‘WE ARE MIXING INCOMPATIBLE POPULATIONS’
Being terrified in a long-term care facility started long before the COVID-19 pandemic came along
Every day, Bill Salhany battles his body that’s racked by nerve pains in his hands, legs and neck.
“I haven’t left my room today, I just feel … sometimes I feel totally defeated,” the 68-year-old retired RCMP officer said when we spoke by phone.
“All I can hope for is a better day tomorrow. I just try get through rest of the day without too much suffering.”
Salhany has had a torturous recovery after waking up a quadriplegic following triple bypass heart surgery in July 2018. He spent months on a ventilator followed by a tracheotomy and later contracted double pneumonia.
Last summer, he moved into George Pearson Centre, a long-term care home that provides specialized assistance for people with severe physical disabilities, including some who also have cognitive issues, and for people who have mental health and substance-use problems.
In addition to dealing with chronic pain, Salhany’s life and the lives of six others have been made more of a misery by a dozen other residents — people with substance-use problems who are bullying and harassing them.
In August, he lay powerless in bed when his roommate returned home late at night, drunk, high and threatening. It took a lot of complaints and several weeks before Salhany was moved to another room with a different roommate.
But the group of 12 also controlled the canteen, bullying and intimidating others by sometimes circling around them, said Salhany.
“The rest of the population was afraid to go down there. They took it over and even the activity centre in the evenings. They would go and drink alcohol, smoke crack cocaine and marijuana,” Salhany said last week.
“I went to management and said, ‘This has got to stop. It’s not right.’ They said they would take care of it.”
In December, Vancouver police were called and made an arrest following “an incident regarding drugs.” That investigation is continuing, according to spokesman Aaron Roed, who also confirmed that police were called to Pearson 18 times in 2019 and have responded to four complaints so far in 2020. “These investigations vary in why the officers were there,” he said.
The B.C. seniors advocate, Isobel Mackenzie, is aware of drug and alcohol problems at
George Pearson and at several other long-term care homes in the Lower Mainland and at least one other facility in the Interior Health region.
She’s talked to B.C. Housing about the problems that arise when people with addictions — some of whom are coming directly from the streets — are mixed with frail seniors and vulnerable people with profound physical disabilities.
“We are mixing very different groups of people and they’re not mixing well,” Mackenzie said.
“What’s been underappreciated is the impact that they have on the other people who live there.
“Nobody is the villain in this,” she said, noting health authorities and B.C. Housing are “trying to find places to house people with mental health issues and addictions, which they’ve determined are disabilities and that’s what this kind of housing is for.”
OPIOID CRISIS MAKES SITUATION WORSE
Nurses have also been raising concerns with their union president, Christine Sorensen.
Nurses with specialized skills in geriatrics, dementia and palliative care have told her that they are frustrated because they don’t have the skills or the resources to deal with residents who have addictions and very different kinds of mental health problems than the elderly.
Sorensen said nurses have filed complaints with the health authorities and to WorkSafeBC that residents have thrown things at them, verbally abused them and harassed them.
“Once opioid overdoses were identified as a public health emergency, nurses in long-term care started to see admissions of residents who were not the usual ones,” she said.
They were younger, often with brain injuries and more complex mental health issues.
“Some are coming from the street before they’re stabilized in acute care and released to long-term care facilities. And for some people who may have chosen to live on the street for a long time or for those who are not at the long-term care home by choice, it can be incredibly stressful.”
Disability advocate Paul Caune says the drug problem at George Pearson predates the opioid crisis.
“When I lived there (about 15 years ago), there was a resident with his own room and a lock on the door. Nobody else had locks on door. So, I asked, ‘Who is this guy?’ ‘He’s a drug dealer,’” he said he was told.
Caune adds that the difference between then and now is that the residents who were drug users back then “used to be polite and didn’t bother anyone.”
Questioned about the complaints that Salhany and others have made about drug use at the facility, Vancouver Coastal Health refused to make anyone available for an interview.
But in an emailed statement, spokesperson Carrie Stefanson wrote: “Vancouver Coastal Health is committed to the health, safety and security of everyone in our care, especially those who may be vulnerable to the effects of COVID-19. We take any concerns related to these issues extremely seriously.”
Residents at George Pearson have complex physical health needs, said the statement. “Like any long-term care home, there are residents who may also have cognitive impairment due to injury or illness, or have mental health or substance use issues that we provide care for as well. Staff are fully trained to provide the level of care all of our residents require.”
Vancouver Coastal said it is also working with residents eligible under “safe supply” guidelines brought in as part of B.C.’s response to the COVID and opioid overdose crises. Those guidelines allow qualified practitioners to prescribe for addicts pharmaceutical substitutes for opioids, amphetamines and benzodiazepines as well as cannabis, tobacco and alcohol.
‘IT’S NOT RIGHT’
At George Pearson, the December arrest didn’t change anything.
“A lot of residents don’t go down to the canteen or activity wing anymore because the drug users bully us, they surround you to kick us out,” according to the minutes from the Feb. 20 resident council meeting.
“This happens primarily on weekends and evenings. Security cannot do anything, they can only ask them to move along and they are verbally abused. There are no consequences for this behaviour, so it is getting worse.”
Then, along came COVID19.
B.C.’s first case of community transmission was reported at the Lynn Valley Care Centre in North Vancouver on March 7.
Thirteen days later, residents at George Pearson and their families were told the centre was being locked down. Visitors would only be allowed on a compassionate basis and residents could only leave if they were accompanied by a staff member.
Everyone complied — except for the 12.
Fearful of her husband catching COVID, which would almost certainly kill him, Karen Salhany began writing what has become a blizzard of emails to George Pearson’s manager, Romila Ang, to Vancouver Coastal, to the prime minister, to the premier and to anyone else she could think of.
“Little by little, we’re making some gains but not enough to hold them (the drug users) in,” Ang wrote to Karen Salhany in a March 28 email.
“We are not the only home facing the same challenges,” Pearson’s manager added. “MDs (medical doctors) are also working on how people can get their illicit substances through medical interventions/alternatives.
“I’m sorry I don’t have the magical power to solve this at this time. Rest assured however that I am persevering to find a more global solution.”
On March 26, as part of the pandemic battle, the federal and provincial governments agreed to deliver a “safe supply” of drugs — pharmaceutical alternatives to opioids, stimulants, benzodiazepines, cannabis, tobacco and alcohol — to addicts in their homes. But that hasn’t stopped some George Pearson residents from continuing to seek out their drug of choice — crack cocaine.
“One day, I finally exploded on the manager and told her she’s got to do something,” said Salhany. On April 22, a wall was built dividing east from west on Ward 4 as a precaution against the spread of COVID-19.
Salhany and six others are on the east side of the wing. The 12 residents on the west side live behind a locked door with their own exit to the outside and no access to shared facilities.
Nurses, care aides, food services staff and cleaners all put on personal protective equipment before going through the locked door.
“They can smoke their cocaine, drink their alcohol, go and meet their pushers. They get the freedom to roam around that we once had. So it’s a bittersweet kind of thing,” Salhany said.
“They’re still openly drinking and using crack cocaine and Vancouver Coastal (Health authority) is allowing this and it’s not right.”
But Salhany and his family empathize with the drug users. “They need to have their own facility where they can get some treatment,” Bill said.
COVID-19 has ripped through long-term care homes, with residents accounting for 82 per cent of the Canadian deaths, tragically highlighting many systemic weaknesses and leading to calls for provincial inquiries or even a national one to help reset how longterm care is delivered.
“While we are reimagining long-term care, commingling is one of the issues we need to talk about,” the seniors advocate said. “We need to talk about how we are addressing small, unique populations who not only can’t get their needs met, but are also impinging on the quality of life of others.”
There’s a real urgency to addressing the problem because of the growing number of younger people who have brain injuries from lack of oxygen after being revived from opioid overdoses.
“Where do we put them?” Mackenzie wonders.
“They are alive, but they are incapacitated to the point where they can no longer live independently. But what does that look like?”
There are different philosophies about long-term care, including integration (the model in B.C.), segregation (which is being done on Salhany’s ward now due to COVID-19) and grouping people based on their shared histories or interests.
Integration, in practical terms, means that in all communities — but especially smaller ones — anyone needing a bed in long-term care is placed in the first one that’s available regardless of their situation.
Residents have no choice in their roommates or mealtime companions. Their only common denominator is that they are no longer able to live independently.
“These are communities of people where many of them are living out their last days,” said Mackenzie. “But we are mixing incompatible populations just because we only have one category of complex care.”
Most glaringly, it means conflict. But, as crucially, it means residents’ quality of life is equated only with their physical needs without little consideration for their social, emotional or even spiritual needs.
In a landmark survey done by the seniors advocate, loneliness is one of residents’ most common complaints.
The most successful dementia village model is in the Netherlands. Its longterm care homes are smaller and residents are placed in groups based on shared interests such as music as well as common histories that might include having grown up on farms or been professionals.
Imagine what that must be like for both the residents and the staff. Then think about what’s happening here.
Imagine being frustrated and fearful at work. Imagine being the sole young person living among the frail elderly.
And then imagine Bill Salhany — bullied, frustrated and unable to fend for himself.
They all deserve better tomorrows.