Long before COVID-19, families say Canada’s long-term-care system was broken. Now they’re ‘furious and scared’

COURTENAY, B.C.-Earlier this year, Delores Broten and others wrote letter after letter complaining about the treatment of their loved ones in a chain of B.C. retirement homes.

But they didn't bother addressing any letters to the owners of the company.

"It would've been a waste of postage," said the 71-year-old Broten in February.

That's because the company that runs her husband's care home is owned by the government of China.

"Of course, the Chinese government sees the homes as just one of their many global investment holdings," she said.

Broten's letters, addressed to officials with the provincial and federal governments, did not mention concerns about COVID-19. At the time, the deadly virus had not yet begun its rampage through Canadian seniors homes.

But even before coronavirus, Broten alleges that her 85-year-old husband, Don, suffered the ramifications of serious understaffing and mismanagement at Comox Valley Seniors Village, a private seniors home on Vancouver Island. It's one of 21 senior-care facilities run by Retirement Concepts, the largest chain of private retirement homes in B.C.

In the past year, health authorities have taken the unprecedented step of seizing control of four Retirement Concepts care homes in the province that failed to meet legislated standards, including Comox Valley Seniors Village. They cited problems that have included disease outbreak, as well as emotional abuse and neglect, according to government reports seen by the Star.

Pacific Reach Seniors Housing Management, which manages the Retirement Concepts chain, does not deny the government's findings, but points to hiring difficulties leading to understaffing as a root cause of its problems.

Broten and others with loved ones in the care homes say their pre-existing concerns have now turned to outrage as they watched the virus devastate other long-term-care facilities. Unable to visit because of COVID-19 lockdown protocols, their anxiety about what their loved ones are facing has skyrocketed.

"It's making me furious and scared. Are they being fed properly? Being helped to use the bathroom? Are they being parked in empty rooms alone? The history of problems at Retirement Concepts makes it hard for us to trust them," Broten told the Star in April.

Broten has lived on Vancouver Island since 1978 and works as a magazine editor, while her husband, Don, worked as a lighthouse keeper, a truck driver and a crane operator following a career in the navy.

Called "Crying Out Loud," Broten's group has been fighting to bring attention to what they call systemic oversights that make government-subsidized senior homes across the country unnecessarily vulnerable to disease outbreaks.

Canada's first coronavirus death was a man in his 80s, a resident of Lynn Valley Care Centre in North Vancouver. Currently, 21 B.C. care homes including Dufferin Care Centre, which is part of the Retirement Concepts chain, have a combined total of 212 confirmed COVID-19 cases and 26 deaths. There have been 14 confirmed cases and one death in relation to COVID-19 at Dufferin Care Centre.

But the coronavirus isn't the first thing to put seniors in care in harm's way. It was a "nightmarish" situation for some much earlier, one that illustrates why families and advocates say sweeping changes were needed to elder care in this country long before anyone had ever heard of COVID-19.

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Greta Judd's husband, Dales, was 65 years old in 2015 and in great physical shape after a lifetime of biking and running marathons when he was diagnosed with dementia.

Soon, he was having hallucinations and would go on to lose his memory and the ability to speak coherently.

Judd quit her job as a special needs educational assistant and cared for Dales in their home for as long as she could. But when he got a government-funded spot in the well-appointed Comox Valley Seniors Village in April 2018, she was enormously relieved.

He died less than a year later during a norovirus outbreak in the seniors home, documents show. Judd said she was too shocked to request an autopsy, but now wonders why the home's operators didn't conduct an investigation into cause of death when another resident in her husband's ward also died during the outbreak.

This happened after the home promised to clean rooms more thoroughly following a previous norovirus outbreak, Judd said, referring to minutes from family council meetings.

Judd and Broten are both members of the group of about two dozen family members - mostly women - who are trying to pressure the government to overhaul the regulations around care homes.

They first spoke with the Star in February at a coffee shop in Courtenay, B.C.

The group wants the government to consider eliminating for-profit care homes if they cannot ensure they will provide satisfactory care.

"I thought a privately operated home would give the best care, but, boy, was I wrong," said Judd through tears. As she tries to stop crying, another widow puts a steadying hand on her arm.

The coalition was named "Crying Out Loud" because members say it's time that more Canadians talk honestly about the emotional challenges and financial burdens of aging with complex medical conditions.

"You think you won't end up in a place like that, because your family will take care of you. Well, we were the family taking care of our husbands and we had no choice. This could happen to you," Judd told the Star in February. "We're fighting for you."

Since social distancing measures were introduced in an effort to slow the spread of coronavirus, the group no longer meets at the coffee shop, but they have a website, and are continuing their letter-writing campaigns, which they now organize through Zoom video conferences. Judd says COVID-19 is just another example of problems within long-term-care homes.

"I think coronavirus has brought to light all the things we've been talking about that are inadequacies in some of these care homes, such as staff working at more than one facility at a tine and carrying viruses back and forth," she told the Star in a phone interview earlier this month.

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In Canada, there are also three main types of long-term care homes: Not-for-profits that are fully government-funded; privately owned homes that receive government contracts; and completely privately funded homes. All must meet minimum standards in order to maintain their licences.

Retirement Concepts receives provincial funding to provide residents with subsidized care.

In 2016, Pacific Reach Properties brokered a deal to sell the Retirement Concepts chain to Anbang Insurance Group, a Chinese holding company, in a move approved by the Canadian government in 2017.

Two years later, on Feb. 23, 2019, Chinese government regulators seized all of Anbang's global assets. (Anbang's former chairman, Wu Xiaohui, had been facing fraud charges in China, and Chinese officials said a government takeover of the company's assets was necessary to avoid insolvency.)

Retirement Concepts had previously received numerous complaints about the treatment of residents.

Pacific Reach Properties, a Vancouver-based company, is the former owner of Retirement Concepts. Following the sale of Retirement Concepts to Anbang, Pacific Reach Properties remains responsible for overseeing and operating Retirement Concepts facilities. Though the Chinese government doesn't play a direct management role in the running of the senior homes, it is the sole owner of Retirement Concepts through its Cedar Tree Investment Canada portfolio, according to legal documents seen by the Star.

It was a sale that the B.C. Ministry of Health told the Star it had objected to from the start.

Isobel Mackenzie, head of the B.C. Office of the Seniors Advocate, said "it's possible" that foreign owners overseeing their investments at a distance may be less likely than domestic owners to deliver the best quality of care.

Frankly, that's hard to prove, she said.

However, she noted that there is ample evidence pointing to broad, systemic issues with Canada's publicly funded private-care model that both the Retirement Concepts saga and outbreaks of COVID-19 cases in other senior homes help illustrate.

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Two months ago, staff were seen hurrying back and forth in the lobby area of the Comox Valley Seniors Village, where healthier residents were allowed to come and go as they pleased.

Broten was visiting her husband Don, who was eating his dessert of diced canned peaches with a plastic fork. He spilled most of the fruit, but didn't seem to mind.

"He doesn't like it when I try to help," she explained.

Earlier that month, she said Don looked right at her and told her she looked beautiful.

"After he's gone, no one will tell me I'm beautiful," she said, with a quiet laugh and downcast eyes.

As Broten prepared to leave the ward, promising her husband that she would return the next day, she noticed a new worker being trained in the dining room.

It was a positive sign, she said. Broten alleges that understaffing has been a major issue at her husband's care home.

"Not only was the lack of cleaning egregious, our husbands would be left in bed for most of the day with their medical issues ignored because the tiny team of staff was overwhelmed," Broten alleged of Comox Valley Seniors Village.

Understaffing is a "chronic" issue facing the senior care industry worldwide, says Colin Milner, CEO and founder of the International Council on Active Aging. In developed countries such as Canada with a large aging population, wages for senior aides are generally low, with health-care aides earning $19 an hour on average, according to a survey of listed wages in job advertisements on indeed.com

Health-care workers, who often struggle to earn a living wage, sometimes work at multiple care homes in B.C. to make ends meet. According to provincial health officials, this could have been one reason there was such a high rate of community spread at B.C. care homes.

Before the COVID-19 pandemic hit, B.C. had already pledged to invest more than $1 billion to improve care for the aging population, including investments in assisted independent living and funding additional staffing levels so seniors could receive more hours of direct care each day.

The coronavirus prompted B.C. officials to temporarily ban senior care aides from working at multiple facilities to prevent the possible spread of the virus. For the next six months, all care workers will also receive the same hourly rate of around $25.

Jennie Deneka, partner at Pacific Reach Seniors Housing Management, the senior home arm of Pacific Reach Properties, acknowledged in a statement to the Star that low wages are a factor in their "ability to recruit and maintain staff."

"But it's not just about wages. Our recruitment efforts have been further hampered because of the issue of affordable housing. In some circumstances, we have had to take the extraordinary step of housing staff. In Summerland as an example, we have close to 20 staff living with us in a dedicated wing. We are doing the same in Comox and Nanaimo," Deneka wrote in an email.

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Retirement homes receive $1.3 billion of taxpayer funding a year in B.C. alone, and both private and not-for-profit homes actually receive similar levels of subsidies, according to a recent Seniors Advocate study.

But in the 2017-18 fiscal year, B.C.'s for-profit care homes failed to deliver 207,000 hours of care for which they received public funding, while non-profit homes over-delivered by about 80,000 hours, the report found.

"Unfortunately, the way we set up the government contracts is that we basically give these care home operators a lump sum of money and we trust that they're going to deliver good care to people," said Mackenzie, who is mandated by the government to monitor and critique system-wide issues affecting the well-being of seniors.

"Then, we generally let them keep whatever money is leftover between what they spend and what we fund them.

"Operators under investigation continue to get full funding, so there is no financial incentive to comply because there are no penalties for non-compliance," she said.

Mackenzie said all provinces are, to varying degrees, either lacking legislation that includes financial penalties, or not imposing penalties for problematic senior care operators frequently enough.

"It doesn't make sense when officials routinely issue fines for things like speeding or not paying taxes on time."

She said she hopes that the pandemic will spur officials to take decisive actions to address long-standing problems, such as low wages that contribute to chronic understaffing at certain facilities.

A spokesperson for Island Health, Vancouver Island's government health authority, said he couldn't comment on details of individual cases. In response to public criticism that current penalties don't pose enough of a deterrent, he said officials are "required to follow a legislated process built on the principles of administrative law and procedural fairness."

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When the pandemic subsides, a class-action lawsuit over alleged neglect, mistreatment and abuse of vulnerable senior citizens awaits.

The lawsuit names Retirement Concepts, its parent company, Cedar Tree Investment, and former owner and currently contracted operator Pacific Reach Seniors Housing Management, as well as the B.C. Ministry of Health as defendants.

"The central objective of the class action is to bring about sweeping, permanent, and systemic change in these facilities," said Patrick Dudding, a lawyer representing the family of Blondine Huebner, a deceased former resident of Waverly Seniors Village in Chilliwack, B.C., which is owned by Retirement Concepts.

Huebner's two children, Erwin Huebner and Krista Kilvert, are the only named plaintiffs in the suit, but their lawyers have been busy collecting testimonies from other affected family members across B.C. The Vancouver Island family members of the "Crying Out Loud" group are not represented by Dudding, but some have contributed documentation and testimonials as supporting materials for the class action lawsuit.

"We have to see to it that the abuse and neglect of frail, vulnerable senior citizens stops immediately, and that we put safeguards in place to ensure that this never happens again," Dudding told the Star in early February.

The allegations in the statement of claim have not been tested in court.

"Our next hearing is booked for June " At this time we intend to proceed with that hearing as scheduled, but of course that is subject to the courts reopening before then, and our date not being vacated to deal with the backlog resulting from the closure," Dudding said during a phone call last week.

All of the named defendants declined to provide comment on the lawsuit, and declined to comment on specific allegations the Star presented to them. Stephen May, the spokesperson for the ministry of health, said the ministry could not speak to the case as it was an ongoing legal matter.

However, in a statement of defence the Ministry of Health's lawyer filed in response to the class action lawsuit seen by the Star, the ministry said it shouldn't be named as a defendant because the ministry distributes funding to regional health authorities, and monitoring senior care is the responsibility of regional bodies.

COVID-19 cast a spotlight on seniors homes across this country.

Dr. Theresa Tam, Canada's top public health officer, said this week that "close to half" the country's 724 COVID-19 deaths were in long-term care, where aging and vulnerable residents live in close proximity to each other and where staff have been carriers or become infected.

In Quebec, which has the most confirmed cases in Canada, nearly half of the province's 328 deaths from COVID-19 have occurred in long-term-care facilities.The Quebec coroner's office on Sunday launched an investigation into Ri(C)sidence Herron, a long-term-care home in a suburb of Montreal, where 31 people have died in conditions Premier Franiois Legault described as "deplorable."

B.C. Health Minister Adrian Dix has said there will be a review of the spread of COVID-19 at retirement homes.

When asked if the B.C. Health Ministry was aware of any criminal investigations into deaths at senior long-term care facilities, a spokesperson said the information "is not publicly available at this time."

Meanwhile, the new EquipCare BC program created in response to COVID-19, will provide $10 million to enhance infection prevention and control measures at the more than 440 long-term care and assisted living homes in the province.

Judd and Broten are optimistic that greater public attention to the issues at senior homes means authorities will better monitor for abuse and prepare for future pandemics.

"This is what our group is about. We are going to keep fighting for those long-term changes. We didn't know COVID was coming, but we knew there had to be changes," Broten said.

Joanna Chiu is a Vancouver-based reporter covering both Canada-China relations and current affairs on the West Coast for the Star. Follow her on Twitter: @joannachiu