Published at 1:21 am. Updated at 5:00 am.
“She slipped through the cracks”
“It’s like she fell through all the cracks. She provided for all their needs. And his needs were not understood. She was really misunderstood, this lady,” complains coroner Julie-Kim Godin in an interview with La Presse.
Rema Kessler killed herself in her bathroom on February 15, 2022. Her body was found the next day in her apartment in a residential home for independent seniors in Montreal, ironically by a domestic helper she had hired privately after encountering inadequate services and several months of delays. His girlfriend Maureen Adelman was immediately notified by phone. She heard the news with dismay. “She was a fighter. She describes her as an extremely lively, intelligent woman with very strong opinions. Why did she have to go so far? »
PHOTO MARTIN TREMBLAY, THE PRESS
Coroner Julie-Kim Godin
His story, “really sad,” emphasizes 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 care and who end up having an accident and dying as a result of the risk they expected. Otherwise, the lack of services can lead to despair and people giving up or committing 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 illness. She was weak and tired. She has been at odds with her family and 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 collaborated with several medical and psychosocial organizations and stakeholders: General Practitioner, CLSC, Autonomy Support Department for Elderly (SAPA), Nurse, Info-Social Hotline. She was followed by CLSC Côte-des-Neiges.
In particular, the woman asked for services to make her everyday life easier, to manage her finances and for psychological help.
Sometimes it would take several months before she received an answer. What was ultimately offered to him did not meet his needs, the coroner found.
An example: Ms. Kessler asked for help with meals on the weekend morning. Instead, he was offered help with dinner. She refused treatment and food aid simply stopped.
“The CLSC was unable to adapt. If she asks for lunch, she must be offered lunch, the coroner ruled. On several occasions we have told him: You ask us for A, we offer you B. If you don’t take B, we will close your file. They closed the file and resubmitted it six months later. »
Another example: Ms. Kessler had difficulty accepting her loss of autonomy and sometimes expressed her needs cautiously or ambiguously, resulting in an unsuitable offer or outright rejection. “They were very strict about service. Older people can be proud. For me, this is no reason for refusing service, emphasizes the forensic pathologist. When the guard came into the house, Madame wanted to show that she wasn’t feeling so bad. She found it difficult to accept the decline. And given that, he was denied care. »
In the months before her death, Ms. Kessler’s mental health deteriorated and her contacts with medical professionals intensified.
She indicated to CLSC staff several times that she was having dark thoughts. No safety net was deployed.
Here is the sequence of events:
In December 2021, two months before she ended her life, Rema Kessler reapplied to CLSC for home services and help managing her finances. She received a referral for a consultation with a social worker and was placed on a waiting list. Collection was scheduled within 30 days. “While she waited to receive services, no support or safety plans appeared to have been put in place, although Ms. Kessler was open about her desire to die at the time,” coroner Julie-Kim Godin noted in her report.
On January 13, 2022, the octogenarian asked his family doctor for medical help so that he could die that same day. She didn’t want to hear anything when the supervisor explained to her that this wasn’t possible. She was therefore taken to St. Mary’s Hospital in western Montreal and hospitalized there for ten days. She was examined by physiotherapy and occupational therapy. The hospital took steps to allow her to receive more services from CLSC, including psychosocial monitoring and an assessment of her needs and the safety of her home. However, there is no sign of his desire to end it.
“There appears to have been no request for suicide prevention services or a safety plan for his return home. “It was likely assumed that her primary care physician would inquire, but she was not immediately informed,” the report said.
On January 22nd, Rema Kessler returned home alone.
On January 31, 2022, Ms. Kessler’s doctor contacted her after being alerted by a relative. The 88-year-old admitted to “extreme fatigue, difficulty carrying out everyday activities, suffering from deteriorating health, isolation and a general loss of interest.” She needed help, she said. The doctor recommended that CLSC increase benefits.
On February 4, 2022, Ms. Kessler was examined by a social worker.
Although the octogenarian told her about her wish to die and she revealed when and how she wanted to end her life, the nurse concluded that her patient was at low risk of suicide.
She committed suicide on February 15th.
Two health facilities were interviewed in depth by Me Godin, whose 10-page report contains 7 recommendations and 13 sub-recommendations. She points to several shortcomings, including the CLSC’s inability to adapt to the needs of its users, lack of openness to understand why it rejected certain services, inadequate psychological support and poor suicide risk assessment.
Me Godin is categorical: Ms. Kessler’s death could have been avoided. She regrets “many missed opportunities to help.” [l’aînée]which clearly contributed to his distress.”
“When people don’t have access to the care and services they need, it creates distress. The coroner believes that this distress here has developed over time. We want to make sure people stay in the community. I understand people who also want to stay at home, but we have to offer them appropriate services,” she said in an interview.
La Presse contacted the two health and social centers involved in this matter.
A spokesman for the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, which includes the CLSC Côte-des-Neiges, said they were not allowed to comment on a specific case “to maintain confidentiality.” “. [des] Patients.” “We followed all the coroner’s recommendations. »
The CIUSSS de l’Ouest-de-l’Île-de-Montréal, which oversees St. Mary’s Hospital, from which Ms. Kessler was discharged without psychological safety, conducted an internal investigation and made its own recommendations over those of the coroner. An action plan is implemented.
“In all of our hospitals, ongoing training is provided to teams on suicide prevention, suicide risk screening, assessment and intervention for people at risk of suicide, and stress and suicide risk. We are also working to improve our service offering in terms of the close monitoring that needs to be carried out on users after a suicidal crisis,” explains spokesperson Hélène Bergeron-Gamache.
Other cases
• An 81-year-old woman was found dead in her home in March 2022. Because it took several days for her body to be discovered, the medical examiner was unable to determine with certainty the cause of death. According to the investigation, the octogenarian felt very alone since her husband’s death. She hardly ate any more. A relative said she “let herself go.” The woman was awaiting a home care assessment after being reported to CLSC by police.
• A 64-year-old woman fell from her balcony in the winter of 2022. Despite psychological problems, two hospitalizations for suicidal ideation, and multiple requests for help, she had not sought psychiatric or psychological follow-up care or pharmacological treatment. She had told health professionals that she believed she was infested with insects, that she had difficulty carrying out her daily activities and that she felt she had lost control of her life. She had asked for “significant support”.
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: Department of Health and Human Services
15,289
Number of Quebecers awaiting primary psychiatric service, of which 10,418 are out of hours.
Source: Department of Health and Human Services
28.4%
Percentage of seniors in Montreal who frequently report experiencing psychological distress. That seems like a lot (more than one in four), but it remains the age group that says they experience the least.
Source: Quebec Population Health Survey 2020-2021
Do you need help for yourself or a loved one?
Quebec suicide prevention hotline: 1 866 APPELLES (277-3553)
Difficult to recognize suicide risk in seniors
Suicide risk is more difficult to recognize in seniors because many symptoms of depression and suicidal ideation are similar to those of aging. This fact is all the more worrying as the suicide rate among women aged 65 and over has increased in recent years. Camille Poirier-Veilleux, social worker and regional responder for public health interventions for suicide prevention at Montreal Public Health, helps us better understand the situation.
What specific risk factors are there for seniors? What are their weak points?
Seniors have very unique risk factors. We can think of all the bereavements that come with aging, be it the loss of loved ones, the loss of a home in which we have lived all our lives, or the loss of physical health. We lose certain skills. Even in this phase of life there are changes, transitional phases that can go very well, but can also be more difficult. We are also talking about a decline in social relationships, meaningful connections, we are losing friends who are also aging. Older people are more likely to live alone, which can have a negative impact on isolation. There are also ideas we have about aging. We may feel useless or a burden to those close to us. It also has a lot to do with morale, you can imagine. The pain associated with certain illnesses increases with age. It has a huge 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 for 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 where suicide rates have increased slightly since 2010. The number of suicides in 2020 was “particularly high”, the INSPQ said. with 63 suicides. Should we be worried?
This will be a trend to follow. This is the only age group where we see a slight trend [à la hausse] in the latest data. This is 2021 data, so it’s not the most current data, but it’s what we have. We look. We’re not necessarily worried, but the fact remains that we will be paying particular attention to this group. […] The data we have has its limitations. [Sur le terrain]Since the pandemic, more psychological distress has been reported among older people. The community organizations we work with often tell us this.
Is suicide risk more difficult to identify in seniors? Are the symptoms different?
For seniors it is a little more complicated. Depression does not manifest itself in the same way as it does in adults or adolescents. The signs of depression in seniors are somewhat disguised. Sometimes it’s fatigue, sleep problems, confusion, which may be related to normal stages of aging, but may not be related at all, but rather related to mental health. . Are sleep disorders related to age or are they more related to the person’s preoccupation with a life event? As for suicidal thoughts, that’s it too. Behavioral changes that help us recognize suicide risk may also be related to aging. For example, I’m thinking of someone who has less desire to see their friends. Generally, as an adult, we will say to ourselves: well, the person is isolating himself, he is not doing well. But to an older person we say: Oh, but it’s normal for them to go out less, for example they have problems walking.
Can the lack of resources in the health network and delays in access to health care affect the psychological distress and suicidal ideation of older people?
We cannot make a cause and effect connection when we talk about suicide, it is multifactorial. On the other hand, access to care and services is extremely important. Therefore, it is a target for interventions to improve the accessibility of care and services when access problems exist.