Health Minister Terry Lake:
Re: Shortage of long-term care beds on the Sunshine Coast
We, the physicians of the Sunshine Coast, request your help in addressing a severe shortage of government-funded long-term care (LTC) beds in our community. We are asking for your assistance because the current Vancouver Coastal Health (VCH) proposal does not adequately meet our current or future requirements for residential care beds on the Sunshine Coast.
In order for you to appreciate our concerns, let us first give you the statistics relevant to our LTC bed shortage. The population on the Sunshine Coast as of July 1, 2015, was 29,177. Of this number, 3,268 residents are over age 75, which equates to 11.2 per cent of our population. This is significantly higher than the provincial average of 7 per cent. In our calculations we utilized the commonly used benchmark to determine adequacy of LTC beds in a community by reviewing the number of beds per 1,000 persons over age 75, as it is largely this demographic group that utilizes these beds.
The Sunshine Coast currently has 244 government-funded LTC beds, which represents 74 beds per 1,000 persons over age 75. By comparison, the average number of LTC beds for other communities within the VCH region is 91.5 per 1,000 persons over age 75. Thus, for our population of 3,286 over age 75, we require at present 57 additional beds to bring us up to the VCH average.
In February 2015, VCH announced it was requesting bids from interested parties for the construction of 15 to 25 new LTC beds for the Sunshine Coast. At that time, we physicians met with Mike Nader, then chief operating officer for VCH, and strongly pointed out how insufficient those numbers were in terms of meeting our present and future needs. We do not feel that our concerns, nor the needs of our community, have been addressed by the current proposal.
On June 1, 2016, VCH announced that it had signed a contract with the Trellis Group to construct a new 128-bed LTC facility (Silverstone) due for completion in 2018. Of these beds, 125 will be government funded. At the same time as that contract was announced, VCH also indicated that they planned to close two older LTC facilities on the Sunshine Coast: Shorncliffe Care Home and Totem Lodge, which combined have 105 LTC beds. Not only is the proposed net increase of 20 beds inadequate for our present and future needs, but also the entire contract process was completed without involving Sunshine Coast physicians or any other local stakeholder groups.
The physicians of the Sunshine Coast have concerns with the non-consultative process by which VCH made these decisions. We also are concerned that our two government-built and operated LTC facilities are being replaced by a single privately-built, for-profit operated facility. We share our community’s concerns for the potential loss of experienced caregivers due to lower wages and benefits and lower staff-to-patient ratios in a for-profit private facility. As well, we are concerned that the move to a for-profit privately run facility may well compromise patient care as several studies have shown that patient care in such facilities is generally of lower quality than that in publicly run facilities.
Our primary concern, however, is the completely inadequate number of new LTC beds in the VCH proposal. As noted above, to meet the VCH average of 91.5 beds per 1,000 persons over age 75, we presently require an additional 57 beds. By 2018, when the new facility is meant for completion, our population over age 75 is projected by the BC government to be 4,038. This will increase our total LTC bed requirements to 370 beds, which means that 126 additional beds will be required to bring us even with the VCH average.
At present, more than 40 per cent of the acute care beds at our hospital in Sechelt are occupied by patients awaiting LTC placement. These patients wait four months on average and in the case of one patient of whom you were made aware, nine months. While awaiting placement, these patients are looked after by acute care nurses who have not been trained to work on largely geriatric residential care wards. The cost of looking after these patients in an acute care hospital is three times what it would be in a LTC facility. Furthermore, rather than having 40 acute care beds, we effectively have just 24 beds to service our population’s acute care needs, which are significant in an elderly population.
The end result of our LTC bed shortage is hospital overcrowding. Our emergency department often has half a dozen or more beds occupied by admitted patients who regularly have to wait days before a bed is available on the ward. Consequently, our emergency room physicians struggle to find space to properly examine new patients. Patients on the wards are often doubled up in rooms designed for single occupancy, thereby decreasing privacy and increasing the risk of hospital-acquired infections. Sick patients are often discharged prematurely, resulting in increased patient readmission rates. As a result, our physicians, nurses and support staff find themselves working in an increasingly stressful environment.
We are aware that as part of VCH’s request for qualifications and solutions process, there was an option to expand the total number of new beds to 125 “in the short to medium term, should circumstances allow.”
Mr. Lake, we request your help in addressing the chronic under-provision of government funded LTC beds on the Sunshine Coast. The net increase of 20 LTC beds that would result from the recent agreement between VCH and the Trellis Group falls well short of meeting our present and future needs. We require 126 new long-term care beds on the Sunshine Coast by 2018 in order to just bring us even with the average number of beds for communities under the VCH umbrella.
We hope that in your capacity as British Columbia’s Minister of Health you will be able to take the appropriate action to ensure that the Vancouver Coastal Health Authority fulfills its obligations to our community.
Dr. Jim Petzold, Dr. Karen E. Forgie and the Physicians of the Sunshine Coast Division of Family Practice
