At Nelson Jubilee Manor, 45 per cent of residents are given anti-depressants despite just 17 per cent having been diagnosed with depression. Photo: Tyler Harper

Report: Nelson’s residential care facilities under-performing

Jubilee Manor and Mountain Lake Seniors Community were included in a provincial survey of facilities

A report released last month shows Nelson’s two residential care facilities are failing to meet several provincial standards.

Nelson Jubilee Manor and Mountain Lake Seniors’ Community were included an investigation by the Office of the Seniors Advocate of 292 residential care facilities in British Columbia.

The investigation included a 108-question survey posed to each facility’s residents, as well as an examination of care services and quality for a period between Oct. 1, 2015 to Sept. 30, 2016. The overall results were released Sept. 15, while facility specific results were made public Nov. 17, the latter of which can be found attached at the end of this story.

What it finds is that both of Nelson’s facilities are not meeting residents needs.

Pegasis McGauley, chairperson of the Nelson Area Society for Health, which advocates for seniors’ care, attributes that to the city’s lack of available beds and an aging population.

“We haven’t kept up with the change in demographic,” said McGauley. “So the people who are in residential care need more care. Well, where does that come from? How is it financed?”

Jubilee offers 40 publicly funded beds, while Mountain Lake has 85, along with seven beds that are privately funded.

Cindy Kozak-Campbell, executive director of residential services for the Interior Health Authority (IHA), told the Star that a request for proposals for a 43-bed facility to be built in Nelson was made public in January.

That initiative, however, has since been scrapped. IHA relies on private companies to build and run facilities, and those companies must include plans for care, staffing, past experience and details on the proposed building.

Kozak-Campbell said no applicants were found that could meet the authority’s standard. IHA is now considering alternate plans, although Kozak-Campbell could not yet disclose what those plans are.

The provincial standard for funded direct care hours per resident — how much time staff dedicate per day to an individual — is 3.36. The Interior Health Authority (IHA), which runs Jubilee and is responsible for oversight at Mountain Lake, has its own standard of 3.15.

Mountain Lake, which is operated by Park Place Seniors Living Inc., meets the IHA standard, while Jubilee is 3.19 hours. Other facilities are far worse. MSA Manor in Abbotsford, for example, has just 2.72 hours available per resident. Arbutus Care Centre in Vancouver receives 2.68 hours.

Isobel Mackenzie, the provincial seniors advocate, said 80 per cent of facilities in B.C. fail to meet the provincial standard, which she concedes is too low to begin with.

But standards are also negotiated on an individual basis by each of the five health authorities based on funding, which makes the level of 3.36 hours even more difficult to reach.

“That’s what I want to get away from, and I want to get to provincial standards, provincial monitoring and provincial compliance,” said Mackenzie, adding that 2.5 million hours of care per year need to be added provincially.

The state of Jubilee Manor and Mountain Lake

Kozak-Campbell said Jubilee Manor, which opened in 1979, was meant to serve a healthier population than it does now.

“It was built as a personal care home when we had very different people coming into residential care, who were still mobile and may not have had as many medical concerns including cognitive problems,” she said.

“We’ve got a geography in the building that makes it difficult for people if they have any type of confusion or dementia, and rooms that are very small and make it difficult to provide care for people with very complex needs.”

In the survey put to Jubilee residents and their most frequent visitors, in which they could reply as either poor, fair, good, very good or excellent, 42 per cent said the overall quality of care and service was very good. That’s well above the provincial average of 35 per cent.

At Mountain Lake, which opened in 2005, respondents were more mixed. Thirty-four per cent said care as very good, while 42 per cent said rated it as simply good.

An even split of respondents said they want to live in Jubilee, which is down from the 61 per cent provincial average of people who are happy in their facility. Only 47 per cent said they want to live at Mountain Lake.

Related: Nelson Jubilee Manor survey results

Related: Mountain Lake Seniors’ Community survey results

The survey does not include responses from facility staff. McGauley said staff turnover leads to stress for residents, and that more effort needs to be made to take care of the people working in places like Jubilee and Mountain Lake.

“Most of those people are pretty dedicated, but they get worn down by getting called in too often to do extra shifts when somebody else doesn’t show up, and having to cover someone else’s job,” she said. “That’s really hard on you.”

Anti-depressants given to undiagnosed residents

Mackenzie’s report also includes eye-opening stats about how residents are medicated.

In B.C., 47.8 per cent of residents receive medication for depression, despite just 23.9 per cent actually having been diagnosed with the disease.

At Jubilee, 45.4 per cent of residents receive depression medication, but only 17.4 per cent have been diagnosed. Those numbers are similar at Mountain Lake, with 50.8 per cent given meds despite just 19.6 per cent of residents having been determined as depressed.

Kozak-Campbell said this occurs because those anti-depressants are being used to treat other conditions.

“Someone with dementia, they may be on medication that is for depression, but it may be to help them sleep, or it might be to help manage behaviours,” she said. “So that would help explain that discrepancy.”

Mackenzie said the practice is problematic and needs to be reviewed at a provincial level. If a doctor is following clinical guidelines, she said, anti-depressants are only recommended after other remedies such as exercise and a reduction of stimulants are tried.

But those steps aren’t always practical in residential care.

“When you think about what’s happening in a care facility, people are sleeping during the day, people are parked in front of TV sets, they aren’t getting as much exercise as they could because they need help to have that exercise,” said Mackenzie.

“They aren’t necessarily getting the fresh air. So all these kinds of things we would do in the community with people having challenges with the things we are prescribing antidepressants for that aren’t depression, we aren’t doing in our facilities. We are using medications because it’s more efficient.”

Anti-psychotics are also being given to residents with no proper diagnosis.

At Mountain Lake, 19.5 per cent of residents received anti-psychotics, while 15.5 per cent are given the meds at Jubilee. The provincial average is 26.9 per cent.

Kozak-Campbell said IHA is working to reduce the practice. Mackenzie added staff need better training to determine and eliminate behaviour triggers.

“I think we may have to become more tolerant of some behaviours that really fall short of the need to medicate but are still annoying,” said Mackenzie. “There’s a big difference between somebody is annoying me and I’m in physical danger because of the actions of somebody.”

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