FEATURE: The waiting list

Joy Knecht has been waiting in Queen Victoria Hospital for a residential car bed for more than 300 days. Her daughters aren't happy.

Joy Knecht with her family

The wait time to get into Mount Cartier court averages five months, but for some seniors, the it’s double that. When Joy Knecht was bumped down the list for someone from Grand Forks, her daughters took her plight public, raising questions about why joy couldn’t get a spot.

Joy Knecht has been in Queen Victoria Hospital since October 19, 2014.

More than 300 days ago, she was brought to the hospital because her dementia reached the point where it wasn’t safe for her to live at home.

“Her dementia was quite quickly onset. She was pretty much fine by herself. We had nurses coming in and out before that with the home care system, just checking on her and making sure she was alright,” said her daughter Michelle Knecht-Filipovic. Then, “She had a fairly quick decline and had to be hospitalized.”

Joy was on the waiting list for a space in the Mount Cartier Court residential care facility then, and she remains on the waiting list now, biding her time in a cramped hospital room. There are two other ladies in the hospital in her situation, said Michelle.

Recently, a space opened up in Mount Cartier Court, but it was given to a senior from Grand Forks who had to be evacuated from the Hardy View Lodge care facility when the roof collapsed. Interior Health scrambled to find spaces for the 38 seniors who were left without beds, placing them in various nearby facilities.

Knecht-Filipovic wonders why her mother – who is at the top of the waiting list – wasn’t given the space, and the man forced to wait in hospital like her mother.

“We have questioned why he couldn’t have been moved into hospital the same way as everyone else would have been,” she said. “I said to Dr. (Robert) Halpenny (the president and CEO of Interior Health), this is wrong, it’s unfair, and you guys have broken your rules.”

***

Interior Health doesn’t have strict rules governing placements in residential care facilities. To be eligible, a health care needs assessment is conducted to see if a patient qualifies, and the applicant must have a health care need that requires 24-hour nursing and personal care.

“Placement is based on an assessment of urgency of need and risk,” said Dianne Kostachuk, Interior Health’s director of operations for community integrated health services. “The risk can be fluid. If you’re the first person on the list, if we have a case that is more urgent from a risk perspective and a need perspective, then those with needs will be placed first.”

Basically, someone who is living alone at home will be considered at higher risk than someone in a place considered safe like the hospital.

There is also no official local priority given and placements can be made from outside the community if deemed necessary, said Kostachuk. “We look at it from a broad spectrum across the authority.”

Mount Cartier Court, commonly known as the cottages, has 44 private rooms. There is consistently a waiting list. According to Interior Health, there are currently 11 people waiting for a room.

IH didn’t supply historica waiting list statistics, but the number of people on the wait list is reported to the City of Revelstoke’s health care committee. According to the minutes from those meetings, the wait list has ranged from a low of two in November 2013, to a high of 12 in March 2015. Of those 12, five were waiting in the acute care wing of Queen Victoria Hospital.

Darshan Lindsay, a spokesperson for Interior Health, said the average wait time to get into the cottages is 142 days. Some individuals are placed quickly, while others are required to wait.

“This is due to the fact that individuals are placed in residential care based on urgency of need and risk (safety considerations), and not chronological order on a list,” she said in an e-mail.

According to government policy, seniors are expected to take the first bed they are offered, regardless of location; they can request a transfer to their preferred facility after they enter residential care.

***

Marcy Cohen is a researcher for the Canadian Centre for Policy Alternatives and the BC Health Coalition. In 2012, she produced a report titled Caring for BC’s Aging Population that looked at all levels of seniors care.

According to the report, access to residential care dropped by 21 per cent between 2001-02 and 2009-10.

The report also looked at the number of patients in hospital due to lack of appropriate residential or home care services. It says that between 2005-06 and 2010-11, there was a 35.5 per cent increase in the number of hospital beds in B.C. taken up by people requiring an “Alternate Level of Care.”

The shortage of residential care beds costs the province money. It takes anywhere from $825 to $1,968 per day to care for someone in hospital and $200 per day to house someone in residential care, the report says.

Residential care facilities were also looked at by the B.C. Ombudsperson in a comprehensive report on seniors care published in 2012. According to the Ombudsperson, it costs about $6,000 per month to care for a patient in residential care, with up to about half that amount subsidized by the government, depending on the patient’s income.

The Ombudsperson’s report says wait lists went up in all health authorities between Sept. 30, 2008, and Mar. 31, 2011. In Interior Health, the wait list increased to 591 people from 489 in that period.

The report notes that seniors that wait in hospitals are charged for their care, even though they don’t receive the same level of service as they would in residential care.

“Since the ministry has said that 30 days is the maximum time seniors should have to wait for placement, I concluded that it is unfair for health authorities to charge seniors for their hospital stay when they are forced to wait longer than 30 days after assessment for a bed to become available,” the Ombudsperson wrote.

The ministry has not followed through on that recommendation; Knecht-Filipovic says her mother is being charged $1,000 per month.

Cohen told me the wait lists and the shortage of beds leads to an “advocacy strategy game in terms of how you work the system.”

The long waiting lists were the result of several factors. “Some of it is existing rules, some of it is not enough beds, and some of it is not enough early intervention and supporting people at home.”

***

One of the issues Knecht-Filipovic raised is the living conditions in the hospital. She described cramped rooms shared between two patients, where the beds are within arms reach and there’s little privacy. There used to be a cordless phone at the nursing station that families could call to speak to their parents; that no longer exists. Her mother has been moved four times — for someone with Alzheimer’s, it means having to re-learn their surroundings each time.

“That’s the quality of life that these ladies and gentlemen are asked to live,” she said. “I never expect in a million years she’s going to get better. I did not expect the environment she’s going to be living in was going to be part of the problem and making her worse.”

Those comments were echoed by Fran Carlson, who’s father Frank Grace spent 10 months in Queen Victoria Hospital waiting for a space to open up in the cottages. A veteran of the Second World War, he had a fall that resulted in a crushed vertebrae and he couldn’t live at home anymore. At the hospital, he had to use a walker, then a wheelchair. He was moved from room to room, going from extended care to acute care, usually sharing a room.

Carlson asked about moving him into one of the empty rooms, but hospital staff said no.

Because he was in the hospital, he was considered to be in a safe place and wasn’t a priority on the waiting list. Eventually, Carlson threatened to take her father home in order to move him to the top of the list. He was finally granted a spot at Mt. Cartier Court.

Kostochuk said Interior Health prefers seniors live at home as long as possible, with support from home care aides and nurses.

“That is the ideal situation, not just from our perspective, but all research and evidence suggests that’s the best place for folks to be waiting,” she said.

The hospital is “the last place we would want folks to be waiting.”

She said hospital care could be looked at by IH.

“On a regular basis, we’re trying to ensure we’re delivering the best possible care in the best possible environment at all times,” she said. “There’s always opportunity to look on a regular basis to ensure if there’s any opportunity for improvement.”

Knecht-Filipovic suggested putting long-term care patients in some of the empty rooms at the hospital.

“If you would put them in the wing that’s empty and put them in a room by themselves, that would solve at least 98 per cent of the problem there,” she said. “Give them some room to have some dignity of life.”

In her ideal situation, her mother Joy would get a room at Mt. Cartier Court. “That’s where she needs to be.”

She hopes by speaking out, she’ll help the situation for everyone’s parents — not just her mother’s.

“In a community like Revelstoke, which has incredibly large aging population, they’re going to find themselves in this position over and over and over,” she said.

The worst part of it for her is that she finds herself reading the obituaries to find out if a resident of the cottages died. “You have to wish for someone’s parent to die in order for your parent to get what you want,” she said. “Awful. It makes you sick to your stomach.”

 

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