Category Archives: Health

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.

Can Wi-Fi Harm Kids?

Hearings on Wi-Fi in classrooms reveal large differences in the level of trust of information about health impacts.

It’s not often CBC radio host Gregor Craigie’s soothing voice puts someone on the defensive. But Craigie said he’d heard from many people complaining about the Greater Victoria School District’s (GVSD) decision to appease protesters by holding hearings about the health dangers of Wi-Fi. Since all the science shows Wi-Fi is safe, Craigie posed to school board chair Tom Ferris, “They wonder why [such hearings] would even be considered.”

Eventually, the elected official gave up portraying GVSD’s “investigation” as much more than political flak-catching. “The thinking is that if people don’t have an opportunity to air their views and get some sort of response,” Ferris answered, “then it’s something that may go on and continue to worry parents.”

Maybe that suspect commitment to truly investigating the issues explains the uncomfortable atmosphere later that same day in the GVSD boardroom as a 14-person Wi-Fi Committee commences a series of meetings. The committee includes teachers, parents, principals and several elected trustees, along with GVSD secretary-treasurer George Ambeault and technology director Ted Pennell; there are no health experts or scientists. Ambeault facilitates with grim terseness. Most committee members rarely if ever ask questions of the presenters, while teacher-member Michael Dodd, who’s already announced he’s wary of Wi-Fi, is perpetually lobbing softball questions at the anti-Wi-Fi presenters like, “Could you explain that further?”—to the obvious irritation of Ambeault and others.

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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.”

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The Health Care “Crisis” Con

While journalists help the Liberals drum up hysteria, health spending has actually remained relatively stable for decades.

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It was one of those articles that makes me think, “Wow, I’ve been so stupid.”

I love reading those.

We’ve all heard alarms about health care gobbling 40% of BC’s provincial budget. Our Liberal government asserts that, at current growth rates, health care will be mainlining 100% of BC’s budget by 2040. You can’t help but start screaming with the expanding mob, “More cuts! De-fund Viagra! Privatize! Unplug the elderly!”

But The Tyee‘s Will McMartin analyzed thirty years of BC health budgets and completely dispelled such claims. It’s worth the read (I checked the numbers); however, McMartin’s central point was simple: Don’t forget the BC Liberals have repeatedly cut taxes and the budgets of most other ministries. ­The end result in a quick analogy: While the government spent $2 on health care and $8 on other ministries decades ago, today government spends a bit over $2 on health, but barely more than $3 on all other ministries. That’s the primary way health care has gone from taking 20% of the budget to taking 40%.

McMartin contrasts this by calculating health care spending as a percentage of gross domestic product (GDP), a more common standard for comparing public expenditures across governments and decades. GDP represents the overall economic activity and tax base from which a government can draw for funding public services. Government data show BC’s health spending has fluctuated steadily around 5-7% of GDP since the mid-80s (See here, especially page 106, table A 3.5, and the GDP numbers here). Essentially, relative to our overall economic strength, health spending now is in line with where it’s always been. So, while we can still improve our health care system, clearly, we needn’t be acting as if we’re having a financial near-death experience.

This eye-opener made me wonder, ‘How is it I’ve read innumerable hysterical articles about BC’s health care budget, and have never heard this simple counterpoint?’ (According to the Canadian Institute for Health Information, as a percentage of GDP, BC is actually at the lower end of spending nationally. See here and here for details.) Intrigued, I revisited how local media have handled the issue the past two years.

Most coverage was typified by Rob Shaw’s Victoria Times-Colonist news story: “Health care continues to devour money and accounts for 42 per cent of the entire $40-billion budget,” wrote Shaw. He quoted Premier Gordon Campbell: “[I]t’s really important for people to understand that the costs of our health-care system are staggering, frankly.”

No other point of view on health spending was quoted. While Shaw seemed guilty of simply lazy journalism, others seemed more manipulative—or manipulated.

T-C staffer Jack Knox wondered how much we’ll “shovel into the gaping maw” of health care’s “ever-growing, insatiable appetite”. Interestingly, he related health spending to GDP, but only in one specific context: “Health spending has been outstripping the economy for decades…” Knox wrote.

I soon spotted this imprecise but alarmist refrain reappearing ad nauseum like a Republican talking point on Fox TV. No articles cited BC’s low health spending relative to GDP; however, many roared menacingly about the high growth rate of BC’s health spending relative to GDP.

“[B]etween 2001 and 2005, public health expenditures have grown faster on average than total revenue…” wrote public administration professor emeritus Jim Cutt in an opinion article about the approaching “financial brick wall”.

T-C news columnist Les Leyne parroted the same idea being spun by BC’s previous Liberal health minister: “Abbott said health spending grows twice as fast as the GDP and has done so for 20 years…”

It does sound terrifying. And it’s terrifically misleading. That’s because the growth rate for health spending is relative to a much smaller dollar amount than the growth rate for GDP.

Why is that significant? Well, if I spend $5,000 on consumer goods this year, that’ll be 400% more than five years ago. In that same time, BC’s GDP increased by a measly 17%. So now ministers and journalists are crying, “Rob Wipond’s increases in frivolous spending have been outstripping the increases in productivity of BC’s entire industrial base thirty times over! Stop Rob Wipond before he consumes the whole province!”

Sound absurd? You bet. Rob Wipond’s consumption still represents just 0.0000025% of provincial GDP.

To abandon ludicrous comparisons, then, and examine the numbers: BC GDP was $79.35 billion in 1990 and $197.93 billion in 2008, an increase of 150%. Meanwhile, BC health spending was $4.4 billion in 1990 and $14 billion in 2008, an increase of 218%. And that slight (hardly “twice as fast”) difference in growth seems significant, until we calculate that it merely means health spending was 5.5% of GDP in 1990 and 7% in 2008—within its normal fluctuation range. Much of that recent rise isn’t due to health spending increases, anyway, but GDP drop-offs after Wall Street meltdowns.

Spinning the tale the other way, though, the BC Liberals make it sound like they’ve been dramatically increasing health care funding. And in the atmosphere of crisis, they can justify privatization—something they’ve shown a propensity towards with hospital and nursing home operations, facility ownership etc.

What’s staggering to me personally is how I fell for such bafflegab for several years. I console myself that, when I actually write about a topic or take a political stand, I do some research first. But now I’m disturbed about what other illusions I have yet to dispel.

Though I guess that makes us humble, and not quick to parrot what anyone tells us. And that’s a good thing, isn’t it?

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Originally published in Focus, August 2010.

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” »