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VERNON - If the care home attacks that left a Vernon and Kamloops senior dead three years ago happened today, the incidents — and the circumstances leading up to them — would likely be handled somewhat differently by the Interior Health Authority.

Following the 2013 deaths of Polson Special Care unit patient Bill May, 85, at the hands of his 95-year-old roommate John Furman, and Kamloops senior Jack Shippobotham who died after being attacked by a fellow resident at the Overlander Residential Care Unit, the Interior Health Authority launched a care review for seniors with complex behaviours.

“At the heart of this review process was safety,” Interior Health’s executive director of residential services Cindy Kozak-Campbell says. “(Interior Health) wanted to learn from these incidents to make facilities safer, while also maintaining dignity for clients in care.”

While section 51 of the B.C. Evidence Act prohibits the disclosure of much of the information collected in the review, the recommendations were released to family members in January 2014.

“Without this protection afforded by the Act, many health professionals would not participate and the findings from the review would be incomplete without their participation,” Kozak-Campbell says.

WHAT'S CHANGED?

The 2014 report includes 18 recommendations, and over the past two years, Interior Health says it has completed many of them and is in the process of implementing the rest.

The report calls for enhanced communication processes in chronic behaviour disorder units for staff to call for support from outside the unit during emergency situations, something Kozak-Campbell says has been accomplished with ‘Code White’ training. When an employee activates a Code White alert, additional staff are deployed to the site. 

The Code White response instructs staff to de-escalate behaviour with a hands off approach, and if that fails, to use physical interventions as required such as restraints and medication.

“Interior Health staff are trained to respond to any escalating situation before it leads to an unfavourable event,” Kozak-Campbell says.

To reduce the risk of incidents between residents, Interior Health has a new guideline requiring all new residential facilities be built with entirely private rooms. Currently, in the health authority’s 26 residential care units, less than ten per cent of residents are currently in shared rooms, Kozak-Campbell says.

Certain site modifications have also been made to improve safety, including the installation of locking mechanisms on some, but not all, bedroom doors, improvement of sight lines with the use of mirrors, and the addition of cameras in common areas.

Families have called for more monitoring in residents’ bedrooms, including the possible use of video or baby-monitor type devices, but Kozak-Campbell says those have their downfalls. 

READ MORE: After three senior deaths and three years, Interior Health no closer to preventing another, families say

“We’ve considered those in the past. The cameras are very intrusive on someone’s privacy so we wouldn’t be looking at that. We have looked at things like baby monitors, but you need staff in a place so they can hear it. Carrying around the baby monitor is one more thing that’s hard to do if you’re providing care,” she says, noting some sites have started using them.

As for locking mechanisms that allow patients out of their rooms but keep other residents out, Kozak-Campbell says those have been installed in some places but are not always the solution.

“It can be very isolating for the resident,” she says, explaining that even though the resident can get out, there is a feeling of confinement because the door must be shut.

“To me, it’s the last thing we should be doing. We should be looking instead at what are the factors contributing to the resident’s behaviour and how can we change those things.”

The intake and admission process for patients has also changed, and now involves a more in-depth assessment process including asking family members specific questions about past histories of aggression.

“Although it (intake process) is still in development, those processes have been implemented at facilities with high and severe behaviours. They’ve been refined and reintroduced in response to that event,” Kozak-Campbell says of the August 2013 incident between Bill May and John Furman.

ENHANCED TRAINING

A large part of the health authority’s response to the events of 2013 focussed on enhanced skills training for staff. As of June 2016, Kozak-Campbell says 483 staff were trained in the Physical, Intellectual, Emotional, Capabilities, Environment and Social program (PIECES) and 1,298 were trained in the Gentle Persuasive Approach. The programs help frontline staff address risk, develop a suitable patient care plan, and defuse escalating situations.

Kozak-Campbell says care home staff require more training now than they did ten or 20 years ago because of the higher volume of patients coming into residential care with complex care needs.

“Five years from now, probably everyone in residential care will come in with some cognitive loss. At times it feels daunting,” Kozak-Campbell says. “Partly because it is so complex and the health system is shifting around us. I’m really proud of the progress we’ve made expanding skills and how staff are using it on a daily basis.”

In units where residents experience severe behaviours, management teams now meet weekly to go over new and emerging risks, and specific care concerns are reviewed daily, Kozak-Campbell says.

“The staff meet more frequently together. It could be shift to shift, daily, or a couple times a shift. They review the population they have at that time — what’s working well, where are we still seeing some risky behaviour, what can we change?” she says.

The health authority has also hired two behaviour consultants who work across the region, as well as one nurse practitioner in Kamloops whose job is focussed directly on supporting care for individuals with responsive behaviours.

“We’re considering expanding the use of nurse practitioners and assessing how it will align with the strategic work with care of the elderly,” Kozak-Campbell says.

According to the B.C. Seniors Advocate, nine seniors have died due to resident aggression over the past four years. A recent report by her office found more than 422 incidents in which residents were harmed between 2014 and 2015. It’s left families of the victims demanding action.

Kozak-Campbell says Interior Health is doing everything it can to keep residents and staff safe from violence at its facilities.

“I understand these families have expressed some concerns about what they see as a lack of action, and I’m really sorry to hear that’s the case. We’re not always able to be clear in what we’re doing. It’s not always evident to the public,” she says.

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