Street-entrenched patients are endangering elderly residents and nursing staff, say sources.
“The language, sexual assault, the physical aggression, the weapons, I mean, it finally breaks us. The whole system is breaking us.”
–Lana Lekopoy
Patients with severe mental illness and addictions are being channelled into B.C. long term care homes, endangering elderly residents and creating unsafe work conditions for nursing staff, while facility operators reliant on public health funding are scrambling to keep up with the influx, according to several sources.
In what appears to be a province-wide Ministry of Health strategy, health authorities are cramming hard-to-house individuals into existing long term care homes and have plans to expand the system by adding beds and building new facilities with special “pod model” designs that separate patients depending on their needs, Northern Beat has learned.
According to B.C.’s health minister, nursing homes have always had some younger patients and all residents must meet the same criteria to qualify for long term care. But other healthcare sources say these younger, heavily addicted patients – often street-entrenched, and sometimes violent or psychotic – do not belong in long term care.
Existing long term care facilities are not equipped to provide the heightened security required to keep these patients, other residents and staff safe. And staff are not trained to deal with their intense, complex healthcare needs and chaotic behaviours.
According to sources in several health authorities, deeply addicted patients are nonetheless being foisted onto the long term care system where they do not receive specialized addictions treatment services and before standardized protocols and practices have been developed for nursing home staff to even know how deal with them.
The result in some facilities is a dangerous “free-for-all, out-of-control” environment with few rules, where patients do illicit drugs at will, come and go as they please, and are visited at all hours by their drug dealers and fellow drug users, said a nurse who has worked in two troubled Vancouver Island care homes, and who described the environment as “a glorified homeless shelter.”
Appeasing patients top priority for administrators
The younger patients intimidate elderly residents and bully nurses to the point of being verbally abusive, even violent, while health authority administrators and nursing union officials turn a blind eye, said Lana Lekopoy, who worked at Park Place seniors facility in Ladysmith, and more recently, in the ‘special persons unit’ at the health authority-run Dufferin Place nursing home in Nanaimo.
A registered nurse with nearly 40 years experience, Lekopoy said the seven patients in the special persons unit buy and sell drugs in front of nurses, have sex and smoke drugs on the property within view of residents, carry weapons, and bully, threaten and intimidate with no consequences.
“We are called the filthiest names all day, every day. It’s deplorable.”
She said the message from health authority management is clear – the patients’ behaviour must be tolerated and their demands accommodated, no matter if the health, safety or dignity of other residents and staff are compromised by it.
“There’s just no protection for us. We’re on our own.”
Lana Lekopoy
“We’re housing drug addicts and trying to do our best to support them as nurses. And we’re failing miserably because they’re absolutely dominating us.”
With almost no protocols or policies in place, nurses are expected to allow practices and situations that don’t meet the standard of care they were trained to provide, she said.
“It puts our entire nursing career in jeopardy. We’re knowingly practicing without policies and protocols. It’s terribly rattling.”
Weapons, threats and sexual assault
One morning shortly after 7 am, a man showed up on the long-term care ward in Dufferin Place. The visitor approached Lekopoy, the only nurse on duty, with an eight-inch serrated hunting knife sticking out of his back pocket.
“I’m being polite because I don’t know what’s going on, except I know the person who’s visiting is a bad ass.”
When she reported the armed man to administration, “they just shut me right down. It was pretty much ‘Oh, calm down.’ They said as long as he’s being polite and he’s not lighting [drugs] up, then he’s got every reason to be there.”
Lekopoy disagreed.
She’s worked in acute care, a cardiovascular operating room, as a medivac nurse, a nurse consultant, and she delivered babies solo on reserves in northern Manitoba. “I’ve seen and dealt with lots and lots of stuff.” But she said she’s never worked in conditions as sub-standard as the last four years on Vancouver Island.
“When I go to work, I shouldn’t have to be checking the window [in the nursing room] and checking the screen and checking the little latch to make sure… I’ve got an escape.
“That’s how sick it is. [Patients] barricade us into the office and scare the shit out of us. That’s why we succumb to their demands. Because we’re scared.”
Lekopoy described a nursing colleague who was assaulted by a patient.
“This one guy was drunk and stoned, he grabbed my sweet 50-year-old friend and twisted her arm and pulled his pants down and shoved her face in his bare penis and said, ‘Suck my you-know-what.’
“This is our life. This is what nursing has become.”
Lana Lekopoy
Calling security is often futile because they’ve got their hands full next door at Nanaimo Regional General Hospital and can’t always arrive quickly enough to help, Lekopoy said.
“Sometimes they’ve got such a violent [hospital patient], there’s four or five of them with one person. They have a really, really hard job.”
Since staff are supposed to only call security and leave them to determine whether to call police, nurses and care aides are left to deal with dangerous or abusive situations alone.
“There’s just no protection for us. We’re on our own.”
Lekopoy filed a claim with WorkSafe BC and has been on stress leave from Dufferin Place since February.
When asked how many of these severely addicted patients suffering mental illness were occupying long term care beds, a Ministry of Health spokesperson said the ministry doesn’t keep track of that data. The ministry redirected Northern Beat’s inquiry to health authorities. More than two weeks later, no response has been provided by the health authorities.
‘Disaster in the making’
Gwen O’Mahony called the situation at Dufferin Place “a disaster in the making.”
Forcing elderly people with mobility and cognitive issues to reside with active illicit drug users shows inadequate due diligence and risk assessment on the part of the province, said O’Mahony, a former BC NDP MLA and current BC Conservative candidate for Nanaimo-Lantzville.
“Addiction care is a highly specialized area of medicine that must be offered in a safe, appropriate facility with the proper resources and supports in place, not a patchwork quilt of services each community is forced to piece together,” O’Mahony, also a former healthcare worker, said in a statement.
In Kelowna, a similar situation is unfolding.
Long-term care operators are being forced to accommodate street-entrenched, mentally ill patients with severe addictions they feel unable to safely house and care for, said Renee Merrifield, the former BC United Opposition health critic.
“From the [operators] that I have talked to, they are all being basically demanded if they’re funded by [the health authority], that [the health authority] believes that they can use the beds for whatever they choose,” Merrifield said in an interview.
Operators reliant on health authority contracts often feel unable to push back, she said.
One operator confided how worried they were about trying to house residents the facility was not designed for and said they’d asked the health authority to at least slow the pace of new admissions so staff could have more time to transition new arrivals into the facility. The ward occupied by the street-entrenched patients was packed, Merrifield added.
“[The health authority] believes that they can use the beds for whatever they choose.”
Renee Merrifield
While touring a facility provincially, Merrifield noticed one wing of a facility had unusual security construction that prevented access to the rest of the facility. The operator was in some distress, telling her they had been forced to modify the facility as best they could at significant expense to accommodate the new patients, but felt the situation was untenable.
“Rather than dealing with those with mental illness, those with addictions, those coming from a street-entrenched environment,” government is placing those people in hospitals and long term care, she said.
“Whether it be into the hospital, or whether it be into a long-term care facility – neither one of these are places or spaces are designed to handle or deal with their care needs.”
BC government ignored its own recommendation
A special independent investigation commissioned by then-Attorney General David Eby back in 2022 said as much.
One month before he was acclaimed BC NDP party leader and slipped on the mantle of premier, the investigators he’d commissioned reported back with solutions to the catch-and-release crime plaguing the province’s inner cities. To no one’s surprise, they found a portion of the most prolific crime was being committed by people with severe mental health and addictions living on the streets.
Among the many constructive recommendations and insights in the repeat offending report, the authors advised the province to create “low secure units” to deliver intensive rehabilitation, social housing education and employment services to people with complex mental health and substance use needs. The units would be for individuals who don’t belong in jail but are a high risk to others, requiring greater security than an in-patient or shared-room hospital setting.
Instead, two years later, those people are sharing multi-bed hospital rooms with general patients and displacing and endangering elderly dementia residents in nursing homes.
Collen Middleton, founding director of the Nanaimo Area Public Safety Association, said one of his members working in Nanaimo healthcare was upset at the sub-standard palliative care their parent received at Dufferin Place because nursing staff were overwhelmed dealing with younger mental health and addictions patients.
Their parent’s treatment regimen was repeatedly interrupted, down to missed doses, said Middleton. “Because the nurses were being redirected to triage issues with other patients related to violence and assaults and drug use in Dufferin place.”
As an expert in the health system, the association member understood full well the level of care that should have been delivered and wasn’t, Middleton said. The person won’t speak publicly about the situation for fear of being professionally penalized by the health authority.
Another Nanaimo resident familiar with Dufferin Place, Janayh Wright said she was worried about her grandmother and other residents’ safety and care when her grandma was living in the nursing home. With open drug deals directly outside the facility, Wright said in a public statement she felt unsafe visiting the facility at night.
New long term care ‘pod model’ planned
In a brief interview on July 31, Health Minister Adrian Dix would not confirm or deny severely addicted individuals are occupying long term care beds. Nor would he admit their presence was creating unsafe working and living conditions in any nursing homes.
When pressed about the disruptive, sometimes violent behaviour and rampant drug use reported by sources in some care homes due to these patients, the minister acknowledged long term care circumstances are always challenging.
“It’s one of the reasons why we moved, for example, in our new long term care homes, to the sort of pod model, the ones we’re building,” said Dix. “So you can create and put together better care, so that people are not all together. That’s part of the reason we’re changing the way we do long term care, because even amongst just the seniors’ population, there are very different needs, very different people. And so that’s a pretty major policy response.”
According to his ministry, the B.C. government plans to add a total of 1,164 new long-term-care beds to the public long term care system over an unspecified time. The beds will be spread across all five health authorities, including new facilities in Nanaimo-Lantzville, Campbell River and Colwood, and a public 200-bed, Providence Health-run facility in Prince George.
Currently, B.C. has more than 32,000 long term care beds, 28,500 of which are publicly funded.
Presumably, the new care homes featuring the special “pod design” mentioned by Dix will accommodate mental health and addictions patients in communities across the province.
By comparison, BC United committed to building a minimum of five regional recovery communities and to implementing modern secured, mandatory treatment for individuals at risk to themselves or others.
The BC Conservatives promised to re-open mental health facilities and expand mandatory care.
The BC Greens party platform doesn’t address secured care, but has called for private treatment services to be regulated.
Empty LTC beds with 5,000 people on wait list
Besides the health and safety risks, placing addictions patients in long term care is taking badly needed beds away from elderly patients, O’Mahony said in an interview.
Since these patients can’t safely room with seniors, they are sometimes the sole occupant of two or four-bed rooms. They are often gone for a day, days, or even a week at a time, leaving the room empty, said Lekopoy. There are times on that unit when they’re gone more than they’re there, but the room must be held for them until they return, she added.
This when the average wait time to get into a long term care facility in B.C. was 209 days in 2023 and the number of people on the waitlist rose 136 per cent over the previous year to 5,175 people, according the BC Seniors Advocate.
“We shouldn’t be taking a ward that can have 20 plus elderly people that really need care, all for the love of seven really volatile patients who are not recovering, that we’re keeping actually, in a state of addiction,” O’Mahony said.
Ministry of Health spokesperson said the ministry doesn’t keep track of how many empty beds there are in the system as a result of housing these new patients and the health authorities have yet to respond to the inquiry.
‘No one has our back’
“I’ve always said to my gal pals… we can do any shift… [if] someone’s got your back,” said Lekopoy.
“But now no one – and I mean no one – has our back.”
WorkSafe BC, however, has been supportive.
WorkSafe BC reported 524 “acts of violence” claims were accepted from long term care staff in 2023. Of the total violence-related claims filed for combined acute care and long term care staff, 535 claims were from nurses and 654 from care aides.
The actual violence is more prevalent, because no one files a complaint on the first incident, Lekopoy said.
“We take and take and take, and do and do and do, then you finally crack.
“The language, sexual assault, the physical aggression, the weapons, I mean, it finally breaks us. That’s what I find most disturbing, is that the whole system is breaking us. To the point where then we have mental health issues. And we need help.
“I mean, here I am a wonderful, experienced nurse. And I’m not nursing.”