We are writing to express our concerns regarding the crisis of seniors’ care in the Comox Valley.
Community Health Services is the public agency that supports frail seniors to stay at home as long as possible. The community health workers provide services such as shower assist, help with dressing and grooming, heating and serving meals at home, continence care, and dispensing medications safely. The importance and value of this service to our community cannot be emphasized enough.
At present, up to 40 visits a day are being cancelled in the Comox Valley due to a staffing shortage. There is variability in the ability to provide a range of services from week to week. Family members and friends of clients have been asked to step up to fill in the gaps wherever possible. This will increase the risk of caregiver burnout. Due to the pandemic, important services like the Adult Day Program and blocks of respite in complex care facilities are no longer available. Many seniors in the Valley don’t have family and friends nearby, and are heavily dependent on Community Health Services to meet their basic needs. For these folks, there is no safety net.
Home support is important for hygiene, nutrition, safety, social connection and rehabilitation. Without a robust system of support, we anticipate more visits to the emergency room, and more admissions to hospital.
Here is an example, using a mythical patient. Mrs. Z has moderate stage dementia and lives alone. She has short-term memory impairment, and forgets to take care of her personal hygiene, take her medications, or eat. However, with four times a day home support, she does very well at home in her own environment. Without it, she would require admission to a complex care facility much earlier in the course of her illness. In the morning, the home care worker comes to help her out of bed, wash and dress, dispense medications, and set her up with breakfast. At lunch, a worker returns to set up her lunch and say hello. In the mid-afternoon, a worker returns to check on her and change her Depends. Finally, in the evening, it’s a supper meal and getting ready for bed… a change of clothes, another wash, and settling in.
With one or two visits a day instead of four, one can see how this would negatively impact Mrs. Z over time. Her hygiene and continence care may diminish and she might develop an infection or open wound. Perhaps she would lose weight because she isn’t reliably getting all her meals a day. She might get uncomfortable in wet Depends and try to take it off herself, suffering a fall and fracture in the process.
The management of Community Health Services is working incredibly hard to remedy this situation and hire more staff to fill the positions. At the moment, the situation in the Comox Valley is that if you are a senior with money, you can hire private care to meet your needs reliably. If you don’t have money, the system you are depending on is in trouble.
The crisis in home care staffing will almost certainly result in more ER visits ($1,500 a visit) and more hospital admissions ($1,278 a day for an acute care bed). During a pandemic, the last place we want to see our frail seniors is in hospital if they don’t absolutely need to be there. Not only does that place them at some risk, it also takes up beds which may be required for seriously ill people in the coming months. If the home care crisis continues on its current trajectory, surgeries may need to be cancelled because the hospital will fill up with frail elderly people. These patients could be supported at home if we had services available, but they will be admitted because they can’t manage with once a day home support, and then they’ll wait for months in hospital for a complex care bed because that’s another shortage, another problem.
We are doctors, not politicians or home care managers. We can point out the importance of home care, and the consequences of not having it.
If people aren’t applying for the jobs of public system care aides, as a community we have to ask ourselves why that is, in order to improve the situation. What incentives can we offer? Better pay? More benefits? Access to low-income housing?
At this point, we have more questions than answers. Our elders deserve solid dependable care in the twilight of their lives.
Dr. Mandy Ruthnum, Dr. Stefan Schovanek, Dr. Natasha Frolic,