While there has been no official link made between an altercation between two elderly Bastion place dementia residents and the death of one of the men four days later, the BC Nurses Union is pointing to the incident as an example of inadequate staffing and safety mechanisms in long-term care facilities.
John Young, 93, died Tuesday, Oct. 7. Four days earlier, in the early morning hours of Friday, Oct. 3., Young was involved in what Interior Health officials are describing as an “unwitnessed altercation” between two dementia patients living at Bastion Place.
It appears that Young had wandered into the room of another resident who had a history of aggressive behaviour. Tracy Quewezance, regional chair of the BC Nurses Union for the Thompson/ North Okanagan, said the man had previously assaulted a Bastion Place nurse this summer.
Both Young and the other man were taken to Shuswap Lake General Hospital, where they were assessed and then both later returned to Bastion Place.
The B.C. Coroners Service is investigating the situation and an autopsy is being conducted to determine the cause of death. Those results are expected in the next few days.
“We were informed of this death shortly after it occurred and because the circumstances were unusual for a long-term care home, we have opened an investigation,” said Barb McLintock, with the BC Coroners Service Friday.
Karen Bloemink, executive director of residential services for Interior Health, confirmed the Oct. 3 incident to the Observer, saying staff at Bastion Place, “responded quickly and appropriately to provide care to both men involved.”
“At this point there is no determination as to whether this altercation is connected to his death. There is an ongoing investigation by the regional coroner and we are waiting for that outcome.”
Salmon Arm RCMP were also called to investigate the situation at the request of the coroners service.
“Our investigation didn’t find any evidence of criminality,” said Staff Sgt. Kevin Keane of the Salmon Arm RCMP.
Quewezance said the incident is an example of an increasing problem of inadequate care.
“This is what we are seeing becoming more common every day in long term-care facilities. There’s not enough staff for the number of residents, the complexity of care for these residents is increasing, so they have higher needs and there are not enough secure beds and units.”
Both men were residents of a 21-bed unit, which includes 10 secure beds for dementia cases that require a level of care and monitoring that is above that of the majority of residents at the 80-bed facility. The men were not housed in the 10-bed secure section, but instead were housed in other beds in that unit.
Quewezance said the resident with a history of aggression is one of three people housed in the “transition” beds at Bastion Place who have been identified as inappropriately placed, meaning they should be housed in more secure unit.
“This happens in all facilities across the province – there’s one or more residents who are identified as inappropriately placed and needing a higher level of care, but there are not enough funded secure beds at that level. This man should have been in the secure unit, but there were not enough beds and nowhere else for him to go. It’s very sad, really.”
The BC Nurses Union is also advocating for higher staffing levels at the facility. Currently the base level of staffing for the 21-bed unit during the night shift is one licensed practical nurse and one care aide. There is a registered nurse on duty at night for the entire facility.
Bloemink points out that on the night of the incident between these two men, Bastion Place had already brought in one additional staff member for that unit.
“We were already above the baseline model for that night… We have the ability to create safety by changing some of our methods of operations and by bringing on staff, one-on-one staff if needed.”
In addition to staffing, increased security measures also need to be put in place which would prevent residents from wandering into other rooms, said Quewezance.
“It is not (the patient’s) fault, with dementia you have people who can be aggressive, violent and confused and when they have someone wander into their space, it can be a recipe for disaster. What we need are more appropriate secure facilities that can keep people apart for their own protection and safety.”
Bloemink says Interior Health recognizes the nature of dementia can make residents unpredictable and they are committed to ensuring each resident gets customized care, as the presentation of dementia symptoms can vary widely and change depending on the progression of the illness.
She notes that Interior Health is already conducting its own investigation into the situation and information will also be recorded as part of a B.C.-wide provincial incident learning system.
“Interior Health always want to learn what we can from any situation and continue to improve care to our population of dementia clients… We want to learn so we can do better next time and reinforce our effort on the things we are already doing now.”
She says Interior Health has met with the families of both men and will continue to do so.
“We, of course, offer our sincere condolences to the family.”
