Carol Kuszniaj recalls the last time she and her mother, Ruth Murray, sang together.
She was visiting her mother at Emerald South nursing home. The two sat in the community room and sang "You Are My Sunshine." Her mother knew the words, so that was the song they always sang.
Her mother seemed so happy that Kuszniaj took a selfie shot of the two of them together. Her mother looked right into the lens and offered a small grin.
The next day, Kuszniaj took more pictures of her mother. But this time, it was to document the deep purple bruises blooming all over her mother's body, the gashes across her temple and nose, and the blood that trickled down her neck.
Her 82-year-old mother who suffered from dementia had wandered into another nursing home resident's room. That resident, apparently thinking Murray was an intruder, beat her so severely that she ended up at Erie County Medical Center in critical condition with broken bones and a collapsed lung.
Kuszniaj's eyes spilled over with tears as she snapped photo after photo of her mother's broken frame.
Three days later, her mother died.
Kuszniaj's eyes filled with tears again on Friday. But they were tears of happiness and relief as County Executive Mark Poloncarz signed "Ruthie's Law" and handed Kuszniaj and other family members a copy.
The new law, fast-tracked by the County Legislature, requires that all nursing homes in Erie County contact designated loved ones within two hours and provide "all known information" if a resident suffers serious injuries requiring outside treatment.
"I can't think of a better thing government can do," Poloncarz said. "At its core, government has a responsibility to protect its citizens."
Ruthie's Law also requires nursing homes to give prospective nursing home patients and their families a copy of the nursing home's performance rating and to provide a summary of incident reports to the county's Department of Senior Services twice a year.
Murray's family members, including stepdaughter Dawn Murray, called Ruthie's Law "a step in the right direction."
But representatives for Erie County nursing homes have said the law conflicts with state and federal nursing home regulations, and therefore is unenforceable.
They also said some provisions of the county law duplicate what state and federal laws already require, such as the mandate that nursing homes "immediately" alert family members when serious injuries occur. The county would be better served advocating for more nursing home beds allocated toward patients with severe behavioral problems, they said.
Ruth Murray's story
Murray's story highlights the tragic consequences when good options are scarce.
Murray was a friendly and active woman through her late 70s. She could walk for miles. She used to run deliveries for a printer and volunteered to make blood bank runs for the Red Cross. No one anticipated that she would suddenly suffer a series of health setbacks in 2014 and 2015 that landed her in the hospital and contribute to a rapid mental decline.
What started as a bowel obstruction turned into a septic infection. Murray also underwent two bouts of treatment for breast cancer and suffered adverse mental effects from anesthesia, Kuszniaj said. Before long, Murray was leaving oven burners on and mistakenly mopping the kitchen floor with cooking oil. Her husband and family could no longer adequately care for her.
She spent a month in the dementia unit of Buffalo General Hospital before her family was told they needed to move her to a different facility. The family worked with a Medicaid caseworker who found several nursing home options for Murray.
Because Murray was a poor Medicaid patient, "the only ones we were given choices for were low-rated," recalled Sandra Smith, another daughter who lives in San Antonio, Texas.
Emerald South home
Murray, a known wanderer at the nursing home, had been at Emerald South nursing home for a year when she apparently walked into a fellow resident's room. The man, who had been at the nursing home for less than two weeks and reportedly had a history of aggression toward other residents, mistook Murray for an intruder, family members said.
Kuszniaj and Murray's sister, Louise Spahn, were running a yard sale that morning when Kuszniaj got a call from a nursing home. A staff member said Murray had gotten into "an altercation with another resident."
Kuszniaj asked how serious the injuries were and she said she was was told her mother suffered a cut and bump her on her head.
When Kuszniaj asked if she should go to the hospital, the staffer said Murray likely would be evaluated at the hospital and returned to the nursing home within a few hours, Kuszniaj recalled. The staffer indicated that a rush visit to the hospital was unnecessary and that Kuszniaj could visit her mother at the nursing home later in the day, she said.
After a few hours passed, however, Kuszniaj's sister became suspicious and called the nursing home from Texas. Smith then asked for the number to ECMC and spoke with an emergency room doctor there. The doctor informed her that their mother was in critical condition and listed her injuries.
"I said, 'I think you have the wrong person,' " Smith recalled.
But the doctor didn't have the wrong person.
Smith interrupted the doctor to call Kuszniaj and Spahn, telling them to rush to the hospital. Kuszniaj was the first to walk into her mother's room.
"They opened the curtain, and I screamed," she said.
She backed up and slid down the wall. Spahn reached for Kuszniaj and pulled her into a chair before laying eyes on her sister. Then she walked into the hallway and wept.
The graphic photos Kuszniaj took showed her mother black, blue and bloody. Her neck, nose and jaw were broken. So were 11 of her ribs and the bones on the right side of her face. Her lung had collapsed and had to be reinflated twice.
That weekend, Smith flew in from Texas. She had her laptop with her and used it to play all of her mother's favorite songs.
But Murray never recovered. She went from being agitated but alert on Friday to gradually slipping into oblivion. One of the last times family members recalled Murray opening her eyes was when they sang her "You Are My Sunshine."
Three days after her hospital admission, Murray's breathing changed. Within a few hours, she was gone.
The family doesn't blame the nursing home resident who beat Murray for what happened. He had no understanding of what he was doing. But the family does blame the nursing home and is suing Emerald South for failing to keep Murray safe.
Kuszniaj and Smith, whose father died at a young age, lost their last remaining parent last summer. But the siblings said that for the first time Friday, with the signing of Ruthie's Law, they feel something positive may finally come from all the devastation.
"I'm really hoping that it actually does some good," Smith said.