When Daniel Silcox pulls off the stretch of winding highway that leads him to Bobcaygeon, his heart usually soars. He loves the rural Ontario town, which is about 45 minutes from where he and his wife, Muriel, run a pony farm. Lately, though, the drive has the opposite effect. Instead of landing on a favourite sidewalk café, his eyes travel to Pinecrest Nursing Home, where nearly half of the 65 residents died of COVID-19 and its complications at the outset of the pandemic. “It’s inexcusable what was allowed to happen,” says Silcox. “I believe it could have been prevented. The government was asleep at the switch.”
Long before COVID-19, Silcox knew intimately that long-term care was in crisis. In 2007, his father, James—a World War II veteran, devoted husband of 63 years and father of six—died at 84, the first of eight victims murdered by nurse Elizabeth Wettlaufer. The deaths were all in long-term care homes, and the perpetrator went undetected for years.
“Every time I learn of more deaths in long-term care facilities, I feel like I’m reliving my dad’s death,” says Silcox. During the early days of the pandemic, watching the news from his living-room couch became something of an obsession—Global at 5:30, CBC at 6, CTV at 10. His need to follow what was happening across the country was relentless. Each time he heard a report about more deaths, more mistreatment, more abuse, he broke down in tears. As of press time, nearly 6,700 long-term care residents in Canada had died of COVID-19. That’s 81 percent of the country’s death toll, the highest rate of any major economy in the world reporting COVID data.
In 2018, Silcox watched much of the 42 days of testimony at Ontario’s inquiry into the systemic failures that allowed Wettlaufer’s killings to transpire. He also met with Health Minister Christine Elliott and inquiry commissioner Justice Eileen Gillese on more than one occasion. In July 2019, when the inquiry released a four-volume report totalling more than 1,000 pages, Silcox was relieved when recommendations included increasing staffing levels, better supervision of medication and infrastructure improvements that would create a better culture of care for seniors. “They said they were going to clean up the industry. I took them at their word,” he says.
As of February 2020, Ontario had implemented 18 of the inquiry’s 91 recommendations, including a policy that directs inspectors to review a home’s history of critical incident reports before new inspections, and making it possible for homes to file incident reports to the College of Nurses of Ontario electronically. Then the pandemic hit, taking the lives of thousands of Canada’s most vulnerable citizens. “We should have screwed the bolts down tighter so much faster,” says Silcox. “They had plenty of warning of what was coming.”
The hours in Ontario’s 626 long-term care facilities are long. The workload is heavy, and the pay is less than in hospitals. Nowhere in Canada is there a minimum staffing ratio of personal support workers (PSWs) to residents, though anecdotal estimates put ratios at approximately 12 residents to each PSW. Most patients have cognitive impairments and need help with basic tasks like using the washroom and eating. These are just some of the reasons that long-term care nurses are hard to find, and why it’s an even greater challenge to keep them once they’ve been hired. Turnover rates for long-term care nurses and personal support workers are staggering: A 2009 study of facilities in California cited year-over-year turnover rates of registered nursing staff between 55 and 75 percent. No such statistics are available for Canadian facilities, but anecdotally, staff turnover seems similarly high here.
Perhaps that’s why, when Elizabeth Wettlaufer went for an interview at Caressant Care nursing home in Woodstock, Ont., in June 2007, it felt more like an orientation to her than a professional vetting. By that point, Wettlaufer had racked up years of complaints and suspensions at four institutions and hadn’t worked as a registered nurse for nearly a decade. But many of her transgressions were buried in sealed employment files. Unaware, Helen Crombez, the home’s director of nursing, guided Wettlaufer through the 163-bed facility, introducing her to patients and describing who she would give medication to on her shifts. Caressant needed a nurse, badly, and Wettlaufer got the job the same day she interviewed. She would go on to kill seven patients at Caressant and one at Meadow Park Long-Term Care in London, Ont.—in addition to assaulting or attempting to murder at least six other patients. She would also confess her crimes to at least six people, none of whom alerted authorities, before getting caught.
Wettlaufer was born Elizabeth Parker in 1967, while her parents were students at a Bible college in Toronto. When she was four, her family moved to South Zorra, a rural community near Woodstock. As a child, Wettlaufer rode her horse in the sprawling meadows behind her family’s brown brick house. According to a childhood friend, Glen Hart, a nearby tree still bears a heart with the initials of her parents, Doug and Hazel Parker, carved into it.
Doug worked as a salesman and Hazel as a secretary, according to legal interviews with Wettlaufer during the inquiry into her crimes—since she declined multiple interview requests from Chatelaine, that 112-page transcript is where much of the information about her personal life in this story comes from. The family were devout Baptists: Doug was a lay pastor, often filling in at South Zorra Baptist, preaching to the 100-strong congregation of fundamentalists, with his wife, his daughter Bethe (as Wettlaufer was called) and his son Robert in attendance. Most of Wettlaufer’s aunts, uncles and cousins attended the same church.
Hart says that in high school, Wettlaufer began struggling with her sexual identity. Acknowledging her attraction to women kicked off a roiling, lifelong conflict between her sexuality and her family’s religious views. When she was 14, Hart says Wettlaufer tried to kiss a female classmate—a friend of his—and was rebuffed. A few years later, while pursuing a bachelor of religious education at London, Ont.’s Baptist Bible College, she attended a service with a girlfriend at a gay-friendly church and was subsequently kicked out of school. Her devoutly religious older brother stopped speaking to her.
Her parents flatly refused to believe that their daughter could be bisexual. They sent her to conversion therapy, a spiritual intervention practice that attempts to change its participants’ sexual orientation. (These programs have been discredited as dangerous pseudoscience and are banned in Ontario, Nova Scotia and Prince Edward Island. Last March, the federal government tabled legislation to ban the practice nationally.) Wettlaufer emerged feeling closer to God, like some semblance of order had been restored to her life. Hart had recently come out as gay, and remembers Wettlaufer vowing not to be: “I’ll never do it again. Pray for me, okay?” she said to him then. After repenting, Wettlaufer was allowed back into college, but she and her brother never fully reconciled.
In 1991, Wettlaufer graduated with a minor in counselling, then enrolled in a nursing program at Conestoga College in nearby Stratford. She excelled, earning straight As, but the ongoing internal battle with her sexuality was exhausting. She began to drink, often, hard and usually alone. She also stopped going to church.
Her diploma required completing a nursing placement, and in her last year at Conestoga she accepted one at the Geraldton District Association for Community Living. The facility offered care to the developmentally challenged in a town north of Thunder Bay, Ont., on the shores of Lake Nipigon. In June 1995, the town’s hospital offered her a part-time casual position. Soon, she had taken on a second job at another assisted-living facility, sometimes completing an eight-hour shift there before a night shift at the hospital, working 20 consecutive hours overall.
Wettlaufer had seen Northern Ontario as a place to make a fresh start somewhere far away from home. But she began to loathe the isolation, the flat landscapes and long nights of soundless dark. Her sadness swelled into depression and she began taking drugs from the hospital’s medication room: Ativan, Valium, even a dose of morphine refused by a patient. One night in September, she swallowed 30 mg of Ativan from the ward’s medication room, saying later that she had wanted to take her own life. Stumbling around and slurring her words, she continued doling out doses of medicine to patients until a co-worker noticed, took her by the hand and guided her to a bed. For days, she was a patient in the same hospital that employed her. Then, she was fired.
Rather than revoking her credentials, the Ontario Nurses’ Association (ONA) tried to help, setting Wettlaufer up with a counsellor and alcohol addiction treatment, and placing her on temporary incapacitation leave. A powerful union, the ONA helped Wettlaufer grieve her termination—the hospital agreed to amend her file to say that she resigned her job for health reasons and to offer that explanation to anyone calling for a reference in the future. The College of Nurses did impose conditions on her licence, saying she had to stay sober to keep practising, but by 2007 the incapacity citation was no longer on her ONA record. When she was hired by Caressant, the home had no way of knowing what had really happened in Wettlaufer’s first job.
In February of 1996, Wettlaufer moved back to Woodstock. She began seeing a counsellor for substance abuse issues and attending group support meetings. Within months, she had a new position at Christian Horizons, a five-bed group home for people with disabilities. She was employed as a support worker, not a nurse; but not knowing she’d been fired previously, her managers encouraged her to use her skills. Soon, Wettlaufer was teaching other employees how to administer medication, and how to safely move elderly patients. She was also responsible for ensuring each patient received the correct medication and dosage, and for letting the pharmacy know when supplies were running low.
Wettlaufer began attending services at South Zorra Baptist again, which is where she met truck driver Donnie Wettlaufer. The two married within a year, moving into a white bungalow just off Woodstock’s main street. The next few years were steady: she stayed employed, married and sober. But by 2006, things began to unravel again. The 39-year-old’s struggles with the destabilizing forces in her life—sobriety and sexuality—had never truly gone away, and she began to reach out to women online, forging bonds that turned romantic. She also began to hear voices, telling her that she needed to make things right with God. When she had a thought she didn’t want, she began singing a Bible verse aloud. Interacting with other people got harder and harder, as she got angrier and angrier with God and with herself.
Later, she would tell lawyers in the public inquiry that this is when she began to fantasize about killing people: her psychiatrist, her co-workers and her patients. It was a way to sublimate her anger, she said. In her fantasies, she had power and control. Wettlaufer knew that these fantasies were dangerous and tried to keep them on a low simmer. She convinced herself that it was possible to divide her brain into two, using one part to fantasize about murder and the other to go about life as normal.
In her time at Christian Horizons, Wettlaufer received numerous warnings about medication dosages, and a one-day suspension while her managers investigated accusations that she was emotionally abusing patients. By July 2006, her obsessive-compulsive tendencies had gotten so intrusive that she took a leave from work and spent two weeks in Woodstock’s psychiatric hospital. There, she was diagnosed with depression and borderline personality disorder, and given Seroquel, an antipsychotic sedative, and Fluvoxamine, an antidepressant and anti-obsessional. In early 2007, Wettlaufer’s husband found out about an online relationship she was having with a woman in New Brunswick, and the couple began divorce proceedings.
By spring, she was preparing to move to New Brunswick to be with her girlfriend, quitting her job at Christian Horizons, where she’d worked for 11 years. A brief breakup cancelled that move; but by September, her girlfriend had moved with her two teenagers to Woodstock. Her girlfriend lived with Parkinson’s disease and wasn’t able to work, which meant that the financial responsibility for a family of four suddenly rested entirely on Wettlaufer. “Everything was such a mess,” she’d later say, reflecting on this year.
She didn’t want to ask for her old job back, as Christian Horizons had a policy against hiring people in same-sex relationships (that rule has since been struck down in court). So she applied at Caressant and was hired immediately as a registered nurse.
Compared to Christian Horizons, Caressant moved at a whirlwind pace. Instead of five residents, Wettlaufer was responsible for 32 people during her daytime shifts: administering medication, changing dressings, speaking to families, processing doctors’ orders and keeping up with paperwork, as well as supervising other nurses and dealing with problems as they arose. At night, she became responsible for all 163 patients, alongside a registered practical nurse (RPN).
Like 57 percent of Ontario’s long-term care homes, Caressant is privately owned and operated for profit, an incentive to keep costs as low as possible. Today, wages for PSWs in Ontario range from $15 to $28 per hour, with hospitals and publicly funded homes at the higher end and private homes at the lower. Many PSWs work at multiple facilities to make ends meet, which became a liability during the pandemic, exacerbating the spread of COVID-19.
At Caressant, Wettlaufer’s fantasies started up again—this time, they were about experimenting on patients, injecting them with medicine just to see what would happen. And then, she began acting on them. What if, Wettlaufer thought on one particularly hectic shift, she just gave 86-year-old Clotilde Adriano too much insulin and watched what happened? And so she did. She also began to test out insulin doses on Clotilde’s sister-in-law, Albina, who was 88. She’d later call the feeling that welled up in her “the red surge,” and say she targeted both women—who survived the attacks—because they had dementia and couldn’t fight back or report her.
In August 2007, during a double shift that began at 3 p.m. and was set to end at 7 a.m. the next morning, she grew increasingly overwhelmed. She became incensed when one of the residents, Silcox’s father James, began yelling. Wettlaufer went to the fridge that held insulin, her weapon of choice for all of her murders. Improperly administered, it causes a patient’s blood sugar levels to plummet, but is virtually undetectable. She pulled cartridges from a box and loaded them into an insulin pen.
When James Silcox died at three in the morning, the doctor on call ruled it death by post-surgery embolism. It was Wettlaufer who filled out the paperwork. Silcox says that until Wettlaufer’s confession, he and the rest of his family had no reason to question what they’d been told years before. He first heard that his father’s death had turned into a murder investigation on the radio.
Things only became more unstable for Wettlaufer, and in December 2007, she killed her second victim, 84-year-old Maurice Granat. At home, she and her partner were drinking too much, and within a year of moving in, they split up. At work, her performance began to slip significantly, and she was reprimanded for skipping shifts and making medication errors. On one shift, nurse Robyn Laycock found Wettlaufer standing over a palliative care patient, whispering to him in a high-pitched, childlike voice. “If you want to, let go, it’s okay. Your family will understand,” she said. “Your time is here. See the light.” One Halloween, she came to work dressed as the Grim Reaper. Yet all the while, colleagues say, she was kind to her patients, often bringing them treats, like pie, on their birthdays.
The first of Wettlaufer’s confessions came in 2008, when she told a new girlfriend that she had killed two people in her care with insulin overdoses, and that she’d tried to kill another. “Don’t do that anymore,” her girlfriend said. “You don’t want to get caught.” Her girlfriend didn’t tell anyone at Caressant or the police, and Wettlaufer attempted to murder 60-year-old Michael Priddle later that year. (Priddle, who had Huntington’s disease, would pass away peacefully four years later.)
The second group of murders came in a burst, much like the first. In the final months of 2011, Wettlaufer killed three Caressant residents: Gladys Millard, 87, Helen Matheson, 95, and Mary Zurawinski, 96. At the same time, she prayed and prayed, attempting to control her actions through what she called her devotion to God. She stayed up at night writing poetry: “As my life is measured by intravenous drops / I yearn for the ghost of a touch,” read one verse.
Her social circle consisted mainly of her cats, a Jack Russell terrier named Nashville, and high school students who volunteered at Caressant. Wettlaufer had become the subject of gossip at work, reprimanded because of her overtly sexual comments to both colleagues and the young volunteers. She sometimes even asked the teenagers to come home with her.
Her second confession was to a teenage volunteer, who Wettlaufer took to Medieval Times in Toronto as a birthday treat. On the hour-and-a-half drive, the student commented that Wettlaufer was acting differently than usual. “I’ve given my life back to God,” Wettlaufer said. “I was doing some bad things.” She described her murders to the student, and the girl was stunned. “Well, you’re not doing them anymore?” she asked. Wettlaufer said no. Two days later, the student ended the friendship. The teenager also failed to tell anyone.
Her pastor also stayed silent. While they were sitting around his kitchen table in October 2013, Wettlaufer confessed to him that she had killed patient Helen Young, a 90-year-old woman who’d come to Canada from Scotland as a young bride shortly after World War II. Along with his wife, the leader of Wettlaufer’s queer-friendly church in Woodstock took her hands and prayed with her. “This is grace. This is forgiveness,” her pastor told her. “But if you do it again, we’ll have to report you.”
The next person to let Wettlaufer off was an ex-boyfriend, who she confessed to the next year over text message. She admitted just how many people she’d killed, and said that she was thinking of turning herself in to the police. “Why don’t you stop being a nurse?” he asked her. “Why don’t you change your job so that you don’t have the opportunity?” He, too, failed to alert anyone who could stop her.
In March 2014, Wettlaufer killed patient Maureen Pickering, 79. Her colleagues also discovered that one of her medication errors had caused a patient intense pain. At long last, the nursing home fired her, citing her lengthy record of infractions. Once again, the ONA grieved the termination, negotiating to change it to a voluntary resignation on her official record. It also secured Wettlaufer a $2,000 settlement and a letter of reference. “We wish her well and are pleased to provide her with this reference,” reads the letter, signed by Wanda Sanginesi, vice-president of human resources at the home. During the eventual inquiry, the ONA representative tasked with advocating for Wettlaufer (an RN who had worked alongside her at Caressant) testified that other nurses who’d made more egregious errors were still working at the home. In an emailed statement, the union told Chatelaine that it has advocated for improvements in long-term care for decades, and that it’s up to employers to do due diligence when hiring, and to report concerns to the College of Nurses of Ontario.
Caressant agreed to one more ONA demand: to seal Wettlaufer’s employment file. The very next month, she was hired at another local nursing home, Meadow Park Long Term Care. Almost immediately, she began stealing morphine to get high. Within months, she killed her final victim, Arpad Horvath, resigned from Meadow Park, spent two weeks in Woodstock’s psychiatric hospital, and took two overlapping jobs, one as a nurse for an agency, Lifeguard HomeCare, which rotated her through seven different facilities and another with home care provider Saint Elizabeth Health Care.
During that time, she attempted to kill two more victims. When she learned that part of her work at Saint Elizabeth might involve caring for diabetic children, Wettlaufer resigned. She said later that she hadn’t trusted herself not to hurt them.
In September 2016, Wettlaufer took the train to Toronto and checked herself into the Centre for Addiction and Mental Health. While there, she began chatting on Facebook with Hart, her childhood friend from South Zorra. Eventually, she told him that God had failed her, explaining that she had killed people and God hadn’t prevented her. He called the police. Wettlaufer also confessed to her psychiatrist, who asked for a handwritten statement and reported her to police.
Wettlaufer waived her right to a trial, pleading guilty to eight charges of murder in the first degree, as well as four counts of attempted murder and two counts of aggravated assault. In 2017, she was sentenced to eight concurrent life sentences, with additional years to be served concurrently for the attempted murder and aggravated assault charges. She is serving her time at Institut Philippe-Pinel de Montreal, a hospital with a wing for female inmates where she’s being treated for mental illness. She’ll be eligible for parole in 2041, but as Justice Bruce Thomas noted at her sentencing, she’s unlikely ever to get it. “She was the shadow of death, passing over [her patients] on the night shift,” he said, as Wettlaufer sat, her face devoid of emotion, before him.
In the months following Wettlaufer’s arrest, Helen Crombez, the nursing director who had hired Wettlaufer at Caressant, either quit or was fired—Caressant declined to confirm which. (The home did confirm that it was ordered by the province to temporarily stop accepting new patients.) Then came the lawsuits. Susan Horvath, daughter of Wettlaufer’s last victim, filed a $12.5-million suit against Caressant Care Nursing Home, Meadow Park Long Term Care and the Ontario Nurses’ Association. Her brother, Arpad Horvath Jr., filed his own $250,000 suit, as did Andrea Silcox, Daniel’s sister. None have been settled.
In 2017, Ontario Court of Appeal Justice Eileen Gillese began overseeing a public inquiry to investigate the events that led up to Wettlaufer’s crimes. For two years, at least seven lawyers collected more than 400,000 pages of documents and testimony from Wettlaufer’s employers, colleagues and the families of her victims. Lawyers spoke at length with Wettlaufer herself.
The evidence was damning: By the end of Wettlaufer’s nursing career, she had more than 130 complaints on her record. Brenda Van Quaethem, Caressant’s administrator, testified that the home often opted to discipline Wettlaufer with counselling or verbal warnings because those options were cheaper than suspending a nurse with pay. The wages, and cost of the inevitable union grievance, would come from the same budget pool as other critical expenses, such as payroll and patient care.
On July 31, 2019, the families of Wettlaufer’s victims crowded into a Woodstock hotel to hear Gillese’s conclusions. She found that no individual in the system was at fault, that Wettlaufer’s crimes were made possible by failures of oversight rooted in a failure of imagination that rendered such crimes inconceivable. In Gillese’s opinion, the crucial issue was that there were no systems in place to prevent, deter and detect the type of crimes that Wettlaufer committed.
Gillese outlined 91 recommendations intended to address the systemic failures that allowed this to happen. Many were ideas that wouldn’t cost much money, from stronger education and training requirements for nurses, to more rigorous background checks, particularly when someone has been terminated. The judge suggested stronger medication management systems in nursing homes and strategies to better analyze incidents relating to possible insulin overdoses.
Some recommendations would be more costly. Gillese also called for the provincial health ministry to fund infrastructure changes, like adding windows to medication rooms and improving tracking systems for medications like insulin cartridges. She emphasized the need for a revamped death record system, one with more and better information about individual deaths, which could track evidence-based information electronically to identify spikes and trends.
Unsurprisingly, she also recommended including an increase in the number of registered staff at long-term care homes across Ontario. Wettlaufer herself told the inquiry that chronic understaffing helped to hide her crimes for so long. Gillese said she could imagine Wettlaufer’s crimes happening—and going undetected—at any facility in Ontario.
The inquiry’s recommended staffing increase hasn’t happened, and inadequate staffing has been blamed for some of Ontario’s COVID-19 deaths. Not only that, but Ontario’s Conservative government has quietly reduced inspections in homes across the province, moving away from proactive unplanned inspections to reactive inspections that respond to specific complaints. In 2017, 85 percent of the province’s 626 homes received a proactive inspection. In 2018, the year Doug Ford was elected, that number fell to 60 percent. Last year, proactive inspections were completed at just nine homes in the entire province.
COVID-19 has exposed other systemic failings, too. Low pay is a factor: In B.C. and Quebec, long-term care workers’ wages were increased early on, but Ontario didn’t offer a $4-per-hour salary increase until the second month of the pandemic. In April, the government sent the Canadian Armed Forces into facilities in Ontario and Quebec to relieve overwhelmed PSWs. Military personnel found horrifying conditions, eventually releasing a 15-page report detailing their observations of abuse, contamination, pest infestations and forceful feeding that led to choking. The report centred on five Ontario homes, four of them for-profit and privately owned. There have been calls to do away with for-profit senior care entirely. At least two families have sued facilities, and at least three class-action lawsuits have been launched in Ontario and Quebec.
The Ford government has launched an independent commission into long-term care in Ontario, with a final report due in April 2021. Daniel Silcox calls this idea ludicrous. “We sat through two years of testimony,” he says. “The recommendations have so far been ignored.”
For Silcox, another investigation means a reiteration of compounding problems that complaints and reports have outlined, clearly and at taxpayers’ expense, for two decades. At press time, the Ministry of Long-Term Care told Chatelaine that 80 percent of the recommendations that came out of the inquiry into Wettlaufer’s crimes were “completed or underway.”
Conflating government neglect with Wettlaufer’s repeatedly ignored confessions, Silcox says he’s been forced to confront an ugly truth: Society doesn’t care nearly enough about its elders. “We naively thought there was a standard level of care,” he says. “We were absolutely dead wrong.”