asked for help with meals on weekend mornings. Instead, he was offered help with dinner. She refused treatment and the food assistance service was simply canceled.
“The CLSC was not able to adapt. If she asks for lunch, she must be offered lunch, the coroner rules. On numerous occasions, we told him: you ask us for A, we offer you B. If you don’t take B, we close your file. They closed the file and six months later, she launched them once more. »
Another example: Mme Kessler had difficulty accepting his loss of autonomy and sometimes expressed his needs with reluctance or ambiguity, which resulted in an unsuitable offer or outright refusal. “They were very rigid in terms of service. Older people can be proud. For me, this is not a reason for refusal of service, insists the coroner. When the attendant came to the house, Madame wanted to show that she was not that bad. She had difficulty accepting the decline. And faced with this, he was refused care. »
In the months preceding her death, M’s mental stateme Kessler deteriorated and his interactions with medical professionals intensified.
She indicated on several occasions to the CLSC workers that she had dark thoughts. No safety net was deployed.
Here is the sequence of events:
In December 2021, two months before ending her life, Rema Kessler reapplied to the CLSC for home services and help to manage her finances. She received a referral for a consultation with a social worker and was placed on a waiting list. Pick-up was planned within 30 days. “While waiting to obtain services, no support or safety plan appears to have been put in place, even though Mme Kessler was at this point speaking openly regarding his desire to die,” coroner Julie-Kim Godin noted in her report.
On January 13, 2022, the octogenarian asked his family doctor to obtain medical assistance in dying that same day. She didn’t want to hear anything when the caregiver explained to her that this wouldn’t be possible. She was therefore transported to St. Mary’s Hospital, in west Montreal, and hospitalized for ten days. She was evaluated by physiotherapy and occupational therapy. Steps were taken by the hospital so that she might obtain more services from the CLSC, including psychosocial monitoring and an assessment of her needs and the safety of her home. Nothing, however, regarding his desire to end it.
“There does not appear to have been a request for suicide prevention services or a safety plan for his return home. It was likely assumed that her family doctor would follow up, but she was not immediately informed,” the report says.
On January 22, Rema Kessler returned home alone.
On January 31, 2022, M’s doctorme Kessler contacted her following being alerted by a relative. The 88-year-old admitted to being “extremely tired, having difficulty carrying out daily activities, suffering from a decline in health, isolation and a general loss of interest.” She needed help, she said. The doctor advised the CLSC to increase services.
On February 4, 2022, Mme Kessler was evaluated by a social worker.
Even though the octogenarian told her of her desire to die and she revealed to him when and how she planned to end her life, the caregiver concluded that her patient presented a low suicidal risk.
On February 15, she committed suicide.
Two health establishments were severely questioned by Mr.e Godin, whose 10-page report includes 7 recommendations and 13 sub-recommendations. She points out several shortcomings, including an inability of the CLSC to adapt to the needs of its user, a lack of openness to understand why she refused certain services, inadequate mental health support and a poor assessment of suicide risk.
Me Godin is categorical: the death of Mme Kessler might have been avoided. She deplores “many missed opportunities to help [l’aînée]which clearly contributed to his distress.”
“When people do not have access to the care and services that are required by their needs, it leads to distress. This distress here has evolved over time, the coroner believes. We want to make sure people stay in the community. I understand people who want to stay at home too, but we must offer them services accordingly,” she said in an interview.
The Press contacted the two health and social services centers involved in this matter.
A spokesperson for the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, of which the CLSC Côte-des-Neiges is a part, indicated that they might not comment on a particular case “in order to preserve confidentiality. [des] patients.” “We have followed all of the coroner’s recommendations. »
The CIUSSS de l’Ouest-de-l’Île-de-Montréal, which oversees St. Mary’s Hospital from where Mme Kessler was given leave without a psychological net, conducted an internal investigation and implemented his own recommendations as well as those of the coroner. An action plan is being implemented.
“Training on suicide prevention, suicidal risk screening, assessment and intervention with a person at suicidal risk and on distress and suicidal risk are offered continuously to teams, in all our hospitals. We are also working to improve our service offering on the close monitoring that must be carried out with users following a suicidal crisis,” indicates spokesperson Hélène Bergeron-Gamache.
Other cases
• An 81-year-old woman was found dead in her home in March 2022. As it took several days before her body was discovered, the coroner who investigated was unable to establish the cause of death with certainty. According to the investigation, the octogenarian felt very alone since the death of her husband. She hardly ate anymore. A relative said she “let herself go”. The woman was awaiting an assessment for home care following being reported to the CLSC by the police.
• A 64-year-old woman threw herself from her balcony in the winter of 2022. Despite mental health problems, two hospitalizations for suicidal ideation and several requests for help, she had not benefited from any psychiatric or psychological follow-up nor pharmacological treatment. She had told health professionals that she believed she was infested by insects, that she had difficulty carrying out her daily activities and that she felt like she had lost control. control of his life. She had asked to be “supported significantly”.
21 009
Number of Quebecers waiting for a first home care service as of September 9, 2023. An increase of 447 compared to March.
Source: Ministry of Health and Social Services
15 289
Number of Quebecers waiting for a front-line mental health service, of which 10,418 are out of time.
Source: Ministry of Health and Social Services
28,4 %
Proportion of Montreal seniors who frequently report experiencing psychological distress. That seems like a lot (more than one in four), but it remains the age group who say they experience the least.
Source : Quebec population health survey 2020-2021
Need help for you or a loved one?
Quebec suicide prevention line: 1 866 APPELLE (277-3553)
Suicidal risk difficult to detect among seniors
Suicidal risk is more complicated to detect in seniors, because many symptoms of depression and suicidal ideation are similar to those of aging. This fact is all the more worrying given that the suicide rate has increased among women aged 65 and over in recent years. Camille Poirier-Veilleux, social worker and regional responder for public health interventions in suicide prevention at Montreal Public Health, helps us to better understand.
What are the risk factors specific to seniors? What are their vulnerabilities?
Seniors have risk factors that are quite unique. We can think of all the bereavements linked to aging, whether it be loss of loved ones, of a house where we have been all our life, of a state of physical health. We lose certain abilities. There are changes that also happen at this stage of life, periods of transition that can go really well, but can be more difficult. We also talk regarding a decrease in social relationships, meaningful connections, we lose friends who were also aging. Seniors are more likely to live alone, which can affect isolation. There are also ideas we have regarding aging. We may have a feeling of being useless or a burden to those close to us. It also has a lot to do with morale, one can imagine. The pain that is linked to certain illnesses is more present when you are older. It has a big impact on mental health. And there is ageism in general, all the discrimination that older people can experience in our societies.
PHOTO PROVIDED BY CAMILLE POIRIER-VILLEUX
Camille Poirier-Veilleux, social worker and regional respondent for public health interventions in suicide prevention at Montreal Public Health
According to the National Institute of Public Health of Quebec (INSPQ), women aged 65 and over represent the only group for which the suicide rate has increased slightly since 2010. The number of suicides in 2020 was “particularly high”, says the INSPQ, with 63 suicides. Should we be worried?
This is going to be a trend to follow. This is the only age group for which we observe a slight trend [à la hausse] in the latest data. This is 2021 data, so it’s not the most recent data, but it’s what we have. We are watching. We are not necessarily worried, but the fact remains that we will pay particular attention to this group. […] The data we have has its limits. [Sur le terrain], more psychological distress has been reported among seniors since the pandemic. The community organizations with which we work often tell us this.
Is suicide risk more difficult to detect in seniors? Are the symptoms different?
It’s a little more complicated for seniors. Depression will not manifest itself in the same way as in the adult or youth population. The signs of depression in seniors will be somewhat camouflaged. Sometimes it’s fatigue, sleep problems, confusion, which may be related to normal stages of aging, but which may also not be related at all, and may be more related to mental health. . Is difficulty sleeping related to aging, or is it more related to the person’s preoccupation with a life event? As for suicidal thoughts, that’s it too. Behavioral changes that help us identify suicidal risk may also be linked to aging. I’m thinking, for example, of someone who has less desire to see their friends. In general, for an adult, we will say to ourselves: oh well, the person is isolating themselves, they are not doing well. But for an older person, we will say: ah, but it’s normal that she goes out less, she has trouble walking, for example.
Can the shortage of resources in the health network and delays in accessing care have an impact on the psychological distress and suicidal ideation of seniors?
We cannot make a cause and effect link when we talk regarding suicide, it is multifactorial. On the other hand, accessibility to care and services is super important. Therefore, it is a target for intervention to increase the accessibility of care and services if there are access problems.
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