'it happens all the time': how saskatchewan hospitals fail elderly patients
a saskatoon fight announcers story reveals a greater problem in how saskatchewan's hospitals are unequipped to help older adults.
9 minute read
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mike mcguire faced the camera on day 63. he wore a grey shirt and a small smile, telling an instagram audience how his mother lois came to a saskatoon hospital with a bladder blockage and was now fighting for her life.
“my mom is 93 years old. she came into that hospital able to walk, able to talk, able to eat, able to drink. she has lost many of those abilities on a regular basis, now,” the professional wrestling and fight announcer told the camera on feb. 28.
mcguire’s baritone voice usually fills a room. but he had spent more than two months all but living in hospital, documenting his mother’s care, and his tone was now measured and slow.
mcguire made videos like this to express sorrow, to connect with people, but most of all because he was furious.
his mother had come to a hospital to get better. but instead, she was getting sicker and sicker, with no end in sight.
“i’ve now been told many times that she’s not going to survive staying here,” mcguire said.
a few weeks later, lois mcguire was dead.
on the surface, a 93-year-old passing away in hospital may not seem remarkable. but mike maintains his mother’s death was unnecessary and preventable. experts, while declining to comment on any specific patient’s case, said lois mcguire’s death reflects a larger, unseen trend that affects thousands of seniors accessing hospital care every year.
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for these patients, the ordeal and monotony of a hospital stay can be as big a danger as the sickness that brought them there. dr. roslyn compton, a nursing professor at the university of saskatchewan, says she has seen countless adults like lois mcguire who arrive in hospital relatively healthy, and then suddenly decline.
“it is the untold story of hospitalizations of older adults,” compton said.
lois comes to hospital
lois mcguire came to hospital two days after christmas. like many 93 year olds, her health wasn’t perfect. she had early dementia, mike said. they were mulling a move to a long-term care facility. but for the time being, she could talk, walk and live in a home with minimal assistance
after a few days in a hospital bed, that changed. days of little movement caused her muscles to deteriorate. on one of her first days, mcguire remembers her happily eating a piece of farmer’s sausage and potatoes. a few weeks later, she was being fed through a tube. every week, mcguire said his mother would get a new doctor. but she didn’t get better.
compton says the sudden transition to hospital, the loss of routine and sudden stress can trigger delirium, a sudden disorientation and decline.
mike mcguire holds a photo of his mom lois. lois died at st. paul’s hospital earlier this month after being hospitalized for what seemed like a routine health issue. photo taken in saskatoon, sk on friday, march 25, 2022.
matt smith
/
saskatoon starphoenix
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“delirium doesn’t actually have to be caused by a disease. the infection might have been the trigger. the disorientation, the lack of stimulation, the loud noises, shifting them from room to room ╤ all of those things compound,” compton said.
mcguire says he knew his mother was suffering from delirium because it had happened before. three years earlier, he said lois mcguire went to hospital after she broke a rib, where he saw the same symptoms beginning.
now, mcguire said his mother was stuck in a cycle of brutal logic. she was too sick to be discharged from a place that, in some ways, was making her sicker.
dr. krista lagimodiere said that trend is not uncommon. lagimodiere, a saskatoon geriatrician, says sending such elderly patients to hospital can be like using a hammer on a screw. often, she said, such patients only come to hospital because there are not other adequate options to help them recover at home or other settings where they can maintain routines.
“we’re putting the blame on the patient when actually we should be putting the blame on ourselves,” lagimodiere said. “it speaks to the fact that we, as an organization, as a health authority and providers, need to look at the system and see what we can do better.”
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delirium is not a mysterious problem. lamogidiere said as many as one in three older patients develops it in hospital. but many doctors and nurses aren’t familiar with it or have little experience addressing it. when lamogidiere and a colleague were originally hired, the province celebrated with a news release: it had meant they doubled the number of geriatricians in saskatchewan — from two to four.
geriatricians dr. megan surkan and dr. krista lagimodiere joined the sha in 2020. at the time, there were only two other such experts working in the province.
michelle berg
/
saskatoon starphoenix
now, lamogidiere is one of just two such experts practicing full-time in saskatchewan.
“i’m not sufficient to support the numbers of patients we have,” lamogidiere said. “we don’t have an inpatient geriatric psychiatry unit. we don’t have a geriatrics unit or an acute care for the elderly unit. we’re missing a lot of really key pieces for supporting patients with dementia in acute care.”
in a letter sent to mike mcguire, health minister paul merriman said government is responding by hiring two new graduating students as geriatricians starting this summer.
but the problem only promises to get worse. the number of canadians older than 85 has doubled since 2001, according to statistics canada, which warns it could triple again by 2046.
“that’s part of the issue,” dr. samir sinha, the geriatrics lead at sinai health in the toronto area said. “we don’t have the right mix of people that we need to better support our population.”
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a bigger problem
over time, mcguire’s posts about lois’ deteriorating condition began to garner more attention.
he got a phone call with everett hindley, the province’s minister for seniors, and then opposition ndp seniors critic matt love. mcguire said he was motivated to try and ideally keep patients like his mom out of hospital, so they could recover in a better setting.
what he didn’t know, at that time, was that this was an issue canadian health regions had been flagging for years ╤ and one saskatchewan has historically struggled to address.
“you ultimately have this phenomena where people are stuck in a hospital,” sinha said. “they want to go home. they might want to go to a long-term care home or a rehabilitation centre, for example.
“but we don’t have enough capacity in the system to help people get the right care at the right place at the right time.”
the problem is so common it has its own acronym: alc, or alternative levels of care. in a nutshell, it means a patient is receiving care that doesn’t actually match their needs.
they might be better treated in long-term care, for example, or supported by a nurse at home. but because those services aren’t available, they wind up in hospital.
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despite the name, “alternative” level of care is very common. the canadian institute for health information estimated that in the 2020-21 fiscal year, 16.9 per cent of days patients spent in hospital were classified as alc. more than one in 20 canadian patients in hospital, at some point, is designated alc. the vast majority are older adults.
in 2020, a study into long waits at saskatoon emergency rooms identified one of the challenges as the high number of patients considered alc. these patients, the report said, could be better off receiving care elsewhere but were stuck in hospital, meaning they were in a bed that might otherwise go to a different patient.
at the same time, the number of days alc patients spent in saskatchewan hospitals had been rising before the covid-19 pandemic. in the 2016-17 fiscal year, sha spokesman doug dahl said, there were 105,559 alc “days” recorded across the health authority. in 2019-20, it grew to 129,771.
shan landry, a senior’s advocate and former health system administrator, says the problem is that there are plenty of routes to the hospital, but few in-between steps that would balance comfort and familiarity with addressing the medical needs of older adults. those people, landry said, may need exercise, stimulation and help getting dressed just as much as they need complicated medical interventions.
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“the hospital isn’t set up to do that,” landry said.
an arrest at st. paul’s
lois mcguire adopted mike when he was two years old.
“she always wanted a little boy, and i was available,” mike said. biologically, she was his grandmother, but he credits her with making him who he is.
“she is quiet and timid until she has something to fight for. then she’s a pitbull, she’s relentless. not in a violent, aggressive or angry way. she just doesn’t relent,” mcguire said in an interview.
he absorbed some of those qualities. by his own admission, he clashed with some of the doctors and nurses caring for his mom. security escorted him out of the building once in february. he filed a complaint with the provincial regulator after a doctor struggled to remove a feeding tube from her nose as she groaned in pain. at one point, he said, he raised his voice with another doctor in march.
st. paul’s hospital in saskatoon is seen in this photo taken in saskatoon on monday december 7, 2020.
michelle berg
/
saskatoon starphoenix
he says that exchange is why saskatoon police came to his mother’s room at st. paul’s hospital the day after and arrested him on charges of uttering threats.
on a phone call shortly after his arrest, he denied doing so.
“i feel so bad that i apparently came off that way,” he said.
originally, one condition of mcguire’s release from custody was that he could no longer visit the hospital where his mother was dying. he said sha security intervened, granting him permission to come back. the charges were eventually dropped.
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the morning after mcguire was arrested, he sends a text message around 6:30 a.m. it’s a photo showing a beaming lois mcguire standing in front of snow-capped mountains, with the green waters of a river flowing underneath. she carries a gold frame with the words “chase your dreams” written inside. next to her, written in white font, is a date: march 19. she had passed away that day.
what happens next
mcguire recently travelled east to lay lois to rest.
he took the long way back, he said, visiting places he would have liked to go with his mom: chicago, indianapolis, michigan. then he came back to saskatoon.
“i did things that reminded me of her, and good times we had back together, mcguire said.
hindley, saskatchewan’s minister on the file, acknowledged before lois’ death that her care was not adequate.
“it’s not acceptable. it’s not what mike should expect for his mom lois. that’s not what i would expect for my parents of loved ones,” hindley said in march.
but mike mcguire is not convinced government is taking the issue seriously. in march, he wrote health minister paul merriman’s office, asking for a sit-down to speak about senior’s care. he did not hear back until july, outlining a list of spending priorities and investments government is making in long-term and seniors care.
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mcguire said the solution needs to be a greater, wholesale change.
“i’m not doing this for me anymore. i’m doing it because everyone who has reached out to me, who has talked to me, has said something like this has happened to their family members,” mcguire said.
the best suggestion for preventing alc hospitalizations is also the simplest, some say: keeping older adults out of hospital in the first place. lamogidiere and compton say models in manitoba, ontario and b.c. have shown success by deploying more resources directly to communities.
in recent years, saskatchewan has stepped up funding of home care services, where a nurse visits older adults in their domicile as an alternative to hospitalization. but many argue there is still too much focus on expanding the number of beds and long-term care spots, which experts view more as stopgaps than lasting solutions.
“the knee-jerk response from politicians is often to just announce they are funding more beds,” sinha said.
“we actually manufacture a lot of this alc. a lot of it is actually created unwittingly by our own processes of care and not having a proactive and preventative approach.”
mcguire blames some of his mother’s treatment on doctors who treated her, though he adds others provided excellent care.
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he believes the ordeal points to a deeper issue in a medical system that cannot care for the very same people who built it.
“it’s something everyone kept saying to me,” mcguire said. “‘it happens all the time.'”
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