Thursday, March 02, 2006

Albo's tragic case entirely predictable, and avoidable

VICTORIA - Almost seventy years they were married, Al and Fanny Albo.
But they died apart. Fanny was 91, and her heart was failing fast. Her sons knew she didn't have long to live. They wanted her to die with peace and dignity, and the couple to stay together for their last days.
Government policy and bad judgment by Interior Health Authority staff made that impossible.
There aren't enough acute care beds in hospitals, or long-term care beds in communities. If someone - like a dying old woman - is an acute care bed, she's blocking other patients.
So she gets moved, even if it's to a care home in a town 105 kms away over mountain roads, where she knows no one.
The government's "first available bed" policy says the priority is to clear the acute care bed. Someone who should be in long-term care has to take the first available bed, even if it's in a distant community, and wait for an opening closer to home.
Patents can pay for private care. But if they're counting on the government, they should be prepared to be moved.
In Fanny's case, that happened over the objection of her family and doctor. She was shuffled into an ambulance so quickly her husband had no time to hug her or kiss her goodbye.
And two days later she died.
Health Minister George Abbott dispatched his deputy to investigate, and this week she reported. It's a useful effort. But some of the biggest questions aren't answered, and the language is fuzzy.
Start with how both Albos ended up in hospital. Mrs. Albos was admitted in December because of her failing heart. But she rallied, and was sent home to be with her 96-year-old husband. They were supposed to get home care support to help him cope.
But it didn't happen. "The home support was insufficient in quality and time commitment," Ballem says. Within weeks her condition worsened, and Al suffered painful compression fractures of his vertebrae from trying to care for her.
They were both admitted to hospital. Ballem couldn't say why, but noted fewer home support services are available in Trail than in the rest of the province.
Why was Mrs. Albo moved? The main reason, Ballem says, is that no one took the time to think about what was best for her. They didn't consider a palliative care bed (though since Trail has only one, that's not surprising). They didn't question whether the first available bed policy made sense in this case.
The Interior Health Authority comes in for a slagging in the report. No one - nurses, family doctors, community - trusts the authority, or feels involved and consulted. (I'm offering a more direct paraphrase of the report.)
But the report doesn't really talk about the pressures. "There is a need for better alignment of home and community care and primary care resources with the health needs of the community," Ballem writes.
What that means, I think, is that it was mistake to close obsolete long-term care beds before replacements were ready. The Trail region has 90 fewer beds now than it did in 2001, according to local health care groups. They have been also been warning for three years about cuts to home care.
The Liberals promised 5,000 additional long-term care beds by 2006. In 2002, they said 4,200 beds were needed immediately to meet demand.
But the promise has been broken, and so far, they have added only 607 beds since 2001 - a record worse than the NDP's poor performance.
So health authorities juggle impossible demands. Leave someone in acute care while they wait for a local care placement, and they do badly and the bed is lost. Surgeries are cancelled, ER hallways fill up.
Push them into a distant long-term care home, and families are shattered.
Things may be worse in the Kootenays, but this is a problem across B.C.
Footnote: The government's apparent surprise at this case is could have been avoided by a subscription to the Trail Times. The newspaper has been reporting since 2002 on concerns about cuts to home care and long-term care, and the increasing risk to seniors and their families. Their dissatisfaction with the Interior Health Authority was also chronicled repeatedly.


Anonymous said...

The Blame Game

"Their dissatisfaction with the Interior Health Authority was also chronicled repeatedly."

IHA CEO Murray Ramsden has already started playing the blame game: "...changes are necessary so that our staff and managers are supported..."

Uh... Murray... You have had your position for over four years. You are the one who's responsibility it is to make sure this stuff doesn't happen - You are the one responsible for these messes; don't try to download this onto YOUR middle managers.

Anonymous said...

From what I hear today, even though there is only one pallative care bed in the town, it was available the day Mrs. Albo was moved away.

Anonymous said...

Its all alright because The News at 11 P.M. the other night gave more time to Sam Sullivans missing Wheelchair than to this story . Which seems to be playing everywhere but the news and Brand X

BevinBC said...

Yes, and we must not forget that they closed many, many care homes and beds when elected 1st time around.