A Son’s Story: BC’s Dwindling Senior Healthcare System
October 1, 2010
For my father, that morning in February 2001—the one that began our family’s engagement with the dysfunctional and chimerical world of seniors’ care in British Columbia—started inauspiciously enough. He sat down at the dining room table, as was his custom, to write a letter. He had always been a prolific letter writer, preferring the intimacy of ink, paper, and envelopes to the impersonal realm of e-mail, which to him was a strange and sorry technological excuse for communication. His handwriting measured up to physician stereotypes, a scrawl that only habituated eyes could decipher. This time, however, when he put pen to paper and attempted to trace out the first word, nothing happened. His mind knew what it wanted to do, but the signals his brain dispatched to the fingertips were muddled and interrupted. A bit of plaque had clogged an artery that supplied oxygen to his brain. The symptoms were all too familiar, and his self-diagnosis was swift and certain.
“Well, Andrew,” he said, rolling the r with his wonderfully lyrical Scottish brogue, when he phoned later that morning. “There’s nothing to be worried about, but I’ve had a wee stroke.” He spoke as though discussing not himself but one of his patients, delivering the diagnosis with a calm, compassionate frankness that, in retrospect, was astonishing.
At first the stroke seemed far from catastrophic. His retirement proceeded much as it had before. Together with my mother, he travelled and tended his legendary raspberry patch, his unassuming charm and sense of adventure barely diminished, the penultimate chapter in a life that was the stuff of novels. After graduating from the University of Aberdeen medical school in 1946, he’d embarked on a postwar tour of Britain’s far-flung and slowly crumbling empire, visiting colonies like Ceylon and the Aden Protectorate. He particularly loved retelling versions of a story about hitching a ride on a cargo plane deep into what is now Yemen’s Wadi Hadramawt region, a remote land of arid mountains and shifting sands where hospitable Bedouin sheiks conspired with eccentric British functionaries who had spent too much time beneath the Arabian sun sipping gin and tonics. To a young Scottish doctor, it must have seemed like a strange and magical place. Decades later, whenever he met somebody of Arabic extraction, he would clasp his hands together and utter the eloquent greeting “Assalam Alaikum,” or “Peace be upon you.” Invariably they would smile in surprise at this little bearded Scotsman showing them an unexpected courtesy in their native language so far from their homelands.
After he married my mother, in 1955, they travelled together to Africa, to what was then the colony of Nyasaland where he worked for two years as a missionary doctor and cared for the ostracized residents of a nearby leper colony. He loved people, especially people with accents. One day, while gardening in his front yard, he struck up a conversation with a passing stranger, as he often did. He detected a Slavic accent and was intrigued. The gentleman, visiting on business from the Czech Republic, ended up staying for dinner that evening and became a close friend of my parents. On family hiking trips in the Rocky Mountains, while his four children cowered in embarrassment, he occasionally greeted people on the trail with, “We’re the Findlays, we’re from Kamloops, and where are you from?” That’s the kind of man he was, able to transform the anonymous into the memorable with a few kind, or unusual, words. In his retirement, after a career that spanned public health, general practice, and the Workers Compensation Board, he acted as a watchdog for the beloved grasslands park on the outskirts of town that he had played an instrumental role in preserving. For his efforts he was honored with a plaque on a rock and a trail fringed with bunchgrass, sagebrush, and Ponderosa pine that bears the name Doc Findlay’s Trail.
Not long after the “wee stroke,” Dad’s life began to change. It had deprived his brain of oxygen, causing cells to atrophy and die. The official diagnosis was vascular dementia, the second-most-common cause of dementia after Alzheimer’s. Like a river scouring a sandy bank, the stroke gradually eroded his cognitive and physical abilities. Memory loss and confusion over simple math problems were followed by impaired mobility. At age 80, after too many close calls at traffic lights and stop signs, he surrendered his driver’s licence. He adopted that telltale shuffle, and other indignities began to pile up. Reading became a frustrating exercise; he was unable to link thoughts and ideas from one page to the next. The family watched with alarm as he slid toward the cognitive abyss, and my mother struggled to care for his increasing needs while maintaining their household of nearly 40 years. Home support provided some respite, but soon three visits a week from a care aide weren’t enough.
In September of 2005, a fall while getting out of bed sent my dad to hospital—the same hospital where he had delivered dozens of babies during his decades of general practice. A brief return home was followed by another trip to the hospital. Meanwhile, our mother was reaching her emotional and physical limit. A troubling realization crept into the family dialogue; we would soon have to make the unthinkably difficult decision to outsource Dad’s care to the state. That October would be the last time he would sleep in his own bed.
In the cold parlance of seniors’ health care, my father had become a “bed blocker.” While awaiting space in a seniors’ care facility, he was occupying an expensive bed on a hospital ward ill-equipped to deal with the range of needs presented by dementia patients. It seemed horribly unfair that, after a rich life of travel, public service, and devotion to family and career, he could be reduced to a statistic on a government chart, and I shared the guilt that I knew everyone in our family harbored. Dad deserved better.
It was no comfort to know that we were now sharing decisions about his care with a health authority that had ranked last in performance of all health authorities in B.C., and that B.C. ranks near the bottom of the heap among Canadian provinces when it comes to seniors’ care. It’s a slide that has been well documented. In 2005 the Canadian Centre for Policy Alternatives published the report Renewal and Retreat, which uncovered deeply disturbing trends in residential seniors’ care. Between 2001 and 2004, the number of publicly funded residential care beds in the province dropped by 1,464. In those three years we went from 100.4 beds per 1,000 seniors over the age of 75 to 83.4 beds, placing B.C. 13 percent below the national average and second to last among Canadian provinces. In addition, there was a dramatic shift to for-profit seniors’ care, with 90 percent of bed closures coming at nonprofit facilities; a corresponding percentage of new beds was opening at
facilities owned by corporations keen to capitalize on the business of warehousing our burgeoning population of elders. Topping off this lamentable litany, according to Statistics Canada, the B.C. government funds just 3.7 hours per senior per day for all related services including nursing, janitorial, and recreational therapy, again putting our province in last place.
Given demographic trends, which will see the proportion of B.C. residents aged 65 and older rise from 15 percent today to 23.5 percent by 2030, the troubles are bound to get worse. And while government takes the scalpel to publicly funded care beds, disturbing allegations are being made about standards of care and safety at private seniors’ facilities. There have been hideous examples of abuse and neglect—isolated, but troubling. One December, while we celebrated Christmas with dad, an 83-year-old woman suffering from Alzheimer’s wandered out of the Pine Grove Care Centre in Kamloops through doors that were supposed to be locked. The outside temperature was –20ºC. Hours after being reported missing, she was found frozen to death in a snow bank mere steps from the centre, which is owned and operated by the Vancouver-based company Park Place Seniors Living.
The message from these dismal funding statistics and sad stories is that seniors’ care in the province is in disarray. Not surprisingly, in June 2008, when B.C. Ombudsman Kim Carter issued a call to the public to come forward with complaints or issues surrounding seniors’ care, the response was overwhelming. Karen Sawatzky, a spokeswoman for the ombudsman, says, “It’s definitely confirmed that this is a very significant and pertinent issue.”
Art Kube, former president of the Council of Senior Citizens Organizations of B.C., says his organization has been harping about the increasing privatization, erosion of standards, quality of care, and funding shortfalls for the past decade. “Care and profits,” he says, “just don’t mix.”
In this present system of seniors’ care, it’s the proverbial squeaky wheel that gets the grease. Laurie Harris fought hard to secure a bed for her mother at Zion Park Manor, a financially strapped but reputable nonprofit care facility in Surrey that’s licensed by the Fraser Health Authority. Harris had battled with health officials ever since her 83-year-old mother transitioned from her home to Surrey Memorial Hospital in 2006 and then, after weeks of uncertainty, landed a bed at Zion Park. And she’s the first to admit that her pugnacious and aggressive character has been her best, and perhaps only, weapon.
“It’s incredibly complicated. It’s taken me three years to understand this system, and I’m still figuring it out,” says Harris, who was forced to relocate from Victoria to the Lower Mainland to help her parents navigate the serpentine corridors of seniors’ care bureaucracy. “I’ve been forced to advocate for my mother, and I got what I wanted but I’m still not comfortable in that role. If you’re not a stalwart person you’ll get shuffled around forever. There are just too many people and not enough beds.”
My father’s experience is far from a horror story, but it shares much in subtle detail with other stories unfolding in family rooms and seniors’ homes around the province. When we realized Dad needed to be in a home, it was a time of great confusion and stress for my mother. The anguish of surrendering the care of her life’s love to strangers employed by the government, or a private corporation, was compounded by the ludicrously arcane manner in which the health authority seems to conduct its business. My father spent six weeks in hospital—an eternity, it seemed—until word descended from the health authority that a bed was available at a nearby seniors’ facility. The next morning he was moved to his room at the lodge. There he became quickly entrenched in an over-medicated routine of eating, bathing, sleeping, and being wheeled back and forth from his small private room to the dining hall, imprisoned by a diminished mind and a body that no longer did its bidding.
My mother, though she had come to terms with moving her husband of 55 years into a facility, never faltered in her love, care, and devotion, visiting twice a day at mealtimes, and always for special events. My brother, the only one of the children who lived nearby, was a pillar of support. The rest of us, dispersed throughout B.C. and the Yukon, visited as often as we could—not often enough, I’m sure. The lodge, in spite of the organizational confusion that seems to surround its management, is surprisingly pleasant, and I grew to enjoy my visits there. The front-line staff was compassionate and caring, injecting an atmosphere of lightheartedness and fun into what could have felt like a depressing warehouse of the living dead.
Still, no amount of joviality or decorative accoutrement can conceal an aged, institutional atmosphere. The walls, of whitewashed brick, are adorned with pastoral murals presumably meant to recapture something of the natural world that most residents have long left behind. A faint but pervasive antiseptic odour mixes with smells of laundry, food, and stale coffee. Wide windows in the dining room look out over a peaceful inner courtyard, in the centre of which lies a simple wooden structure, the Chapel of the Pines. Generally there is more laughter than sadness around the lodge, and there are few secrets; normally discreet topics are discussed as casually as the weather among visiting family members.
The lodge is one of those publicly owned and operated facilities that are clouded in uncertainty. The provincial government wants to close it but can’t: there are simply too many old folks lined up and waiting for beds. The uncertainty that hovers over the place is reflected in the slow erosion of amenities and the awkward management. When Dad first arrived there was an active social calendar organized to engage the minds of residents, Happy Hour every Wednesday afternoon, visiting musicians and storytellers. Eventually the recreational activities slowed to a trickle.
Decisions about residents’ care can be baffling and deplorably handled, such as on the day one woman arrived for a visit and was told that her resident husband would be shuttled off the next morning to a privately owned, publicly funded facility across town. No advance notice—just get packed. Such callousness is symptomatic of a system under critical stress and does little to engender faith in the province’s approach to seniors’ care. Neither do some of the bizarre, Kafka-esque redundancies, such as the ongoing closure, renovation, reopening, and closure again of floors at the lodge; beds are often left empty while seniors languish (expensively) at a nearby hospital awaiting placement in a facility. This egregiously inefficient use of public resources is no doubt connected to the government’s desire to offload responsibility for seniors’ care; it would be laughable, in a Monty Python sort of way, if people weren’t being put through an emotional meat grinder.
In Dad’s final days, often the only signs to suggest recognition and awareness were a faint glimmer in his blue eyes, a raised eyebrow, a subtle nod. Last December, just before Christmas, I sat with him and other residents to sing carols with one of the staff members. It was a heartwarming comedy of half-forgotten choruses and off-key murmuring but also some surprisingly melodic voices. Music always manages to tap something in our psyches, even in those lost in the neurological mists of dementia. After the singsong was over, a few residents went back to staring blankly at a TV screen. Another tapped her feet in her wheelchair while one of the eccentric care aides belted out a Broadway tune in her operatic tenor.
Despite the institutional trappings, my visits to the lodge grew to feel like visiting family—an odd, hybridized family of confused elders, their spouses and offspring, care aides and nurses, but a family no less. Between them they forge an informal support group, born out of mutual understanding and grieving. Through it all, my father endured the cruelties of dementia and affronts to his privacy with an aplomb and graciousness that were inspiring. Whether it was his practical Scots nature or just the hazy effects of the disease, we will never know.
When Christmas was over, it was time for me to head back to Vancouver Island. I kissed Dad on the forehead and left him at his table. He studied me silently, blue eyes opaque behind thick glasses, a quizzical look on his face. For a moment his lips moved, but no sound came forth. Four months later, on April 20, the long goodbye came to an end. Dad was finally liberated from an incarceration of mind and body, and his family from the frustrating labyrinth of seniors’ care. None of us—Dad included—could have imagined this would be the final chapter to a wonderful life lived with kindness and dignity. VM