A coroner’s inquest into the 2018 starvation death of Florence Girard is providing insight on a British Columbia government program that employs people to share their homes and provide care for adults with disabilities.
After five days of testimony, a picture is emerging of a sector that depends on home share providers taking on significant responsibility for low pay, with limited support.
While there were regulations aimed at ensuring the safety and well-being of individuals in home shares like Girard, responsible officials were at times unaware or treated them as box-ticking exercises.
“Shared living is a very difficult service model in a lot of ways,” said Shelley Macfie, testifying Friday.
Macfie worked 40 years in various roles for Kinsight Community Society, which was previously called Simon Fraser Community Living. In 2017 she temporarily returned from retirement to Kinsight as a shared-living co-ordinator and took over responsibility for Girard in July 2018, three months before Girard’s death.
The heavy commitment and lack of a living wage make it difficult to recruit home share providers, Macfie said. “They can’t afford to live if they’re home the whole time with the individuals they are supporting. I think they deserve reasonable compensation for what they do.”
The inquest was told Thursday that Astrid Dahl’s pay to look after Girard was $2,219 a month, which included $400 that she was to spend on respite care. Girard was also eligible for $716 a month in provincial disability benefits for shelter and groceries that would have gone to Dahl.
Girard would also have received between $600 and $800 in disability benefits to cover costs, but it was unclear whether she had a bank account or how that was managed.
Some 4,200 adults with developmental disabilities in B.C. are living in home shares contracted through local agencies like Kinsight.
Community Living BC, a Crown corporation responsible for adults with disabilities, presents shared living as having many benefits that can enhance the quality of life for a person with a disability.
Girard, who had Down syndrome and was a longtime client of CLBC, was 54 when she died in Dahl’s Port Coquitlam home. She had lived there under Dahl’s care since 2010.
Macfie testified she did not see Girard in the three months between the time she took responsibility for the file and Girard’s death, though she had been in the home and communicated with Dahl.
Macfie said she understood from Dahl that Girard was recovering from the flu and didn’t insist on seeing her. “I just didn’t think there was any issue. I didn’t pick up on any red flags. Nothing.”
There is a need in the sector for better supervision, she said. “Maybe it should be in a perfect world a weekly visit, or something to that effect.”
Held in Burnaby with a five-person jury, the inquest’s primary functions are to determine the facts related to Girard’s death, make recommendations on how to avoid similar deaths in the future and assure the community that the death was not overlooked or ignored.
Dahl had already been found guilty in the B.C. Supreme Court in 2022 of failing to provide the “necessaries of life” to Girard and sentenced to a 12-month conditional sentence. The sentence was increased to 15 months in jail when the Crown appealed, but because Dahl had served the original sentence, she was not imprisoned.
The Crown at one point charged Kinsight as well in relation to Girard’s death but stayed those charges in 2020. The BC Prosecution Service approves or continues charges only in situations where Crown counsel believes there is a substantial likelihood of conviction and a prosecution is required in the public interest.
According to documents from Dahl’s criminal trial, the roughly five-foot-tall Girard was “significantly overweight” when she started living with Dahl. She dropped to 120 pounds by 2013, a period during which she was monitored through doctor’s appointments.
But around 2014, Dahl stopped taking Girard to doctor or dentist appointments, despite entering care agreements with the agency saying she would. Girard also had osteoarthritis, difficulty with stairs and lived with pain. There were concerns on record that she suffered memory loss and may have had dementia.
Even as Girard lost dangerous amounts of weight in the months ahead of her 2018 death, Dahl failed to seek medical attention.
Girard weighed just 50 pounds when she died.
“I’m still very haunted and troubled by this case and the state in which Florence was found,” testified Nathan Dobie, a corporal with the Coquitlam RCMP, stressing the impact on the investigative team was large.
There have been very few examples of similar cases in Canada, but investigators were aware of another elderly CLBC client in Kamloops who was found to be starving around the same time. Their life was saved thanks to a doctor noticing they hadn’t seen the person in some time and requesting they visit, he said.
Most of Dobie’s testimony was about the RCMP investigation and evidence the police found, though he offered a few observations on how care for vulnerable people needs to change.
Isolation is common in cases of abuse and neglect, he said. “When people become isolated is when we see bad things happen.”
Both Dahl and Girard were isolated, and that increased as Girard aged and her mobility decreased. Along with the care plan there should have been a plan for social engagement, something that would have also given Dahl some respite, he said.
Systemic checks are important, but it’s important to not become fixated on the paperwork and forget about the actual person, said Dobie.
As a government agency, CLBC should have access to Medical Services Plan and PharmaCare records that could be checked instead of having to rely on a care provider’s word, he said. “These things need to be verified.”
Dobie highlighted the layers of bureaucracy between CLBC and the person who is receiving care. CLBC contracts to an agency that in turn contracts to an individual home share provider. “I’m not commenting whether that’s right or wrong, but there is a different relationship that develops than if I had an employee, for example.”
It is easier to keep track of an employee and to provide them assistance when they need it, Dobie said. “I think it’s important we not only support the person in care but we ensure that... we’re actually looking at what that home care provider is doing or feeling and if there have been any changes in their life and those might be triggers we need to do something more to assist them.”
It was clear from testimony that Dahl made decisions not to seek medical care for Girard, believing it was what Girard would have wanted, and that Kinsight staff were either unaware of the decisions or trusted Dahl to make them.
Earlier in the week Dahl testified that Girard hated going to the doctor and dentist and could not be bribed or forced, adding she told three Kinsight officials that she was no longer taking her. “Nobody said anything about it,” she said.
“None of us knew what to do,” Dahl said. “I didn’t know what else to do with her. I was stuck in a loop of not knowing what to do.”
Dahl worked 27 years for Kinsight, including in the group home where Girard lived before she moved into her home. “We just hit it off,” Dahl said. “We just gelled together.”
She felt responsible for Girard’s care and that she was the best person to make decisions for her, she said, though she regretted not consulting Girard’s sister Sharon Bursey more, particularly in the last months of Girard’s life.
If she could go back, she would take Girard to the doctor annually whether she wanted to go or not, Dahl said. “It’s different when you’re in the thick of it and with the person all the time,” she said. “It just felt mean.”
She also expressed regret for not getting Girard medical attention towards the end of her life. At the same time, she said she had seen people die in hospice and group homes and thought it was best for Girard to be at home, though there was no formal end-of-life plan.
Dahl said she felt alone as she made decisions about Girard’s care. “I tried to keep feeding her; she refused to eat,” she said. “I was so zoomed in on Flo I didn’t zoom out and look at the big picture, so that’s on me.”
Throughout Dahl’s testimony she described a strained relationship with Kinsight and the people working for it. “It was an agency that ran their staff on fear and threats, not kindness and understanding.”
Staff were more interested in bureaucracy than in genuine care, Dahl said. “Their mantra was ‘paper before people,’” she said. “They can write all they want about communication, but that’s what I did and every time I did they just called me a troublemaker.”
Krista Maniezzo, whose last name at the time was McGrath, was the shared-living co-ordinator for Kinsight responsible for Girard up until July 2018, a few months before Girard’s death.
She didn’t consider Girard to have complex health needs, she said. “I wouldn’t assume someone with Down syndrome automatically has an acute or critical health-care need, just as I wouldn’t assume someone with autism or post-traumatic stress disorder has an acute or chronic health-care need.”
Nor did she believe a health-care plan was needed, even though it was well documented that Girard had lost weight rapidly, had severe osteoarthritis and had been prescribed strong painkillers.
“It’s my understanding, reading this, that a health-care plan is introduced with an individual who has an acute or chronic health-care condition, or where there’s an identified critical health-care need,” Maniezzo said when presented documentation during the inquiry. “Flo did not meet any of those based on what I was understanding from where she was at and what her current supports were.”
There was nothing to flag that Girard needed to see a doctor, Maniezzo said. “She didn’t change a lot through the time I knew her.”
The last time she saw Girard was in February 2018, at which time she appeared as she usually did, she said. She was in the home again in August 2018 with another client who was going to move into the townhouse, but did not see Girard on that visit.
In November 2017 Maniezzo had gone through a checklist with Dahl about Girard’s care, but it became clear in her testimony that she had checked several boxes without verifying the information was correct. For example, she checked that she had verified the standing order for non-prescription medication, something that has to be updated annually, even though Girard had not seen a doctor who could have written the order since 2014.
Maniezzo, who was about 25 when she took on the management role with Kinsight, acknowledged that she relied on Dahl’s assessment. “You trust what is being told to you. There was a lot of trust that I had with Astrid.”
Responding to a question about how to prevent similar deaths in future, Maniezzo said, “It just keeps coming back to the amount of safeguards Flo had in her life, and there weren’t many.”
Everyone who saw Girard had a vested interest, either as a contracted care provider or working for Kinsight, Maniezzo said. Girard’s sister saw her a few times a year, she said, which is understandable, but not enough to provide a safeguard. “The things that keep us safe are part of our everyday lives.”
Tamara Taggart is the volunteer president of Down Syndrome BC, an advocacy organization with 300 members. Testifying on the second day of the inquest, she said she hopes Girard will be the catalyst for much-needed systemic change.
The system is difficult to navigate and lacks resources, she said, adding there needs to be more support for caregivers, not more paperwork. “We need less bureaucracy,” she said.
Taggart also highlighted that managers and CLBC staff are paid well while benefits to people receiving care are minimal.
“Florence shouldn’t be living in dire poverty while the people tasked with protecting her are on vacation.”
CLBC CEO Ross Chilton’s total compensation in the 2023-24 fiscal year was $310,864, plus a vehicle allowance of $11,862 and $1,503 to cover parking.
CLBC paid Kinsight about $11.5 million in the fiscal year ending March 31, 2024.
The inquest is set to continue until Wednesday with testimony scheduled from Kinsight CEO Christine Scott and Adam McKinnon, an assistant deputy minister in the provincial Ministry of Social Development and Poverty Reduction.
So far the publicly available witness list includes nobody from CLBC.
The jury is expected to report and make its recommendations either Wednesday or Thursday.
Read more: Health, Rights + Justice
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