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.
“I can’t help but feel that the negativity of this article must have had a terribly demoralizing effect on the staff who try so hard, under sometimes difficult circumstances, to do their best to bring care and comfort to the residents,” wrote one. “It certainly demoralized me.”
“How dare you categorize all us care aide workers,” wrote another. “Shame on you.”
Interestingly, both sides were reflected in one particular relative’s opinion. “There are some outstanding caregivers out there. Some really quality, amazing human beings,” he said. “But there are many more of the other kind… On the bulletin board there’s a huge poster, ‘It is your duty to report neglect and abuse and document it.’ Well, see what happens when you actually report abuse and neglect. You are the one who is going to pay a heavy price. It’s like, ‘How dare you suggest that our staff have done this.'”
As for the doctors, lodge administrators, Vancouver Island Health Authority and provincial government… They were resoundingly silent. (We do know the article generated disquiet at various care homes and senior levels of government; their silence is deliberate.)
First, let me say that I recognize there are many admirable people working in long term care. They’re doing the best job they can while increasingly overworked. And some residents’ situations are better than others’. That said, my article didn’t pretend to comprehensively diagnose all the good and bad in care homes. It was focused on the extremely tenuous legal rights of the elderly (or of anyone, for that matter) under BC’s archaic, draconian “incapability” and mental health laws, and on the lack of accountability in our generally deteriorating residential care system.
So, as I heard more tales of abuses, even as my own carefully researched complaints received stony non-responses from those in authority and “how dare you”s from downtrodden staff, I realized all this actually highlighted the article’s central point: People’s basic human rights are being trampled, and nobody is accepting accountability.
To fully appreciate how dire the situation is, it’s important to understand that even just entering these homes, absent any abuses, is itself a harsh end to freedom for most retired people accustomed to their own routines. “When they go into a facility, that [personal routine] becomes a regimented, collective routine,” one care worker explained. At first, that may just mean structured meal times and limited personal space; eventually, it’ll likely mean others control how and when you bathe, exercise and go to the washroom. “It’s almost like the Borg in Star Trek,” she commented. “You become assimilated into the system.”
Worse, though, you’re simultaneously stepping into a legal abyss while becoming weaker and more vulnerable. You’re now in daily contact with health professionals and, at any time, a contracted doctor you’ve never known before may strip you of all your rights to make decisions about whether you can walk outside, have visitors, or refuse heavy sedation. Or he may not. It’s up to his or her discretion, with no scientific criteria or appeal process. Alternatively, staff may simply use that “possibility” as leverage over you sometimes.
Meanwhile, health professionals police themselves, and tend to be infamously delinquent in these responsibilities.
As for the care attendants helping with your everyday needs, they simply have no licensing or regulatory body.
Even relatives won’t necessarily truly advocate for you, so ingrained is our cultural deference to health workers.
And what sort of checks and balances do facility administrators and VIHA have in place? Here are some revealing examples:
BC’s Ombudsman has opened 150 investigations into unresolved problems at care homes.
In spite of numerous major scandals (Beacon Hill Villa, anyone?), not a single facility in this region has ever had its licence revoked. VIHA doesn’t even have established policies and procedures in place for stopping chronic medication errors. In one case, bumbling VIHA intervenors suggested facility staff wear orange bicycle safety vests when administering drugs, in hopes that, if others steered clear of them they’d make fewer medication errors. (The weird experiment apparently worked-and was soon cancelled.)
Last July, complaints about the nutritionally-bereft delivery food came to VIHA’s Board directly. As per VIHA’s policy of creating bizarre mockeries of public accountability, questions to their Board have to be submitted in writing and then responses are read out verbatim with no discussion permitted. (But at least we know the responses have been carefully thought out, right?)
So why are our health experts letting notoriously bad hospital food spread to residential homes, where ailing seniors are actually being expected to live on this tasteless, anemic, food-like product?
“VIHA and its contracted service providers are required to comply with nutritional standards as set out in the Canada Food Guide,” VIHA’s Board clarified reassuringly.
Have you looked at this notoriously industry-influenced and decidedly unscientific guide? If meals were two pieces of white bread, a heaping tablespoon of sugared peanut butter, and a cup of powdered milk three times a day, so long as all that came with a daily can of green beans and one stick of reconstituted celery, it’d all be “A-OK” with the Canada Food Guide. (Yes, lodge doctors can recommend special individual diets; but it’s a difficult process and, of course, if substantial improvements were common, everyone would be doing it.)
All this isn’t professional behaviour and reasonable accountability in action; it’s a joke.
And if you try to sue them all? Few lawyers are knowledgeable about health, civil rights, mental capability or mental health law. Most that can earn livelihoods in this area do so by regularly consulting for and defending the government, lodges, health authorities, and doctors. It’s nearly impossible to get these experts to turn around and attack their biggest clients in court. If you do get a lawyer, she’ll find little leverage in BC’s emaciated legal protections for those deemed incapable or mentally disordered. Thus, the circle of disempowerment completes… forming a noose.
That’s why I’m confident that all truly “good” people working in residential care are as concerned as you and I. Those people aren’t complaining about my reporting being unfair to them, because they know who’s really being treated unfairly in all this. Surely, then, they’ll join in pushing for more accountability throughout the residential care system.