The Province from Vancouver, British Columbia, Canada • 5

Saturday, June 9, 1973 "-province hv Ions-term uatients can Jjeds PAGE FIVE get Do private hospitals if lit 1 sr nil 4 1 3 provide a crutch? So you're faced with the important task of finding long-term nursing care and medical treatment either for yourself or others? Well, good luck. You'll discover many problems besides the medical ones. First, how to get into an extended-care unit? Despite new construction, the supply of beds is short and the waiting lists are long. Secondly, do you or the patient meet the requirements? Oakherst, Vancouver, the last private hospital built in B.C. Tr OS? By JOHN BRADDOCK Province Medical Writer Oakherst and Banfield both have wards ties between private and public hospital assistance be smoothed over by BCHIS payments was rejected.

Publicly, Cocke answered The Province: "The government already pays for private hospital welfare patients. Hospital insurance is not designed to pay for people in the private sector, which is why we used direct payments from the rehabilitation department. We don't plan any changes now." If the government's taking no further action with private hospitals at the moment, there certainly is activity with privately-owned rest homes. They are being polled by the government to see if they'd be interested in taking intermediate care patients. Intermediate care is considered to be a step below extended care for those that require only some nursing assistance.

WeUare rates to rest homes are set up on a different, and usually cheaper, system. But whether rest homes are equipped to take on intermediate care patients is now a matter of dispute within the B.C. Rest Homes Association and a subject of scorn within the B.C. Private Hospitals Association. In fact, Shepherd claims it's against the Rest Homes Act.

The NDP has not explained, either, why it's wrong to support private enterprise with hospitals but right to support private enterprise in rest homes. Shepherd sees a need for co-operation between government and private enterprise in the health field. He says hospitals are expensive; there's no escaping that. But despite all the problems and imbalances, private hospitals make extended care beds available at around $16 a day Kv iM -life WfA'r iiuiiu iiuiii iciiuui Shields' bright idea Banfield Pavilion, the $2.5 talks about richer patients having to subsidize poorer ones and therefore paying more than they should. Administrators of older hospitals say they survive with welfare cases only because their mortgages have been paid off.

And yet another answer is that some hospitals just don't survive. B.C. Private Hospital Association secretary Mrs. Auretta Shields runs her finger down a list of private hospitals in the province and reads out those closed or closing al-1 most 300 beds. SHEPHERD Among tliese are: Taylor Manor, Victoria 20 beds; Worthington, Vancouver 18 beds; Sunnyside, West Vancouver 29 beds; Angus, Victoria 45 beds; Strathcona, Vancouver 18 beds; Bonnie Lynn, Vancouver 18 beds; Oak Lodge, Victoria 41 beds; Cottage Hospital, Abbotsford 34 beds (but it's been sold to Matsqui Hospital); Glenwood, Agassiz 20 beds Scenic View, Surrey 29 beds; Oaklodge, Victoria 41 beds.

Add to this the 21 hospitals under the poised axe, then it seems the freeze of private hospitals is going to wast many much-needed beds. So say the private hospital operators. Cocke, says the on the other hand, government is con iff f) i exrcnueu iikb iinycia ui nurses station Mrs. hospital and keep the remaining $170. But, in a private hospital, patients who can afford it who have to afford it pay around $16 a day for extended care.

Those who can't rise to this financially can be placed on welfare but, through a hodgepodge of laws, pensioners forfeit their whole pension and have to turn it over to the municipality. Shepherd says this is ly unfair. The Private Hospitals Association has asked Cocke for better equity for pensioners, either by allowing BCHIS payments in private hospital situations or by imposing a higher nominal sum in public hospitals, thus creating revenues to be used elsewhere. Cocke has since announced his department is considering a $5-a-day charge to patients in extended care at public hospitals. That would still leave a pensioner with $50 for his own use.

But Cocke noted that there would have to be an assessment committee of some sort as some patients would be unable to pay even the $5 a day. However, if private hospitals hoped the money thus generated would be used to offset the Imbalance of payment (by the provincial government via the municipalities) for welfare patients' beds, they'll be disappointed. Cocke talked of placing greater emphasis on public home-care services. Private hospitals have the added problem that their regular paying patients often run into financial problems and can't pay regular fees. A private hospital that doesn't have the heart to kick such a patient out then must accept lower payment through the government welfare scheme.

Private hospitals claim the economically viable rate for a bed is about $li a day. They receive only $11.95 a day for welfare cases but it's an increase, over the $10.35 rate existing before last December. The increase came almost at the same time as a not-so-welcome government decree that upped the minimum wage. Private hospital operators aren't dismayed by the higher minimum wage per se, but they point out the results are not so much a minimum wage but a minimum shunt of all wages of hospital employees. They all demanded more.

Salaries have been low. When you ask: Who pays the difference between what the hospital bed costs ($16) and what the municipality pays the nurses will say: "We do." Few of them are on union rates. There are other answers to their question. Shepherd MRS. SHIELDS of good private hospitals, and that it is time they spoke out.

Despite the NDP's long-term intentions, the government quickly realized private hospitals were needed. Health Minister Dennis Cocke has announced that 21 hospitals threatened with closure would have a reprieve, subject to a six-month termination notice at anytime. "There is no doubt," says Dr. H. G.

Weaver, a director of The Glen Private Hospital at 1036 Salisbury, Vancouver, one of the menaced, "the gov- emment is using us." How long the private hospitals will continue to be "used" is difficult to predict. Government officials say they're hindered in their assessments because many potential patients remain at home, unheard, although in need of care. Others are in rest homes that fly the "boarding home" banner and thus escape mandatory inspection. But the B.C. Hospital Insurance Service says there are 3,000 public extended care beds in operation now; the immediate need is for 1,400 more, and a total of at least 5,000 will be needed by 1976.

These figures are only for the elderly they make no allowances for disabled younger persons. The situation was put more forceably at a recent B.C. Hospital Association (BCHA) conference on extended care by Dr. Embert Van Tilberg, chairman of the former committee on extended care for the BCHA. He estimated at least 2,660 beds are required to catch up with past predictions of bed needs for 1969.

That's right we're more than four years behind. So it's not surprising to find many patients in private hospitals receiving extended or intermediate care. Shepherd says almost half of the 3,000 private hospital beds are occupied by long-terra patients. And, he says, they should come under the BCHIS payment scheme similar to patients in public hospitals. And herein hangs a tale: Most people know that patients in public hospitals pay a nominal sum of a dollar a day.

The actual cost of their bed about $20 a day for extended care is paid by the BCHIS. This means a pensioner receiving a $200 a month would pay $30 a month to the They're stiff. Too stiff, said some doctors at the B.C. Medical Association's recent annual meeting. But, it was explained, the strictures are forced by demand, for you can't allow a borderline patient to loll around in an extended-care bed when more deserving cases are waiting outside.

The new provincial government is trying to catch up with visible successes. The 200-bed Banfield Pavilion of the Vancouver General Hospital was opened this year. So. was the 300-bed Gorge Road Hospital in Victoria. Tenders have now been called for a 75-bed extended care hospital on the Saanich peninsula, and another 75-bed hospital has been okayed in principle in Abbotsford.

Then there are proposals for a 300-bed extended-care hospital in New Westminster; a 75-bed unit in Coquitlam. Construction has started on yet another 75-bed wing to St. Vincent's Hospital in ver and a 150-bed facility is planned for Holy Family Hospital in Vancouver. All these should be under way by the end of this year. Then there are plans for adding 150 beds to Mount St.

Joseph Hospital in Vancouver next year, and expanding Louis Brier Hospital from 60 to 120 beds. So there's no lack of activity. Yet at the moment it's not enough. The waiting list for the Banfield Pavilion, for example, was 380 at the end of May. Hence the strict criterion on eligibility.

The criterion, says Assistant Deputy Health Minister Jim Mainguy, is that a patient has to be disabled to the point of having great difficulty in getting around and in need of 24-hour nursing care. "But if a person is independently mobile even by the help of a wheelchair he can't have extended care This is the general principle." However, here's a tip. You don't have to be confined to your area. A person in Vancouver can apply for an extended-care bed in Victoria; a person in Saanich can apply to Abbotsford providing he or she is willing to travel the distance. This sometimes helps.

But many people in B.C. fall Into a no-man's land. Either they're waiting for beds that aren't available or they're waiting for beds but aren't eligible. Instead, they stay in highly specialized acute-care hospitals at $76-odd a day to the taxpayer. Or they remain at home to be looked after as circumstances dictate.

Or they're placed in private hospitals or rest homes. To this extent the government is having to tolerate private hospitals. It's an irksome situation for the NDP, which proclaimed in its election campaign that private hospitals must go. "It's not this government's policy to favor profit-making in the health field," said Premier Dave Barrett "Let's have that clear." "We do not believe in hospitals operating on a profit," he 1 Patient and visitor fttiWt "fr 'C told the legislature. "We have inherited a situation that we wanted altered for years I publicly make the appeal to the private hospitals to understand very clearly that we are now the government I want the private hospitals to understand that when we said in an election campaign that we don't believe in private hospitals operating, we mean it and we intend to act on it." Yet in view of the fact that private hospitals are a crutch to the extended-care policies, the operators are understandably annoyed at the steady downgrading and denigrating of their establishments by successive governments.

By now the owners are divided, some thinking of closing, others eager to fight. Russell Shepherd, president of the Private Hospital Association of B.C., notes that "private hospitals were the first hospital system in the province. "And they're not outdated." They were encouraged to expand by the Social Credit government and many licences were issued between the late 1950s and the mid 1960s. But then cost of paying for welfare patients was such the government clamped down, licences were cut off, and the last private hospital allowed to be built in B.C. was constructed in 1965.

BARRETT At the same time, says Shepherd, Socreds began to redirect welfare patients away from private hospitals into boarding homes or rest homes for extended care. Rest homes were cheaper, for their services were less. Finally, Social Credit threatened closure of a number of private hospitals not because of the service they supplied, explains Shepherd, but because of age of their buildings. And, of course, no new buildings could be constructed to replace them. Shepherd nods when asked if it isn't true that some private hospitals created their own downfall.

Newspaper files alone have many horror stories of poor conditions and slack care, especially of the elderly. He says that's one reason why the association was formed to maintain standards, to push for hospital accreditation. He stands by association members: "Go into any of the hospitals. Just walk in anytime and see for yourself." lepherd says little is heard nil! at Tht Clen 1 million extended care unit at sidering buying private hospitals. To Dr.

Weaver over at The Glen, who has offered his hospital for sale to the government but has received no definite decision, the gubernatorial pondering is just frustrating. He says he's not against the government, but if it wants to close down private hospitals it should do it, not keep them wondering. The Glen, 40 years old, is one of the buildings "condemned" for being too old. Asks Weaver: "Have we not got things the wrong way around? We may have gone a bit nuts on new buildings when the really important thing is quality of care." To prove his point he takes off a wall the certificate of the Canadian Council of Hospital Accreditation. It's a prize award.

Some public hospitals in B.C. have still to win it. Switch now to Mrs. Shields in her other role that of administrator, owner, founder, originator, go-getter of. the last private hospital allowed to be built in the province: Oakherst Private Hospital at 7430 Oak, Vancouver.

She says It took four years of frustration to get Oakherst built. Her voice is low with suppressed anger at the thought of the scheme collapsing now. "After all we've been through all the Wood, sweat and toil my family were in on it (the project) and we try to provide a true family setting for the patients we designed every inch of the building before anything was even put down on paper no bureaucrat in Victoria could possibly put into this hospital what we've put into it." Later she asked for the bureaucrat statement to be de- us' and freshly painted Vancouver General Hospital leted. It would have been if it had not tied in to another point. Layout of Oakherst has corridors radiating out from a central nurses' station, allowing nurses to keep an eye on all the wards.

After Mrs. Shield's private hospital decided on this plan, Vancouver General Hospital's extended care unit, the Banfield Pavil-lion a public hospital followed suit. But to get back to welfare rates. Cocke says that when he announced the increase from $10.35 a day to $11.95 during his luncheon address to the B.C. Private Hospital Association he was loudly applauded.

The figure was decided after government inspectors visited private hospitals and appraised the need. "The government has no intention now of changing payment procedure," he says. However, validity of even this higher figure js questioned. It's a tricky subject for the government. The matter goes back to the dispute between the King George Highway private hospital and the municipality of Surrey that reached the Supreme Court of Canada in the summer of 1971.

The Supreme Court upheld the hospital's claim it should be paid $11 a day for welfare beds, not the $8.05 the municipality then gave. The decision set an alarming precendent to the Socred government. It sped through an order-in-council that welfare payments to date be considered payment in full. The order was contested, and clarification is being sought on the reasons for the Supreme Court of Canada's findings. So this spring 10 hospitals of the Lower Mainland filed actions in the B.C.

Supreme Court against their municipalities. Lawyer Duncan Shaw says filing the actions is "merely to preserve the rights" to i with claims if this is requested later. Really, they are waiting to see the outcome of another test case that goes to the Supreme Court of Canada this fall: Parklane Private Hospital versus the City of Vancouver. Parklane is another of Mrs. Shields' hospitals, the forerunner of Oakherst.

"Until this is settled," says Shaw, "it is by no means certain if the new $11.95 welfare rate is valid either." Privately, Cocker is strung between the court cases over welfare payment and the legislated structure of BCHIS. No one was astonished when the Private Hospital Association's suggestion that inequali- including overhead, construction costs, taxes mortgages. Public hospitals, he says, make their beds available at $20 or more a day, and this sum deos not include capital costs. (Capital costs are split 60-40 between the provincial government and regional hospital boards. Restrictions on the amount works out to $10,000 a bed for single-storey buildings and $13,000 a bed for others.

The land price is extra.) "If the public really knew the coits of public hospital beds, they'd faint," says Shepherd. And he suggests that if private hospitals need government assistance to reduce the financial burden on the less wealthy patient, the government also needs the assistance of private enterprise to ensure efficiency of operation." COCKE As for the charge some times made that private hospital owners make vast profits off the misfortune of others' the operators are unanimous in their reply: the statement is just silly, Shepherd says he sees no harm in owners receiving liveable returns, like doctors or other health worki ers. And if there's doubt, "the books could be opened to the government." He says no discussions along these lines have been held with the government. Nor are they likely to be. Private hospitals, to the NOP, are an anachronism.

Government efforts with extended care are placed on opening up new public hospitals, Increase home care services, finding causes of disability, reversing senility, getting patients back into the community after having overcome the setbacks of age of accident. The Private Hospital Asso, cir.tion casts a baleful eye on these fine suggestions. It sees home care, for instance, costing the community $20 a day just for the nurse who'll be able to be with the patient only a third of the 24 hours. It warns that other costs will be similarly high. Says Shephered: "Suddenly the Dublic Is eoine to become aware of what's happening.

But it may be too late at that point." Yes, there are many problems, besides the medical ones, about extended-car beds. the government is using Dr. H. G. Weaver a director of The Glen Private Hospital in Vancouver.

The Glen has been 'condemned' for being too old at 40. The Clcn Private Hospital immaculately clean.