Letter to the editor re: Troubles reported at Hilltop
On Feb. 1, I had a letter published in the Squamish Chief in response to an article written by Melanie Green in The Chief on Jan. 4, 2018.
You can read Melanie's article here:
Melanie did extensive research for this article, and talked to many sources before submitting her story. The main gist of the article is that the understaffing at Hilltop, which is an issue at most facilities, has led to inadequate care, such as infrequent bathing (one bath a week is the policy for all facilities, not just Hilltop), infrequent Depends changes, rashes, long waits for residents to get help to the bathroom or to be fed, low quality food, and residents left unattended in bed or in wheelchairs for hours. Family members have to advocate continually for basic care, as I had to do for five and a half years for my own mother. I saw all of these problems and much more at Hilltop in that time.
According to a survey from the Office of the Seniors Advocate, Hilltop ranks 3.09 hours of funded care, which is below the 3.36 minimum recommended standard, which most agree is much too low. $500 million in new government funding will be going into senior care, but it is unclear whether Hilltop will benefit, because Hilltop House has a higher staffing rate than many other residential care homes in BC. A very scary thought.
Four letters of support of Hilltop have been sent to the Chief, and published on their website. The Chief published my letter in the paper, but not on-line, so I'm doing it here on my website.
The letters of support, for the most part, are defending the staff, who are upset by the article, and I'm assuming, by my letter, but they all agree with one thing: there is a problem of understaffing at Hilltop. The latest letter is by a resident at Hilltop, Randy, who has been there for 14 years. He is a wonderful man, I saw him in the halls and at dinners when I visited my mother, and I'm very glad he is getting good care, but my experience with my mother, and many other family members' experiences have been much more negative.
"The staff, in general, is excellent. They are overworked, working overtime and double shifts, which then leads to burn out and illness.
The health care system is continually out of balance due to the shortage of staff. Once they fall ill due to burnout, the system becomes even more taxed in the staff to patient ratio.
Even when we are fully staffed, the workload is too heavy for the staff to manage at times.
I want to point out that it is the system that is not healthy. The staff do the best they can. I am happy with the care I am receiving."
I know Randy is trying to defend the staff, and I agree most of the staff members are dedicated. But Randy is making the same point I'm making - that there is a severe shortage of staff at Hilltop. Burn-out and staffing shortages are detrimentally affecting care. Randy also says:
"I have been in other facilities that make Hilltop House look like a palace."
This is very true, which is terrifying, but it doesn't mean we should give up trying to improve life for the residents at Hilltop.
When I was advocating for my mother, I witnessed a lack of communication between staff, family, residents, and management which led to many problems, ie. care plans not being followed. There was also a lack of accountability and a defensiveness in both staff and management which made change very difficult to achieve. Suggestions were interpreted as interference. I would only write letters of complaint when absolutely necessary, because the atmosphere was so uncomfortable for weeks afterward. Much of the staff was sympathetic and recognized the problems, but because they were overworked and facing an impossible task, they could only continue to do their job to the best of their ability.
To deal with the understaffing, I hired private companions and a private rehab assistant for my mother, and for a while, hired someone to give her a second bath a week because her skin was so compromised. I paid an additional $1500-$2000 for this care, on top of the cost of Hilltop, approximately $3,400 a month.
I feel my being vocal about the understaffing at Hilltop is not a criticism of the staff, it is a criticism of the system, and of the government for putting the staff in such an impossible situation. I know staff want the best for the residents, but to improve the lives of everyone involved, we need better training in dementia and complex needs care, and an enforceable staff-to-resident ratio. The suggested 3.36 hours of funded care per resident is difficult to measure and enforce, and is not even being achieved in most of our residential care homes today, including Hilltop.
This is my letter:
Re: Troubles Reported at Hilltop
My mother lived at Hilltop House for over five years, and recently passed away. Like Janice Hayden, I can’t go back to Hilltop. My mother was one of the residents who suffered from “undiagnosed rashes,” if you can call blisters and beet-red skin from nape of neck to knees a “rash.” My mother developed this rash three times because she wasn’t kept dry, she was dehydrated, she received only one bath a week (until I finally managed to procure a second one) and because she fought off the care aides when her “as needed” medication for chronic pain was not administered, which was often.
My mother also had dementia, and while I do not blame staff for the normal trajectory of the disease, after the rashes, she went from strong and ambulatory to wheelchair-ridden and sling-assisted.
The inconsistent care arose from understaffing. Most of the time, on my mother’s wing, there were two care aides for about twenty-four residents, and one licensed practical nurse, who was responsible for an additional nine residents in the locked unit.
Over the years I wrote several letters to management, but became more vocal after my mother’s palliative care experience. In February, my mother, always a stubborn woman, spent ten days dying. My sister and I stayed with her twenty-four hours a day, afraid to leave her side because, unless a registered nurse was assigned her care, staff members were inconsistent with her pain medication. We often had to track them down. Nor did they have swabs for her mouth, a basic necessity for the dying. By way of explanation, we were told that not all staff were trained in palliative care.
Though I feel deeply for the many staff members who loved and cared for my mother, I feel my complaints have brought about changes to palliative care. A few months ago, when my friend’s father was dying at Hilltop, there were mouth swabs. Small victories.
While it’s nice to see letters of support for Hilltop, defensiveness, denial, and naiveté will not bring about change. We need honest dialogue.
I believe the province must legislate a reasonable, specific, measurable, enforceable staff-to-resident ratio, an approach that is followed in childcare facilities. Our elderly also belong to a vulnerable population and deserve to live out their last years in safety and with dignity.