Category Archives: Seniors

Kathleen’s Demise: a cautionary tale

There’s much to learn about BC’s laws and eldercare system from the last years of Kathleen Palamarek’s life in a local nursing home—especially from the battles that were fought in her name between her children, care providers and the Vancouver Island Health Authority.

 

It was a small but important epitaph for a much-loved woman. NDP West Kootenay MLA Katrine Conroy spoke in the provincial legislature in June in support of a public inquiry into the recent “suspicious death” of Kathleen Palamarek, an 88-year-old resident of Broadmead Lodge in Saanich.

During Lois Sampson née Palamarek’s five-year struggle to help get her mother out of the nursing home, Kathleen became an icon to local seniors advocates. That’s why the Saanich Peninsula Health Association, Vancouver Island Association of Family Councils, Old Age Pensioners Organization local, and others have been blitzing politicians, media and public agencies with requests for an inquiry.

“[T]he suspected abuse was due to overmedication, and the family needs answers,” said Conroy.

Yet the story involves much more than possible improper medicating; I’ve been following it since 2006. Kathleen’s life, and now death, is a tragic example of how our outdated guardianship laws summarily declare seniors “incapable” and thereby turn them into battle zones over which families, health professionals and others fight for control amidst an increasingly troubled eldercare system.

Read more.

Crisis Behind Closed Doors

Data obtained through a Freedom of Information request shows nearly half of all seniors in long-term care in BC are being given antipsychotics like Risperdal, Zyprexa and Seroquel. That’s almost twice the average for the rest of Canada and amongst the highest rates found anywhere in the world. And even though Health Canada warns these drugs cause a doubling of death rates in the elderly, care workers admit they’re mainly being used as chemical restraints in the absence of adequate staffing and proper oversight.

“IT WILL RELAX YOU.” That’s the only explanation hospital staff gave when administering the antipsychotic medication to Carl. At least, that’s the only reason he recalls—soon he began experiencing “very strange cognitive feelings.”

“I’m a reasonably logical person,” he says, but suddenly he was in a “swimmy universe that didn’t make any sense.”

Carl (not his real name) became indifferent to his normal interests; inexplicably disengaged when friends visited: “like I was talking to them through a tunnel.” He felt as if he was in a “mind meld” with the Alzheimer’s patient next to him, losing his memory and connection to the world. Though he reportedly looked more docile, inwardly he was intensely disturbed. “I wasn’t relaxed at all.”

Carl didn’t understand what was happening and assumed the serious physical illness for which he was receiving treatment was the cause. Yet his experiences come straight out of the clinical drug literature.

A 2009 study of people’s subjective experiences with taking antipsychotics found many complained about “cognitive impairment” and “emotional flattening,” while few mentioned calmness or relaxation.

Antipsychotics are a class of tranquillizing drugs routinely used to help rein in the minds of people diagnosed with intense schizophrenia. In recent years, they’ve been used increasingly (albeit usually in smaller doses) to “calm” elderly people with dementia in hospitals and long-term care facilities.

Yet they’re hardly benign. Now widely described in medical literature as “chemical restraints,” common effects include foggy somnolence and disorientation, cognitive impairment, akathisia or “inner agitation,” extreme weight gain, diabetes, loss of muscle control, and muscle rigidity. Within a year of use, fully one-third of seniors will have Parkinson’s-like tremors from drug-induced brain damage. Within several months of use, death rates of seniors double—mainly from heart attacks.

Fortuitously for Carl, one long-time friend visiting him daily happened to be a nurse. She knew his illness could’ve precipitated some temporary psychological slippage, but nothing like what she was seeing.

“His personality was changing,” she says. “His cognitive level was changing in a downward spiral.”

But hospital staff barely knew Carl except in this irrational, helpless state, so they told her she should prepare for her 65-year-old, recently retired friend to spend the rest of his days in a nursing home.

After hearing of Carl’s story, I wondered: How many more like him are there?

 

Half of all residents are given antipsychotics

For two years, I tried to find out how many seniors in BC long-term care facilities were being given antipsychotics. Freedom of Information deadlines came and went. Not a single report, document, or email appeared.

It seemed unbelievable that this number wasn’t known. Since 2002, Health Canada has been repeatedly warning doctors against using antipsychotics in seniors with dementia because of the doubling of death rates. Nevertheless, antipsychotic use in Canadian nursing homes has continued rising inexorably, and alarm has been spreading through the medical literature and media. In 2006, BC spent $76 million on antipsychotics, making them our fifth most expensive class of drugs (for comparison, that’s double the arts and sports funding in our provincial budget). Yet no one in BC’s health ministry had the slightest interest?

Even my contact at the Office of the Information and Privacy Commissioner became frustrated with my persistence. “I can’t keep going back just telling them to search again,” he said. Repeatedly.

And then in March of this year, it magically appeared (see downloadable document below). A provincial-wide analysis using PharmaNet data had been completed months before I’d first asked to see one in 2009.

So now we know: Nearly half (47.3 percent) of seniors in long term care facilities in BC are taking antipsychotics. That’s close to double the US and Canadian average of 26 percent, and four times the rate of Hong Kong, which is at the low end of the spectrum.

“Do we have any answers…as to why BC has a higher use of antipsychotics in LTC [long-term care]?” wrote Darlene Therrien, a health ministry research and policy director who was wondering if a methodological error could be producing such huge BC numbers.

“I can’t see any issues in the data that would explain it,” emailed analyst Brett Wilmer. “I’m pretty sure it’s a health system phenomena…”

When I received these documents, I requested interviews. Ministry of Health spokesperson Ryan Jabs emailed back, “I can’t find a person from the program area who is comfortable speaking with media on this topic.”

So we’re left on our own to figure out what those BC health system “phenomena” are—and how dangerous they might be.

Read more.

Better Care Homes, or Better Euthanasia?

Parliamentary committee members witness a dramatic confrontation over elder care.

Local MP Denise Savoie invited two representatives from the federal Parliamentary Committee on Palliative and Compassionate Care to hear Vancouver and Victoria speakers in November. Developing recommendations on elder care, assisted suicide and abuse, the committee’s half-day session before 40 people at James Bay New Horizons broke down in a bizarre, foreboding fashion.

Presenter Wanda Morris set an emotional tone. (A Right to Die Society advisor, her online bio reflects on the putting “gently to sleep” of “my sister’s beloved dog, Sparky.”) Morris advocated legalizing “merciful euthanasia under a physician’s supervision,” describing people suffering pain “like my bones are sticking through my skin.” Would we deny people the right to jump from the Twin Towers to escape the flames of 9/11? Our laws, she said, are a “devastating, odious form of tyranny.”

While Morris acknowledged that it was also important to improve our elder care system, in the meantime, she pleaded, people need another option.

“I object!” One elderly man cried, demanding to present an opposing viewpoint. Another similarly protested. But another wept in concord with Morris, describing emptying her mother’s lungs of fluid in her final days because “she couldn’t die her way.”

Read more.

Seniors’ Care Homes in Need of Care

With 70% of South Island residential homes rated medium or high risk, will the Ombudsperson’s report, new regulations from government, and more frequent inspections be enough to prevent the deepening crisis in seniors’ care?

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Released a week before Christmas, the BC Ombudsperson’s first of two reports on the care of seniors made a brief splash in the media before drowning under the deluge of feel-good holiday fare. That was unfortunate, because Ombudsperson Kim Carter’s report, entitled The Best of Care: Getting it Right for Seniors in British Columbia (Part 1), discusses three key issues and reveals fundamental problems in seniors care and the provincial government’s reticence to address those problems.

In previous Focus articles (see “Who Has the Right to Control Your Life?” January 2009 and “Surviving the Borg,” March 2009), it became clear that seniors could far too easily and unscientifically be declared “incapable,” “incompetent” or “mentally ill” under BC’s archaic and draconian Patients Property Act or Mental Health Act, and instantly lose all of their rights. This opened the door to a variety of ills, including medical maltreatment, abuse from staff or family members, and care homes being unresponsive to complaints. Basically, as long as seniors’ rights weren’t strong, not much institutional will or political pressure to address their concerns could be generated.

A rescue plan lay in the wings, though: A modernized Adult Guardianship Act, many years in the making with stakeholders and already passed third reading in the legislature, would replace the Patients Property Act, and provide seniors in different circumstances with a much more variegated set of powers, rights and options.

Unfortunately, as Public Guardian and Trustee Jay Chalke, Q.C. laments in his latest annual report, that “long overdue” legislative change has been postponed indefinitely by the BC Liberals, supposedly “because of economic conditions.”

In that context, it’s not surprising that the Ombudsperson would issue early–with a special sense of urgency–a preliminary list of findings and recommendations on seniors care which spotlights the rights of people she describes as “the most frail and vulnerable” of all seniors: those in residential homes. Continue reading “Seniors’ Care Homes in Need of Care” »

Surviving the Borg

More stories pour in about the crisis in our residential care homes.

No article I’ve written for Focus has provoked so many impassioned calls, emails, posts to my website, and interceptions in the street than my feature about long term care of the elderly (“Who has the Right to Control Your Life?“, January).

Many relatives of seniors said the stories of deteriorating conditions in care homes and people being unfairly stripped of their rights reflected their own experiences. “On Christmas Eve in 2006, my mother was abducted,” described one woman. “[They began] transferring her to different nursing facilities where they were drugging her with so many drugs that she could not lift up her own head…”

Another wrote, “[S]taff have frequently written reports itemizing problems, and the numerous reports are consistently ignored. Continuing issues such as filth-still there; toileting-constant struggle; activities-not very many that actually engage people…”

For these people, seeing the issues publicly aired was heartening.

But many frontline care attendants accused me of being negligently selective in my examples and grossly unfair to them. Continue reading “Surviving the Borg” »