The Vancouver Island Health Authority (Island Health) has reissued a Request for Proposals to add 120 new beds for patients requiring a complex level of care in the Comox Valley.
Island Health says it hopes to award contracts for the new beds in early May and expects they will open for patients sometime in 2020.
That’s good news for people needing complex care, and especially for their caregivers. The glaring and long-time shortage of complex care beds in the Comox Valley has distressed caregivers, and resulted in some horrific tragedies.
It’s also good news for Comox Valley Hospital workers. A workforce staffed for 129 admitted patients has been dealing with serious overcapacity issues — up to 170 admitted patients — since the new hospital opened in October.
Most of those 30-40 unexpected patients no longer need acute care, but remain in the hospital because of the Valley’s shortage of complex care beds.
It’s a problem that dates back many years, but surprisingly the new Comox Valley Hospital was planned as if it would never have patients needing an alternate level of care.
That strategy might have worked, or at least diminished the current problems at CVH, except Island Health was slow in issuing a Request for Proposals and awarding the contract for new or replacement beds. And then, it cancelled the RFP completely.
On Sept. 30, 2016, Island Health issued an RFP for 70 new or replacement residential care beds for the Comox Valley. The press release said contracts would be awarded in April 2017 and opened in 2019.
But, on Aug. 3, 2017, Island Health cancelled the RFP, shortly after its board of directors decided the four hospice beds located at St. Joseph’s should be moved to a secular facility that could provide Medical Assistance in Dying (MAiD).
Tim Orr, the director of residential services for Island Health, told Decafnation that St. Joseph’s policy not to permit MAiD was one of several factors in the decision to cancel the 2016 RFP. The new RFP requires at least one proponent to provide end-of-life services including MAiD, and house six hospice beds.
FURTHER READING: Island Health RDP press release
What’s in the RFP?
The Island Health press release says the 120 new beds may be awarded to more than one proponent, and than the number of new complex care beds awarded to each proponent will be determined in the evaluation of each proposal.
“Should the RFP result in more than one successful proponent, at minimum, one of the selected proponents will be required to provide for six community hospice care beds and allow for the provision of MAiD (Medical Assistance in Dying) on site,” the release said.
And successful proponents must provide 3.36 direct care hours per resident day, as per provincial standards.
The release also states that the “new RFP includes flexibility for greater capacity in the future, opportunities for a full spectrum of complex care including innovative models of dementia care ….”
The community has responded to the Island Health announcement with cautious optimism.
Our sources believe that 120 new beds will relieve the stress on the new Comox Valley Hospital, but will not provide a complex care bed for everyone in the Valley who needs one.
Because there are so many nonpaid (mostly family member) caregivers in the Valley, and because only the most in need of acute care get into the hospital, that the Valley may actually need more than 150 and closer to 200 complex care beds.
Our sources expressed disappointment that the announcement didn’t include an increase in respite beds, adult daycare programs or resources for Community Health Care, a program designed to keep people at home as long as possible.
Will St. Joseph’s apply?
The wording of the RFP press release appears to open the door for The Views at St. Joseph’s to apply for additional beds without agreeing to provide MAiD on site, which is something the Catholic church opposes on ethical grounds.
The Views at St. Joseph’s already provides publicly-funded complex care beds that are mostly occupied by patients with dementia. The Views board of directors has outlined a vision for a dementia village” similar to Hogeweyk in the Netherlands.
A private operator in Langely, B.C. just announced that it will open Canada’s first “dementia village” next year. Verve Senior Living says the project will cost patients between $6,000 to $7,500 per month, but is open to working with the B.C. government to make residence more affordable.
Island Health will accept proposals until May 11, but does not say when the contract or contracts will be awarded. It generally takes a minimum of two years from awarding a contract to its completion.
The Island Health board of directors will meet at 1.30 p.m. on March 29 at the Crown Isle Resort ballroom. People may ask questions in advance to be answered in written form at the board meeting, or make 10-minute presentations to the board if they apply by March 15.
In other North Island Hospitals news, Dr. Jeff Beselt has resigned from his position as the Executive Medical Director for the Comox Valley Hospital and Campbell River Hospital. According to a Island Health spokesperson, Dr. Beselt stepped down to focus on his family. Island Health named Dr. Jennifer Grace, of Campbell River, the interim EMD for the region, which includes Campbell River, Courtenay, Comox and Mount Waddington/Strathcona. You can view a farewell video for Dr. Beselt here, and read reviews of Dr. Grace here.
FURTHER READING:Canada’s first “dementia village;”BC retirement home chain sold to murky Chinese ownership group
The Vancouver Island Health Authority (VIHA, or Island Health) board of directors will hold their March meeting in the Comox Valley.
It’s an opportunity for Comox Valley and Campbell River residents flummoxed by the myriad errors in planning the new hospitals to ask questions or make presentations to the directors and Island Health executives.
The board will meet from 1.30 p.m. to 3 p.m. on March 29 at the Crown Isle Resort ballroom located at 399 Clubhouse Drive, Courtenay.
With the Comox Valley Hospital still running over capacity — due in large part to the shortage of long-term care beds — citizens might ask when Island Health will re-issue the Request for Proposals to build “new or replacement” beds.
Island Health originally issued an RFP for 70 “new or replacement” beds in 2016, then abruptly withdrew it last summer after deciding to move the community’s four hospice beds to a facility not operated by a religious organization.
Citizens might also ask when Island Health will correct planning errors such as the location of landing pads for emergency transport helicopters, the lack of space for storing health records and other oversights detailed in a series of articles on Decafnation.
FURTHER READING: Online forms for questions and presentations to the Island Health board
The board will only consider questions submitted in advance using an online form available on the Island Health website.
But, curiously, the board won’t speak to those questions at the Courtenay meeting. They will answer them in written form to be distributed at the meeting and uploaded to the Island Health website.
Individuals or groups planning a presentation to the board must apply using an online form at least 14 days in advance of the meeting (a March 15 deadline).
The Island Health board includes two area directors: Anne Davis, program coordinator for the Comox Valley Transition Society; and, Claire Moglove, a retired lawyer and former Campbell River city council member.
FURTHER READING: The Decafnation series on the Comox Valley Hospital
Nearly a month after Decafnation published the first of four articles that spotlighted problems at the new Comox Valley Hospital, the Vancouver Island Health Authority (VIHA) has issued a press release in response.
The VIHA statement released on Feb. 2 says, in part:
“Recently, there have been public statements focused on the North Island Hospital Comox Valley campus. While we know there are inaccuracies in some of these statements, we also acknowledge there are truths.
“This is a normal part of a change of this magnitude and we want to assure our staff, physician partners, patients, volunteers and the communities that the hospital serves, that we are listening and working very hard to make necessary improvements.”
These sentences contain several troubling statements.
WHAT DO YOU SAY? — Decafnation invites health care workers and others to respond to the VIHA press release with a comment below or on the Decafnation Facebook page.
First, the VIHA release repeats a claim by CVH Medical Director Dr. Jeff Beselt made to a reporter for 98.9 The GOAT that the first Decafnation article published on Jan. 15 wasn’t entirely accurate.
Decafnation immediately made repeated requests for Beselt to specify those inaccuracies. Those requests were ignored until this week.
But the errors Beselt points out have nothing to do with any of the serious issues raised in our four-part series.
Here are the three errors in the first article to which Beselt says he was referring:
1 — The cost of the Comox Valley Hospital was $331.7 million, not $350 million. We rounded up the original estimate. We’ve also requested data on any cost overruns, which are not uncommon in construction projects.
2 — The hospital building is not ‘owned’ by Tandem Health. Beselt himself errs here. We did not report the building is “owned” by Tandem. We said the building is “leased” from Tandem. It is more correct to say the building is ‘managed’ by Tandem Health under a 30-year operating agreement. It’s interesting to note that VIHA pays Tandem Health a monthly fee for these management services.
3 — Decafnation stated that St. Joseph’s General Hospital was overcapacity on the day it closed. Beselt says that St. Joe’s was not overcapacity on that day because patient numbers were reduced for purposes of the move to the new hospital.
He’s correct for the reason he states. But the point was that St. Joe’s had been overcapacity frequently for several years before the move — a result of having to place people in acute care beds that no longer need that level of care. Further, it was known on the day St. Joe’s closed, and during the construction of CVH, that the roughly 30-40 percent of patients needing an alternate level of care (ALC) would transfer over.
It is Decafnation’s policy to correct errors of fact quickly, so each of the articles now make note of these three corrections and one other similar error in the third article of the series.
The more troubling statement in the VIHA release is that the problems Decafnation has reported are “… a normal part of change of this magnitude ….”
It’s true that some of the issues, including staff morale, relate to former St. Joseph’s staff members habituating to the VIHA culture, and our articles reported on that.
But that doesn’t account for all of the specific problems we have identified, such as not planning for overcapacity, not recognizing that the spacious floor plan would require higher staffing levels, forgetting to include whole departments and later squeezing other departments to fit them in and not providing sufficient residential bed capacity and adequate access to other services for unpaid caregivers in the Comox Valley.
Not to mention failed heliport planning at both Comox Valley and Campbell River sites.
We could go on, but these hardly seem like “normal” parts of a well-considered planning processes. Especially when our sources say they repeatedly raised these and other specific concerns in public and employee meetings during the planning stage.
Did VIHA management simply not listen carefully to its front-line workers during the planning process? VIHA says it did, but there’s a large contingent of north Island hospital employees who strongly disagree.
The VIHA release also says it is “working hard to make necessary improvements.” We reported that in our series, too, and hope to someday see the results of that effort.
But neither Beselt or other VIHA executives would say what specific actions they have taken or plan to take. Decafnation would love to report on those measures and how they have mitigated some of the employees’ uneasiness and mistrust.
The fact is, Decafnation accumulated a multitude of information about which the taxpaying public should be concerned. We only published the portion of this information that we could independently verify and collaborate.
Following publication of the series, readers have expressed further concerns and also related patient experiences relevant to the issues raised in our articles, which we also have not published.
Starting today, however, Decafnation is publishing a selection of those observations. The point is to illustrate the breadth and variety of concerns about the building, changed procedures and how VIHA has managed the transition from St. Joseph’s.
We encourage readers to continue sharing their comments on this website or on our Facebook page.
We also encourage VIHA to not gloss over these concerns or dismiss them in public statements by trying to discredit sincere reporting. We hope instead that VIHA undertakes corrective measures that specifically address overcapacity, understaffing, low morale, health care worker safety, excessive overtime and other issues.
North Island communities deserve a great hospital. Decafnation will support every real effort to achieve that goal.
Note: This is just one sample of a voluntarily submitted comment from a single reader that was not posted to our website or Facebook page. You can view publicly made comments on those sites HERE and on the articles themselves, which are posted HERE. Decafnation has not verified this particular reader’s information.
“During an appointment for a procedure at the CV hospital in mid December, I noticed many things about the “flow” for the patient is pretty makeshift at that new hospital. The way sound carries around the admitting desk is about the worst design possible. Sound travels very well among the chairs in the waiting area which are located across the hall from admitting. It also travels well from one admitting kiosk to the next. So patients hear way too much about each others’ admitting process. On the contrary, voices don’t carry well from the admitting kiosks across the hallway to the patient waiting area, and there is no PA system, so you can’t hear your number being called.
“As a result of the sound design, I was able to overhear a conversation between an admitting clerk and another person about the staffing situation that day. They were quite far away from the desk and trying to be discreet, but I still heard it due to the acoustics.
“Apparently the centralized staffing process isn’t working well. They started the day with one person short, but nobody told them. This caused them to fear that their coworker was missing or maybe had an accident or something.
“Signage isn’t very good. It is nearly impossible to find one’s own way from admitting to “minor day procedures” (which isn’t a good name for a place that seems to only do endoscopy). Most of the patients arriving on the same day as my procedure had mistakenly gone to the second floor surgical unit, gotten lost, and then finally were guided by an employee to the “minor day procedures” waiting room.
“Upon arriving at the department, I noticed that area where the receptionist would normally sit was unlit and not staffed. I found out by overhearing another conversation later that the department was short a unit clerk, and running behind schedule due to misdirected patients and no unit clerk to round them up. Instead of a receptionist, there was a whiteboard on an easel where someone has crossed out the word “minor”(day procedures) and changed it to “important!”. Whoever wrote that knows how the patient feels…anytime you are going under anaesthetic, it feels pretty “important” to the patient and the family. The white board stated that the patients should take a seat and someone would come out to greet them.
“When my name was called, I was guided into the department, given a gown and a pillowcase, and directed to a change room. After putting all my personal belongings into the pillowcase, I was directed to place the pillowcase on a small metal cart, alongside many other blue pillowcases that contained other patient belongings. I thought it was weird that there were no lockers, because I had a similar procedure at St. Joe’s a few years ago and I was given a locker and a key. Patients must leave their full pillowcases in the hallway inside the department during their procedures. I then noticed a handwritten sign on a wall that read “LOCKERS!”.
“I was then guided to an area where one of the stretchers is located. The stretcher is still located in the curtained-area, and there are five chairs all crowded alongside the stretcher in a curtained area and you are pretty much knee-to-knee with all the other male and female patients who are also gowned. This encourages a great deal of unsolicited patient “sharing” about their individual medical conditions.
“I later heard from a friend who works at CVH that the original plan was to send gowned patients back to the main “minor procedure” waiting room to wait alongside all the patients and family members who are in street clothes. On the day of my procedure, there would not have been enough chairs there for all of us, and also I would not feel comfortable standing there in a gown among so many clothed strangers. So at that point, I understood why we were all ushered to a makeshift waiting area inside the department.
“After my procedure was finished, I was directed to the pile of pillowcases to retrieve my belongings and sent to a patient bathroom to change back into my clothes.
“At every interaction, the staff and my doctor treated me in a very caring professional way. The procedure went very well and I felt the staff all did an excellent job of mitigating the shortcomings of the staffing situation and the limitations of their physical surroundings. But after over $600 million dollars (Editor’s note: rough estimate for both hospitals) was spent on the project, the patients, staff, and doctors all deserve better.”
The independent analysis of the Vancouver Island Health Authority (VIHA, or Island Health) delivered by external consultants Ernst & Young two weeks ago concluded that an electronic health records system implemented at Nanaimo Regional General Hospital (NRGH) was “not properly planned or implemented.”
Consultants also found that the poorly functioning system, known as iHealth, was additionally challenged by “a general climate of distrust in the hospital.”
The Ernst & Young report reinforces the findings of another external analysis conducted by the Vector Group in early November that described the atmosphere at the Nanaimo hospital as “toxic,” an environment caused by management bullying its workers, retaliation and secrecy.
FURTHER READING: The Ernst & Young report
While those two analyses refer to NRGH specifically, north Island health care workers describe similar situations at the new Comox Valley and Campbell River hospitals.
After a two-month investigation involving multiple interviews with more than 30 different sources at both hospitals, Decafnation has found the facilities were not properly planned and that employees feel the concerns they raised during the process were ignored, and that decisions and information were kept secret. And they now fear retaliation for speaking out.
The purpose of Decafnation’s four-part series was to give these employees a voice in the hope that Island Health executives would start to listen to front-line workers and implement a genuine effort to mitigate the problems that can still be fixed.
And the public has a right to know that our communities didn’t get the hospitals we were promised.
FURTHER READING: The four-part series and other health care stories
Decafnation urges the B.C. Ministry of Health to conduct external studies at the two north Island hospitals similar those undertaken at Nanaimo, and to hold Island Health executives accountable.
The top executive of the region that includes the Nanaimo hospital no longer works for Island Health. Yet, all of the top executives involved in the planning of the two north Island hospitals remain in place.
FURTHER READING: Island Health exec sacked
And there’s more that needs to be done.
REVIEW ISLAND HEALTH — An external review should be done of Island Health itself. It’s clear that changes are needed at an organization where such mismanagement is allowed to occur.
RETURN TO LOCAL HOSPITAL DISTRICTS? — An analysis of Island Health might find that a restructuring of regional health authorities could have prevented these problems. The former B.C. Government merged the province’s 52 local hospital districts into five regional health authorities. The Vancouver Island Health Authority is further broken down into five geographic areas. Geo 1, which includes our two new hospitals is massive, extending from Courtenay to the whole north Island and portions of the mainland’s upper west coast.
The province used this same logic to break the large Comox Strathcona Regional District into two smaller jurisdictions, and it has improved local governance.
REVERSE THE P3 REQUIREMENT — The NDP government should reverse the trend toward building all major infrastructure projects in the province under public-private partnerships (P3). The new Cowichan Valley Hospital, which is now in the planning stages, should not be built as a public-private partnership.
Numerous studies have pointed out the dubious benefits of P3 facilities, some going so far as to say they are a bad deal for taxpayers.
FURTHER READING: P3’s double the cost of government borrowing; The hidden price of public-private partnerships
Many of the problems at the two north Island hospitals resulted from private companies pushing decisions during the planning process based on profitability, rather than what would best serve the community or health care workers.
PROPERLY FUND THE HOSPITALS — Planners badly misjudged the necessary capacity at both hospitals. As a result, both hospitals have been overcapacity since they opened and will never be adequate without further expansion. But the low morale among staff could be improved if Island Health properly staffed the hospitals based on reality.
Both north Island hospitals are incurring excessive overtime and most employees are stressed. That’s not a healthy or successful way to run any organization, public or private.
BUILD RESIDENTIAL BEDS ASAP — Island Health’s failure to assess the residential care requirement in the Comox Valley is epic. They don’t seem to know what to do. But those who work in the field of community Health Services know. The Comox Valley needs up to 200 new residential beds immediately.
It will take three years to get a new facility up and running. But with new funding right now, St. Joseph’s could reactivate its award-winning transitional care unit to accommodate the people who need that level of care but who are now taking up more expensive acute care beds at the Comox Valley Hospital. That would help to solve many issues surrounding overcapacity and understaffing.
COMMUNITY HEALTH SERVICES — Unpaid caregivers and those employed in home support programs need more funding. The Comox Valley needs more Adult Day Care programs and more respite beds.
At least a third of unpaid caregivers (usually family members) are in distress because the province isn’t supporting them with greater access to ADC programs and respite beds. They are burnt out, angry, and they deserve better for attending to their loved ones. Not to mention that unpaid caregivers save the province $3.5 billion per year.
SUPPORT ST. JOSEPH’S — The St. Joseph’s board of directors has an excellent vision to create a Dementia Village and campus of specific care for seniors on its former 17-acre hospital site. There should be no conflict between the Catholic-run facility and the Canadian Medical Assistance in Dying law, as 95 percent of patients currently in The Views (St. Joe’s residential care facility) suffer with dementia. And dementia patients don’t qualify for MAiD.
Taking these actions will move health care in the Comox Valley and Campbell River in a positive direction, and diminish the human toll on workers and patients that bad planning has created.
Those responsible for planning the hospitals that fell short of their promises and the community’s expectations should be disciplined.
And the provincial government must reverse policies from former governments that have fostered these problems.
It’s too late (or too early) to renovate our new hospitals, but swiftly addressing these issues will make the best of our given situation and support dedicated health care workers who continue to act professionally and provide the best patient experiences possible.
With the Island’s largest over-65 population percentage and one of the lowest number of residential care beds per capita, Comox Valley caregivers are in distress and hospital workers feel the brunt of overcapacity and understaffing. VIHA says more beds and support services are coming, but health care workers worry they won’t be enough to fix “a system in chaos.”
This is the fourth in a series of articles about problems surfacing at the new Comox Valley Hospital. Previous articles have examined staff morale, hospital planning and changes in culture and procedures.
Unexpected problems at the new $350 million Comox Valley Hospital — low staff morale, overcapacity, understaffing and overtime expense — have largely resulted from questionable decisions in the planning process and a shift to Vancouver Island Health Authority (VIHA) culture and procedures, according to sources in a two-month investigation by Decafnation.
But there’s another elephant in the room: The failure of the B.C. Ministry of Health to provide sufficient resources for seniors health care has pushed the Comox Valley to a crisis point.
The new CVH was built for a maximum capacity of 153 beds, although it was budgeted and staffed for only 129. That left room to add 24 additional beds by 2025, based on planners growth projections.
But the hospital has had more than 150 admitted patients on a regular basis since it opened. On Jan. 10, 2018, there were 168 admitted patients, already 15 over the expected 2025 maximum capacity and 39 over the number for which VIHA has budgeted and staffed the hospital.
That has escalated the understaffing problem and heightened awareness of inefficiencies in the building’s floor plan. It’s caused patient flow issues affecting the emergency department and the Intensive Care Unit, say our sources.
The winter months are typically the most stressful for health care providers everywhere as influenza and other illnesses tend to peak, which CVH planners would have taken into account. But that’s not the critical source of overcapacity at CVH.
About 46 of those 168 patients on Jan. 10 required an alternate level of care (ALC). These are patients, mostly elderly, who no longer need acute care and should be discharged and transferred to specialized care beds, usually in a residential care facility — sometimes referred to as long-term care.
Except there aren’t any residential care beds available.
This is not a new problem for the Comox Valley, or Vancouver Island. Almost every Island community has struggled with a shortage of residential care beds for over a decade.
But our sources say the shortage has already reached crisis proportions in the Comox Valley, and it’s about to get worse.
How did this happen?
The Comox Valley has a higher percentage of its population over the age of 65 (26 percent) than Victoria (21 percent), and both are higher than the provincial average (18 percent).
We also have the highest percentage in B.C. of people over the age of 85 who are now living independently, say our sources. When those people can no longer live on their own, the Comox Valley will suffer the most.
And yet, the Comox Valley also has one of the lowest number of residential care beds per capita funded by VIHA, according to our sources. But they say the VIHA method of determining the right number of beds for a community is vague.
For example, British Columbia has a total number of residential care beds equal to 7.4 percent of province’s population over age 75. That number drops to 6.8 percent on Vancouver Island, and goes down further to 5.3 percent for the Comox Valley.
Or, if VIHA based the number of residential care beds on 75 beds per 1,000 people over the age of 75, which is roughly the provincial average, then Vancouver Island would be short by 10 percent and the Valley by a whopping 30 percent.
There is an immediate need for more than 150 additional residential care beds in the Comox Valley, our sources say. Some put the number closer to 200.
Some of our sources attributed the problem, in part, to a 2003 shift in senior health care policy.
That was the year the B.C. Liberal government introduced a new assessment process to restrict access to residential care to only those needing “complex care,” meaning medical services. The result was that those who qualified for residential care were more acute (sicker), and this shortened the length of stay from 2.5 years to 1.8 years.
FURTHER READING: Residential long-term care planning: The shortcomings of ratio-based forecasts
Our sources believe this caused VIHA to decide fewer residential care beds were needed to service the same intake rate.
How has this affected the new hospital?
Those responsible for planning the new CVH made the assumption that although there were 40-some ALC patients in acute care beds at St. Joseph’s, the new hospital would have none. They incorrectly assumed there would be sufficient residential care bed capacity in the Comox Valley by the time the hospital opened.
That strategy might have worked, or at least diminished the current problems at CVH, except VIHA was slow in issuing a Request for Proposals and awarding the contract for new or replacement beds. And then, it cancelled the RFP completely.
On Sept. 30, 2016, the Vancouver Island Health Authority (VIHA) issued an RFP for 70 new or replacement residential care beds for the Comox Valley. The press release said contracts would be awarded in April 2017.
Construction would start in the summer of 2017 and the beds would not open until the summer of 2019, nearly a year and a half after the hospital opened in October of 2017.
But, on Aug. 3, 2017, VIHA cancelled the RFP, shortly after its board of directors decided the four hospice beds located at St. Joseph’s should be moved to a secular facility that could provide Medical Assistance in Dying (MAiD).
Tim Orr, the director of residential services for VIHA, told Decafnation that the restriction on providing MAiD at the Catholic-operated site was one of several factors in the decision to cancel the 2016 RFP.
As of Jan. 23, 2018, no new RFP has been issued. Given the original three-year time frame from issuing an RFP to opening the beds, the Comox Valley is unlikely to see any new residential care beds before 2021.
With ALC patients unaccounted for by planners, CVH was overcapacity when it opened its doors and has remained so for the first four months. This has exacerbated the transitional problems at the new hospital.
These problems include patient flow. There are usually no available beds for people treated in the emergency department (ER) who need to stay overnight. So the ER expansion area has been filled with acute care patients.
The same problem occurs in the Intensive Care Unit, our sources say. Due to timing issues, there is often not an acute care bed to move patients out of ICU when they no longer need that specialized care.
FURTHER READING: Strengthening seniors care delivery in B.C.; Abbeyfield closure highlights seniors housing issues
And the additional unnecessary cost to taxpayers is significant. Acute care beds cost taxpayers between $800 to $2,000 per day, while residential care beds typically cost about $200.
The BC Care Providers Association has proposed redirecting some acute care funding to the development of new long-term residential care facilities.
Caregivers in distress
Hospital workers aren’t the only Comox Valley people affected by the residential care bed shortage. Family members are on the front line of this problem.
“The system is in chaos,” said one source. “And family caregivers are covering it up.”
According to B.C. Seniors Advocate Isobel Mackenzie there are roughly one million unpaid caregivers in B.C. 91 percent of them are family members, usually adult children (58 percent) or spouses (21 percent).
Mackenzie estimates these unpaid caregivers save the provincial government $3.5 billion per year.
In an August 2017 report, “Caregivers in Distress: A Growing Problem,” Mackenzie said 31 percent of unpaid caregivers were in distress in 2016, which represented a 14 percent increase in the actual number of distressed caregivers over the previous year.
She defines ‘distress’ as anger, depression and feeling unable to continue.
This has resulted in horrific personal tragedies.
Multiple sources have collaborated accounts of unpaid caregivers falling ill themselves due to the stress for caring for loved ones, including medical emergencies that require hospital stays. This means their loved ones also end up in acute care hospital beds, waiting for a residential care bed from there.
Some unpaid caregivers have even been stressed to the point of dropping their loved ones off at the hospital emergency department and refusing to take them back home, although this is rare, according to our sources.
Caregivers are distressed because there is so little help available.
The experience of trying to get a loved one onto the list for a residential care bed can be a long and frustrating experience, our sources say. The patient must not only meet the “complex care” requirement, but must also exceed the care that Community Health Services (formally called Home and Community Care) are able to provide.
The Comox Valley has only two Adult Day Care programs that give caregivers a break to attend to personal matters, such as cleaning their house, running errands and looking after their own health through exercise or socializing.
And the wait to get into ADC programs can take up to a year, and it’s restricted to one or two days per week.
In her report, Seniors Advocate Mackenzie said that access to ADC programs has declined by five percent across B.C. and that the number of days accessed was also reduced by two percent.
There are only two publicly funded respite beds for the Valley’s population of 66,500, so it can take caregivers up to a year to schedule a bed. Respite beds take loved ones for a week or two to give the caregiver a break.
The Comox Valley does have one additional private respite bed. It requires a 14-day minimum stay at $200 per day, which is unaffordable for some caregivers.
How VIHA has responded
Tim Orr, the director of residential services for VIHA, told Decafnation that “Enhancing residential care bed capacity in the Comox Valley is a top priority.”
“We are currently experiencing high patient volumes at our hospitals, including North Island Hospital Comox Valley campus,” he said. “Patient volumes do not appear to be tied to any one cause, and the Emergency Department is busy with patients presenting for a wide range of issues. Occupancy fluctuates daily; and often several times throughout the day depending on ER volumes and patient discharges.”
But Orr cannot say when VIHA will issue an RFP to build more residential care beds here. It’s expected, but not guaranteed, that the RFP will be released sometime this winter.
In response to questions from Decafnation, Orr said VIHA recognizes that the Comox Valley needs more complex care beds and is working with the province to issue an RFP for additional complex care beds.
“This new capacity will help meet the current need and Island Health will continue to monitor the need in communities across Vancouver Island and add capacity where most needed as resources come available,” he said.
Orr said VIHA looks at the population over 75 years of age in addition to reviewing what home supports and other community resources are in place.
“The general population health is also a determining factor that drives demand for LTC and Island Health then determines which communities have the greatest need for new long term care capacity,” he said.
NDP MLA Ronna-Rae Leonard gave Decafnation the following statements:
“The new Comox Valley (residential care) facility was long anticipated in our community. I understand Island Health is taking a step back … Our government is working hard to increase the overall residential care spaces in the Comox Valley to address the aging population needs.
Regarding other issues raised in the Decafnation series, she said, “I look forward to hearing the results and how any issues that have been raised will be addressed. I have passed along the concerns I’ve heard about the new hospital to the Minister’s office.”
The Comox Valley ranks among the favorite places for Canadians to retire. So it’s no surprise that our population has aged at a rate nearly double the provincial average.
Without a major expansion of seniors health care infrastructure to deal with this influx, the problems at the new Comox Valley Hospital and the distress felt by unpaid caregivers in our community will worsen.
Our sources say that in addition to “hundreds more” residential care beds, the Comox Valley also needs improved access to ADC programs and more timely access to respite care. They also feel a review of Community Health Services may be required.
The Comox Valley Hospital is not only a new building, inside there’s a brand new management culture and procedures that some say takes a step backward in patient care and staff morale.
This is the third in a series of articles about problems surfacing at the new Comox Valley Hospital. Previous articles have examined staff morale and how the hospital was designed and planned. A future article will look at how the lack of residential care beds in the Comox Valley has contributed to these issues.
UPDATE: This article has been updated to clarify that Tandem Health manages the north Island hospitals and receives a monthly fee for the service and that the Campbell River hospital has been managed by VIHA only since the health authority’s creation in 2001, not since the opening of the 60-year facility.
Most people have been faced with dramatic changes in their working or personal lives, and how well each individual adapts to that change depends on a variety of unique circumstances.
For long-time employees of St. Joseph’s General Hospital, the transition to the new Comox Valley Hospital operated by the Vancouver Island Health Authority (VIHA) has presented a triad of difficult changes, including a less flexible management style and some systems that are less efficient and effective.
So, after the first three-and-a-half months of operation, a two-month investigation by Decafnation has learned the changes have pushed staff morale down to a new low.
First, St. Joseph’s was run like a small, independent local business. It won the 2013 Chamber of Commerce award for Business of the Year.
FURTHER READING: Annual Chamber of Commerce awards; Culture of fear, bullying at VIHA Nanaimo hospital
St. Joseph’s building was physically small. People worked in close proximity. The systems and procedures allowed people to move around among departments, helping colleagues as needed.
These things created a tight bond and camaraderie among employees that doesn’t exist at the much larger CVH operated by the multi-jurisdictional VIHA, according to our sources.
Second, St. Joseph’s was a publicly funded hospital operated autonomously by local management and a board of directors. The new CVH is a public-private partnership operated by VIHA in a building managed by the private sector, which receives a monthly fee for the service.
Third, while St. Joseph’s was by no means a laggard in medical and systems technology, the new hospital has brought more technology to the workplace.
Dr. Jeff Beselt, Island Health’s Executive Medical Director for Geography 1, which includes Campbell River, Courtenay, Comox and Mount Waddington/Strathcona said VIHA understands that it takes some people longer to adapt to change.
“We all miss that closeness,” said Beselt, who worked in the region for several years before the change. “I recognize that some people are really hurting.”
He said VIHA has blended its ways of doing things with St. Joseph’s procedures to create the best quality patient care, and to support staff through the change.
“But this is the new system (procedures and technology at CVH),” he said. “This is the future; the old system is over. We’re just part-way on that journey.”
But some of those new systems have reduced efficiency, affected patient care and battered staff morale.
Patient care issues
Medications — Physicians and nurses have told Decafnation that new technology has resulted in some patients getting their medications late. For some on strict regimes, such as those in severe pain, this is a critical issue.
The new automated medication dispensing technology is designed to reduce errors, which Beselt said occurs more often in hospitals than people are aware.
The system restricts nurses from dispensing medication for more than one patient at a time, which makes the process take longer, but staffing has not increased.
“Adding more checks and balances requires more people … but it improves patient care,” he said.
Colonoscopies — The new hospital is doing fewer colonoscopies than were done at St. Joseph’s. Beselt estimated about 20 percent fewer, though sources estimated the reduction as high as 50 percent.
Beselt said the drop is due to introducing the Provincial Infection Control Network standards, which VIHA uses at all of its acute care sites.
“These stringent requirements extend the reprocessing time of the rooms, scopes and other associated equipment between patients to ensure the highest standard for patient safety.” he said.
Microbiology laboratory — St. Joseph’s Hospital employed staff and equipment to do microbiology analysis in its laboratory in order to provide physicians with timely results before deciding on patient treatment options.
It was a medical service that a local hospital could decide to provide, but one that VIHA decided to centralize. There is no microbiology lab at CVH or the new Campbell River Hospital. All samples are sent to the microbiology lab in Victoria.
Yet smaller hospitals in other B.C. health authorities have retained their microbiology labs. Both Cranbrook, which operates 73 acute care beds, and Fort St. John, which has 55 acute care beds, have microbiology labs.
There are 248 potential acute care beds between Campbell River and Comox Valley hospitals.
Our medical sources could not say if relocating microbiology lab work to Victoria, lengthening the time to get results, had affected patient care. But a source said the new time lag had played a role in a recent case at Campbell River Hospital, though Decafnation was unable to confirm that information.
“Due to provincial privacy legislation, Island Health (VIHA) cannot comment on individual patients and their care,” Beselt said.
Centralized staffing — Department leaders and local staffing clerks no longer arrange staffing for their areas. All staffing for Vancouver Island hospitals has been centralized in Victoria and Campbell River.
When someone calls in sick, the information goes to Victoria or Campbell River where an automated text or email is sent out to all the relevant VIHA employees asking for people to fill that person’s shift. But department leaders don’t know who might not show up for work that day and cannot make arrangements with their staff to fill the gap.
Everything has to go through the automated system. Any given staff member might get numerous automated messages every day, blowing up their phones.
But due in part to low staff morale, those vacant shifts often go unfilled, resulting in a volume of overtime uncommon at St. Joseph’s.
Front desk issues — Clerical workers at CVH only have access to portions of hospital computer systems relevant to their departments. This provides security but also prevents clerical people from helping out in other departments for which they don’t have computer access, and it’s also causing problems at the front admitting desk.
The front admitting desk was supposed to be supported by four to six universal admitting clerks who were cross trained to admit all out patient appointments. That training has not yet occurred.
There are now two or three clerks doing admitting for Ambulatory Care patients and another two to three clerks doing admitting for Medical Imaging patients.
In the morning, the ambulatory care admitting clerks are busy, and the medical imaging clerks are not busy. In the afternoon, the medical imaging clerks are super busy and the ambulatory care clerks are standing around.
“This looks terrible to the people waiting to be called,” said a source. “They don’t understand why there are clerks standing around talking and they are being kept waiting, and in fact some will lose their appointments.”
This problem was identified at the front desk pre-occupancy risk assessment, but has not been addressed.
Our sources say doctors and numerous patients have complained about this.
Bureaucracy — The transition to a more bureaucratic organization has taken a greater toll on former St. Joseph’s employees.
As one source put it, “Comox is just getting introduced to the ineffectiveness of (VIHA) whereas Campbell River staff are more aware of the futility already.”
Campbell River Hospital has been managed by VIHA since the the health authority was created in 2001.
Department leaders at St. Joseph’s had the flexibility to fine tune their operations for the greatest efficiency, which isn’t allowed by the Vancouver Island Health Authority. To make a necessary change now, they have to go to different levels and committees.
“St. Joseph’s staff were either not listened to or respected by (VIHA) from the very start of this process,” the source said, adding that CVH staff are really in a period of grief and mourning.
“Campbell River staff have lived and breathed (VIHA) and transitioning into a new privately owned building has been easier, but the buildings are just flawed in so many ways,” the source said.
FURTHER READING: VIHA fires alleged “trouble maker,” not perpetrators
No cafeteria — There’s no cafeteria at CVH where staff can meet colleagues from different departments. There is only a bright, but small bistro operated by the locally-owned Rocky Mountain Cafe in Comox.
This seems like a small thing, according to our sources, but they say it illustrates the VIHA culture of keeping people isolated in silos.
Our sources say St. Joseph’s staff expressed concerns about how this would affect the culture of the new hospital.
“Not only has the one gathering place been lost,” said a source. “The transit to and from that place also brought about a culture where everyone talks to everyone else on the way to/from the cafeteria. Short of linens? Well, just stop and talk with the staff who supply linens on the way to the cafeteria. Need to submit a last-minute payslip into payroll? Well, just stop by and drop it off to meet the deadline on the way to lunch.”
Despite inefficiencies in some of the VIHA systems and their unfavorable effect on staff morale, VIHA has not yet taken steps to mitigate the cultural change for St. Joseph’s employees, or to acknowledge that some of the old systems might produce as good or better results.
Next: How the lack of adequate residential care beds in the Comox Valley has contributed to the stress and low morale of hospital staff, and its effect on patient care.
FURTHER READING: Hospital helipads may be unusable; Flawed planning at root of hospital’s problems; Low morale at new Comox Valley Hospital