Letter sent to AgeCare - Skypointe

Below is the letter I wrote to AgeCare Corporate (headquarters to the company which runs AgeCare - Skypointe). With all the news about what is being seen our long term facilities , I thought to share my experiences, thoughts and observations as a resident in one of their residents. At the time of typing this (July 19, 2020), I have not received a response.

July 12, 2020

Dear Drs. Hasmukh Patel and Kabir Jivraj.

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 your 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 seen across Canada as well as in Calgary. I am writing this letter to express 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. 

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 the 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 Dysfunction (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 to AgeCare - Skypointe for my continuing care as I now require total care for my daily basic needs on August 5, 2018. They had just opened the 6E Martindale LTC wing and then in late August I became one of the first residents to reside in the 6W Martindale LTC wing. So I have been able 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 it is expected as a new facility and with communication we found solutions. Right from day one at AgeCare - Skypointe, the staff on 6E and 6W Martindale LTC wings treated me with professionalism, kindness, compassion and made me feel a part of family. Being a quadriplegic and away from my family in Ontario, the staff had try to make me feel that this my home just not a LTC facility. I joined the Resident & Family Council (RFC) as co-chair representing our residents, and through these meetings I have found the members of AgeCare-Skypointe leadership approachable and listen to my concerns or suggestions on a variety of matters. Patricia Blais (Director of Care) and Alina Wlostowka-Stach  (6W Martindale Unit Manager) have gone above and beyond ensuring I had all the equipment and supplies to support my daily basic needs and being proactive to prevent injuries such as pressure sores. 

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. So many lessons have been learned during our lockdown as well as seeing what protocols already in place for outbreak situations. 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, your team at AgeCare-Skypointe already had in place the restrictions for visitors prior to the provincial guidelines. When it went public that McKenzie Town Community Care Centre had an outbreak of Covid-19, staff were notified that if they worked there it would impact shifts here. The leadership at my facility had implemented temperature screening of staff, essential visitors as well as all of their residents. As of July 11, 2020, there has been no provincial guidelines by Dr. Deanna Hinshaw, on how to reopen our LTC facilities and senior residences, but I expected it will be a slow reopening due to recent spikes in cases throughout Alberta. There is much to consider to ensure the safety and health of residents and the staff caring for us. I know for sure, has I share with my family with the outbreak protocols in place and forwarding the daily or weekly email, it has brought comfort to my family and friends that I am the top priority at AgeCare - Skypointe. 

At AgeCare - Skypointe, we have hospitalists that are based out of Peter Lougheed Centre who provide our medical care like a Family GP. I would like to acknowledge my appreciation of their support in my wellbeing and recovery. My primary hospitalist as well as those who care for me on his behalf have listened to my concerns, bring understanding to diagnoses or conditions I have had to face. Similar to the staff of AgeCare - Skypointe, they have shown me kindness, professionalism, dignity and compassion. This has meant so much to me, as it makes me feel I am a part of the decision making into my own health and care. 

Living in a LTC facility during this Covid pandemic, has provided some anxiety seeing some of the fatal outcomes the LTC facilities have faced. Implementing the daily temperature screening protocols is a great tool to raise a red flag before becoming something serious. 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 showing the steps taken to keep the residents healthy and safe. Having lack of in-person contact has shown the effects of 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 any exposure. When I went back out to the dining area for meals after isolation, I was surprised what I saw. Residents who were feeding themselves before were now needing either assisting in eating or had changed to total feeding by the Home Care Aides (HCAs). Some seems withdrawn, non-talking or have become more quiet. AgeCare-Skypointe had started around May/June opportunities for virtual visits via Zoom/FaceTime or have a designated room where a window is open to allow an in-person visit or a designated area for outdoor visit. These are wonderful options, but only having them once a week is still difficult. As we wait for Dr. Deanna Hinshaw’s recommendations in reopening LTC facilities, it is something to think of for the future. 

One of the greatest impact the Covid-19 restrictions has had on me was not being able to receive my weekly (2 days/week) of 1-hr physiotherapy sessions as the services are not available at my facility. Initially, as our facility was not at full capacity, I was able to receive 2 OT sessions a week for 30 minutes providing arm and leg passive exercises to help reduce muscle atrophy due my immobility. Then added a private physiotherapist to support my muscle tone and strength to work along my OT sessions. Unfortunately, in September 2019, I was taken off the OT list has my condition is a slow and chronic and improvement is slow. Presently, we have 1 Occupational therapist and 1 rehabilitation aide providing care for approximately 128 LTC residents. In their explanation of to why I was being taken off the OT list, with the limited resources they can only provide about 10% of LTC residents. I cannot see how that is acceptable. In 2019, I had to spent over $11,000 to ensure I had weekly physiotherapy as my facility could not provide this service. Are we able to re-examine how sufficient staffing is determined at a LTC facility to ensure therapy services are provided to LTC residents at your facilities?

One of my main concerns that I have observed and experienced since arriving at AgeCare-Skypointe as well as during this pandemic is seeing insufficient of staff which would ensure the safety of the residents which impacts the staff’s safety. Currently, we have on my wing 33 rooms and one of them is a double room which means at capacity we have 34 residents to be cared for. At the moment, in the day & evening we have a LPN with 4 HCAs and on nights there is a LPN or RN with 2 HCAs. This approximately 8-9 residents per HCA for day/evening shifts and 17 residents per HCA on the night shift. Looking at those ratios, how is this a safe environment for either residents or staff? We have already a few of HCAs who have had back, shoulder or neck injuries during providing care to a 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 people stay longer their mobility decreases therefore now requiring 2-3 HCAs). 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 5 or 6 residents that use walkers the remaining are in wheelchairs (~28 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 the safe? 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. I think LTC facilities staffing quota should be re-examined keeping in mind the safety of residents and staff.

The last concern I have is from the perspective of wheelchair accessibility in common areas within the LTC facilities so it can feel like their home. Due to my size, the width of my wheelchair is wider which has provided obstacles in accessing area 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, the dental clinic and if the RFC meetings had to be held in the conference room, I could not have access. In addition, other areas which could be improved is the size of shower. The commode chair that a few of us residents use, barely fits the shower area. This makes the staff have to unnecessary lifting and maneuvering before I can take my shower. Once in position they must raise one 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. As AgeCare-Skypointe was a new facility (2018), I was surprised to see wheelchair accessibility issues. My question in the building of LTC facilities, why are the common room areas and our bedroom door size are not the same size? If this is to be my home, sad that I can use my “living room” (lounge/sunroom ) for visits instead of using my room or for using services available 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?

Sorry for the long letter, but I wanted to acknowledge my appreciation of the care and compassion I have been receiving during this pandemic. In addition,I hope there will be opportunities to share our positive and challenging experiences as a residents or family caregivers in a LTC facility to improve our home and care.

If you wish to follow up with me on the information shared, feel free to contact me via email at laura2travel@yahoo.ca. I will happy to assist. 

Sincerely yours, 

Laura Jean Rutherford, CHIM 

AgeCare - Skypointe; Calgary, Alberta; Room 6041

cc’d:

Mr. Amir Rajani (General Manager,