Bruised and listless — that’s how Janice Hayden says her mother was found at Squamish residential home Hilltop House in the spring of 2016.
Hayden had visited the day before, and almost every day since her mother moved into the facility in 2014. That Thursday morning, she got a call saying something was wrong and her mother needed palliative care.
“She basically beat herself to death,” Hayden said, noting her mother was sitting in her wheelchair in the common area. “People were coming and going but nobody did anything.” Her mother died days later.
Hilltop House is in need of increased staffing to provide quality care for residents with complex needs, according to several sources who contacted The Chief following its recent article about the care home’s standing in a provincial survey held by the Office of the Seniors Advocate.
The situation is desperate, the sources say.
Hilltop House is the only publicly funded residential care home in Squamish and is run by the provincial health authority, Vancouver Coastal Health.
The former Liberal provincial government previously announced $500 million in funding would roll out for senior care and committed to raising the hours of funded care to 3.36 per resident day.
Hayden acknowledged that her mother had dementia and behavioural issues when she entered Hilltop in 2014, but says her mom was fully mobile.
During her stay, the elderly woman was placed in the “isolation ward” and strapped to a wheelchair after healing from two separate falls.
Hayden claimed that ward held “nine of the most vulnerable patients,” often staffed with one care aide. “Everybody else is unattended when they are busy,” Hayden said. “I would see [patients] hitting their heads on the floor or walking the hallways naked.”
Hayden claims to have witnessed “alarming standards of care” that included personal hygiene issues such as limited diaper changes, undiagnosed rashes, blood on the floor, heavy medication without consultation with family members, patients not being fed on time or food going cold, missed bathing schedules, and bells ringing with patients waiting over an hour to go to the bathroom.
After her mother’s death, Hayden never returned to Hilltop House.
Seven other sources with stories of what they consider inadequate care at Hilltop came forward to The Chief, but wish to remain anonymous because of concerns that speaking out could potentially affect their family member’s care.
Several claimed they were told there wasn’t much Hilltop management could do and to consider moving their family member if problems persisted.
Vicki Marlatt’s father was a resident at Hilltop House for three years until he passed away in April of 2017. “We were seeing things like one care aide trying to feed six people at a time,” Marlatt said.
“Or people asking to go to the bathroom but staff being too busy to help.”
Before her father died, Marlatt hired a private care aide who was not qualified to perform “health care related” tasks but could take her father to activities he loved. Marlatt remained concerned about how often her father’s diaper was being changed and his teeth brushed, as well as how long he waited for meals and the lack of autonomy in when he could bathe.
Marlatt wrote two letters to patient care quality review at VCH and complained to management but alleges after initial conversations, she was told nothing could be done.
Marlatt says she and a small group of others, all of whom had family members in complex care at Hilltop, met with Liberal MLA Jordan Sturdy and Keith McBain, a representative from VCH, in early 2017 to address concerns about staffing.
In that meeting, Marlatt claims it was disclosed the $500 million in provincial funding will not be granted for more staffing at Hilltop House but will be earmarked for activities.
Sturdy said he recalls VCH open to conversations in the spring meeting with concerned family members worried about confidentiality but said: “there wasn’t much evidence that they would be targeted.”
Sturdy encouraged families to speak up and noted the problem is complex.
“One of the real challenges [the provincial authority has] is there’s a limited number of trained people that actually live in Squamish,” he said, adding his takeaway from the meeting was that there would be an effort toward improved communication between patients, relatives and the institution itself.
VCH denied several requests for an interview. An email from Carrie Stefanson, public affairs leader, dated Dec. 15 stated the health authority could not discuss the private meeting and would “not comment on specific cases or legal matters.”
“When it comes to staff, Hilltop House has a higher staffing rate than many other residential care homes in the province,” Stefanson said, referring to the Ministry of Health target from “some years ago” which set an average of 3.0 hours of direct care, which includes RNs, LPNs, and care aides. The Ministry also set a target of .36 hours per person for “allied therapies,” such as physiotherapy or social work, she added.
“Currently, Hilltop House exceeds the provincial standard for nursing care at 3.16, but is below the target for Allied therapies at .25. We acknowledge that allied health staff levels could be higher. Like many health authorities, we are taking steps to increase the hours of care our residents receive. We always welcome input from family members and are committed to quality improvement,” Stefanson said.
No further information was provided on where the $500 million of provincial funding for senior care would be allocated.
Stefanson said their bathing policy is in accordance with provincial guidelines. “All of our 86 residents receive at least one bath per week; younger residents receive two baths per week if we can accommodate.” Residents unable to return to the facility on their own must be escorted by staff or family and those who can return on their own are free to leave at any time, Stefanson added.
“Hilltop is their home, and we respect that,” Stefanson said.
A spokesperson on behalf of current Minister of Health Adrian Dix sent an emailed statement saying adequate residential care home staffing is one of the issues they have been aware of for some time and while it will take time to fix it, they are committed to getting it done.
“The premier has given me the mandate to work with the parliamentary secretary for seniors to improve and strengthen services to ensure seniors receive dignified and quality care,” the statement said.
Presently, it is not clear whether the $500 million of provincial funding will go to more staffing at Hilltop House.
“We cannot yet speak to the outcome of the upcoming budget, but we are working with health authorities to determine how to move forward to achieve the recommended 3.36 direct care hours per day as an average by health authority - something that has been long overdue” Dix’s statement said.
The improvements can’t come soon enough for some.
The problem is systemic at Hilltop House, which has needed more staff for years, said one anonymous source, pending current litigation with VCH over her partner’s death earlier this year. He was a complex care resident of Hilltop House for five years.
This source told The Chief she was certified as a care aide with the hopes of working at Hilltop House but after graduation two years ago was not hired because of the conflict of interest.
“I know they’re short-staffed,” she said, noting she visited her partner twice a day. “If I wasn’t there, very seldom would he be in his chair. He was often left in his bed.”
In the summer, this source alleges patients were sometimes not let outside. “They transfer managers for a year or two and then they change the manager,” she alleges, adding that the situation was similar with nurses and care aides because their schedule is intermittent. “You’re dealing with new people all the time,” she said.
There are a few bad apples but some staff go above and beyond, claimed another anonymous source who currently has a family member in complex care at Hilltop House. But that doesn’t change the fact that there’s limited care, the relative stated.
“The bells are always going — patients left hours at a time unattended. I’ll walk through there and I can’t find anybody to speak to,” this source alleged, adding most staff are busy at bathing and feeding hours but are not around at other points of the day.
“[My family member] was covered in sores...Their skin is always red because they’re not changed enough.”
This same relative also worried about the nutritional value of the food. “You can’t eat with a fork, you have to eat with a spoon because they’re so overcooked there’s nothing left in them.”
Sharon Sponton is the provincial treasurer for the British Columbia Nurses Union and she noted that according to the survey from the Office of the Seniors Advocate, Hilltop House ranked 3.09 hours of funded care.
“Over 90 per cent of care homes don’t meet that minimum standard of 3.36 hours,” she said, noting Hilltop House has the added pressure of being the only facility in the Sea to Sky Corridor. However, the 3.36 is a minimum standard of care and just a starting point, she said.
“We certainly know there’s been chronic underfunding and under staffing in residential care,” she said, adding it affects patients, families, staff and communities.
Sponton also said the employees at these care homes face difficulties working on chronically understaffed teams. They have to prioritize care and it leads to burnout and decreased standards of care like over medication, she said.
“We continue to push health authorities and the government to demonstrate and explain what the impact of staff shortages are on residents across B.C.,” she said. “Our seniors have contributed tax dollars to communities they’ve lived in for a lifetime and it’s so vital that we care for them.”
