Lost intransition
At the convergence of B.C.’s opioid, mental health and housing crises are vulnerable seniors like Melanie Keays. They are being cycled by homeless shelter staff to hospitals, and discharged by hospital staff back to shelters, sometimes in nothing but a gown. It happened to Keays twice in one day. The heartbreaking story of the homeless seniors nobody wants …
SURREY, B.C.— An alarm bell ringing in the hospital corridor makes it hard to think, let alone talk. Down the hall a female patient moans in pain, distracting the social worker momentarily. She turns back to the frail woman speaking softly from a hospital bed in front of her.
“But I don’t want to go to Chilliwack,” says 64-year-old Melanie Keays, her voice barely audible.
“I know, but you have to work with us,” the social worker replies. “We don’t want to send you out on the street.”
It’s mid-November, and Melanie has been in this bed at Surrey Memorial Hospital for 10 days. Hospital staff insist there is nothing physically wrong with her — “unfortunately, she is medically stable,” as the nurses keep saying — but the hospital doesn’t know what to do with her. She has no home and the shelter she was living in refuses to take her back.
She has no bank cards or access to cash. She uses a walker and struggles to climb even small sets of stairs. The pharmacist doesn’t know where to send her metha- done prescription once she leaves the hospital.
Keays is in recovery from decades of heroin use, and she requires a lot of support. She forgets critical appointments. She needs in-home care to help her bathe and keep her clothes clean. She is frail, and her health is consistently precarious.
Her Surrey-based methadone doctor says she should be in an assisted-living care home. But staff at the hospital want to put her in a taxi to the Salvation Army shelter in Chilliwack, more than 70 kilometres away from her friends, her family and her only supports.
Keays is not the only one. In February, an elderly woman was discharged from Chilliwack General Hospital and dropped off by a taxi at the city’s Ann Davis Transition House. Missing a shoe and wearing only a hospital gown, within half an hour she was so violently ill that she collapsed in the bathroom and staff sent her back to the hospital in an ambulance, according to transition house director Patti MacAhonic.
Chilliwack Mayor Ken Popove made headlines in March when he criticized Fraser Health Authority for discharging two other seniors from Surrey Memorial Hospital in February — a 76-year-old woman with severe incontinence and mobility challenges, and a wheelchair user with open wounds on his feet — to the Chilliwack Salvation Army shelter. Popove says the hospital didn’t tell shelter staff what kind of care the patients needed.
More than 40 days later, Popove says the woman is still in the shelter, where staff are unable to care for her properly.
“A homeless shelter is no place for a person with health concerns or special medical needs,” Popove wrote in an open letter to Dr. Victoria Lee, president and CEO of the publicly funded health authority that serves 1.8 million people and oversees 12 acute-care hospitals from Burnaby to Hope in the Lower Mainland.
“Are hospitals regularly discharging patients into homeless shelters?” his letter asked. The answer is yes. These stories point to a revolving door that shuffles an increasing number of vulnerable seniors from hospital to shelter, and a health system that struggles to care for them.
Debby Byron knows this better than most. A mobile case worker at the Lookout Society’s Guildford shelter in Surrey, Byron is one of the first people to help Keays feel valued and supported.
“Our seniors are the new face of homelessness, and it hasn’t even peaked yet,” Byron says.
Shayne Williams is the CEO of the Lookout Society. He says people like Keays are victims of four complex and interrelated social issues: unaffordable housing, the opioid crisis, an aging population and mental health crisis. These problems often overlap in cases like Keays’, compounding the complexity of care.
“We have a dedicated ministry of mental health and addictions now, the only one in the country, which will help,” Williams says, “but in terms of the overall ability for the system to care for these vulnerable people, access has been a challenge.”
Williams says more than 200 people experiencing homelessness go to Fraser Health emergency rooms every day, often becoming part of the never-ending cycle that leads from shelter to hospital to the street and back again.
It’s a problem across the country and has been for years, particularly where affordable housing is out of the reach of most middle-income people, let alone those of limited means.
“We need a better overall picture of where people are falling through the cracks of the whole housing support system,” Katie Plaizier, project manager for Toronto’s Centre for Equality Rights in Accommodation, told the Star in a 2017 interview about a report on an emerging crisis in the Greater Toronto Area involving evictions of senior tenants.
Since his letter hit the news, Popove learned of several other cases of vulnerable seniors being shipped from hospitals around the Lower Mainland to shelters in Chilliwack.
“At the end of the day, a shelter is not an appropriate place for these people to be in,” Popove says. “That’s bottom line, in my opinion.”
Fraser Health would not comment on specific cases, citing privacy concerns. In a statement, it says these cases were “troubling, and Fraser Health takes them very seriously.”
“Finding suitable housing is a challenge across our region,” the statement says. “A discharge transition from an emergency room to a shelter would only happen when the patient is deemed medically stable and ready to leave the hospital. We make every effort to find them suitable housing if they don’t have a home to return to.”
But Popove says that assertion is “bulls--t,” and evidence shows people are being discharged when they’re not medically stable, and that shelters often are given no warning.
During this investigation, the Star found five other recent cases where seniors experiencing homelessness say they were displaced from their communities to shelters in Chilliwack, Surrey, Delta and Vancouver.
Many of the people the Star spoke to did not want their names or stories told publicly, for fear of being stigmatized further.
While landing in a hospital bed is certainly not a good long-term solution, in many cases it’s better than landing on the street. That’s what happened to Larry McConkey. He was a client at the Hyland House shelter in Surrey until early December. At 70 years old, McConkey uses a wheelchair and has been struggling with alcohol dependency for years.
He says he returned to Hyland House one evening in December after having had too much to drink. The shelter says it is low barrier, meaning sobriety isn’t a requirement to access its services, but McConkey says that didn’t appear to matter.
After an altercation with staff, he says he was told to leave. Mark Usher was there when it happened and corroborates McConkey’s account.
Now in his 50s, Usher has himself been a shelter client for years. He also sits on Fraser Health’s opioid addictions panel in New Westminster and volunteers with the non-profit Purpose Society for Youth and Families. He has become an unofficial and seemingly tireless advocate for vulnerable people in the system, with his own network of contacts at shelters and service providers across the Lower Mainland.
Usher says it was raining and cold the night McConkey was asked to leave Hyland House. With nowhere else to go, Usher took McConkey to the Quibble Creek sobering centre for the night. From there, McConkey bounced between the sobering centre and another nearby shelter for weeks, his health and sobriety continuing to decline.
Meanwhile Usher had gotten an apartment at the Ted Kuhn Towers, a supportive housing project in Surrey run by Options Society, the same organization that runs Hyland House.
“Larry was at the shelter until they kicked him out for drinking,” Usher says. “Then I got him into an emergency weather response shelter, but nobody wanted to go the extra mile for him, so I took him in with me.”
Usher’s apartment wasn’t much — a cramped bachelor unit with a tiny kitchen — but it was something. Both of them slept on mats on the floor for a while, until Usher could arrange proper beds. He also got McConkey’s prescriptions for a heart condition renewed and made sure he had nutritious food to eat. For about a month, McConkey stayed sober and his health improved. He even started a regimen to build up his strength and become less reliant on his wheelchair.
Like McConkey, Keays has been through the system many times before.
Over the summer, her ex-husband Richard Griffin says she spent 66 consecutive days in a hospital bed at the Peace Arch Hospital in White Rock before social workers found her a space at the Hyland House shelter in Surrey.
“It makes me feel horrible,” Griffin says of the constant shuffling around. “It’s painful to see her struggle like this.”
Though they’ve been separated for decades, Griffin is one of Keays’ only sources of reliable support. A recovering addict himself, who was on the street for years, he now lives in a transitional housing unit and isn’t allowed to have roommates.
He also sits on a number of drug and alcohol use panels in Surrey, and spends most of his time supporting fellow recovering addicts and marginalized people in the Surrey area.
But taking care of Keays has pushed him to his limit. She became homeless about two years ago, when she broke up with the man she had lived with for 20 years.
So it fell to Griffin to make sure Keays got to her appointments on time, to help her sift through pages of Craigslist rental ads neither of them can afford, and to be the bulwark against a Byzantine system of paperwork-filled bureaucracy that he says the shelter staff weren’t helping with.
Keays says she found living at the Hyland House shelter isolating. “Every day I wanted to get out of that place,” she says. “But I needed someone to help me.”
So she would call Griffin, sometimes as many as seven times a day, to come get her.
‘I needed someone to help me’
“She keeps getting bounced from agency to agency,” Griffin says. “She is falling through the cracks. I’ve been this watchful eagle for so long, and it’s taking a toll on me.”
By November, the cycle had started again. Staff at Hyland House sent Keays to the Surrey hospital in an ambulance on Nov. 7. She was examined and released, but within an hour the shelter sent her back to the hospital again. Griffin was out of town, so he called Usher for help, who raced to the hospital to try and figure out what was going on.
One nurse told him Keays had been caught smoking in her room, a charge Keays denied. Her bed at Hyland House had been given away because she had been discharged, and all the other local shelters were full, the nurse says. A different nurse told Usher, who was also living at Hyland House at the time, that it was because the shelter didn’t have the resources to handle someone with Keays’ needs.
Regardless of the official reason, “Hyland House isn’t willing to touch this at all,” the hospital’s social worker told Usher, out of earshot of Keays. So Usher called his network of contacts in the social services around the Fraser Valley, looking for somewhere that might be willing to take Keays.
Ten days went by before Griffin got a call from the hospital. The only solution staff could find was to send Keays in a cab to the Salvation Army shelter in Chilliwack.
Since she became homeless, Griffin says Keays’ mental health has taken a worrying dive, and he feared the shock of being sent to Chilliwack might be too much.
“If they send her to Chilliwack, she’ll be totally isolated,” Griffin says. “I can’t believe this s--t.”
So he called Usher again, and Usher raced back to the hospital to try and negotiate with the staff. The best they could do was keep her for one more night, the social worker says. Usher again called his contacts at shelters as far afield as Vancouver, hoping that would be better than Chilliwack. He also went to Surrey-Newton MLA Harry Bains’ office and asked for help.
By the time he got there, it was past 5 p.m. on a Friday. Staff at Bains’ office tried to call Fraser Health to ask for a reprieve until Monday morning at the very least, but couldn’t get any traction.
Options Society, which runs Hyland House, would not discuss Keays’ case or that of any of its clients.
Deputy executive director Slinder Balaggan says staff work hard to support clients to find permanent housing. But sometimes people are asked to leave when they haven’t upheld their end of the bargain in terms of searching for housing.
“There is a lot of support,” she says. “We have to know that if it’s a conversation about discharge, we feel that we have really brought everything to the table that we possibly can.”
Sometimes a client “is presenting as just not wanting to leave the shelter. We have a lot of folks who would love to make the shelter (a permanent) home,” Balaggan says.
Exacerbating the problem is social support agencies and health care providers that operate in silos, making cohesive case management difficult.
“We’re really limited in what we actually know about people,” Balaggan says. “We have no way of knowing which steps have been tried before.”
After agreeing to keep Keays for an extra night and aided by Usher’s efforts, the staff at Surrey Memorial discovered Lookout Society’s Guildford shelter had an open bed.
But when she arrived, Keays’ mobility challenges meant she couldn’t climb the ladder to a top bunk, so she slept on a mat on the floor for days until the shelter could arrange a lower bunk.
Byron, the mobile case worker at the Guildford shelter, says they could take Keays because a provincially funded pilot program in Surrey called the Health Care to Shelter Working Group keeps dedicated spaces for people like Keays who are discharged from hospitals and have nowhere to go.
Balaggan says Hyland House is also part of the Hospitals to Shelters pilot, although it’s unclear why they gave away Keays’ bed when she was sent to hospital and didn’t take her back when she was discharged.
It’s mid-December. In the month that Keays has been living at Guildford, Byron has taken over her casework, arranged transportation to and from her methadone and doctors’ appointments, helped her search for housing and started the paperwork to get her approved for government-subsidized assisted living.
Keays has been sent back to the Surrey hospital a number of times. But each time, staff at Guildford held her bed for her and checked in on her while she was there, Griffin says.
Keays started making friends in the shelter, doing arts and crafts with them and beginning to build a community. Instead of seven or eight calls a day to Griffin, she was calling only a couple times a week to go out for coffee.
“I was almost in tears. It was night and day,” he says of the support Keays was receiving. “They really support their people, and they go the extra mile.”
But there’s still a big problem with housing beyond the shelter system.
“All service providers in the Lower Mainland sit at the same table,” Byron explained. In order to choose who gets into an assisted living space, “each provider can put forward five names that might be a good fit.”
“Melanie is number one on our list right now,” Byron says, “but the wait list is up to100 people at a time. It’s five years long right now.”
That means Keays could end up spending the next five years living at the Guildford shelter. If that’s what it takes to find her a home, Byron says that’s what she will fight for.
At the same time, shelter and outreach providers across the Lower Mainland say the number of seniors experiencing homelessness is rising.
Statistics from the annual Metro Vancouver Homeless Count show the number of homeless seniors tripled from less than 250 people in 2008 to more than 750 in 2017.
“This year we ran our mobile outreach program five nights a week,” says Union Gospel Mission spokesperson Jeremy Hunka. “The more we go out, the more need we see. We’ve seen a substantial increase in the past few years.”
Workers from the Salvation Army are seeing the same thing, according to Jim Coggles, executive director of Vancouver Harbour Light.
“A more disturbing trend for us is that we aren’t just getting an increase in the number of folks 55 and over, but we were seeing some very senior ages.
“We had a mother and a daughter come in where the mother was well into her 90s and the daughter was in her 70s,” he says. “It was a situation where they were really in trouble.”
It’s late February, and a rare ray of sunshine cuts through the clouds as Griffin cruises through Surrey in his battered Nissan sedan. Keays sits beside him, the sun on her face, smiling.
As the car rolls through the Whalley neighbourhood, they pass a man asleep on a curbside lawn, a mountain of possessions piled into shopping carts beside him.
“That was me once upon a time,” Griffin says. “I had a shopping cart like that. We called them Whalley Winnebagos.”
Griffin eases his aging car around the corner and down Surrey’s 135A street. They drive past empty sidewalks that only a year ago were covered in tents and hung with tarps. Around 200 people lived along the so-called Surrey strip before the province paid to install modular housing on an empty lot nearby.
“What if we had something like this for our elderly people?” Griffin says. “Wouldn’t that work, Melanie?” She nods, but adds she wants to have a roommate.
Keays isn’t the only person Griffin’s put this question to. He’s been sending letters about the idea for months to provincial cabinet ministers.
None of them has responded, and Griffin has been too busy to press the point. He came home one night in February to find an eviction notice taped to his apartment door. He’s been in his transitional housing suite for nearly four years, and now he’s being told he must move out by the end of May to make space for new tenants.
He’s spent the past two years worrying about Keays and trying to help her navigate the system. Now he’s facing a return to homelessness if he can’t sort something out in time.
“I have no idea where I’ll go,” he says. “I wake up every morning wondering ‘what’s the plan for today? Where am I going to live?”
‘She is falling through the cracks’