Letter to Minister of Health Adrian Dix regarding Long Term Care in B.C.
The Honourable Adrian Dix, MLA
Minister of Health
PO Box 9050
June 2, 2020
Dear Minister Dix,
I am writing on behalf of the members of the BC Rural Health Network to express my concern over the general state of seniors care and more specifically, the state of long term care in British Columbia.
Covid-19 has shone a spotlight on the appalling conditions in many Canadian long term care facilities that have led to the deaths of many of their residents. The pandemic crisis has identified serious flaws and gaps in the system and raises difficult questions: what will we learn from this experience and what are we going to do about it?
Although BC has not been immune to this problem, it has fared better than most other provinces. Beginning in 2018 with your government’s initiative to increase the direct care hours seniors receive in facilities, your government has shown their commitment to caring for BC seniors. The BCRHN applauds Minister Dix, working in conjunction with Bonnie Henry, Provincial Health Officer, for taking decisive action when BC reported its first Covid-19 death at Lynn Valley Care Centre in North Vancouver. The issuance of the single site order, the wage increase to unionized standards, and the guarantee of full time hours for LTC workers demonstrated the government’s resolve to improve the conditions of care by improving the conditions of work.
Stopping workers from becoming vectors for infection by working at more then one site is vital and must not stop here. It has been known for years that other dangerous infections that overwhelmingly affect seniors in care can spread from site to site by the same route (c. difficile colitis, for example). The BCRHN encourages the Minister to take steps to embed these important changes permanently into policy, ensuring that all BC seniors will be protected and receive the care they need and deserve, well into the future.
One of the disturbing facts that has surfaced as a result of this tragedy is that Covid-19 death rates are significantly higher in for-profit LTC homes as compared to publicly operated homes. In fact, depending on the province, for-profit LTC homes have between four and eight times as many deaths.
Concerns about the increase in the takeover of care homes in BC by foreign companies have been raised by many organizations over the past several years, including one of our member organizations in February, 2017. In a report sent to federal and provincial authorities in February 2017, the Support Our Health Care Society of Princeton stated that “The purchase of long term care facilities in BC by Anbang corporation has created a situation in which a foreign investment body sees an opportunity to maximize investment return – not an opportunity to improve service.” Three years later in February 2020, the Ministry of Health announced the takeover of seniors care homes owned by Anbang, citing failure to meet the standards of care. The message couldn’t be clearer, BC must put an end to the operation of LTC facilities by private, for profit companies.
The BCRHN recognizes that improved long term care is but one part of a more comprehensive plan that includes support for seniors receiving home care assistance and support for seniors in assisted living facilities. Our province is making good progress in this area as evidenced in the December 2019 report Monitoring Seniors Services by Isobel McKenzie, BC’s Senior Advocate. We encourage the Ministry to continue this important work.
In conjunction with the BC chapter of the Canadian Centre for Policy Alternatives and the BC Health Coalition, the BC Rural Health Network makes the following recommendations:
- End profit-making in seniors’ care by transitioning to 100% not-for-profit and public ownership
- Create a capital plan that expands the capacity of public facilities to meet the needs of a growing seniors population
- Implement an alternative model of long term care that assures improved outcomes for social connectivity, physical activity, feeling of well being and self worth, and personal economic security
- Improve the conditions of care by improving the working conditions of long term care employees
- Make Family Councils obligatory, rather than optional, to increase family-led accountability and transparency and to serve as an early warning signal for unsafe care
- Recognize that home support services in combination with community-based seniors services are the first line of defence in providing support for seniors to remain in their own homes and communities longer
We would welcome the opportunity to discuss these and other issues as they apply to seniors living in rural and remote areas of BC. The BCRHN values community engagement and collaboration and we look forward to hearing your response to this letter.
Edward Staples, President
BC Rural Health Network
Reply from MoH re Seniors Care – June 2, 2020 letter
August 29, 2020
Dear Edward Staples:
Thank you for your email on June 11, 2020. I am writing on behalf of the Honourable Adrian Dix, Minister of Health, regarding the concerns your organization has raised about long-term care in BC. Your message has been directed to the Seniors’ Services Branch, as long-term care falls within our portfolio. I apologize for the delay in my response.
I would like to begin by thanking you and the rest of the BC Rural Health Network for the dedication shown in advocating for increased access to quality care for those living in remote and rural communities. Providing a safe, dignified, and fulfilling care environment for everyone in BC is a priority for the Ministry of Health (the Ministry).
As you have outlined, the Ministry has taken several initial actions in response to COVID-19. In collaboration with BC’s Provincial Health Officer, health authorities, and BC’s Seniors Advocate, actions taken have included a temporary pause on new admissions and facility transfers, restricting visits to essential visitors only, a temporary suspension of respite and adult day programs, and extending the period in which a resident can be absent from their long-term care home. These initial actions have aimed to limit the potential for COVID-19 being introduced into long-term care homes and were taken to better protect the residents and staff. The Ministry’s actions continue to evolve in response to the COVID-19 pandemic.
The Ministry is committed to reviewing and strengthening how long-term care services are delivered in BC. The Ministry is considering the lessons learned through the experience of COVID-19 and its impact on seniors as well as the staff that care for them to inform positive changes in the system. The Ministry, as it moves forward, will engage with the Office of the Seniors Advocate and other stakeholders and associations who represent the home and community care sector on this important work.
The Ministry is engaged in ongoing work to improve monitoring and accountability across the long-term care sector. Standardization of funding for long-term care will be a significant step towards increasing the consistency of care across all providers and enhancing the accountability for delivering safe, quality care.
As BC’s population grows and ages, facilitating equitable access to long-term care services is of increasing significance to meeting Government’s commitment to delivering the services people rely on. The Ministry strives to improve and strengthen health services for seniors and other adults who have complex care needs and continues to focus on improving the range of supports available to people living in long-term care to ensure they receive dignified and quality care.
The Ministry greatly appreciates and values the efforts made by the BC Rural Health Network and other community members in advocating for the care of BC’s seniors.
Seniors Services Branch
Health Services Division
William L. Day
5295 Webster Street Hedley, B. C. Canada V0X 1K0
Tel: 250 462 8671
The Editor, Princeton Similkameen Spotlight
11 July 2018
The House Of Commons All-Party Standing Committee on Health has recently endorsed and recommended the implementation of a Canadian Pharmacare Program.
Many currently healthy people are not aware that prescription drugs are covered by our Canada health insurance only while the client is in hospital. Insurance outside the hospi- tal varies greatly among provinces and territories.
For example, the same out-of-hospital cancer treatment can cost you $0 in Nunavut; $3,000 in BC; $20,000 in PEI.
Currently, Canadians pay more for prescription medications than citizens in any other of the 29 wealthy OECD countries except Switzerland and the USA.
More than three million Canadians are under-insured or uninsured for prescription drugs outside approved hospitals.
Researchers have found that overall, 5.5 per cent of respondents across Canada reported they couldn’t take their medications as prescribed because of costs. In B.C., the propor- tion falling through such cracks in the health system was highest among all provinces and territories, at 8.11 per cent.
Unlike all other industrialized countries, neither the USA nor Canada have established a drug plan that would allow their national governments to negotiate drug prices on behalf of their entire population.
In summary, Canada remains the only industrialized country with universal health insur- ance but no national Pharmacare strategy for its citizens.
The Support Our Health Care Society (SOHC) of Princeton will be doing its best to acquaint Similkameen residents with our collective problem and opportunity. We will be providing information in Princeton at retail outlets and surveying our local public on the issue. We intend to inform our MPs and MLAs of our activities and findings. To date they have been very receptive. Readers are encouraged to go to the government website to read the original complete document and join the discussion: https://www.let- stalkhealth.ca/pharmacare.
For further information, contact the Support Our Health Care (SOHC) society at (250) 295 0822; mail Box 257 Princeton BC V0X 1W0; website http://sohc.ca/.
The power to engineer this change lies with us, with Ottawa and our collective Members of Parliament and MLAs. They are listening and waiting for us to signal our support for change.
The Time Has Come.
Bill Day, Vice President, Support Our Health Care Society, Princeton BC
The BC Rural Health Network is one of over 150 national and provincial organizations who have co-signed the Canadian Health Organization’s letter to the Honourable Bill Morneau, Minister of Finance, calling on all parties to work together to implement universal, public pharmacare within this government’s mandate.
February 13, 2020
The Honourable Bill Morneau, P.C., M.P. Minister of Finance
Government of Canada
Ottawa, Ontario, K1A 0A6
Dear Minister Morneau,
We are a diverse coalition of 150 national and provincial organizations representing health care providers, non-profit organizations, unions, workers, business, seniors and patients from coast to coast to coast. In November 2019, over 150 of our organizations signed a joint Pharmacare Now Statement calling on all parties to work together to implement universal, public pharmacare within this government’s mandate. We are now calling on your government to make the financial commitments that are needed in this year’s budget to make this program a reality.
As laid out in the report of the Advisory Council on the Implementation of National Pharmacare, an additional $3.5 billion is needed by 2022 to roll out the first stage of universal, public pharmacare. This stage would provide access to a national formulary of essential medicines by January 2022. Incremental increases in annual spending would subsequently be required to roll out a full, comprehensive formulary by January 2027.
The majority of Canadians voted for pharmacare in the 2019 election. We are counting on your government to fulfill its promise to Canadians by implementing the Advisory Council’s recommendations. Universal, public pharmacare would improve the health of our population and would save Canadians billions of dollars every year. Canada can’t afford not to adopt this program. …..
Complicated gratitude: a letter to my mother’s physician
Rachel B. Cooper
CMAJ January 27, 2020
On the morning you administered medical assistance in dying (MAiD) to my mother, you kindly and gently explained what we could expect. You reassured us that she would feel no pain, but rather drift off to sleep quickly. You entered my mother’s room and greeted her warmly. You took in the scene: family members sitting in every chair that was permitted to be in the hospital room. You graciously turned down the glass of scotch we offered you — the scotch we poured to toast my mother. You knelt beside the bed, holding my mother’s hand, and asked her whether she wished to go ahead. She assented. You encouraged us to embrace her as she took her final breaths. When my mother died, you leaned down to the bed where my sister and I lay, holding our mother, and quietly informed us that she had passed. And at our request, you opened the window so that her soul could escape the hospital room. With utmost respect, you fulfilled my mother’s final wish — to die with dignity.
In the minutes, hours and first few weeks following my mother’s death, I could not help but think of you as her executioner. In the final days of her life, following her decision to formally request MAiD, my mother’s longstanding delirium cleared. The mother I remembered from childhood, with her sharp wit and hearty laugh, reappeared before my eyes. She was no longer the confused, paranoid, hostile and forgetful person I had come to resent over the last several months.
And here you were to help steal her away, once and for all. Your clinical offering to fulfill her last wish of dying with dignity — and its finality — brought her back to life. The irony wasn’t lost on me.
Six months earlier, our mother was in the intensive care unit on the brink of death. We discussed end-of-life care and planned a funeral. I stood by her bedside, held her hand, and told her I loved her and that I forgave her. I told her she could let go. But for better or for worse, she fought like hell to live, and we brought her home.
On the day you provided MAiD, as you arranged the supplies, I quickly flashed back through the last six months. My thoughts lingered on my mother’s final days spent recounting 69 years’ worth of memories and wisdom.
“Should we sing something?,” my sister wondered aloud.
I buried my head in the crook of my mother’s ankles, eyes clamped shut, and we began to sing “What a Wonderful World” — the same song my sister sings to my infant nephew before he naps.
I was entirely unaware of your presence behind me, and was reminded only when you put your hand on my shoulder. For an executioner, you have a gentle touch.
You relieved my mother of the endless breathlessness caused by her end-stage chronic obstructive pulmonary disease. You enabled her to rest and slumber peacefully for the first time in months, if not years. I took comfort in the fact that you fulfilled your professional duties ethically, within the parameters of the legislation. You allowed my mother to have a good death. An ethical death. A compassionate death, free of the suffering she experienced in life.
In the moments following my mother’s death, our family held one another and sobbed. You offered condolences. We bowed our heads slightly. I felt gratitude for the privilege of living in a country that provides for its citizens in life and until death.
My mother is gone, but you didn’t take her. Her illness robbed her of her stamina, strength, and dignity. She was riddled with pain and suffered immensely. You alleviated her suffering. But in her relief, we suffer the loss.
I conclude my letter to you, doctor, with deep gratitude — gratitude for your humanity, your compassion and your ethics. I no longer see you as my mother’s executioner. You were her saviour.
A POTENTIAL SOLUTION TO THE DOCTOR SHORTAGE
THE TIMES COLONIST
December 28, 2019
Letter to the editor
My doctor has retired and no one has taken over his practice. Given the current situation regarding physician production and the outflow of doctors due to their retirement age, it’s highly unlikely that I’ll ever have a family doctor again.
I consider myself to be a relatively healthy 61-year-old despite having completed 37 years of military service, including multiple operational deployments. Currently, I require little more than an annual visit to renew prescriptions as required by Veterans Affairs Canada.
Now, I’ll be another lost patient joining the queue at a local walk-in clinic to access primary-care services. Should I be successful in the patient-care lottery and “win” one of the available appointments, it will use up the valuable time of a highly trained physician, time that could be better used by much more acute or complex patients.
It’s long past time for B.C. to address this situation by adding physician assistants (PAs) to primary-care clinics along with physicians and nurse practitioners in a fully funded, collaborative practice setting.
The education and credentialing of physician assistants is not the issue that protectionist bureaucrats at the B.C. Ministry of Health once used as an excuse to block their integration into our rapidly failing health-care system. Physician assistants are employed in Manitoba, Alberta, Ontario and New Brunswick, while Canadian Armed Forces physician assistants, where the skill set originated, provide quality medical care in some of the most remote locations in Canada.
Data suggests that 70 per cent of patients could be appropriately managed by physician assistants. With physician assistants joining the currently overworked health-care team, this would greatly improve patient access to timely and appropriate care and no doubt restore the dignity to patients begging for access to the public health-care system.
So, the question becomes, when can British Columbians expect to see physician assistants added to staff of the urgent primary-care clinics?
Mike McBride, Colwood
February 26, 2019
The BC Rural Health Network sent a letter to the Honourable Adrian Dix, M.L.A. Minister of Health
April 10, 2019
Reply from the Ministry of Health
Joanna Richards, Executive Director – Primary Health Care
Primary Health Care
May 21, 2019
Powell River Voices set up a committee to organize a petition for Healthy Food in Healthcare. Their letter to the Vancouver Coastal Health Authorities can be found below.