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Mayor’s Task Force on Seniors’ Needs,
COMMENTARY on Availability of Care Services
Comparative Study Report for Tumbler Ridge for Mayor’s Task Force on Seniors’ Needs,
By Dave Price and Charles Helm September 2008 By Charles Helm
Wednesday October 15, 2008  | David Price (centre) delivered his first speech as the official Coordinator for the Tumbler Ridge Mayor’s Task Force for Seniors’ Needs to an interested audience. May, 2008 Tumbler Ridge News Archives
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The Mayor’s Task Force on Seniors’ Needs was created at the end of 2007, and included Tumbler Ridge seniors, service groups and professionals. From the outset it was realized that in order to improve the quality of services available to seniors in Tumbler Ridge, adequate data was required. Professor Greg Halseth and his research team from UNBC were contracted to do a number of studies, which included a comprehensive door to door survey and interviews with focus groups. The final part of this research was a “Comparative Study”, in which Tumbler Ridge was compared with similar communities in northern British Columbia.
This Comparative Study Report has recently been completed. It is of necessity objective and dispassionate, simply providing an easy means of considering the best evidence available, on the type and quality of services provided in rural communities with equivalent rural care needs in northern British Columbia. It uses a novel concept, the Rural Care Needs Index (RCNI), based on population and distance from referral centre. The Report does not seek to advance the argument of those in Tumbler Ridge who feel they have been “short-changed” in terms of health care services. It simply presents the numbers and statistics in as fair and objective a manner as possible.
It was felt by the Mayor’s Task Force that a commentary on this Report, reviewing its details and expressing the particular concerns of the community of Tumbler Ridge, would be beneficial not only for the Task Force, and for residents, but also for elected leaders and administrative staff when they make the case for an increase and improvement in these services. Dave Price and Dr Charles Helm were requested to provide such a Commentary, which is reproduced here (in slightly abbreviated form).
A public meeting was held on September 29th at which these findings were presented and discussed. The completed studies now provide a solid body of data and evidence. Meetings are being scheduled with politicians and the Northern Health Authority to begin addressing the issues that these studies raise. While this process continues, a strategic Action Plan on how improving services for seniors is near completion, and will be presented soon to the Task Force.
Potential Levels of Disparity
There are many levels at which a remote community like Tumbler Ridge may be disadvantaged. Questions which can legitimately be asked include:
1) Does BC provide health and associated services to its rural communities and their seniors to the same degree as other provinces?
2) Does the Northern Health Authority receive its fair share of services compared to the Lower Mainland?
3) Does the North East Health Services Delivery Area receive equivalent funding per capita compared to its Northern Interior and North West equivalents?
4) Have the needs of Tumbler Ridge been given less attention than those of other communities in the North East?
5) Does Tumbler Ridge fare poorly when compared to other small northern BC communities of equivalent size and isolation?
The Comparative Study Report mainly examines this last question, but raises issues that pertain to some of the other questions.
Making a Case for Enhanced Services – Different Arguments
Arguing for improved and increased services for Seniors in Tumbler Ridge can take one of two powerful, distinct forms.
1) It could be argued that Tumbler Ridge, with its inspired foothills setting, well-planned design, and excellent, accessible, centralized infrastructure is the ideal place within the Peace Region for Seniors to settle and live out their days in as healthy and productive a manner as possible, if only adequate facilities and services were present to enable this.
2) It could be argued that Tumbler Ridge lags unfairly behind similar communities in northern BC in terms of such services for Seniors, and that, at the very least, services should be improved so as to be on a par with other such communities.
Clearly, these two arguments could be combined into one super-powerful case.
However, although many residents suspected that services in Tumbler Ridge were inferior compared to similar communities, it was recognized at an early stage by the Task Force on Seniors’ Needs that objective, reliable evidence was needed if such a case were to be made. Although, due to unanticipated difficulties, the Comparative Study Report took longer than expected to produce, it provides such evidence, and reviewing and interpreting it reveals that these suspicions were indeed valid.
Population Changes compared with Changes in Services
Tumbler Ridge has been through perhaps the most extreme demographic changes of any BC community in the past decade. Following the closure of the first generation of coal mines, the town was “saved” by the influx of home buyers (mostly Seniors) and the development of a unique tourism product. Subsequently, resurgence in industry has led to a dramatic population increase.
Professionals at the Tumbler Ridge Health Centre and residents have noted cynically that population declines are acted upon swiftly by Health Authorities, with reduction is services offered (which has the effect of exacerbating the population decrease). Conversely, population increases tend to be ignored unless very firm arguments are made by the community. The overall effect is of a progressive erosion of available services over time.
Comparing Attributes
Important attributes were chosen for comparison in the report, easy to comprehend and relatively easy as regards data collection and processing. Together these factors capture the essence of being able to provide (or not provide) what Seniors and other residents can reasonably expect in a remote community.
Population trends:
The Tumbler Ridge population increase is in part documented in the report, but the more dramatic increases since the last available census were not available for inclusion. While it is true that many other rural communities have also experienced economic growth since 2000, others have declined, and the probable Tumbler Ridge increase of 116% in seven years is significant. This increase has not been met with a comparable increase in services.
Elevation changes in patient transportation:
This seldom measured entity influences difficulty of transfer, especially in hazardous winter driving conditions. Sometimes it may be arguably preferable to keep an ill patient in the remote community until conditions improve, rather than subject the patient and attending personnel to the added hazards of ground transfer. Clearly, remote facilities with a high RCNI that regularly face such problems should be equipped with in-patient monitoring and treatment capacity. Tumbler Ridge scores remarkably high in this regard, yet does not have such capability.
Overnight beds and Complex Care beds:
In general, with increasing RCNI, there is the expected tendency to find overnight beds and complex care beds. The exceptions to this pattern are Houston and Tumbler Ridge.
The absence of inpatient beds in Tumbler Ridge remains one of the major drawbacks for the community. It has ripple effects for loved ones and friends of the inpatients who have to be accommodated elsewhere, and discourages seniors from staying long-term.
Ambulance Service:
The ambulance service in Tumbler Ridge is in a “Catch 22”. There is a demonstrated need for two cars, as the potential for industrial accidents is high as is the potential for MVAs due to the amount of highway driving required. This is compounded by the need to transfer many medical patients to regional hospitals, effectively taking one car out of service for up to 5 hours, leaving the other for emergency response. However; because of the fact that both cars are “Kilo” cars, there are no regular shifts – all response is “on-call”. On-call pay consists of $2/hr. As a result:
- all paramedics, by necessity, have other jobs making availability very difficult,
- it is very difficult to retain qualified staff,
- frequently only one car can be staffed and, because it has to be available for emergencies, Code 2 transfers result in a crew being brought in from Dawson Creek or Chetwynd. This means that a) the patient has a long wait before being transferred, b) the nurse at the ER is paid overtime to wait for the ambulance (more expensive than paying the paramedics), and c) the local paramedics lose the opportunity to earn pay that might assist in retention,
-comparative salaries in the First Aid field in local industry are immensely higher, and have attracted qualified personnel away from the Ambulance Service.
All of this results in TR registering a lower call volume, which is used to argue that we only need one car, and the whole situation spirals downward. The current situation is increasingly serious, with the possible departure of further seasoned ambulance personnel.
Airport and Medevacs:
Despite some good attributes, the Tumbler Ridge airport has drawbacks. Its distance (17 kms) from town is on the high side compared to other communities, and its elevation and situation in a Chinook zone unfortunately often make it unsuitable for the necessary transfers. Although the situation has improved somewhat with increased availability of flights from Alberta, there are still many occasions when lengthy ground transportation is obligatory, something which is not to the critically ill patient’s benefit. A strange situation continues to exist in that the BC jet will not land at our airport in many situations where its Alberta equivalent will land.
Bus transportation:
The regional Northern Health Authority (NHA) Bus Service is one of the success stories of the NHA since its inception, and benefits many patients. It has really only been of benefit to residents of Tumbler Ridge thanks to a locally operated volunteer group, TR Cares, whose van transports patients to regional facilities or to connect with the NHA bus. The absence of a regular bus service to Tumbler Ridge remains inexplicable, and provides another deterrent to Seniors’ retention in the community.
Maternities:
Along with the absence of inpatient beds and complex care beds, the inability to perform low-risk deliveries is a drawback for communities like Tumbler Ridge. The other D&T Centres in northern BC find themselves in similarly unsatisfactory situations, while those with a similar RCNI who have inpatient beds, typically are able to perform such deliveries.
From 2001 to 2005 the number of births to Tumbler Ridge residents varied between 14 and 23. In 2006 and 2007 the number was 33. In 2008, year to date (01 January – 16 September) the number of “first prenatal exams” is 47, projecting to a 2008 total of 64, a significant increase. The resulting burden on women and families is considerable.
Physician numbers:
Compared with its population and its RCNI, the inadequate number of physicians to tend to the population of Tumbler Ridge is clearly evident. A third physician has been sharing the on-call burden, which has improved working conditions. It is hoped that a third permanent physician will begin working in Tumbler Ridge in 2009.
Emergency Department Nursing:
Significant nursing retention issues occur at the Emergency Department. There are few nurses available and most are over 50 years of age (which means things are going to get worse). There are many hours to cover and yet half of all the hours are “on-call”. By its very nature, “on-call” is unpredictable and, therefore, disruptive to people’s lives. Younger nurses come to town, time and money are spent training them to work in the ER but, because there are only casual positions and no regular positions available, they leave to work elsewhere. The concept of Casual ER shifts also raises uncomfortable safety issues.
In the meantime, the remaining nurses work large amounts of overtime at a cost much higher than simply increasing the FTEs. Furthermore, the excessive hours are a burden to the existing nurses, and could result in mistakes, illness, or injury. At the very least, it will lead to early retirement, escalating the problem. A more efficient system would be the creation of part-time positions with the opportunity to “top-up” by picking up the extra shifts. This would provide some stability and predictability and thus be attractive enough to retain younger staff, would take a huge load off of the existing nurses, and would be financed by a significant reduction in overtime. This could be further enhanced by employing local nurses in the Public Health clinic, rather than utilizing visiting nurses from Dawson Creek or Chetwynd.
At the time of writing, it appears that finally the voice of the Head Nurse has been heard, and that such part-time positions will be created. If so, this represents a positive response to prevent the further deterioration and possible collapse of the current system.
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b>Public Health Nursing:
Before the mine closures there was a 1.0 FTE position in Public Health in Tumbler Ridge. This decreased to the current level of 0.3 FTEs, and has not seen any increase since the increase in population and greater number of babies in town. Once again the pattern is evident of Tumbler Ridge having substantially less in the way of services, compared to communities with a similar RCNI.
The bureaucratic situation compounds the problem, as Public Health and Emergency Room nursing issues are administered by two separate authorities that do not usually communicate. An integrated approach is sorely needed, because if local nurses could be employed in Public Health, AND work in the Emergency Room, recruitment and retention would be greatly enhanced.
Home Care Nursing and Home Support Workers:
Prior to the closure of the mines, the HC Nurse was a .8 FTE. Upon the closure of the mines, this was reduced to .7 FTE. In 2005, when the incumbent nurse retired, there was a further reduction to .5, despite the influx of older residents and the re-opening of the mines. This level of service has not been increased back to its former levels and remains at .5 FTE. (When, in 2005, a regional manager for Northern Health was questioned about the need to increase this level of service, the response was: “Tumbler Ridge has kind of fallen off the radar as, with the re-opening of the mines, it is going back to being a young persons’ town”. This position didn’t address a) where the older residents were supposed to go, and b) the fact that many miners and their partners are in the late middle-age cohort, which means that they are approaching the time when they will need the services as well.
Dentist:
Support services (e.g. dentist) that existed when the mines were open previously, and disappeared when the mines closed, have not been replaced now that the mines are back in operation and since the influx of older citizens. While the District of Tumbler Ridge, physicians and the health centre staff try to encourage such support services to return, it is unclear what incentives may be being offered by government or Northern Health that would accommodate this.
There is clearly enough work in Tumbler Ridge for a thriving dental practice. A major barrier appears to be the set-up costs and infrastructure requirements, given that the counseling department was allowed to move into the area previously occupied by the dental office, and that the space now potentially available in the health centre does not have the requisite plumbing etc.
The standard response by Northern Health is that it is not involved in providing dental services and therefore cannot be involved. Yet the Northern Health decision (apparently irreversible now) to move counseling to the area that does have the necessary infrastructure for dentistry has contributed to the current problem.
There is a qualified dentist living in Tumbler Ridge that commutes daily to Dawson Creek to work. Tumbler Ridge is the ONLY community in northern BC with a high RCNI that does not have a dentist.
The situation is untenable, and represents one of the major deficiencies is the care offered in Tumbler Ridge. Attractive incentives, development of the necessary infrastructure and recruiting are urgently required.
Social Worker:
The statistics for social workers are similar to the pattern seen for dentists, with blank spaces next to Tumbler Ridge and Masset, but healthy numbers for most other communities with a high RCNI (Masset in fact has a visiting service agent twice weekly).
The absence of Social Workers plus the absence of a regular bus service is particularly unfortunate, and conspires to place already burdened residents at an increased disadvantage. This is another service that was present previously, albeit on a visiting basis, but has not returned, even though the demographic changes and associated problems make a compelling case for such services to be offered locally.
Assisted Living:
The Report demonstrates that long term care homes are not a feature in communities with an RCNI like Tumbler Ridge (although many of them do have complex care beds). However, the same does not hold for assisted living facilities – once again Tumbler Ridge is the exception, rather than the rule.
It could be argued that developing an assisted living facility during Tumbler Ridge’s initial years would have been unwise, considering the particularly young population at the time. That argument no longer applies, given the influx of seniors and the ageing of the mining population.
The absence of such a facility provides a logical reason for seniors to relocate away from Tumbler Ridge, and gives the impression of a community that is not “seniors-friendly”.
Palliative Care:
There is a palliative care resource in TR, operated by volunteers, that goes unused in part because of the lack of staff sufficiently trained to provide the necessary level of care. Increased FTEs in the Emergency department could be used to provide the more sophisticated needs, and a similar increase in home support staff could ensure the personal care required. Instead, those unable to remain home until death are sometimes transferred to expensive acute care beds in Dawson Creek or, on occasion, go into respite beds in Residential Care facilities such as Pouce Coupe Care Home – an unsatisfactory solution.
Administration:
The significant increase in both the elderly population and the younger families has resulted in a corresponding increase in the administrative load at the Health Centre yet, again, the administrative FTE count has been eroded from former levels (originally 2 FTEs, reduced to 1.2). This results in increased burden on the existing staff that could become a retention issue.
Future changes:
Although it is never possible to predict the future with certainty, the indications are that a substantial further population increase may occur, with increasing numbers of workers at the existing mines, the possible opening of a third mine, and an expanding tourism industry. The ability of existing staff and services to accommodate such increases is limited.
Conclusion and Recommendations:
The Comparative Study Report confirms the notion that Tumbler Ridge, compared with similar communities in northern British Columbia, is disadvantaged in terms of health services offered. It has achieved its objective in providing evidence, rather than merely opinion, to support this notion.
While the study was initiated because of concern about Seniors’ Needs, the deficiencies affect all members of the community from newborn to senior to palliative care patients.
It has become very clear that, when the mines closed, the FTEs of various supports was re-allocated to other communities (understandable) but, upon the influx of older citizens and the re-opening of the mines resulting in population levels returning to former levels and the need for support services actually increasing, the FTE counts have NOT been re-adjusted upwards to their former levels.
Seniors moving en masse into Tumbler Ridge in 2001-2004, in the process contributing to the continued survival of the community, could quite reasonably have expected that the relevant authorities would have noticed, and would have developed and enhanced services to reflect this demographic change. In the absence of such an appropriate response, volunteer efforts to improve quality of life and services have taken their place, and the vision and foresight evidenced by two pharmacists coming in and establishing an outstanding business provides a welcome contrast.
Some of the troubling issues raised in this Commentary could be addressed quickly and efficiently, whereas others, such as the need for overnight beds and assisted living facilities, require a longer-term approach. An innovative approach is recommended, in order to develop a facility with built-in flexibility that addresses Tumbler Ridge’s specific nature and needs.
The coalition of seniors, professional and municipal groups that has formed the core of the disciplined and effective functioning of the Task Force on Seniors Needs is an effective example of community action that could form a model for other communities in Canada that are similarly affected.
Our view is that, in making the case for enhanced services for Seniors, both of the arguments mentioned at the outset should be employed:
- At the very least, what is offered in Tumbler Ridge should be on a par with what is offered in similar rural communities in northern BC. This is a concept that resounds with Canadians, who rightly value fairness and equality. At the present moment, Tumbler Ridge is not receiving this fair and equal treatment.
The second argument, that of Tumbler Ridge being uniquely suited within the northeast to provide a haven for Seniors because of its special attributes, can effectively be tacked onto the “equality” argument, making for a compelling case.
However, drawing attention to these very real concerns needs to be seen in the context of the overall health care situation in Tumbler Ridge, and priorities need to be identified. For example, if Core Services such as Ambulance and Emergency Nursing deteriorate, the value of striving to improve other services for Seniors becomes a moot point.
These issues need to be brought to the attention of the authorities with urgency so that timely action can be taken.
Despite all the problems mentioned above, the Tumbler Ridge Health Centre remains a friendly, supportive place to visit, with its attractive “one-stop shopping” nature, and a relative absence of the long waiting times that characterize so many facilities in Canada. Its continued effective functioning in spite of trying circumstances should be seen as a tribute to the dedicated staff who work in it and who endeavour to provide true “small-town care” in the best sense of the word.
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