by George Le Masurier | Jul 18, 2018
The former St. Joseph’s Hospital is being called back into action. Some patients in acute care beds at the Comox Valley Hospital, who are waiting for residential care beds, will move to St. Joseph’s to alleviate the new facility’s chronic overcapacity
Eleven months after the new Comox Valley Hospital opened, the Vancouver Island Health Authority (VIHA) will finally unburden its staff from chronic overcapacity.
And it will give Comox Valley family caregivers some extra opportunity for relief with three additional respite care beds.
VIHA has contracted with St. Joseph’s to open 21 residential care beds in the former acute care hospital site at the top of Comox hill. The beds will be available in September.
And the health authority said they will also convert space on the new hospital’s fourth floor, which was reserved for expansion, into a 17-bed residential care unit for mostly elderly patients who need an alternate level of care.
Norm Peters, Executive Director, Surgery, End of Life Care & Residential Care at Island Health told Decafnation that “By moving (ALC patients) to St. Joseph’s, it opens up acute care beds at the hospital for people who require acute care.”
Almost every day since the new hospital opened with 129 acute care beds, it has been dramatically overcapacity. The number of admitted patients has soared to 178 on occasion, nearly 50 percent higher than planned.
That has stressed workers at the hospital, which was budgeted for 129 patients.
FURTHER READING: Record 178 patients at CVH; Flawed planning at root of hospital’s problems
Most of the overcapacity has been due to patients in more expensive acute care beds who are waiting to transition to long-term care facilities. But the Comox Valley has had a dearth of long-term care beds for many years, so these patients have had no option but to stay in the hospital.
In fact, those in charge of designing the new hospital never planned for any ALC patients (alternate level of care). Hospital planners naively assumed that VIHA would have provided enough beds at residential care facilities such as The Views at St. Joseph’s, Glacier View Lodge or the Seniors Village.
The new 21 beds at St. Joseph’s are temporary until VIHA opens a proposed 151 new complex care beds sometime in 2020, if they can be built that fast. Contracts for those beds, spread among multiple providers, won’t be awarded until at least Aug. 31.
Michael Aikins, administrative officer for The Views at St. Joseph’s, told Decafnation that the 21 residential care beds and the three respite beds will be located on the third floor of the former acute care hospital.
While the new beds are detached from other Views patients, they will be cared for by Views staff who will follow St. Joseph’s policies.
Aikins said The Views was in the process of hiring care aides, LPN’s, housekeepers, dietary aides and will add hours in other support areas such as maintenance, payroll. They will reinforce their casual workers in all areas.
There will be crossover opportunities to maximize The Views’ resources, but the temporary ALC unit will have dedicated staff to provide day-to-day care to the residents.
St. Joseph’s will make some modest improvements to the hospital rooms that have sat vacant for nearly a year with some fresh paint, new furnishings and improved wayfinding.
St. Joseph’s Board of Directors Chair Chris Kelsey said the board is happy to help and provide support.
FURTHER READING: Island Health press release
by George Le Masurier | Jan 24, 2018
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.
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.
