What we did, and what we learned through trial and error and hard mistakes
Collectively, the Crying Out Loud for Quality Seniors Care group have more than a decade of advocacy at the privately-owned Comox Valley Seniors Village, with beds funded by Island Health. At the end of September 2019, Island Health finally stepped in and appointed a public administrator for 6 months to get the facility back into compliance with Licensing rules.
[In November, Nanaimo Seniors Village was also placed under public administration. In December Selkirk Place in Victoria was also placed under the same public administrator.]
The jury is still out on whether a temporary intervention like the public administrator can fix the systemic problems with for-profit seniors health care.
Over the lengthy time from when we in the Comox Valley first realised there were unacceptable levels of care and cleaning, we have tried many methods of advocacy, and here is a summary of what we have learned so far.
Fear of Complaining
We hear over and over that family are afraid to complain because of possible retaliation by staff on their loved one. We are certain that none of the staff at CVSV, even if they were chuffed at our complaints, would take it out on the residents. Staff do not do this difficult job just for the money; they care. Most of us have been hugged by passing care staff when we were grieving. It helps if you realise the staff are your friends and potential allies, and if they know you see them that way.
The regulation affords a degree of whistleblower protection for anyone, including staff, making a complaint to Licensing; if it’s serious (health and safety related) and you aren’t seeing an immediate response, don’t feel like you need to give the facility more time to respond, escalate; when it’s time to escalate, report to Licensing and not through the patient complaint process (PQCO at Island Health) who will likely just send it back to the facility to address it.
In lay
terminology the regulation prohibits retaliation by a licensed facility against
anyone, including employees, making a complaint to Licensing against the
facility… See Sec 22 Protection for Persons Who Report
http://www.bclaws.ca/civix/document/id/complete/statreg/02075_01#section22
Staff
Staff are instructed not to talk to families and are sworn to secrecy, “confidentiality,” by the facility so take that into account when you approach them. Talk to the staff, and especially the care aides, first, when you see a problem. Often the issue can be nipped in the bud, with a little good will between you and the staff. Make sure you understand that the problem lies with the facility and its procedures, not them. Find out what they think and suggest.
Some of us joined our staff on the picket line during a brief strike and it was noted.
However, if you do run into staff who are abusive in any way, report them immediately.
Hierarchy of Command, and Complaining
Talk to the care aides first. Then to the LPN or nurse who is in charge of that wing. If you don’t get satisfaction almost immediately and it is a safety issue, go to the Director of Care.
If it is not urgent, you can go to your Family Council, if the facility has one. The family council usually has lines of communication to management, either directly or by representation. However, bear in mind that it is consultative only. Management is not obliged to listen to Family Council, although of course wise management does.
However, if it is a health or safety issue, and you get no action from the Director of Care, go directly to Licensing.
If your loved one, as resident, needs physician care or transfer to hospital, request it and insist on it; it’s their patient right and your responsibility as their representative and advocate to ensure they receive appropriate healthcare; we need to be aware that care facilities can be inclined to reduce transfers to hospital or avoid physician attention that might identify their failures (e.g. incontinence related dermatitis/sepsis) to avoid being found to be negligent in providing unacceptable care.
Patient Care Quality Office
Island Health and your facility will encourage you to go to the Patient Care Quality Office (https://www.islandhealth.ca/patients-visitors/patient-care-quality-office) but in our experience this was a useless exercise that derailed serious complaints for months. They are slow to respond, vague in that response, and we have recently learned that, in serious issues, they go to Licensing anyway.
Go to Licensing as soon as you know the facility won’t immediately resolve a serious health and safety issue.
Licensing
Licensing inspects all community care facilities in British Columbia, from day cares to long term care residences. They are busy people!
Their mandate is to ensure that facilities meet the MINIMUM standards of care laid out in the Residential Care Act and Regulations. They are obligated to investigate complaints, whether or not the source is related to a resident. They are your best option, in our experience, but only for complaints within their mandate. Here is a list of issues that Licensing will investigate: https://seniorsvoices.ca/wp-content/uploads/2019/07/Reportable-Incidents-for-Investigation-by-Island-Health.pdf
You can see what all facilities, public or private, are supposed to provide for residential care in the manuals published by I
Licensing is directly responsible to the Medical Officer of Health.
Medical Officer of Health
The MHO is responsible for the health and safety of all residents in their geographical area (there are about 32 in BC.) The MHO’s authority is pretty well unquestionable. As such they check drinking water standards and impose boil water advisories when standards fail, and they check that facilities that hold groups of people meet some health and safety levels.
Direct complaints to the Medical Health Officer should be your very last resort because they are really busy, although they do really care. But if it is necessary, go for it. It was only when one of us alerted the MHO of the conditions during a norovirus outbreak, that Licensing began intensive inspections.
In general, better to let Licensing inform the MHO of the situation.
The MHO has regulatory authority and immunity for decisions concerning appointing of administrator and granting and revoking licenses to operate. If a license is revoked, it means the residents need to be moved to an appropriate facility but where?! The health authority contracts currently in use do not provide a better remedy and specifically, there are no provisions to take over the facility other than the MHO authority to appoint an administrator temporarily.
Media
And what about the media? Media, unfortunately, do love stories about suffering seniors, but you walk a fine line between overplaying your hand, so that the bureaucracy is too involved with damage control to respond to your real issues. On the other hand, media can be your second best friend, after the care aides.
We kept our local media informed, along with our MLA, who helped advocate for us. We did not push the boundaries or try to blow the story up.
We also ran a low key letter writing campaign to the CEO and Board of Island Health to ask them to take responsibility. The letter campaign provided a story basis for news coverage and ensured that Island Health knew that there was community support for the families.
It was the series of letters from the families to Island Health that identified systemic management failures that showed an inability or unwillingness to make the necessary improvements to bring the facility within the “minimal” low bar of compliance combined with a concerted effort to report all complaints to Licensing that had the most effect.
Senior Bureaucracy
We wrote a series of three letters to the senior bureaucracy, pointing out the management failures which were leading to the health and safety issues at CVSV. (https://seniorsvoices.ca/advocacy/family-intervention-comox-valley-seniors-village/)
Contracts for residential care are issued by one level of the health authority bureaucracy, while Licensing and the Medical Health Officer are responsible for standards and regulations. It is an awkward situation which makes compliance and enforcement complicated to understand. (We hope to see some of this change.)
However, Island Health essentially hires these for profit care homes as contractors, and so they are responsible for not only getting what they pay for, but for the safety of those contractors. The senior bureaucrats were unaware of the issues our letters pointed out, and responded immediately with follow up and their own inspections, different from those of Licensing.
However, we have yet to see evidence of Island Health clawing back payments for services not rendered, and that is an issue it behooves taxpayers to pursue. There seem to be no penalties for compliance failures and no regulatory or contractual rights to audit and determine how funds paid have actually been expended on care, as one would expect in a normal contract.