Advocating for healthcare in Alberta - letter to Tyler Shandro - Minister of Health

July 28, 2020

Dear Mr. Tyler Shandro, Minister of Health. 

Hello. My name is Laura Jean Rutherford, I am 49 years old and I am currently a resident on 6W Martindale Long Term Care (LTC) wing at AgeCare - Skypointe facility in Calgary, Alberta. During our global Covid-19 pandemic, the situation with Canada’s LTC facilities and senior residences have come under the microscope due to the high volume of deaths and spreading of the virus seen across Canada as well as in Calgary. I am writing this letter to express to you my observations and experiences at AgeCare - Skypointe from a resident point of view as well as someone who has worked in the healthcare field for over 25 years. In addition, my concern to the recent announcements of cuts to Alberta’s health care system. 

Before moving to Calgary in March 2005, I was a Health Information Management (HIM) Professional working as a coding specialist in the Data Collection area of the Health Records Department in Thunder Bay, Ontario. In 2005, I began as a coding specialist in the Foothills Medical Centre (FMC) and have had the opportunity to work at all Calgary hospitals and urgent care facilities as well as some of the Calgary Zone’s rural hospitals. In 2010, I had the opportunity to become a coding coordinator for Calgary Zone urban hospitals based at the Peter Lougheed Centre (PLC) and Rockyview General Hospital (RGH). In this position I was responsible to ensure clean and accurate data as our team collected the diagnoses and interventions occurring in our inpatient discharges and outpatient visits to the hospital. I participated in presentations to our coding specialists and physicians to share the importance of detailed documentation and capturing data from patient charts on topics such as indicating alternate level of care (ALC); pressure sores/open wounds; and strokes. 

In September 2016 I was diagnosed with a severe case of Guillian Barre Syndrome (GBS) with severe Acute Motor-Sensory Axonal Neuropathy (AMSAN) as well as Autonomic Dysfunctions (bradycardia, diaphragm dysfunction, neurogenic bladder and neurogenic bowel) and it has left me as a functional quadriplegic. I had to spend 700 days in the acute care facilities before my transfer on August 5, 2018 to AgeCare - Skypointe for my continuing care in LTC, as I now require total care for my daily basic needs. AgeCare - Skypointe had just opened in May 2018, so I had the ability to see first hand how my wing functioned as we grew to total capacity during our commission year and onward. We faced kinks along the way but that is expected as a new facility and with good communication we found solutions. Right from day one at AgeCare - Skypointe, all the staff (Leadership, Doctors, RNs, LPNs, HCAs, Housekeeping, Food Services and Allied Health professionals) treated me with professionalism, kindness, compassion and made me feel a part of the family. Being a quadriplegic and away from my family in Ontario, the staff made me feel that this is my home not just a LTC facility. 

Unfortunately, our facility was impacted by Covid-19, we had 4 staff members who tested positive but happy to report no residents contracted the virus. The staff members have fully recovered and passed the protocols set by the Public Health Officer and have returned to work. So many lessons have been learned during our lockdown as well as seeing what protocols already in place for outbreak situations are working. Beginning mid-March, the leadership at my facility had implemented temperature screening of staff, essential visitors as well as all the residents on a daily basis. These are difficult and stressful times we are facing today, especially for those who care for our vulnerable residents in community care facilities across Calgary as well as Canada. As we face nursing homes’ annual respiratory outbreaks, the team at AgeCare-Skypointe already had in place the restrictions for visitors prior to the provincial guidelines instructions. When it went public that McKenzie Town Community Care Centre in Calgary had an outbreak of Covid-19, staff were notified that if they worked there it would impact shifts here. Thus reducing the risk of spread to our facility. 

Living in a LTC facility during this Covid pandemic, has provide anxiety seeing the number of fatal outcomes in the Canada’s LTC facilities as well as the United States. Implementing the daily temperature screening protocols is a great tool to raise a red flag before something serious occurs. Using the established outbreak protocols in place, such as the appropriate PPE, assists in ensuring the health and safety for residents and staff. This has been a learning curve for all of us, I would like to share some observations and experiences of the impact living with such a contagious virus in our environment. As many family caregivers and friends have not been able to see their loved ones since early March, the importance of providing real-time communications to families are essential. Having lack of in-person contact has shown the effects on a resident’s emotional, mental and physical health. I put myself into self-isolation from March 4 to May 28, 2020, to reduce my risk of exposure due to having multiple co-morbidities. When I went back out to the dining area for meals after isolation, I was surprised at what I saw. Residents who were feeding themselves before were now needing either assistance in eating or had changed to total feeding by the Home Care Aides (HCAs). Some seemed withdrawn, non-talking or had become more quiet. AgeCare-Skypointe started around May/June opportunities for virtual visits via Zoom/FaceTime or a designated area for outdoor visit. These are wonderful options, but only having them once a week is still difficult on the emotional, mental and physical health of residents. Of course on Thursday July 23, 2020; AgeCare Corporate updated their Visiting Policy to adapt from a restrictive access to a safe access as per the directions by Dr. Deena Hinshaw. I do believe these changes will assist in the improvement of the residents emotional, mental and physical health.

Mr. Shandro, one of my main concerns in Alberta’s Health care is not having sufficient numbers of trained staff who provide us (residents) in caring for our daily basic needs. Through their care, the HCAs provide residents to have their dignity and respect for themselves as well. The staff provides the care with kindness and compassion which means the world to the person receiving that care. The problem is there is no provincial or federal standard for nursing staff (RNs, LPNs, HCA or Allied Health Therapists) when opening up these facilities in Alberta or across Canada. There needs to an appropriate staff quota ratio of HCA to Residents so it ensures all are kept safe during care as well as the residents basic daily care needs are met in a timely matter. 

Presently, we have 1 Occupational therapist and 1 rehabilitation aide providing care for approximately 128 LTC residents. As they have limited resources they can only provide care for about 10% of our LTC residents, I can not receive any therapies onsite due my chronic condition. They can only provide OT to LTC residents who are recovering from acute conditions such as strokes and fractures. Residents with chronic conditions with slower recovery, like myself, can not receive this care due to the lack of staff in this department. I cannot see how this is acceptable, as this service should be available for all LTC residents (acute or chronic status) for one’s own mental and physical well-being. In 2019, I had to spend over $11,000 to ensure I could have weekly physiotherapy as my facility does not provide this service. We need to re-examine how sufficient staffing is determined at a LTC facility to ensure therapy services (physiotherapy and occupational therapy) are provided to all LTC residents at these facilities!

A main concern that I have observed and experienced since arriving at AgeCare-Skypointe as well as during this pandemic is seeing an insufficient number of staff who are ensuring the care and safety of the residents at the risk of their own safety. Currently, we have on my wing, 33 private rooms and one of them is a double room for a couple, which means at capacity we could have 34 residents to be cared for with 24/7 medical care. At the moment, in the day & evening we have a RN, LPN with 4 HCAs and on nights there is a LPN or RN with 2 HCAs. This is approximately 8-9 residents per HCA for day/evening shifts and 17 residents per HCA on the night shift. When you are looking at the amount of time required per resident, one would need to look at how many HCAs is required and what the task is. It could be something quick but for changing, showering and transporting the resident, it could be 20-30 minutes or longer sometimes. Looking at those ratios, how is this a safe environment for either residents or staff? We have already had a few HCAs who have had back, shoulder or neck injuries while providing care to residents. When opening a new facility how are quotes determined to know sufficient staff is hired? In LTC, you have many clients who have mobility issues requiring either assistance (1 HCA) or total care (2-3 HCAs depending on their size). As residents stay longer their mobility decreases, therefore now requiring 2-3 HCAs, but staffing quotas do not change. Looking at my fellow residents, we range from low maintenance to high complex maintenance like myself who requires 2-3 HCAs to provide care. Looking at my wing, there are probably 6-7 residents who are mobile with walkers, but the remaining residents are in wheelchairs (~27 residents). When you have 3 of 4 HCAs providing care to just one resident, the remaining HCA can only do their best providing care to the other 33 residents. How is this safe for residents? At meal times, in the beginning (2018) we had about 5 residents that HCAs had to help with feeding, now that is up to 8-9 residents. As residents decline in health, their needs for HCAs increases, like feeding and the need for more HCAs to care for one person. My staff are always busy going to each resident for care and at times foregoing their necessary breaks to ensure our needs are being met first. They are hardworking and have a smile on their face when entering my room. I feel I must advocate for them as you do not want to lose these type of employees. This is why I believe there should be a provincial and national standards for staffing quota when looking at our LTC facilities keeping in mind the safety of residents and staff.

My other main concern is from the perspective of wheelchair accessibility in common areas within the LTC facilities so it can feel like our home. Due to my size, the width of my wheelchair is wider which has provided obstacles in accessing areas in and out of my facility. My wheelchair width is approximately 42 cm allowing enough space to get in and out of my room. Unfortunately, I am unable to use the common rooms with doors in my facility; these areas include the lounge room, the sunroom, the salon, and the dental clinic.  In addition, other areas which could be improved is the size of shower to make it more accessible for wheelchairs or mobility issues. The commode chair that a few of us residents use, barely fits into the shower area. This makes the staff have to do unnecessary lifts and maneuvering before I can take my shower. Once in position they must raise one of my commode arms to ensure I am in the shower area as the holding bar is located too low. This is not safe as I do not have core strength to stay upright. As AgeCare-Skypointe was a new facility (2018), I was surprised to see wheelchair accessibility issues. My question when building LTC facilities, why are the common room area doors and our bedroom door size not the same? If this is to be my home, it is sad that I can not use my “living room” (lounge/sunroom) instead of having to use my room for visiting or for using services available within my facility like the salon or dental clinic. When determining the dimensions of the shower area do we measure the length and width of commode chairs to ensure the safety of residents and staff when it’s used? One would think in 2020, a LTC facility/senior residence would be properly fitted for wheelchair accessibility to allow residents to participate in activities within common areas of the facility and shower areas. 

On July 8, 2020, Ontario Premier Doug Ford (PC) announced he would be looking into mandating air conditioning into Ontario’s LTC facilities. My facility is also has issues with temperature control for residents individual rooms. Yesterday (July 27)  it was 28c in Calgary, I had my fan on full and window open to allow the breeze to cool my room off. Even with these 2 things, my room’s temperature was still 25c. I was in my bed using my iPad and I had sweat rolling down my face. Adding to my situation, my disease Guillian Barre Syndrome impacts how my body regulates temperatures. I have fan on full even during the winter months as my room would be too warm for me if I didn’t. Therefore, providing air conditioning in our LTC facilities will need to be done at the architectural planning stages as it involves the venting system which is put into the building before the drywall even goes up. This is a very important component to the infrastructure of our LTC facilities. 

As we look forward to building new LTC facilities/senior residences in Alberta and in Canada, there are numerous things to remember in architectural design of LTC facilities such as: Who are we servicing in the community?; What kind of residents are you caring for and how to make wheelchair accessible for all in your facility? In community care living we have many levels depending on a person’s physical and mental abilities: (1) Home Care for resident at private home; (2) Designated Assisted Living (DAL); (3) Supportive Living (SL4); (4) Supportive Living with Dementia (SL4D); (5) Long Term Care (LTC); (6) Long Term Care - Mental Health (LTC-M); and (7) Hospice or Palliative Care. For example, my facility AgeCare-Skypointe offers the NE communities all institutional levels (2-7). To assist with the architectural design, you would need to look at the wheelchair accessibility to all the rooms and common areas which residents would use to keep them safe and healthy. As residents decrease in mobility overtime or require total care or who are bariatric (obese), they will require a double ceiling lift to transport them from their bed to their wheelchair and then back to bed in a safe manner for the residents and staff. As mentioned previously, the importance of knowing the sizes of your shower area to accommodate all the equipment (ie. height/width of the commode) to provide a safe environment for not only for the residents but also for the HCAs who are caring for them. When we are making these facilities, it should be kept in mind both short term goals but consider how the facility can continue to support the resident as they gradually decline in their health and mobility. There is a strong need in Alberta to build more community care facilities/centres so that they are not taking up acute care beds in our hospitals. If this would occur, I believe this health care costs per person in Alberta which accumulates while in hospital would decrease. I recently found out that in the Calgary Zone (population 1 million +) only has 150+ hospice beds! AgeCare-Skypointe will be the first facility in the NE quadrant of Calgary to offer 15 public-funding hospice care beds. This is another great example that if we had more hospice care facilities in Calgary Zone, this could potentially decrease the number of patients taking an acute care bed in hospitals. As it takes time to build these facilities, therefore it is important in the beginning to look into the future (long term), when deciding the design of the facility; such as what is the age of the population in Alberta and how our province support them for their healthcare.

Mr. Shandro, my last concern is regarding the recent healthcare cuts Premier Kenney and the UPC government are making to our provincial health care system. In Spring 2018 one of your government’s campaign promises to Albertans as stated by Premier Kenney was, “With the most expensive health system in Canada, I believe we can find some savings to do things more efficiently without affecting front-line services,” . My question to you, hasn’t Premier Kenney and your government done exactly that - affect the front line services? Who provides these front line services? It is your doctors, nurses, HCAs, allied health therapists, housekeeping and other supportive services found within our hospitals, LTC facilities and senior residences. Your government has created a mistrust and disrespect to these people who have put their lives on the line for all Albertans these past 6 months caring for those with Covid-19 virus. Your government is going after their pay by rolling back their wages depending on their unions.    AUPE - 2%  (housekeeping and supportive staff); UNA - 3% (nurses); and HSSA - 5% (allied health therapists, EMS), along with job losses from those areas to meet those cuts you are wanting to make. For the 6 years I was a coding coordinator, every year our department had to cut our budget more than the year before; but I do not remember what steps the top part of the AHS organization took to save money. Did they roll back the pay of the administrative positions? Did they look how they could streamline positions to reduce duplication of duties? Have they had to do the same amount of work or more but with less support to complete their tasks in a timely manner? This is what the front line health care employees and support workers do everyday - have a heavy workload but less staff to accomplish completing those duties. They should be acknowledged for the efforts they contribute to Albertans health, not be punished for it. 

I wanted to acknowledge my appreciation of the care and compassion I have been receiving during this pandemic. In addition, I felt I needed to stand up and advocate for myself, for my fellow LTC residents who can not speak for themselves and for the healthcare professionals who cared for me in both the hospitals and at my LTC facility.

I would appreciate an acknowledgment that my letter has been received and read. If you wish to follow up with me on the information shared, feel free to contact me via email at laura2travel@yahoo.ca. 

Sincerely yours, 

Laura Jean Rutherford, CHIM 

AgeCare - Skypointe; Calgary, Alberta; Room 6041

cc’d:

Mr. Jason Kenney, Premier of Alberta (UCP)

Ms. Josephine Pon, Provincial Minister for Seniors and Housing 

Mr. Prasad Panda, Provincial Minister of Infrastructure

Ms. Rachel Notley, Provincial Leader of the Opposition (NDP)

Dr. Deanna Hinshaw, Alberta Chief Medical Officer

Mr. David Shepherd, Provincial NDP Health critic 

Mr. Thomas Dang, Provincial NDP Infrastructural critic

Ms. Lori Sigurdson, Provincial NDP senior and housing critic 

Mr. Justin Trudeau, Prime Minister of Canada 

Ms. Christy Freeman, Deputy Prime Minister of Canada 

Dr. Theresa Tam, Canada’s Chief Medical Officer

Ms. Patty Harju, Federal Minister of Health

Ms. Jag Sahota, Federal MP for Calgary-Skyview 

Ms. Rajan Sawhney, Provincial MLA for Calgary - Northeast 

Dr. Hasmukh Patel, CEO, Interim President & COO of AgeCare Corporate 

Dr. Kabir Jivraj, Managing Director of AgeCare Corporate 

Mr. David Weyant, Chair for Alberta Health Services Board

Dr. Verna Yiu, President/CEO of AHS 

Dr. Sid Viner, Calgary Zone Chief Medical Director

Mr. Naheed Nenshi, Mayor of Calgary 

Dr. Christine P. Molnar, President, Alberta Medical Association

Mr. Taylor Bachrach, Federal NDP critic for Infrastructure and communities 

Mr. Don Davies, Federal NDP critic for Health

Mr. Matthew Jeneroux, Federal PC critic for Health

Mr. Michael Chong, Federal PC critic for Infrastructure, Communities and Urban Affairs

Dr. Nicholas Etches, Interim Calgary Zone Medical Officer