Private or Public Care?

In case you missed it in the local press, Ex-Councilor Doug Evans' family recently made quite a fuss about his treatment in Burnaby General Hospital, and took the opportunity to make a political point. I responded to this with commentary that the family's concern appeared to be misplaced in the political arena.

There are a couple of issues in this story that need to be explored further. While we all sympathize with Mr. Evans' plight, some of us are considerably less sympathetic to his family, whom I would accuse of callous disregard for their relative in attempting, with a good deal of success, to blame society as a whole for their own failings. While I only know the story from what I have read in the press, I am going to comment on the events as reported, and suggest how the outcome should have been a lot different. I think it serves as a warning to all of us who have reached the "golden years" to make provision for worst case scenarios while we still have some of our wits about us.

Apparently, Mr. Evans was picked up by police three months ago, and taken to Burnaby General Hospital after he became confused and wandered off while out for a walk. What is not stated is how long he was lost and how the police became involved. In any event, since he was still living at home in my neighborhood at the time, one wonders what sequence of events brought him into an acute care facility. Were his relatives not notified at the time? There is no indication that he was injured or otherwise in need of acute care. So what happened in the intervening three months while he presumably occupied a $1,500 per day bed and his health progressively deteriorated? According to Diane Evans, his daughter, he was admitted to the hospital by a "psychiatric doctor", drugged and tied to a bed, and his situation went downhill from there. Did the family have no input at the time? Was he violent?

I have a personal instance with the case of my father-in-law, Roy, who is somewhat older than Mr. Evans. Though a bit vague in terms of mental capacity, he does not suffer from dementia; but he has had health issues. He is now 98 and in an assisted living community, where he is thriving rather than just surviving. He is a widower, and was living on his own until several years ago, when he suffered a minor stroke which left him delusional and needing help. When he thought the floor was moving in waves, he called a neighbour, who found him on hands and knees, and pressed his Lifeline button to set in motion the normal help sequence - ambulance for immediate assistance and calls to next of kin, with my wife, Elaine, at the top of the list. He was stabilized and admitted to Langley hospital, where he was determined to have been suffering minor dehydration and likely had skipped some of his blood thinner medication. In a few days he was transferred out of acute care and into an intermediate care ward. Since there had been previous less serious episodes requiring ambulance and hospital care, Elaine, with her older brother from Edmonton, decided the time had come when he should no longer live alone: a decision he would have disputed had he been able. They checked out several private assisted living homes, where residents are independent in small apartments, but have meals and light housekeeping provided, with communal social space and a front desk with round the clock staffing and control of entry and exit. They decided on the facility and we proceeded to move some of his furniture into the one bedroom/den unit selected. The cost appeared affordable at slightly under $3,000 per month. When time came for his discharge from hospital, we took him to his new apartment and explained the arrangement: with the proviso that his townhouse would still be available should he decide that he hated the new place. I should note that while on his own, he had been getting meals on wheels, and was really not capable of cooking, so that his nutrition had also been somewhat lacking.


Although it took him the best part of a year to admit he liked the place, he was enthusiastic about the meals from day one, and though not a joiner and not interested in participating in any of the activities offered, he thrives on the social contact which was almost entirely lacking when on his own. He spends most of the day just sitting in the main common room watching the coming and going and occasionally chatting with someone. 

Roy in his favorite spot in the common room

As one of the older residents, he is respected and appears well liked by both staff and other residents. He is rather deaf, and refuses to wear a hearing aid, so communication can be challenging, but he enjoys all visits from relatives and the few friends he has left. He has some extra help daily to ensure that he maintains his medication and has clean clothes, but otherwise still manages to get himself to the common areas to meals and back to his apartment. He has had a couple of falls, one of which left him in a wheelchair for some time, but he is in an environment which is not too challenging and free of anxiety. If need be, and dementia or physical ailment should deprive him of his limited independence, there is an attached facility with full 24 hour nursing care that he could move to with minimal disruption.

Having been independent with his own small business as a commercial traveler all his working days, Roy's only income above CPP and OAS is from his savings; but having been frugal all his life and socked away enough in very conservative investments, there is more than enough to cover the cost of his maintenance with no subsidy required. This has provided for the relatively high quality of his current home, with no wait time and the added benefit of being with like minded fellow residents, none of whom are wealthy, but are mostly paying their own way. His townhouse was ultimately sold on his instructions, when he saw clearly that he no longer needed it as an alternative living arrangement.

So how does this relate to Doug Evans and the political issue? Clearly, Mr. Evans should not have been left in an acute care facility, where his care was inadequate because the system is overtaxed - principally because of excessive demand for "free" services. Could he not afford private care? I have no doubt that he could: as a civic politician, his past employment as an executive of a major labour union is a matter of public record, and his house in my neighborhood is worth well over a million dollars. But someone would have had to go to the trouble of making the arrangements, which are never simple and always require a substantial effort. Are there enough facilities available for the care of difficult elders? Certainly not in the public domain, and there never will be as long as they are "free"; but there are lots of excellent private facilities available now, and more being opened as demand increases with the boomer generation reaching the end of the road.

What should we, the current elders do? Well for one, we could emulate Roy and my late mother-in-law, and arrange for our progeny to look after our finances when we are no longer capable. Elaine was given full power of attorney over all their finances a couple of decades before it was needed. But that involved a level of trust that may not exist in all families, and does not appear to apply in the Evans family. Living wills are a reasonable option for health concerns, but financial representation needs also be addressed in case of diminished mental capacity. Most of all we need to plan for our endgame, a prospect no one relishes.