Abbeyfield closure highlights seniors housing issues

by George Le Masurier | Oct 19, 2017

They come here to retire. They come from across Canada, the United States and other countries. They come for the Comox Valley’s moderate climate and spectacular landscape.

They come, they stay and they age. And so the Comox Valley’s population has aged at a rate nearly double the provincial average.

Within the next 20 years, the Valley’s population of people 75 years old and older is predicted to double. People over the age of 65 already comprise almost a third of the Valley’s total population, and it will continue to be the region’s fastest growing age group.

They come because the Comox Valley is well-known as one Vancouver Island’s best places to retire.

But it’s less well-known that as a result of this increasing elder population, the Comox Valley has become a not-so-great place to grow old.

Especially for those of modest wealth.

If you can afford them, and find a vacancy, the Comox Valley appears to be awash in private seniors independent- and assisted-living facilities. Most are full and have long waiting lists, and new units sometimes sell out before construction begins.

But for seniors surviving at the lower end of the income scale, and those who need government assistance, there are fewer choices.

That’s why the recent closure of Abbeyfield House in Courtenay, which displaced 10 senior citizens from their independent living home, has created such a community uproar.

Abbeyfield House

The backstory of Abbeyfield’s closure reveals the root problem: There is a dearth of residential care beds and affordable seniors housing in the Comox Valley.

The province’s 12 Abbeyfield Houses are designed for lower income seniors and those who prefer a smaller facility. The houses, including six on Vancouver Island, provide affordable housing for people over the age of 55 who are capable of living independently, but want a “supportive domestic atmosphere (that) provides companionship and freedom from worries and chores.”

As Abbeyfield residents age and their health declines, and they can no longer live independently, it is expected they will move to more appropriate residential care facilities. Then Abbeyfield Houses can make room for independent seniors on their waiting lists. The Courtenay Abbeyfield House had more than 30 eligible seniors on its wait list.

Except there haven’t been any available beds in residential care or similar affordable housing facilities in the Comox Valley. And none of the Abbeyfield tenants wanted to move. They were content with the excellent “at home” care provided by Island Health’s home care program, which it would have continued to do if Abbeyfield had remained open.

When Abbeyfield closed last week, its youngest resident was 91. She should have been moved into residential care years ago, but Island Health had no where to put her. Instead, seven different Island Health professionals have been making an average of 115 visits per week to care for her and other (not all) of the Abbeyfield residents.

Many 91-year-olds do live in the community, however, some with support and some who can still manage independently. Age is not always an indicator of need for residential care.

Island Health told Decafnation that it supported Abbeyfield tenants to continue living in the community — as they do with any person who chooses to remain as independent as possible and who needs support.

But because the Comox Valley lacks sufficient residential care beds to meet growing demand, Abbeyfield had become a hybrid type of care facility to which it didn’t aspire or could afford.

The story of one Abbeyfield resident illustrates how ridiculous the situation had become.

An elderly woman resident suddenly required acute hospital care. The hospital treated her and then sent her back to Abbeyfield on a stretcher. She was bed-ridden. Abbeyfield sent her back to the hospital, which refused her and she landed back in Abbeyfield with Island Health workers providing the care she should have been getting in a long-term residential facility.

One Abbeyfield resident suffering from dementia has occasionally wandered off the premises, requiring the House Coordinator to find and rescue her. But the House Coordinator’s job is only to prepare meals and to do other household chores. There is no overnight supervision at Abbeyfield Houses.

When Abbeyfield closed its doors, Island Health was forced to find placements within the Valley for the tenants, which created a momentary housing crisis. Other people, who desperately needed beds and had waited patiently on the waitlist, were bumped — or triaged — to accommodate the soon to be homeless Abbeyfield tenants.

Placement in publicly-funded residential care is based on several factors, according to Island Health, including urgency and need, and the type of bed and geographical area selected. It is not a first-come, first-serve system.

Most of the former Abbeyfield tenants are now receiving care at Casa Loma; two went to live with family and one resides in another local residential facility.

But another group of citizens, called Save Abbeyfield, believes the Abbeyfield model is still viable in the Comox Valley. And they have offered to step-in and re-open the residence.

They hope to do that before the current board sells the property or gifts it to another non-profit organization.

Jennifer Pass, one of the Save Abbeyfield contacts, said they would address the residential bed crisis in a different way.

“It is necessary to have good relationships with sponsors, and have two sponsors for every tenant,” she said. “Sponsors must be well aware, when their relative or friend moves in, that it is for “independent” seniors. If the resident gets to the point of putting other tenants at risk, and if one has not the support of Island Health in moving the person along, then it may be necessary to evict the person.

“Often a person is hospitalized and then it may be crucial to not allow the person to return to the facility (Berwick, Casa Loma, etc.) all have to deal with this situation.

“I found with my mum that a clear letter as to whose responsibility it would be if she returned to Casa Loma (an assisted living facility) and had a fall or suffered physical harm in assisted living can be very helpful if presented to hospital staff.

“Having sponsors on side is very helpful, and achieved by good lines of communication from the outset.”

Pass and Abbeyfield board chair Joan Carson could probably agree on one point:

The lack of affordable housing for seniors and a lack of residential care beds are distinct problems that became linked because Island Health looked at Abbeyfield as a safe place to park people — its tenants were getting meals and some supervision.

Regardless of whether Abbeyfield reopens, a crisis-driven method of initiating change for our elders is unacceptable. Surely the provincial Ministry of Health can do better than this.

In response to a request for comment, MLA Ronna-Rae Leonard returned the following statement:

“It must have been very stressful for the tenants and families to learn that Abbeyfield was closing. I am glad that all 10 of Abbeyfield’s tenants have been placed in new homes – this is great news.

“One of our new government’s top priorities is improving the services people count on, and we’re working hard, but 16 years of B.C. Liberal neglect can’t be fixed overnight.”

It’s a politicized comment. And disappointing that the newly-elected MLA couldn’t say she was doing something specific to assuage a growing community concern.

And the problem gets worse

Seniors who require residential care beds aren’t just plugging facilities designed for independent seniors, they are also taking up acute care beds — and acute care funding.

Chris Kelsey, chair of the St. Joseph’s General Hospital board, estimates that more than 30 percent of the community’s acute care beds are occupied by people who need an alternate level of care (ALC). In other words, there are perhaps 40-50 frail and elderly people, who do not need acute care, taking up beds at the new Comox Valley Hospital because there is nowhere more appropriate to move them.

This problem isn’t unique to the Comox Valley, but it’s more severe here.

According to a 2015 report by the B.C. Care Providers Association, “roughly 13 percent of every bed-night (province-wide) is being used by somebody who should be at another level of care.”save Abbeyfield

Acute care beds cost taxpayers between $800 to $2,000 per day, while residential care beds typically cost about $200. The BCCPA has proposed redirecting some acute care funding to the development of new long-term residential care facilities.

Kelsey said St. Joseph’s recognized this problem many years ago when it created a transition unit to park people who were previously treated as medical patients, but no longer needed that level of care. It was a controversial move at the time, but is now common among the province’s hospitals.

Is long-term care help on the way?

The scope of the Valley’s problem starts to come into focus when you consider that just 4 percent of the senior population will want or require residential care and there are already 421 residential care beds in four publicly-funded Comox Valley facilities. All of them are full and they all have waiting lists.

Island Health planned to build 70 new residential care beds in the Comox Valley, and issued a Request For Proposal last year. That many new beds would have eased the pressure on many other organizations, including Abbeyfield.

But over the summer, Island Health withdrew the proposal shortly after the change in provincial government and its decision to move the four hospice beds at St. Joseph’s General Hospital to a secular facility, along with two new hospice beds.

The 70 new residential care beds are urgently needed, and their imminent construction gave hope to elderly caregivers and also to housing providers, such as Abbeyfield House.

But the withdrawal of the RFP was crushing. Local care givers now fear a multi-year delay in bringing the new beds into service. But Island Health is more optimistic. The agency told Decafnation that the new beds should be ready for occupancy in late in 2019.

Island Health Director of Residential Services, Tim Orr, says the RFP was withdrawn due to changing requirements and community input. That included whether people would have access to Medical Assistance in Dying (MAiD) and where to locate the four existing and two new hospice beds.

But increasing the number of residential beds in the RFP was also part of the discussion. Orr said Island Health recognizes the Comox Valley’s need for more residential beds, but also for more affordable housing for independent seniors. Other communities have more of the latter.

Orr said faith-based providers, such as St. Joseph’s, are not excluded from responding to the RFP because the typical level of cognitive deficit of residential care patients excludes them from qualifying for MAiD.

One bright spot in this quagmire is the proposal to redevelop and refocus The Views, a 117-bed residential care facility operated by St. Joseph’s. They are planning a dementia village facility, perhaps with more beds, surrounded by a campus of seniors care services that might include a pharmacy and seniors daycare.

They plan to proceed regardless if they are successful in a bid for the additional residential beds contract.

About 90 percent of The Views’ residents have dementia. And while the average age of residential care patients has declined, the percentage suffering with dementia is likely to increase.

To build its vision, St. Joseph’s intends to merge with Providence Health Care in a new society not governed by the B.C. Hospital Act. Because the province does not provide funds for capital construction, the new society could borrow against its assets and future revenue.

Kelsey is confident that Island Health supports this vision, especially since Providence already plays a leading role in B.C. dementia care.

Where do we go from here?

The residential bed crisis in the Comox Valley is a complex problem. It involves medical, ethical and financial issues that won’t be solved by multiple groups asking the provincial government for a variety and sometimes conflicting resolutions.

For political and practical purposes, Victoria wants to hear The Valley speak with only one voice.

But what voice? The absence of a Comox Valley-wide co-ordinating authority has in the past led to short-term thinking and patchwork solutions on a number of different fronts — sewerage, water treatment, transportation and so on.

In order to develop a regional strategy on elderly care and seniors housing for all income levels, all the disparate Comox Valley groups must work together. That doesn’t mean everyone has to abandon their philosophical principles.

It means finding common ground, those points on which there is collective agreement, such as the urgent need to provide more residential care beds. The Comox Valley needs to speak to Victoria in a singular voice on that issue.

Sewer commission passes on chance to follow own plan

by George Le Masurier | May 14, 2017

Given yet another opportunity to follow its own Master Plan this week, the Courtenay/Comox Sewer Commission chose to ignore it. Again.

A letter from two residents of the Area B neighborhood most affected by the proposed construction of a multi-million dollar pump station requested a minor restructuring of the commission’s membership.

But the residents were really questioning the commission’s governance of matters outside of its existing mandate. A matter that the commission’s 2011 Sewer Master Plan said should have been addressed six years ago, but which they have disregarded.

In their letter, David Battle and Lorraine Aitken asked that the Area B director be added to the commission on a limited basis. He or she would participate and vote only “on issues relating to any existing or proposed infrastructure in Area B.”

It’s a reasonable request. If the elected officials of Courtenay and Comox propose to build infrastructure outside of their municipal boundaries, then the elected representative of those in the affected area should have a voice and a vote.

Democracy is based on the idea that all citizens will have a voice in government — their own or their elected representative’s — on matters that concern them. But residents of Area B have been denied representation.

The Courtenay/Comox Sewer Commission comprises members only from Courtenay, Comox and CFB Comox. But where it places sewer pipes, pump stations and treatment facilities affect people outside of those jurisdictions.

The commission’s 2011 Sewer Master Plan anticipated this problem, and is absolutely clear about the appropriate resolution.

The Master Plan says that before the commission embarks on any of the plan’s identified projects, it should create a governance structure for areas outside of the City of Courtenay and the Town of Comox.

Presumably that would entail giving fair representation — voice and vote — to people in areas affected by the commission’s actions.

It’s no surprise that commission members haven’t undertaken even a simple review of governance structure in the six years since the Master Plan was adopted. The commission has consistently neglected those parts of the plan that seemed troublesome, expensive or that might have prevented them for doing whatever they want.

For example, the Master Plan calls for the commission to review and revise the plan every three years. It wasn’t done in 2014, as it should have been, and still hasn’t been done. Other plan initiatives have also been ignored.

The commission and Comox Valley Regional District engineering staff have a long history of ignoring the advice and concerns of the community on sewerage issues. The regional district has been successfully sued twice over engineering mistakes that citizens warned against.

And history is repeating itself. The Sewer Commission has bungled the proposed Comox #2 pump station project from the beginning. It planned the project and purchased the property in secret. It intentionally withheld announcement of its plan and property purchase until after the 2014 municipal elections.

And the commission continues to treat legitimate citizen concerns with disdain, adopting a confrontational posture, rather than trying to find a win-win solution.

The letter from Aitken and Battle presented the commission with an opportunity to change course, and resolve the Comox #2 pump station outrage before the situation devolves into new lawsuits.

The commission should have treated the residents’ letter with respect, and fulfilled its obligations under the Sewer Master Plan, by undertaking a review of its governance structure and decision-making framework that would address Aitken’s and Battle’s concerns.

Instead, they deferred the matter to their June strategic planning workshop. That could be seen as a positive step.

But without advance work to develop possible options and process requirements, legal opinions and geopolitical analysis, nothing definitive can come from the June session. At best, the commissioners will ask that this same work be done and they’ll discuss it again. Later.

To those already suspect of the Courtenay/Comox Sewer Commission’s intentions, this looks like an insincere stalling tactic, perhaps to avoid immediate legal action.

It would be lovely if it were not, and the commission finally recognized the legitimacy of the neighborhood’s concerns and the better and less expensive options available to them.

Valley faces a watershed moment

by George Le Masurier | Mar 31, 2017

Comox Councillor Barbara Price has offered up misleading statements to defend changes to an antiquated sewerage system that serves only Comox and Courtenay residents.

Price chairs the Comox Valley Sewage Commission, which is itself a misnomer. The Sewage Commission does not serve or represent the Comox Valley. It represents the sole interests of the Town of Comox, the City of Courtenay and CFB Comox.

A nearly equal amount of the Comox Valley’s population resides outside these two municipalities and relies on septic systems and wells for their water and sewage treatment. The Village of Cumberland manages its own wastewater.

So Price stretches the truth when she writes that the Comox Valley Regional District is “… planning and managing sewage operations for the region.” That’s a true statement only if you narrowly define ‘region’ as Courtenay and Comox. But Price attempts to give the impression of a broader interest.

The irony of Price’s fake fact is that a Valley-wide sewerage system is exactly what the CVRD should be doing. Instead of furthering the patchwork delivery of wastewater services, which creates inter-jurisdictional fights, the Comox Valley should have a 21st Century model for comprehensive and fair delivery of wastewater collection and treatment.

The issue of the moment is the Courtenay-Comox Sewage Commission’s plan to build a large pump station on Beech Street, which resides in Area B, not within the municipal boundaries of either the Town of Comox or the City of Courtenay.

On that point, Price also misleads readers when she suggests that the commission followed “proper processes” in selecting the Beech Street site, which she also calls the “preferred location.”

A proper process to site such an important public facility would have been transparent. As is required in the Town of Comox, several possible locations would have been identified and the public would have had input before the commission authorized purchase of any property. A fair process would have given a vote to the Area B director who represents people most directly affected by the facility.

But the sewage commission did all of this work in secret. By shutting out the public, and delaying announcement of the property purchase until after the 2014 municipal elections, the commission showed a callous disregard for public sentiment and open governance.

The Beech Street location was not the preferred location of the commission’s own Advisory Committee — formed after the property purchase was announced and comprising elected officials, staff and Beech Street neighbors. The committee gave its top recommendation to upgrading the existing pump station in Courtenay, and for good reason.

Two separate financial analyses — one by the regional district itself and another by a qualified citizen — showed that upgrading the Courtenay No. 1 pump station was less expensive. The independent report predicted savings of $7 million to $12 million in the long-term.

In her op-ed column Price writes that the Comox No. 2 pump station will only be built if it “can be built safely, without harm to neighbours and their necessities (such as well-water access.” CVRD Engineer Kris La Rose made a similar promise in a meeting with Beech Street neighbors last summer. He promised the new pump station would not create any odour or noise discernible beyond the facility’s property line.

Those are bold promises. But can the public have any faith in their veracity? The Courtenay/Comox Sewage Commission made similar promises to residents of the Willemar Bluffs about property erosion and to the Curtis/Brent road residents about odours.

Both sets of residents successfully sued the regional district because the commission’s promises were proved untrue. More than 30 years later, odours from the treatment plant still drift through the neighborhood, which remains skeptical of yet another plan in 2017 to fix the problem.

The Comox Valley faces a watershed moment. Elected officials can choose to invest in patchwork infrastructure that shackles us for decades to deteriorating and outdated technology, or they can create a 21st Century model: a Valley-wide shared service that addresses population growth, new technology and climate change and takes in more service areas and more ratepayers so the burden — and benefits — can be shared more widely.

If not now, then when?

Does the Comox Valley have visionary leaders who see the big picture and consider the long-term? Do we have leaders willing to debate the merits of building a world-class Valley-wide sewerage system with tertiary treatment and resource recovery?

Or, do we have leaders stuck in the past, afraid to think of the greater good because it would be a long, hard sell to voters?

Other North American cities already clean their wastewater to point of reinjecting it into groundwater supplies and, in some cases, directly back into public drinking water systems. They use the byproducts of treatment to fuel their plants, and provide suitable water for agriculture irrigation.

Why can’t the Comox Valley take such a forward-thinking approach?

Social Studies 02.20.2017

by George Le Masurier | Mar 4, 2017

If you hate the same things, you might fall in love

How did Valentine’s Day turn out for you? Not so good? You might want to try the new dating app called Hater. It’s based on the premise that long-term compatibility depends more on the things you hate than what you love.

The scientific basis behind the app comes in part from a 2011 study by psychology professor Jennifer Bosson published in Personality and Social Psychology Bulletin. The study argues for the merits of shared negative attitudes, which are more likely to create lasting bonds than mutual likes.

And politics plays a significant role. According to a recent Reuters poll, 13 percent of U.S. couples have called it quits over the presidential election. One 73-year-old California woman divorced her husband after 22 years of marriage because she felt betrayed that he voted for Trump.

Courtenay Mayor Larry Jangula pops his cork over the CVRD

Courtenay Mayor Larry Jangula exploded into an angry rant recently about wasteful spending at the Comox Valley Regional District. He’s not wrong.

For example, the CVRD plans to overspend on a number of patchwork sewerage system projects. It wants to build a controversial new pump station in Comox, when the CVRD’s own financial analysis shows that upgrading the Courtenay #1 pump station is the better and less expensive option. That alone could save millions of dollars.

CVRD data also shows that in the long-term it would be less expensive to expand the existing Comox pump station at Jane Place than build a second one.

And the CVRD has designed a system to replace the HMCS Quadra sewer outfall at a cost of more than $1.7 million dollars. The province’s most innovative septic system designer says the CVRD’s design is overbuilt, and estimates an alternative solution could cost less than a half-million dollars.

Taxpayers should ask their elected officials why they aren’t pressuring the CVRD to rein in these costs.

It’s immigrant entrepreneurs who make America great

According to the National Foundation for American Policy, immigrants are just as likely to be successful leaders in business as people born in the U.S.A.

The think tank says immigrants have founded close to half of the startup companies estimated to be worth more than $1 billion. That group includes Apple co-founder Steve Jobs, the son of a Syrian immigrant, and Sergey Brin, a refugee from the former Soviet Union, who co-founded Google.

Reason No. 1069 why we should start over on another planet

Princess Diana campaigned to ban land mines and to remove those left behind long after conflicts have ended. Former First Lady Michelle Obama promoted exercise and healthy diets to stem the growth of childhood obesity and early onset diabetes in America.

Melania Trump, on the other hand, sees her First Lady role as a money-making opportunity. She’s suing a British tabloid for $150 million because it reported that she had once worked for a modeling agency that was actually an escort service for wealthy men.

How did she justify the $150 million in damages? She claims the report has damaged her “opportunity … as an extremely famous and well-known person” to make millions of dollars selling jewelry, clothing and makeup while serving as “one of the most photographed women in the world.”

Molly Guilbeault, ready to work at Leung’s counter

by George Le Masurier | Jan 24, 2015

Molly Guilbeault, at Leung’s

In the late 1970s and early 1980s, I often slipped into Leung’s Grocery store at the top of Fifth Street in Courtenay, B.C. for a Denver sandwich at the lunch counter. There was something addictive about those sandwiches. Maybe it was the grease or the extra fresh onions. But I was hooked. I’d even take my toddler daughter there on weekends. She wasn’t a fan of the Denver sandwiches, but she loved their classic milkshakes.

On one particular Saturday, my daughter and I were sitting near the street end of the long 1950s-style counter playing eye-spy. The shelves behind the counter were jam-packed with stuff for sale: cigars, metal cigarette lighters, cribbage boards and other games, jigsaw puzzles and, of course, a display of fine pies. There were little signs tacked up everywhere with clever sayings.

While we waited, my favorite server stepped behind the counter. As she got ready to start her shift, Molly Guilbeault picked up a chrome napkin dispenser from the counter and used it as a mirror to apply her lipstick. I grabbed a picture at that moment. It’s still one of my favorite images.

George Le Masurier

Decafnation | Jan. 27, 2017

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