The long wait for residential care
Patient with special needs lived at Sechelt Hospital for five months while on placement list
Wayne Greggain lived at Sechelt Hospital five months, but not because he needed treatment.
Unable to walk and sliding into dementia, the former mill worker languished on a waiting list for residential care on the lower Sunshine Coast.
Greggain went into the hospital for a brain biopsy on Oct. 12 last year after months of neurological symptoms and increasing fatigue.
Until then, his wife Liz Szymanski-Greggain struggled to care for him at home, with only one hour a week of homecare assistance.
He was eventually diagnosed with cerebral amyloid angiopathy with inflammation of the brain, which is largely untreatable.
His quick decline after the biopsy made returning home impossible, but the area’s residential care facilities are full. Residential care provides 24-hour nursing to people who cannot be cared for at home.
So Greggain was in limbo at Sechelt Hospital, paying about $1,000 a month for his care. How long people are stranded is hard to predict because residential care waiting lists are not first-come, first-served.
Placement in residential care is determined by a detailed assessment of each client’s need for daily support, access to assistance and other criteria including spousal unification, time spent on the waiting list, transfers to a preferred facility and whether the client is in a hospital bed rather than living in the community.
Patients with special needs may need to wait for a bed with the appropriate support. Greggain was finally admitted to Totem Lodge and greeted by a number of patients he came to know while they were all stuck in Sechelt Hospital.
Sadly, there is nothing unusual about his story. In the Northern and Vancouver Island Health regions and in rural pockets across the province, hundreds of acute care hospital beds are occupied by people who should be in residential care.
Residential care is for people who require 24-hour medical supervision, mainly near the end of their lives. The median stay is about 450 days.
About two thirds of seniors accepted for residential care in B.C. are admitted to the so-called first appropriate bed within 30 days. But in some regions, the wait can be long.
In the Vancouver Coastal Health region, half of eligible seniors are placed in six days or less. In the Northern Health region, the average wait is 73 days. On Vancouver Island, the average wait was 62 days last year.
While the numbers fluctuate, about 400 hospital beds are occupied by people who are no longer receiving treatment while they await placement, according to the seniors advocate’s monitoring report. Proportionally, the numbers are highest in the North and on Vancouver Island.
A handful of communities in the Coastal Health region — like the Sunshine Coast — also struggle to accommodate seniors who cannot care for themselves in a timely way.
Vancouver Coastal Health has an agreement with Trellis Seniors Services to build and operate a privately owned, publicly funded residential care home. The project is intended to replace two aging facilities — Totem Lodge and Shorncliffe in Sechelt — and to also add 20 new beds.
Thirteen people are waiting for residential care in Sechelt and nearby Gibsons, according to the health authority.
But the project has become a political football and a focal point for protest in the community and by unionized staff at the government-owned facilities to be shut down. Opponents consider privately run facilities inferior to those staffed by government workers. When the District of Sechelt dragged its feet approving a site for the new facility, Trellis was welcomed by Gibsons. But that would have left no beds in Sechelt.
Health Minister Adrian Dix has since announced a deal with the Sechelt First Nation to build on their land.
Access to residential care and assisted living in B.C. has declined by 20 per cent over the past 16 years, as measured by the number of beds relative to the population aged 75 and
older, according to a 2017 report by the Canadian Centre for Policy Alternatives.
Access to home support has declined 30 per cent over the same period. Though more seniors receive care at home, they each receive fewer visits by workers, according to the report Privatization and Declining Access to B.C. Senior’s Care.
The waiting times for placement in assisted living and residential care dropped modestly last year, but Isobel Mackenzie, the seniors advocate, is concerned that the growth in residential care spaces is not keeping pace with our aging population.
“While there has been a 1.5 per cent increase in subsidized residential care beds since last year, the population aged 75-plus increased by 3.5 per cent,” according to Mackenzie.
Fraser Health led the way, adding 294 new residential spaces last year. The Northern Health region added just one, while the number of publicly funded beds in Vancouver Coastal dropped by 24.
In Vancouver Coastal, there are 113 people waiting for residential care, 37 of them in acute care hospital beds, according to the Health Authority.
For patients, it’s a waiting game. “Two whole floors of our hospital are full of people who should be in a care home,” said Szymanski-Greggain. “Think of the difference that would make to the hospital.”