G.R. Baker Memorial Hospital has been operating over capacity since at least 2013, according to Ministry of Health figures obtained by Black Press Media and confirmed by Northern Health.
Most recently, in the 2017-18 fiscal year, G.R. Baker Memorial Hospital ran at an average of more than 19 per cent over capacity.
When a hospital is operating over capacity, it means it has more patients in need of a bed than beds available.
Ideally, says Debbie Strang, the Health Services Administrator at G.R. Baker, “you don’t want a hospital to be at 100 per cent [capacity]. You need to have those beds [free] because you don’t know when the next trauma is coming in.”
The ramifications of a high occupancy rate are also outlined in a copy of a 2015 report by Fraser Health, which was obtained by Black Press Media through the B.C. Freedom of Information and Protection of Privacy Act. The report says “maintaining high hospital occupancy (e.g., over 95 per cent) is associated with longer lengths of stay and higher risk for errors and adverse events.”
There are currently 36 beds in G.R. Baker, with an overflow area on the second floor of the hospital in a former nursing unit. According to Eryn Collins, a media liaison for Northern Health, the overflow area is used for patients “when we’re seeing higher-than-normal patient volume, so it’s based so we can use it for that purpose when needed.”
High hospital occupancy rates aren’t unique to Quesnel. Province-wide, the average hospital occupancy rate in B.C. in the 2017-18 fiscal year was 102.2 per cent, where it has hovered for the last five years.
READ MORE: Hospital congestion a structural issue, ER doctors say
But the numbers aren’t as clean cut as they seem: not all patients taking up beds need to be there. Over the last five years, many of the patients staying at G.R. Baker Memorial Hospital could be discharged but, for one reason or another, were unable to return home and thus remained in hospital.
According to Strang, this could mean they have insufficient community resources to help them, they’re in the midst of a family crisis, there’s a change in the status of a primary caregiver, or they are waiting for a bed in Dunrovin Park Lodge, Quesnel’s only long-term care facility. Another significant factor which can play a role in the discharge of a patient, more broadly, is housing.
Strang says the majority of patients who remain in hospital after reaching the point where they could be discharged (referred to as an alternate level of care patient or ALC) are seniors or persons with a disability which requires a certain level of accessibility that may not be easily met.
In the 2017-18 fiscal year, for example, G.R. Baker averaged at 75.4 per cent capacity without ALC patients. Including ALC patients, the hospital averaged at 119.6 per cent capacity.
Rather than increasing the bed capacity in the hospital, Strang and Collins both suggest improving supports within the community for these patients is a better solution to the problem.
“Those supports are aimed at seeing people either able to return to their home environments with home-health support, or to other accessible living environments, potentially including long-term care but potentially other levels of care as well,” says Collins.
Part of the problem, says Strang, is that there is an aging population.
“We have services that we developed, say, 30 years ago, and now we have to catch up.”
One method of handling this, she says, is being more efficient with the resources they do have, and then working to enhance those services. She says there needs to be a continuum of care: seniors, specifically, should be able to live at home, before moving into a place like Fraser Village, which allows for independent living with some supports, then an assisted living facility, then, eventually moving to Dunrovin for long-term care.
She adds that the new Quesnel Lions Housing Society building, Silver Manor, is a good step toward accessible housing in Quesnel.
“It looks like there’s this huge gap,” says Strang, “when really, there’s all this work going on that’s not reflected in the data.”
Lack of seniors’ housing in Quesnel
An important support which allows patients to be discharged from the hospital is having access to the appropriate housing. Without an appropriate housing situation in place, it can be difficult to discharge some patients, while others have even ended up discharged to the shelter at Seasons House.
Melanie MacDonald, the executive director of Seasons House, says the shelter has seen a growing population of seniors over the past several years. She says poverty and a lack of housing for seniors are two of the primary issues they face in the community.
“We have seniors who are discharged from hospital to us,” says MacDonald, noting one senior at the shelter lives in his car during the summer months and stays in the shelter during the colder, winter months due to “a limited income.”
Other seniors at the shelter do not necessarily fit into mainstream housing: these are the seniors who have problems with their mental health or with substance use.
“We have a woman with dementia who’s lived with us for quite some time, who doesn’t fit because of some of her other barriers and challenges,” says MacDonald. “And there’s just a huge lack of seniors’ housing and seniors’ supportive housing across our province. It’s nice to see the new housing going up in the community because I think that that will fill some of the gap, but not for seniors who we see who are struggling with other issues.”
At any given point, there are between five and seven seniors living in the shelter, says MacDonald. Currently, there are seven.
Peter Nielsen, the founder of Voice for North Cariboo Seniors, echoes MacDonald. Although Silver Manor will help, he says there is still a lack of affordable housing for seniors in the community.
“Most facilities have long waitlists … or aren’t really affordable for seniors,” he says.
Nielsen, who meets regularly with Debbie Strang at G.R. Baker to discuss his concerns about health services for seniors, mentions Dunrovin and other seniors’ housing facilities as places with long waiting lists and says many of the seniors he works with “don’t have a lot of money.”
In mid-December 2018, there were 31 people on a waitlist to get into Dunrovin Park Lodge, Quesnel’s only long-term care facility. According to Northern Health, the average wait is approximately 115 days, or almost four months. It is important to note, says Eryn Collins, that wait times do vary, as emergency placements are sometimes made for individuals with critical, clinical needs.
Seniors’ housing and city council
The issue of seniors’ housing has also come up at city council.
The Age Friendly Initiative Committee, which was then chaired by Mayor Bob Simpson, presented an age-friendly assessment and action plan to the previous council on June 26.
The report details seniors’ housing in Quesnel. There are two assisted living facilities, one public and one private, with a total of 46 units; one residential care facility (Dunrovin) with 117 beds; and an affordable housing apartment building for those aged 60-plus, which has 46 units. The new Silver Manor also features 30 units for seniors.
The report also mentions the new Dakelh and Quesnel Community Housing Society development, which provides affordable and accessible housing. It has 38 units.
READ MORE: Dakelh Housing Society to run McLean Street building as well as Lions’ Silver Manor
Two pages of the 45-page report specifically discuss seniors’ housing. The report lists a few age-friendly features of the city: new seniors’ housing was under construction (Silver Manor, now completed); a reasonable cost of real estate compared to other parts of the province; and the existence of supported seniors’ housing, i.e. Dunrovin.
It also cites areas in need of improvement. Those include: a need for more affordable housing; a need for more supported housing (i.e. assisted and long-term care facilities); a need for more independent-living housing; and a need for more options (i.e. condos, townhouses) for seniors to downsize into as needed.
The report also made two recommendations to council. The first is to redevelop the old Quesnel Junior School site into a “seniors’ development” with a wide spectrum of seniors’ housing offered. The report says this would make more supported and affordable housing available to seniors. It is worth noting, however, that this recommendation is not something that the City has pursued.
The second recommendation is to create a Seniors Directory of all seniors-related services and programs, which would be disseminated widely. This directory would include government resources related to Home Improvement Assistance Programs, which is a series of programs run through the Province of B.C. and dedicated to helping seniors continue to be able to live at home.
The City of Quesnel is also looking into housing. Coun. Scott Elliott is the chair of the Housing Committee and is working on a needs assessment report on housing in Quesnel. He says the report will look at housing en masse and will include seniors’ housing.
Once the report is complete, he says the City will be better able to see what is and is not needed.
“But, I mean,” adds Elliott, “it’s going to be a no-brainer. Do we need more homes for people to age out in? Absolutely.”
Silver Manor
Silver Manor, a new development by the Quesnel Lions Housing Society, offers lower-than-market-value rents for seniors 65 and older. It also features two fully accessible suites available to people with a disability aged 55 and older.
The building officially opened in January and, as of Jan. 9, has one vacancy. The building was originally filled months before it opened, but one tenant was unable to move in.
The manor doesn’t accept pets, and laundry, parking and utilities are not included in the rent, which ranges from approximately $600 to $650 a month.
Mitch Vik, the president of the Quesnel Lions Housing Society, says the building is meant to address just one part of the problem: “Which is, what do seniors do when they can’t manage their home anymore — and they can’t afford a condo?
“That’s what we’ve come up with, with these apartments,” says Vik.
Vik, also a city councillor and the new chair of the Age Friendly Initiative Committee, says although the building has a vacancy, he knows of a number of seniors who have applications for the manor that have not yet been filled out and returned.
Other supports
Aside from more accessible and affordable housing in the community, there are several other supports that can allow hospitalized seniors or those with disabilities to be discharged from hospital. Some of these supports might include home visits from nurses, or help from programs like the United Way’s Better at Home.
Better at Home picks up the piece that health doesn’t cover, says G.R. Baker’s Debbie Strang.
“It’s a huge support.”
In Quesnel, Better at Home is run by Brenda Gardiner.
Gardiner says the program helps seniors with transportation to appointments, house cleaning, snow removal, lawn care and home repair (if it relates to a safety issue) and provides friendly visits.
The program is largely run by volunteers but can cost seniors between $6 and $20 an hour, depending on the service.
“It’s based on their income,” says Gardiner, “and the only thing they would get charged for is the things that we need to pay for.”
The demand is extremely high, with 402 seniors enrolled in the program, compared to 117 volunteers, many of whom only volunteer seasonally.
“We should have cut it off 50 clients ago,” says Gardiner.
“There’s definitely a need [for more supports in the community],” she adds.
Within the community, many seniors also access support from the Voice for North Cariboo Seniors and Seasons House.
As part of his work with Voice for Seniors, Peter Nielsen delivers food every month to low-income seniors.
“I deliver to 50, 60 people every month. And thank god people donate to the cause, because they realize — but most people, they don’t realize the shape seniors are in. I have gone into peoples’ houses and put stuff away for them because they are frail and it was too much work for them.”
At Seasons House, many seniors participate in a drop-in program that provides them with extra food support and a sense of community. Melanie MacDonald says many seniors come in for a meal and stay for a hockey game, for example.
“There are lots of seniors out in the community who are spending the majority of their income on their housing and don’t have enough left over at the end of the month to put food on the table,” she says. “So we serve quite a big population of those seniors.”
The shelter also helps seniors to get on the SAFER rental subsidy program through B.C. Housing.
With files from Tyler Olsen.