Island Health is planning facilities in Victoria and Nanaimo for hard-to-house patients in need of around-the-clock care after an attempt to accommodate them in two long-term care homes failed.
After staff at Dufferin Place long-term care home in Nanaimo complained a small group of violent or psychotic younger patients — some using drugs or alcohol — were creating chaos and safety risks for staff and residents, the health authority has revealed plans are already underway to move them.
A request for proposals for a new or renovated or repurposed facility with 20 to 30 one-bedroom suites in Nanaimo is expected to be issued in a month or so followed by a community engagement process and a request for proposals for a 40-bed facility in Victoria.
“What we’re looking for in this RFP [request for proposals], more than anything, is the separate location to house the population with direct supports from the health authority,” said James Hanson, vice-president of clinical services and acute care in the North Island.
That’s in addition to the health authority’s plans, yet to be announced, for 28 net new beds for people with brain injuries in the south Island and 16 in the central Island.
Special units serve patients with complex needs
Island Health created a “special population unit” in the 138-bed Dufferin Place nursing home in February 2022 for five to 10 patients with complex physical, mental and behavioural issues — sometimes including addiction.
There’s also a 12-bed segregated space at the Summit 320-bed long-term care home on Hillside Avenue in Victoria.
The special population patients, who qualify for 24-7 long-term care, were either already in long-term care elsewhere or in acute-care facilities but weren’t a good fit due to aggressive, sporadic or unusual behaviour.
“The intent of the special population units wasn’t specifically for substance use,” Hanson said. “Only 50 per cent of the people in those two facilities now are known to use substances.” Instead, the units are for people with complex mental or medical health needs.
However, the demographic has changed, Hanson said.
“We are starting to see a younger population who are actively using [drugs] and that have longer-term care needs than we have previously seen in the past,” he said.
“That’s the reason we’re going to issue a request for proposal, because we’re seeing a change in the demographic, and we’re recognizing that we’ll need a different model of care, and location of care, for those sorts of clients.”
Hanson said the health authority offers treatment and harm-reduction support but strictly prohibits any substance use. “We do not tolerate open use inside of the long-term care facilities,” he said.
He concedes, however, “now obviously, people choose to break the rules, like we’ve seen in other parts of the system.”
The timeline for the creation of the new Nanaimo and Victoria facilities — with extra staffing and security for voluntary patients — will be determined by the proposals received, but it could be a year or more before they open.
Nurses describe violence and drug use
Dufferin Place nurse Lana Lekopoy, 59, a registered nurse for almost 40 years, said the health authority’s proposed change is welcome but “nothing will change today.“
And until the new facilities are created, she said, the current unit needs stronger policies and standards of care.
“I understand you can’t just dump people, I get that,” she said. “So we have them. The hospital has them. Well, let’s set some boundaries, let’s have some rules.”
Lekopoy, who is on stress leave after working two years at Dufferin Place, said the health authority promised two years ago specialized staff, security, and programming for the special population patients and it never came.
There are five to seven people in the unit, Lekopoy said, and while that “doesn’t sound like much,” she said they dominate staff time and how the facility runs.
“It’s truly about the drugs, weapons, alcohol, and the violence,” Lekopoy said.
She paints a picture of the patients and their visitors coming at all hours, smoking drugs and having sex on the property, and bullying staff and residents with obscenities and threatening language.
“This is not nursing,” Lekopoy said. “This is insanity. This is not health care. It is just a s—- show.”
The veteran nurse said what is happening is unheard of: “Back in the day, we’d be calling the police. They would be arrested, they’d be disciplined, they would be kicked out.”
Lekopoy maintains it’s not the brain injuries but the addiction-related behaviours that are the real problem.
“We have zero training on how to deal with them,” she said. “We are flying by the seat of our pants because on any given day — and I think this is what the public should know — is that we are at risk of losing our licence every single shift because we are practising without policies and protocols.
“It’s shift to shift, hour to hour, the rules change,” she said.
Another staff member, who requested anonymity for fear of being fired, corroborated Lekopoy’s description of conditions.
The worker said addictions doctors and social and support workers were promised and instead they got “absolutely nothing.”
“There’s no curfew, there’s no rules, there’s nothing if they call us [expletives], we have no recourse,” the worker said. This year a protection services officer was stationed in the facility.
With the special population patients coming and going, medications and care can’t be given at prescribed times. “They have unpredictable behaviour and they’re not being medicated properly,” the worker said.
Patients are entitled to two baths a week — one more than other residents in the facility — but they often miss them.
“What we do for them is not care, it’s not integrity,” said the worker. “It’s not anything to do with encouraging health and healing and respect. We are just servants.”
Staff are also frustrated there’s often just one patient per four-person room in the 24-bed unit.
“You think of those poor vulnerable elderly that are stuck in the hallways, and in the chapel, and what they call alternate level care now in Nanaimo Regional General Hospital, and they can’t get a room because this special population person is taking up a four-bedroom room,” said the worker.
There are about 5,000 people in the province waiting for a long-term-care bed at any given time. At Dufferin, seniors may wait anywhere from two days to 443 days with an average wait time of 104 days, according to the senior’s advocate’s 2023 long-term care survey.
“We had one guy who would come back about every eight or nine days, come for a bath, and come for his cheque, and then leave again,” said Lekopoy, referring to it as a glorified homeless shelter.
Health minister: ‘A small number’ of people
The situation seemingly boiled over in February when a previously sober patient returned after a two-day bender so incapacitated that a nurse was hurt trying to help him.
Since then, the staffers say, they confiscate drugs, alcohol and drug paraphernalia and require patients to go off the property to use them.
Bottom line, said Lekopoy: “I shouldn’t be afraid to go to work.”
The B.C. Nurses’ Union declined to comment.
Health Minister Adrian Dix said while it concerns him to hear these stories, it’s important to remember the population at Dufferin and the Summit is “a small number” of people in just two facilities on the Island “with special units separate from other people.”
Dix said despite the perception, the number of people age 60 and younger in long-term care in the province — for brain injuries, for example, or severe chronic illnesses — is declining, dropping about five per cent in absolute numbers last year.
There has always been this small group of people who are assessed for long-term care and have no other option and the province has to respond to both give them care and keep everyone protected, he said.
“People who are substance-use patients, they go other places, they don’t go to long-term care,” said Dix, adding the province is building such facilities and creating more support for people with substance-use issues.
He said the government has increased long-term patient-care hours, restored higher-paying jobs for health-care workers and hired record numbers, and is making historic investments and building an unprecedented number of modern long-term care homes across the province — “considerable across Vancouver Island.”
Also, because of the diverse needs of an aging population, the government is building long‑term-care campuses with separate villages or pods for more home-like environments that specialize and cater to different needs.
As for facilities where “any of our staff are feeling unsafe,” Dix said that bothers him to hear.
“We have to address that.”
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