Lagging seniors health care affects CVH, distressed caregivers
With the Island’s largest over-65 population percentage and one of the lowest number of residential care beds per capita, Comox Valley caregivers are in distress and hospital workers feel the brunt of overcapacity and understaffing. VIHA says more beds and support services are coming, but health care workers worry they won’t be enough to fix “a system in chaos.”
This is the fourth in a series of articles about problems surfacing at the new Comox Valley Hospital. Previous articles have examined staff morale, hospital planning and changes in culture and procedures.
Unexpected problems at the new $350 million Comox Valley Hospital — low staff morale, overcapacity, understaffing and overtime expense — have largely resulted from questionable decisions in the planning process and a shift to Vancouver Island Health Authority (VIHA) culture and procedures, according to sources in a two-month investigation by Decafnation.
But there’s another elephant in the room: The failure of the B.C. Ministry of Health to provide sufficient resources for seniors health care has pushed the Comox Valley to a crisis point.
The new CVH was built for a maximum capacity of 153 beds, although it was budgeted and staffed for only 129. That left room to add 24 additional beds by 2025, based on planners growth projections.
But the hospital has had more than 150 admitted patients on a regular basis since it opened. On Jan. 10, 2018, there were 168 admitted patients, already 15 over the expected 2025 maximum capacity and 39 over the number for which VIHA has budgeted and staffed the hospital.
That has escalated the understaffing problem and heightened awareness of inefficiencies in the building’s floor plan. It’s caused patient flow issues affecting the emergency department and the Intensive Care Unit, say our sources.
The winter months are typically the most stressful for health care providers everywhere as influenza and other illnesses tend to peak, which CVH planners would have taken into account. But that’s not the critical source of overcapacity at CVH.
About 46 of those 168 patients on Jan. 10 required an alternate level of care (ALC). These are patients, mostly elderly, who no longer need acute care and should be discharged and transferred to specialized care beds, usually in a residential care facility — sometimes referred to as long-term care.
Except there aren’t any residential care beds available.
This is not a new problem for the Comox Valley, or Vancouver Island. Almost every Island community has struggled with a shortage of residential care beds for over a decade.
But our sources say the shortage has already reached crisis proportions in the Comox Valley, and it’s about to get worse.
How did this happen?
The Comox Valley has a higher percentage of its population over the age of 65 (26 percent) than Victoria (21 percent), and both are higher than the provincial average (18 percent).
We also have the highest percentage in B.C. of people over the age of 85 who are now living independently, say our sources. When those people can no longer live on their own, the Comox Valley will suffer the most.
And yet, the Comox Valley also has one of the lowest number of residential care beds per capita funded by VIHA, according to our sources. But they say the VIHA method of determining the right number of beds for a community is vague.
For example, British Columbia has a total number of residential care beds equal to 7.4 percent of province’s population over age 75. That number drops to 6.8 percent on Vancouver Island, and goes down further to 5.3 percent for the Comox Valley.
Or, if VIHA based the number of residential care beds on 75 beds per 1,000 people over the age of 75, which is roughly the provincial average, then Vancouver Island would be short by 10 percent and the Valley by a whopping 30 percent.
There is an immediate need for more than 150 additional residential care beds in the Comox Valley, our sources say. Some put the number closer to 200.
Some of our sources attributed the problem, in part, to a 2003 shift in senior health care policy.
That was the year the B.C. Liberal government introduced a new assessment process to restrict access to residential care to only those needing “complex care,” meaning medical services. The result was that those who qualified for residential care were more acute (sicker), and this shortened the length of stay from 2.5 years to 1.8 years.
FURTHER READING: Residential long-term care planning: The shortcomings of ratio-based forecasts
Our sources believe this caused VIHA to decide fewer residential care beds were needed to service the same intake rate.
How has this affected the new hospital?
Those responsible for planning the new CVH made the assumption that although there were 40-some ALC patients in acute care beds at St. Joseph’s, the new hospital would have none. They incorrectly assumed there would be sufficient residential care bed capacity in the Comox Valley by the time the hospital opened.
That strategy might have worked, or at least diminished the current problems at CVH, except VIHA was slow in issuing a Request for Proposals and awarding the contract for new or replacement beds. And then, it cancelled the RFP completely.
On Sept. 30, 2016, the Vancouver Island Health Authority (VIHA) issued an RFP for 70 new or replacement residential care beds for the Comox Valley. The press release said contracts would be awarded in April 2017.
Construction would start in the summer of 2017 and the beds would not open until the summer of 2019, nearly a year and a half after the hospital opened in October of 2017.
But, on Aug. 3, 2017, VIHA cancelled the RFP, shortly after its board of directors decided the four hospice beds located at St. Joseph’s should be moved to a secular facility that could provide Medical Assistance in Dying (MAiD).
Tim Orr, the director of residential services for VIHA, told Decafnation that the restriction on providing MAiD at the Catholic-operated site was one of several factors in the decision to cancel the 2016 RFP.
As of Jan. 23, 2018, no new RFP has been issued. Given the original three-year time frame from issuing an RFP to opening the beds, the Comox Valley is unlikely to see any new residential care beds before 2021.
With ALC patients unaccounted for by planners, CVH was overcapacity when it opened its doors and has remained so for the first four months. This has exacerbated the transitional problems at the new hospital.
These problems include patient flow. There are usually no available beds for people treated in the emergency department (ER) who need to stay overnight. So the ER expansion area has been filled with acute care patients.
The same problem occurs in the Intensive Care Unit, our sources say. Due to timing issues, there is often not an acute care bed to move patients out of ICU when they no longer need that specialized care.
FURTHER READING: Strengthening seniors care delivery in B.C.; Abbeyfield closure highlights seniors housing issues
And the additional unnecessary cost to taxpayers is significant. Acute care beds cost taxpayers between $800 to $2,000 per day, while residential care beds typically cost about $200.
The BC Care Providers Association has proposed redirecting some acute care funding to the development of new long-term residential care facilities.
Caregivers in distress
Hospital workers aren’t the only Comox Valley people affected by the residential care bed shortage. Family members are on the front line of this problem.
“The system is in chaos,” said one source. “And family caregivers are covering it up.”
According to B.C. Seniors Advocate Isobel Mackenzie there are roughly one million unpaid caregivers in B.C. 91 percent of them are family members, usually adult children (58 percent) or spouses (21 percent).
Mackenzie estimates these unpaid caregivers save the provincial government $3.5 billion per year.
In an August 2017 report, “Caregivers in Distress: A Growing Problem,” Mackenzie said 31 percent of unpaid caregivers were in distress in 2016, which represented a 14 percent increase in the actual number of distressed caregivers over the previous year.
She defines ‘distress’ as anger, depression and feeling unable to continue.
This has resulted in horrific personal tragedies.
Multiple sources have collaborated accounts of unpaid caregivers falling ill themselves due to the stress for caring for loved ones, including medical emergencies that require hospital stays. This means their loved ones also end up in acute care hospital beds, waiting for a residential care bed from there.
Some unpaid caregivers have even been stressed to the point of dropping their loved ones off at the hospital emergency department and refusing to take them back home, although this is rare, according to our sources.
Caregivers are distressed because there is so little help available.
The experience of trying to get a loved one onto the list for a residential care bed can be a long and frustrating experience, our sources say. The patient must not only meet the “complex care” requirement, but must also exceed the care that Community Health Services (formally called Home and Community Care) are able to provide.
The Comox Valley has only two Adult Day Care programs that give caregivers a break to attend to personal matters, such as cleaning their house, running errands and looking after their own health through exercise or socializing.
And the wait to get into ADC programs can take up to a year, and it’s restricted to one or two days per week.
In her report, Seniors Advocate Mackenzie said that access to ADC programs has declined by five percent across B.C. and that the number of days accessed was also reduced by two percent.
There are only two publicly funded respite beds for the Valley’s population of 66,500, so it can take caregivers up to a year to schedule a bed. Respite beds take loved ones for a week or two to give the caregiver a break.
The Comox Valley does have one additional private respite bed. It requires a 14-day minimum stay at $200 per day, which is unaffordable for some caregivers.
How VIHA has responded
Tim Orr, the director of residential services for VIHA, told Decafnation that “Enhancing residential care bed capacity in the Comox Valley is a top priority.”
“We are currently experiencing high patient volumes at our hospitals, including North Island Hospital Comox Valley campus,” he said. “Patient volumes do not appear to be tied to any one cause, and the Emergency Department is busy with patients presenting for a wide range of issues. Occupancy fluctuates daily; and often several times throughout the day depending on ER volumes and patient discharges.”
But Orr cannot say when VIHA will issue an RFP to build more residential care beds here. It’s expected, but not guaranteed, that the RFP will be released sometime this winter.
In response to questions from Decafnation, Orr said VIHA recognizes that the Comox Valley needs more complex care beds and is working with the province to issue an RFP for additional complex care beds.
“This new capacity will help meet the current need and Island Health will continue to monitor the need in communities across Vancouver Island and add capacity where most needed as resources come available,” he said.
Orr said VIHA looks at the population over 75 years of age in addition to reviewing what home supports and other community resources are in place.
“The general population health is also a determining factor that drives demand for LTC and Island Health then determines which communities have the greatest need for new long term care capacity,” he said.
NDP MLA Ronna-Rae Leonard gave Decafnation the following statements:
“The new Comox Valley (residential care) facility was long anticipated in our community. I understand Island Health is taking a step back … Our government is working hard to increase the overall residential care spaces in the Comox Valley to address the aging population needs.
Regarding other issues raised in the Decafnation series, she said, “I look forward to hearing the results and how any issues that have been raised will be addressed. I have passed along the concerns I’ve heard about the new hospital to the Minister’s office.”
What’s next?
The Comox Valley ranks among the favorite places for Canadians to retire. So it’s no surprise that our population has aged at a rate nearly double the provincial average.
Without a major expansion of seniors health care infrastructure to deal with this influx, the problems at the new Comox Valley Hospital and the distress felt by unpaid caregivers in our community will worsen.
Our sources say that in addition to “hundreds more” residential care beds, the Comox Valley also needs improved access to ADC programs and more timely access to respite care. They also feel a review of Community Health Services may be required.