They should have been given more consideration.That's the major point of the report from the Saskatchewan Ombudsman regarding how Saskatoon Health Region dealt with moving residents of enriched housing out of St. Mary's Villa earlier this year. In his report, Ombudsman Kevin Fenwick stated that "although the Saskatoon Health Region's initial decision to close one wing of a long-term care facility was reasonable, their subsequent decisions, timelines and processes were not."In February of 2012, there was an uproar in the community when the SHR gave 10 residents of enriched housing at St. Mary's Villa just eight days to move out of their rented apartments in the Villa and into new residences. The average age of the residents was 89. Though they were given help by the SHR in finding new residences and arranging movers, as well as financial compensation for any difference in rent for the first year, many of the enriched housing residents and their families found the entire experience traumatic. Issues with organization and a lack of clear communication which led to misunderstandings made an already difficult experience worse for many of them. Behind the need for a move were issues with the Villa's Dust Wing. An engineer's report had stated that there were major structural problems with that wing which had to be addressed. As a result, the SHR decided to move Dust Wing residents to the enriched housing wing, which meant the other residents would have to move out. "When someone tells you that you have to move in eight days, the impact is significant. When you're in your 80s or 90s, it can be even more so," said Fenwick. "Despite the Health Region's good intentions and its efforts to compensate for those very short timelines, these seniors and their families went through a very difficult experience that could have been avoided. They felt stressed and disrespected. Our review details what happened and why, and we have made recommendations to help prevent something like this from happening again."The Ombudsman's review was requested by the Minister of Health and the Board Chair of the Saskatoon Regional Health Authority. Interviews with the enriched housing residents and their families also raised questions that became part of the review.Key findings of the review of the situation include: The SHR made the decision to close the Dust Wing because a structural engineer told them that the Wing would not be safe if they didn't take action. Given the projected cost of repairs, the SHR chose to close the Wing rather than repair it. The decision to close the wing was reasonable, based on the evidence and variables they were weighing. The decision to move the residents from Dust Wing into the enriched housing wing was also reasonable, but the short move deadline imposed on the enriched housing residents was not, nor was the process. As early as December 2011, the SHR had contemplated the possibility of having to move the residents out of the enriched housing wing, but did not want to cause undue alarm by sharing early information before knowing all the details. In doing so, the SHR missed opportunities to provide tentative advance notice to residents and their families and give them a chance to think about what they would do if they had to move. The tight February timeframe comes from the SHR's interpretation of a deadline provided by the structural engineer. The engineer said that the SHR needed to initiate a repair plan within 30 days of his inspection, but when the SHR chose to close the wing instead, it did not ask the engineer for new advice based on this decision. The SHR used an incident command process which was intended to help staff manage the short time frame. Unfortunately, the incident command process focused staff on the task of meeting the deadline at the expense of the residents and their families. Opportunities were missed to provide clear communications with residents and their families to ensure they understood what was expected of them and when. The SHR's lease agreements with the residents stipulated 30-days' notice for moving out. The SHR did not think it could meet this requirement, so chose instead to provide financial compensation and moving assistance.In his recommendations, Fenwick asked the SHR to develop a policy to guide the moves of elderly people receiving their residential services, review its incident command process, and clarify the applicability of The Residential Tenancies Act 2006 in such situations. He also asked that the Ministry of Health review its facility designations and clarify the application of this Act to others who may be renting living quarters from a health region. The biggest error the SHR made, Fenwick told the Journal, was that not enough attention was paid to the needs of the enriched housing residents. The safety of the residents of Dust Wing became their sole focus.Safety, he indicated, must always be balanced with other factors that come into play; the other factors in this situation were the needs of the enriched housing residents.This situation did come up against a backdrop of two other serious situations the SHR had to deal with - a carbon monoxide leak in Dust Wing of the Villa in 2010 which caused some deaths, and a laundry safety incident in Saskatoon. These situations led the SHR to deal with any safety concerns as quickly as they could. "The needs of the enriched housing residents got lost in the shuffle," Fenwick noted, adding that the SHR has been up front about those other incidents influencing how they dealt with this one. The Ombudsman spoke directly with eight out of the 10 enriched housing residents who were moved, and the family of one of the other residents. Overall, they conducted 50 interviews with residents, staff, families and SHR officials. They also looked at board minutes and internal documents. What they heard from residents and their families was that they did not challenge the decision to close Dust Wing, but they did not like the way they were moved, and felt disrespected by the process, and uncared for. The Ombudsman's office said the staff at St. Mary's Villa, who were caught in the middle of this situation, "were an extremely caring and concerned group of service providers... who were torn by what happened. They had a tremendous amount of sympathy for the people in enriched housing."Fenwick closed by saying he hopes the report has given the residents and families some of the explanations they requested when this process began, and that they are now able to move on "and not hang on to what happened."Jim Ramsay, whose mother Alice, 86, was one of the evictees from the enriched housing unit, commented on the report. "I think the Ombudsman clearly shows the extreme mistreatment these individuals received at the hand of the Region. Thankfully, an independent public body has clearly established this. In the press interviews... it appears that the Region is now, at last, admitting to this. This is the first step," Ramsay said. "Now it is time for the Region to accept responsibility for the injuries and suffering it caused my mother and the others. We look forward to putting this behind us so that our mother and her friends continue to recover from the effects of their mistreatment by the Region."One thing noted in the report that upset families was that the media reported each evicted resident was getting $25,000 from the SHR. In fact, the report notes, the amount varied from resident to resident, depending on their needs and where they were moving to. The average was actually around $18,000, with amounts varying from $5,000 to $29,000.In press interviews, SHR president and CEO Maura Davies stated that there were no real surprises for them in the report, though they "very much appreciate the insight the report provided us, viewing the situation from so many perspectives...."Once again, we publicly say, how sorry we are for the stress, the discomfort, the inconvenience and other negative effects that the way we handled the situation had on both residents of enriched housing and their families."Despite the hard work of many staff, Davies said, the way they communicated making changes and the speed with which they did it, could have been done better. "We should have done something different," Davies said. She admitted they were first and foremost concerned about the safety of the residents of Dust Wing and the staff that provide their care. "Particularly given events that had already happened that year to those residents, that was a major driving force," Davies noted, referring to the carbon monoxide leak that occurred in that wing. The SHR also realizes in hindsight, Davies added, that they should have had further discussions with the engineer regarding his preliminary report."But we felt at the time, once we had that document, the clock was ticking. In hindsight... we should've, could've done things differently."No one was comfortable, she claimed, with the decision they made to make the move so quickly, and in hindsight, she feels the SHR should have told the enriched housing residents that a move was possible when they got that report on the flooring in Dust Wing in December. But it was a debate, Davies said, of whether to upset people when a move may not happen, or waiting until they had more answers. "We erred on the side of waiting until we had more information."The SHR has learned a lot from this experience, Davies said, and are already making changes to their policies as to how to handle situations like this in the future. The SHR is also continuing to work with individuals and their families, she noted. When asked if she, personally, could move in eight days, Davies replied that for these residents "it was far too short (notice) and we acknowledge that."As for the state of Dust Wing, they are looking at options, she said. The long term care beds in that wing are needed to meet the needs of the area, Davies said, so they are looking at options this fall to either renovate Dust Wing, tear it down and replace it or do a major retrofit of the entire Villa. They will analyze the options and make a recommendation to the government this fall, she promised. Jim Rhode, chair of the Saskatoon Regional Health Authority offered his apology to the residents of enriched housing for the stress caused by the decisions of the SHR.They are learning from this incident, and will be looking at their incident command system, including how they communicate.
