Violations spark demand for Seniors Village takeover

by George Le Masurier | May 27, 2019

George Le Masurier photo

Violations spark demand for Seniors Village takeover

After three residents died as an indirect result of a norovirus outbreak at Comox Valley Seniors Village earlier this year, a group of family members of the facility’s residents demanded an investigation and better oversight of the facility by Island Health.

Now, two months later, and with no evidence of corrective action by the Chinese corporation that owns the facility, the same Comox Valley family members have asked Island Health to assume its full operational responsibility.

“It is our strong belief that the prolonged, ongoing challenges to bring this facility within compliance are indicative of a larger endemic problem … regarding this facility,” the family members said in a May 20 letter to Tim Orr, the director of residential services for Island Health.

The family members say there have been seven new contraventions of compliance to Residential Care Regulations between March 7 and May 3, all of which occurred since an investigation by Island Health licensing agents in March that resulted in a ‘high risk’ rating for the facility.

That review was triggered by a March 13 letter to Orr from the family members alleging that Seniors Village mishandled containment of the virus and that it may have been caused by food handling and a failure to ensure staff had required immunizations.

And there are currently 12 current contraventions, according to the Island Health Licensing Officer’s May 3 report. And there have been 22 incidents of regulatory non-compliance recorded since 2018.

The family members believe the most serious regulatory non-compliance occurred during the norovirus outbreak, while the top senior management positions remained vacant. A failure to clean the facility violated health and safety regulations, which was compounded by allegedly falsifying records to show the cleaning had been done.

The Comox Valley Seniors Village opened in 2009 by the Canadian company Retirement Concepts, but the problems began to surface in 2017 after it was sold to Anbang, a Chinese insurance company. Anbang purchased 31 Canadian long-term care facilities through its Canadian holding company, Cedar Tree, including seven on Vancouver Island and 24 others in BC, AB and QC.

Cedar Tree, in turn, contracts out management of Comox Valley Seniors Village, and other Anbang holdings, to a management company called Pacific Reach, owned by the former owner of Retirement Concepts.

What’s gone wrong

Problems identified or alleged by family members include unauthorized restraint, falsified records, building filth left uncleaned, incorrect feeding and failing to meet the contracted number of hours of care per resident among their complaints.

The family members believe that Seniors Village receives full payment from Island Health based on 3.11 hours of care per resident, but actually provides only 2.63 hours.

Island Health told Decafnation that “licensees are held accountable to meet all contractual obligations, including resident care hours.” And that Seniors Village has developed a corrective action plan, which Island Health “is monitoring weekly, including the licensee’s compliance to the Act and the Residential Care Regulations.”

Adequate staffing has been an consistent problem at the Seniors Village. The facility operated for six months without any senior management, neither a general manager or a director of care.

The facility has a difficult time keeping staff partly because it pays about $2 to $4 per hour less than other Valley facilities, such as Glacier View Lodge and The Views at St. Joseph. Seniors Village staff went on strike last fall for better working conditions and compensations.

But there are other problems that have caused many workers to quit.

Recently, the facility introduced unpopular shift changes. It essentially fired all its employees and made them reapply for their shifts, although workers were allowed to keep their seniority.

One concept in the shift reorganization, which the company has since reconsidered, would have required workers to rotate among the various wards every five weeks. But that was unacceptable to family members of residents in the dementia ward, where consistency and specialized training is necessary.

Deadly norovirus outbreak

Between Jan. 28 and Feb. 25, the norovirus spread rampantly throughout the facility. The family members believe the outbreak lasted longer than necessary because Seniors Village personnel — without a manager, dietician or care director — did not follow Island Health’s rigorous cleaning procedure.

“Past contraventions show the facility has a history of not having policies and procedures in place and the properly trained staff to executive them,” the family members wrote to Orr on March 13.

Two residents of the dementia wing died from pneumonia after noro infection and another died after refusing food after contracting the virus. Residents with “mobile dementia” often touch floors because they see things there.

According to the Public Health Agency of Canada, people become infected with norovirus through direct contact with infected people, touching surfaces contaminated with norovirus or by drinking water or eating food that has been contaminated, usually by food handlers who have the virus and don’t wash their hands properly.

“Further evidence supporting our concerns that the facility did not follow the required cleaning procedure is that we have determined that the only carpet cleaning during the 29-day outbreak was not steam cleaning as required, but vacuuming, which is specifically contraindicated in Island Health’s procedure,” the family members wrote to Orr on March 13.

The family of one dementia resident who died during the outbreak was permitted access to collect his personal belongings unaware that the required cleaning protocol had not been followed.

“It is unconscionable to us that Island Health would not have immediately stepped into direct this facility’s handling of the outbreak and provide additional resources given the known issues with this facility,” the family members wrote on March 13.

The family members believe that an Island Health run facility would have done a post-incident investigation to identify the root causes of the norovirus outbreak and recommendations to prevent another occurence.

“Why would it not be a requirement for this facility, given its serious breach of a critical public health protocol?” the family members asked Orr in their most recent May 20 letter.

Can Island Health take over?

Island Health has the authority to take operational control of a facility through the Community Care and Assisted Living Act if they believe has endangered public health.

Island Health says they have appointed an administrator at facilities in the past. They have done so twice in the past 15 years at two separate facilities.

“We take the concerns and complaints from residents and families seriously,” an Island Health spokesperson told Decafnation. “There are a number of regulatory mechanisms to direct corrective action on the part of the operators to ensure the safety of residents.”

The family members think the situation at Seniors Village qualifies.

“Severe and irrevocable consequences are both appropriate and needed given this service provider’s continued critical failures to meet the terms of its contract and the regulatory standards,” they wrote on May 20.

The family members told Orr they have supported Island Health’s need to follow a remedial process, and think it’s now “time to take decisive action.”

“If Island Health is of the view that Comox Valley Seniors Village has not yet reached this point, it begs one of two questions: How much longer? Or How much worse does it need to be?”

Family members of Comox Valley Seniors Village residents or former residents who signed both letters referred to in this article are Delores Broten, Bev Foster, Greta Judd, Sharon Jackson and Doug Malcolm.

This article has been updated to remove a sentence saying Island Health had not responded. Island Health’s responses were included in the original article.

WHAT IS THE NOROVIRUS AND HOW DO YOU GET IT?

Norovirus is a very contagious virus that causes vomiting and diarrhea. People of all ages can get infected and sick with norovirus.

Norovirus is sometimes called the stomach flu or stomach bug. However, norovirus illness is not related to the flu which is caused by influenza virus.

People with norovirus illness can shed billions of norovirus particles. And only a few virus particles can make other people sick.

You can get norovirus from:

–Having direct contact with an infected person
–Consuming contaminated food or water
–Touching contaminated surfaces and then putting your unwashed hands in your mouth

The most commonly reported setting for norovirus outbreaks … is healthcare facilities, including long-term care facilities and hospitals. Over half of all norovirus outbreaks reported … occur in long-term care facilities.

The virus can be introduced into healthcare facilities by infected patients, staff, visitors, or contaminated foods. Outbreaks in these settings can sometimes last months. Norovirus illnesses can be more severe, occasionally even deadly, in patients in hospitals or long-term care facilities compared with healthy people.

— Centers for Disease Control and Prevention

SUBSCRIBE TO OUR NEWSLETTER

Early-onset dementia, a heart-rendering disease that took Dales Judd in his prime

Because early-onset dementia afflicts people in their 50s, the symptoms are often misunderstood as a normal part of ageing, like needing glasses to read. But the disease progresses quickly, taking its victims in increments and leaving loved ones in a stressful caregiver role

Let’s vaccinate the whole world against the COVID-19 virus as we did with polio

Let’s vaccinate the world against the COVID-19 virus as we did with polio

Seniors advocates call for longer and more frequent visits to care homes

As seniors struggle with loneliness after nine months of COVID-related restrictions on visitation at most care homes, North Islanders told that Canada needs a National Seniors Strategy

Shirley and Paul Brown share how the CRH pathologist shortage impacted their lives

Shirley and Dr. Paul Brown share their story about how the shortage of pathologist services at Campbell River Hospital delayed a cancer diagnosis, causing unnecessary anxiety and altering the medical treatment plan

Last two CVH pathologists resign angry and exasperated by Island Health tactics

Dr. Chris Bellamy practiced general pathology at Comox Valley hospitals for 31 years until he felt forced to resign by Island Health’s pressure to eliminate onsite clinical pathologist services on north Vancouver Island

Comox Valley Hospital loses another medical service: how the candidates respond

Courtenay-Comox riding candidates share how they would address the reduction of an on-site medical service at the Comox Valley Hospital

$52.6 million Dementia Village planned on former St. Joseph’s General Hospital site

A 156-bed Dementia Village for the Comox Valley took another step forward May 25 as Island Health announced a project development agreement with Providence Living for the project.

Town Hall to explain how VIHA’s cuts have hurt North Island patient care

North Island medical professionals will explain how VIHA’s removal of onsite clinical pathologists’ services in Campbell River — and eventually the Comox Valley? — has affected patient care

The Week: VIHA and province disrespect our hospital board, medical staff and the public

As the Vancouver Island Health Authority reduces health care services to north islanders and deflects accountability, the public looks to the Comox Strathcona Regional Hospital District board for advocacy

North Island hospital board hesitates to take advocacy role, despite rights and precedent

Should the Comox Strathcona Regional Hospital District board advocate for maintaining or upgrading health care services on the North Island? Some directors aren’t sure. But Discovery Islands Director Jim Abram says it’s a no-brainer

Lagging seniors health care affects CVH, distressed caregivers

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.