Her story
For the last three years, Marguerite has lived in a publicly funded continuing care home on the south side of Lethbridge. She raised four children on a wheat farm outside Coaldale, taught Sunday school for forty years, and still makes, she’ll tell you, the best perogies in Southern Alberta. What she cannot make anymore are decisions about her own body — not without them going through someone else first.
She has mild congestive heart failure, osteoarthritis in both knees, and the early, patient grief of outliving her husband. She is sharp. She reads the newspaper front to back every morning. She can tell you, without being asked, the name of every nurse on her wing and which of them have small children at home.
In the last year, Marguerite has been moved to a different room twice without being told why. She has had three medications changed without anyone sitting down with her to explain. She has been spoken about, in her own room, as though she were not there. These are not unusual things. They are — according to the survey data that built this persona — the quiet, routine pattern of an experience that Health Quality Alberta’s researchers hear again and again, from hundreds of Albertans like her.
“They are kind to me. I want to say that first. They are kind. But kindness is not the same as being listened to.”
Her daughters visit every other Sunday. She looks forward to those visits the way a farmer watches clouds. Between them, she reads, she watches the hockey, she sleeps badly, she worries — not about dying, she says, but about being small in the room when things are decided.
In her voice
Three short audio excerpts drawn from Marguerite’s interviews. Each is paired with a transcript. Play one in your next team meeting.
“The first time they moved me, I woke up in a different room and I thought maybe I had — you know — gone confused in the night. But it wasn’t me. They’d moved my bed while I was asleep. Nobody said a word about it the day before.”
“They changed one of my heart pills. I found out because I was given a different colour at breakfast. I asked the girl what it was and she said, ‘Oh, that’s the new one, didn’t they tell you?’ Well. No. They did not.”
“I was a person before I came here. I still am. I am not a problem to be solved quietly in the hallway. Just — please, tell me what is happening. Tell me first. I can take it. I have taken worse than this.”
By the numbers
Marguerite’s persona is a composite. The chart below compares the response patterns of Albertans like her against the provincial average on four dimensions from the Continuing Care Experience Survey.
Data source: Alberta Continuing Care Experience Survey, composite from the lowest-rating cluster (n = 2,104). Dimensions drawn from the renewed Alberta Quality Dimensions for Health.
A day in her care
A composite Tuesday — the quiet kind of day that shows up in the data as a dip in trust, a shrug on a satisfaction form, a one-line comment on the back of a survey page.
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7:40 AM
A new pill at breakfast
The morning aide hands Marguerite a medication she has not seen before. When she asks, she is told — kindly — that it is “the new one.” The change was ordered yesterday. No one spoke to her about it.
Communication gap -
10:15 AM
Rounds outside her door
Two clinicians discuss Marguerite’s care plan in the hallway. The door is open. She hears her last name twice.
Dignity -
1:30 PM
A moment of good care
A recreation therapist sits with Marguerite for twenty minutes and asks about her husband. Marguerite will later call this “the best thing that happened all week.”
Person-centred -
4:50 PM
A room change
Marguerite’s belongings are moved down the hall to free up a bed. She is told about the move while it is happening.
Agency -
9:00 PM
The survey arrives
Marguerite circles “somewhat dissatisfied” on the day’s experience form and writes, on the back, in careful handwriting: “They are kind. I would just like to be told things first.”
The data point we almost missed
What this means for care
Marguerite’s persona is not a complaint. It is a pattern. Across the Continuing Care Experience Survey, Albertans in Marguerite’s cluster consistently report strong ratings on cleanliness, safety, and the warmth of frontline staff — and consistently low ratings on two things: being told what is about to happen, and being included in the decision.
For clinicians, that is a design question more than a clinical one. It is about a thirty-second conversation before a medication change. It is about closing a door before rounds. It is about sitting, not standing, when you deliver news.
Say it first
Before any medication change, room move, or scheduling change, the person directly affected should be told — by name, at eye level, before the change happens.
Close the door
Conversations about a resident should not be audible from a resident’s bed. If they are, the resident is still in that conversation, whether you know it or not.
Ask, don’t narrate
Replace “we’re going to…” with “are you ready for us to…”. A question invites agency where a declaration removes it.
Read the back of the form
Survey free-text is where the Marguerites of our system tell us what the scale can’t capture. Build the routines that ensure it reaches the people who can act on it.
Discussion questions
- Can you think of a change — medication, schedule, room, roommate — that a resident on your unit learned about by noticing it, rather than by being told?
- If you had thirty seconds with Marguerite at the start of her day, what would you tell her first?
- What is one routine on your unit that could be redesigned to make sure residents are spoken to, not about?
- Which of Marguerite’s four lowest-rated dimensions do you believe you could measurably improve in the next quarter?
A construction worker who waited seven hours to be told his son was stable. He asked three times what the medicine was for.