‘We are very angry’: Family wants answers after care worker brought COVID into their home
Michela Caruso was 87, healthy, independent and a loving grandmother to six when COVID-19 claimed her life.
Her family is raising questions about how she - and three other members of her family - contracted COVID-19 in the first place, saying their cases are connected to the Rosslyn Retirement Residence, despite none of them living or working there.
Michela, who immigrated to Hamilton from Italy in her mid-20s, died from COVID in hospital May 27. Her husband, Giacchino (Jack) Caruso, 88, remains in hospital. The family says public health told them Michela and Jack were exposed to the virus when a personal support worker (PSW) caring for Jack in their home tested positive mid-May. They say they were told by the PSW's colleague and health-care contractor CBI Home Health that he also worked at the Rosslyn, home to Hamilton's deadliest outbreak which has since had its licence revoked.
We are still numb. We're very angry," says the Carusos' daughter, Paula Rosati. People tell you try to think of the good times ... maybe we'll get there one day but right now we can't."
The family, however, doesn't know where to direct their anger - at the PSW, the subcontractor employing him, the health group who hired the subcontractor, the Local Health Integration Network who contracted the health group, or the province.
An expert in epidemiology and aging says the Caruso family's situation highlights larger pervasive issues in the seniors' health-care sector, such as a patchwork system of contracted-out care, poorly paid PSWs and vulnerable seniors forced to accept subpar care. Few solutions seem to be on the horizon.
In the meantime, the Caruso children want answers and accountability. They spoke with The Spectator last week by phone from Rosati's Stoney Creek family room, all physically distancing and wearing masks.
How did they catch it?
Jack Caruso had been receiving 20 hours per day of in-home care from a PSW since December. He was suffering from complications related to a heart-valve replacement nine years earlier and struggled to get around his backsplit-level home, bathe or use the washroom on his own.
Even with near-round-the-clock care, Jack relied on his wife of 63 years, Michela, who cooked, did his laundry and otherwise supported him, their family says.
When the pandemic hit, Michela and Jack's three grown children delivered groceries and spoke often with Michela, who kept them abreast of issues with PSWs. She claimed there was a lack of proper personal protective equipment (PPE) use, something the children also noticed when they stopped by. The family purchased masks and left them out for PSWs.
On May 12, Paula got a call from her mom. The PSW working the night previous had fallen ill and left early, she said. His brother, another PSW, took his place.
Three days later, the family got a call from public health. A person who worked in their home May 10 and 11 tested positive for COVID-19. Paramedics came to test Jack and Michela the next day. Michela, who was already showing symptoms, tested positive on May 17. Jack tested positive a day later. The family made the decision to send the octogenarians to hospital after they were unable to get PSWs to come into the home.
Despite Michela being the healthier of the two, the virus hit her hardest. She was transferred to the Hamilton General Hospital ICU, while Jack remained on the hospital's Ward 8 COVID unit.
Their daughter, Maria McChesney, had visited her parents on May 14 to drop off groceries. She also tested positive, as did her 22-year-old son. Maria's worsening symptoms landed her in the ICU with her mom. Their rooms were side by side.
On May 26, a doctor entered Maria's room and called her siblings to tell them COVID had taken over" their mother's lungs.
An hour later, Pat Caruso got a surprise call from his mother. He breaks down when he thinks back to that conversation, one he was too emotional to discuss. It was the last time anyone in the family spoke with Michela.
Early the next morning, doctors wheeled Maria into her mother's room.
I got to hold her hand but she was gone," Maria said through tears.
Their father's health has declined in hospital. The family doesn't expect he'll be able to live independently when or if he is released. They have not told him his wife died. They want to tell him in person.
He's going to be an emotional mess," Paula says.
The family's questions - some answered
While the Caruso children are grieving for their mother, who was buried June 1, they are also demanding answers to how she and their father contracted the virus in the first place.
Specifically, they want to know why the PSW was allowed to work at both the Rosslyn and out of their parents' home, why PSWs were not wearing personal protective equipment (PPE) while caring for their father and why the infected PSW's brother, another PSW who the family understands also later tested positive, was allowed to take his brother's place at the Carusos' home the night he fell ill while working.
CBI Home Health, which was contracted by the Local Health Integration Network and hired subcontractor Concepts of Care, which provided the Carusos' PSW, said they were incredibly saddened" to hear of the family's loss.
In an email, spokesperson Tara Bednarz said CBI provided Concepts of Care with sufficient PPE" and provided additional education and communication on proper PPE usage." They have also repeatedly reinforced" with subcontractors their strict policies" on self-screening and self-isolation.
CBI did not know about the Rosslyn connection, she said, adding she was unable to confirm the PSW worked at the home as CBI is not his employer.
In this instance, we were not told by the subcontractor that this PSW was also working at Rosslyn," Bednarz added. However, at the time and under current Ministry of Health regulations, front-line care workers are permitted to work in a single congregate setting convalescent or group home, while continuing to provide care at private homes in the community."
Concepts of Care did not respond to a detailed list of emailed questions nor to phone messages requesting comment.
In a statement, Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) CEO Bruce Lauckner offered his condolences to the Caruso family.
We can't comment on any specific case, but if there are ever quality concerns raised about a service provider, we work with the respective organization to determine what happened," Lauckner said. The LHIN would not say if it is looking into this case specifically.
As for the province, it says home-care providers - such as a PSW working with a temp agency - are allowed to work in both clients' homes and retirement homes. Retirement home employees, however, can only work in the retirement home.
The Rosslyn outbreak was declared May 10, one day before the PSW fell sick while working in the Carusos' home. A total of 64 residents and 22 staff tested positive for the virus.
The Rosslyn did not respond to a request for comment.
The Spectator asked public health if it is investigating COVID cases that spread to the community from the Rosslyn.
We do link cases to each other wherever we can, however, we are not able to go back and review all possible links to former cases," said Jacqueline Durlov, public health spokesperson. We do know that some staff continued to hold positions across multiple sites, and that is not unusual nor specific to the Rosslyn. Community agencies are working to minimize this, but we understand that in some cases working across multiple sites is essential to maintain care."
Durlov said she could not speak to specific cases due to privacy legislation.
A perfect storm' that highlights important issues in seniors' care
Andrew Costa, an assistant professor with McMaster University's department of medicine who researches seniors' care, called the Carusos' situation a perfect storm," one that exposes larger issues at play in the seniors' health-care sector.
This is a case where it's not one particular thing, it just boiled over for one family," Costa said. Bad luck meant it was them that was going to suffer consequences for larger, system issues."
The larger issues - both COVID-related and not - he highlights include: a sector in which poorly paid, overworked PSWs are its true backbone"; the fact many PSWs are required to work in different settings to make ends meet, potentially spreading the virus; a shortage of workers that means well-meaning provincial policies restricting workers to one health-care setting may backfire, leaving some congregate settings with worker shortages; and a disjointed care system with little oversight.
Costa said while the Carusos' case is tragic, it is not surprising" to hear a PSW infected an elderly couple. He said the extent to which such situations are occurring in the home-care system remains unknown due to a lack of data.
While the seniors' care sector was problem-plagued prior to COVID, for families of loved ones receiving at-home care, the risks are now higher and the decisions more difficult, Costa said.
Sadly, in many cases, it's a tough choice between ... accepting PSWs who are forced to make a living however they can (in other settings such as congregate care) or go without a service," he said.
And while many families want just one PSW who doesn't work in other care settings consistently treating their loved one, with an ever-present PSW shortage, that's hard to come by, he said.
As for the Caruso children, they are demanding system-wide change.
Pat Caruso says the government needs to take its head out of the sand" and strip contracted companies and any group profiting financially from the sector. He wants less bureaucracy, more accountability.
What we want is them to get to the bottom of it and fix it," Pat said. I hope it's not a Band-Aid. I hope it's a complete revamping."
Katrina Clarke is a Hamilton-based reporter at The Spectator. Reach her via email: katrinaclarke@thespec.com