After spending two weeks in October caring for her 89-year-old mother at home, Jeanette Harper says bringing her back to her Nanaimo long-term care facility “was like taking your child to kindergarten for the first day.”
The time at home had highlighted her mother’s decline in ways that regular visits to her in care could not.
“It was very emotional,” said Harper, who also lives on Vancouver Island. “During those two weeks at home, I saw my mother’s deterioration. It was very hard.”
Harper’s mother, Marguerite Bell, has had Alzheimer’s disease for a decade and moved into long-term care about 3.5 years ago. She remembers her daughters and grandchildren but needs assistance with everything from using the bathroom to getting dressed and eating.
Harper had pulled her mother from the Eden Gardens care home to spend more time with her using a temporary absence pass. As Harper spent two-weeks providing 24-hour care, she said she felt that some of her mother’s care needs weren’t being met at her facility.
For example, during Harper’s previous visits, she noticed things like her mother’s teeth and hair not being brushed.
Harper doesn’t blame the care aides who work hard to attend to everyone’s medical needs, but said these tasks are still an essential part of her mother’s health and well-being.
In an email to The Tyee, CEO of Eden Gardens Erin Beaudoin said the staff work under tight time and funding constraints but never force care tasks like hair or teeth brushing on a resident who is resistant.
“We are tight on time and could use more funding to improve on care and the time we have with our elders, but these essentials are not missed,” said Beaudoin. “If an elder does not want their teeth or hair brushed, our staff are trained to accept no for an answer and try a different approach in five to 10 minutes time.”
They try up to five times before a longer break, Beaudoin says, because “we would never force someone to have their hair brushed as it breaks trust between the elder and care partners as well as can result in someone getting hurt.”
After Bell returned to the care home, Harper applied to be designated an essential visitor on Nov. 8, hoping to help her mother in the home with things like hair brushing or getting dressed. She says her mother seemed distressed about returning and Harper wanted to be there more for her.
She was already her mother’s lone designated social visitor, which allowed one visit a week of about 30 minutes. If the home approved her as an essential visitor, she would be able to see her mother more frequently.
Before the pandemic, she and her sister were often there four times or more per week.
Harper waited four weeks for a decision, and then was denied on the grounds that the care home was meeting all of her mother’s care needs.
Eden Gardens, which is operated by a non-profit society, would not comment on specific cases of denying essential visitor status.
“This has been one of the most difficult processes for us to take since the beginning of the pandemic, as we really wish we could have families in more often,” said Beaudoin. “A denial means that a loved one can’t see their parent or spouse, but it also means that the elder is doing fairly well in our home.”
But after Bell returned to the home, staff told Harper she was more resistant to care. Harper agreed with a staff recommendation to administer antipsychotic medication in the mornings to make Bell more compliant in receiving care.
Recent data shows prescriptions for antipsychotics in long-term care in B.C. have risen by seven per cent during the pandemic. About one-third of long-term care residents are being prescribed antipsychotics.
Harper believes if she had more access and could provide essential care, her mother wouldn’t be as resistant or need the medication as often.
The increase in prescriptions “definitely correlates with the fact that you don’t have family in there assisting,” she said.
Harper is not alone in saying the current restrictions are hurting people in care homes. More than 30 individuals with loved ones in long-term care are calling for the province to guarantee an essential visitor is allowed for every resident of long-term care, rather than leaving the decision to the home operators.
“The existing isolation and visitation limits in long-term care and assisted living arguably violate the security of the person and liberty rights of residents of care homes and the rights of their families,” wrote Karen Carteri, the group’s lawyer, in a Dec. 4 letter to Health Minister Adrian Dix and the Office of the Provincial Health Officer.
They say the essential visitor policy is being applied inconsistently across care homes and depriving their loved ones of critical care and time together.
The call echoes November recommendations from the province’s seniors’ advocate, whose recent report found visitor limits have devastated the physical, mental and emotional well-being of residents and their caregivers.
The report also highlighted the role of family in providing essential care as long-term care facilities are often understaffed and under-resourced.
Essential visitors have been allowed at the discretion of care providers since March, and in June new orders from provincial health officer Dr. Bonnie Henry allowed a second social visitor to be designated.
But in the seniors’ advocate report, less than half of loved ones knew they could apply for such an essential visitor designation, and half of those said their applications were rejected.
The group wants an essential visitor guaranteed for each resident to ensure the policy is being applied consistently across B.C., and in November the seniors advocate urged public health officials to expand the number and length of essential designated visits.
In Eden Gardens, there are just nine essential visitors for more than 122 residents, all of whom live with some form of dementia. About a third of residents in long-term care in B.C. had regular visitors pre-pandemic, according to the seniors’ advocate report.
Beaudoin would not say how many applications the facility had received in total but said only a handful had been rejected.
“It is evident from the Reports that no one clear or consistent approach to the ‘one visitor’ policy has been adopted in licensed facilities throughout the Province,” wrote lawyer Carteri. “It is equally evident that some measures and restrictions imposed and adopted by some health authorities and facility operators go beyond those outlined in the Policy, and that this overreach is materially affecting the rights and quality of life of those in care.”
Henry has declined to give a timeline on implementing a promised expansion of social visits. It’s now been two months since the report’s findings were made public.
When The Tyee asked last week when changes would be in place, Henry said she is focused on ensuring the essential visitors policy is applied uniformly across the province.
“As the increased levels of transmission in the communities have made it even riskier in long-term care, what we’re trying to do is to make sure we’re trying to maintain those safe visits over the last few months,” said Henry.
She noted care staff and residents are getting priority for vaccinations to ensure their safety during visits as well. “The focus on being able to safely visit in long-term care is why we’re immunizing health-care workers as soon as we can,” said Henry.
Other provinces with much worse outbreaks in care facilities, like Ontario, have mandated one essential visitor per resident.
But Henry did not say whether she would consider such a move.
Eden Gardens’ Beaudoin said the facility is following current policies.
“All of our elders live with dementia, and we would love to be able to have one essential visitor each, however, that would be outside of the guidelines,” she said.
In a letter provided to The Tyee, Carteri said the group had not received a substantive response to their initial letter. She said she has heard from a number of other individuals who want to join the action as well.
If it were a normal year, Harper would have taken her mom home for Christmas and stay the night with her family.
This year, she planned her holiday visit the day before Christmas Eve. Her other option was to visit on Christmas Day, but she thought she would have a better chance of getting an extra 15 minutes with her mother on a non-holiday afternoon.
“She’s 89, we don’t know how many more years we’ll have with her,” said Harper. “We’re hoping for the vaccine to come soon, but it will have been a year since family can come in when that happens.”
Moira Wyton, Local Journalism Initiative Reporter, The Tyee