Navigating the BC Healthcare System

By Connie Jorsvik

Your Simplified Guide to the BC Healthcare System

It has always been important to be an empowered patient or caregiver, but likely never more so than right now. If we are or someone we care about is seriously ill, we have to rely on the healthcare system -- but it is also on life-support and we must know how to do the heavy lifting in our own care.

Healthcare in British Columbia is nothing if not complicated. General practitioners, specialists, waiting lists, residential care, and everything in between seem to all exist independently of anything else. Knowing where to turn can feel like something you need a medical degree for, or at least, it can feel like an art.

This step-by-step guide for those who suddenly find themselves with serious illness or injury in a medical world that moves too fast and seems to speak another language. Whether you are self-advocating, or advocating for a loved one, and if you are facing confusion or hard healthcare choices in British Columbia, this guide is for you.

• Language: English
• Publisher: Self-Counsel Press
• Release date: Jun 15, 2023
• ISBN: 9781770405462

Connie Jorsvik

Connie Jorsvik is an educator, author, and independent healthcare navigator-patient advocate. Jorsvik spent more than 25 years as a nurse, has been an independent healthcare navigator and patient advocate since 2011, and has supported hundreds of patients and their families as they have journeyed through serious and complex illness, and end of life. Jorsvik believes in empowering those navigating our complex and fragmented healthcare system. She is also the author of Advance Care Planning, another Self-Counsel Press title.

Book preview

Introduction

Optimism isn’t a belief that things will automatically get better; it’s a conviction that we can make things better.

— Melinda Gates

My hope is this book helps educate and empower all British Columbians to ask for the health care they need and deserve. While it will help guide all patients and their loved ones, we don’t specifically address the even more complex mental health system. We hope to add resources for those with mental illness in future revisions.

This book only covers navigating government-funded systems, and is a constant work in progress. I learn more every day — and a lot comes from my clients’ and readership’s knowledge and questions. If I’ve missed something important, please send me a note at [e-mail].

There are a lot of wonderful nonprofit, not-for-profit, and for-profit health professionals and organizations in BC, Canada, and throughout the world, doing incredible, innovative work to improve health and lives — information that seems to take years to be brought into conventional medicine. It would take volumes of books to bring these to you. It is my goal to spotlight some of these businesses in future works.

Our healthcare system was teetering on the edge of crisis in normal times and the COVID-19 pandemic tipped it over the edge. There are long-standing systemic issues, largely due to a chronic lack of funding caught in-step with a rapidly aging population. Financial constraints and lack of personnel have greatly impacted bedside care, home care, and residential care.

Our healthcare system is complex, fragmented, and siloed. It is system-centered and not patient-centered. See Figure 1.

Each arrow in this diagram signifies the transition of care from one silo to another and this is where communication error is high, or communication completely fails.

Each of the bubbles signifies only the most major component of each fragment — and there are dozens of subsections within each. There are also silos within each of the bubbles, and too often, healthcare teams fail to talk to each other.

You and your loved one or care partner must ensure your own safe passage from one point of care to another.

It has always been important to be an empowered patient but likely never more so than right now. If we are seriously ill, we have to rely on the healthcare system, but it is also on life support. In order to get the care you need, you must be prepared, informed, and do the heavy lifting in your own care.

Be proactive! Be assertive! And follow up, follow up, and then follow up some more!

1. Definitions

Healthcare planning is for right now: Doing a little bit of homework now will ensure that your vital health history is delivered at all points of care, including in emergency situations. This will reduce errors due to missed information, especially regarding allergies and medications.

Advance care planning is for your future: It means thinking about your values and beliefs as they apply to your health and then planning ahead for a time when you are not able to make decisions for yourself.

2. Why We’re Reluctant to Do the Work of Crisis Prevention

If you’re procrastinating in putting your healthcare and advance care planning in place, this is a good time to dig a little deeper into your own thoughts about why you are putting it off, if, indeed, you have.

None of us wants to look at the possibility of a crisis of any sort until we’re up to our ears in it. It’s just the way we’re built.

Our brains are generally structured for optimism bias: Also called the illusion of invulnerability, or a personal fable.

Before we go any further, consider doing a little exercise about crises over the last few years and how they affected you:

• Did you think of others who were affected?

• Did you think the events changed how you thought about your own health, well-being, and plans for your future?

• Did you put plans into action? If not, why not?

Consider what happened during the following crises:

• The COVID-19 pandemic: You were likely concerned about your health and that of those you loved, but did you think about the care interventions you would (and would not) want to receive if you did get COVID (e.g., no CPR, no ventilator)? Did you tell your loved ones, and did you make plans and put your affairs in order? If not, why not?

• The BC heat dome: With more than 850 sudden deaths (a truly staggering number) in the Lower Mainland over the course of five days at the end of June 2021, did you think about the others affected by the extreme heat? Did you think, That could have happened to me? If not, why not? Did you make any plans for the next time this happens (because it will)?

• The critical shortage of paramedics: This is one of the most concerning issues. We simply can’t plan for needing emergency services (even though we can have our documents updated and available). The stories of paramedics being called and the wait being two or three hours (or not arriving at all) have been seemingly endless, reaching an all-out crisis during our heat wave. Do you think this will have an impact in the future on you or your family if you are in a serious accident or have a health emergency? If not, why not? What can you do to prepare to some degree?

• The extreme shortage of doctors, nurses, allied professionals, and support workers: Shortages are resulting in delayed surgeries, miscommunication, and missed communication, especially in the transitions of care from one part of the healthcare system to another, creating more pressure to go home after hospitalization.

Each of these recent health crises could have affected you and your family and there will be more of them.

Preparing for any crisis is daunting and planning ahead for a health crisis or the end of our lives can be overwhelming, but it’s actually quite therapeutic. Hundreds of studies have shown that people feel a sense of relief when they’ve looked into their future and put everything in place.

3. How the Healthcare System Got to This Point

The COVID-19 pandemic ripped the lid off some very serious issues that have been building and coming to a boil for decades.

In the early 1980s, I was in my early 20s and my age cohort were already the median age for nurses. My age group would remain at the top of the bell-curve of the age for the next 50 years; as we aged, so did the average nurse’s age. In the 1980s we had a glut of nurses and the number of seats in both nursing schools and medical schools were cut.

I remember the British Columbia Nurses Union made a very public campaign that cutting the number of nursing graduates would result in a massive shortage of nurses by 2020 when a large number would be hitting retirement. But those education seats were not reinstated until this year, when faced with a critical shortage of nurses. The BC Ministry of Health added 602 seats to university nursing schools throughout the province in an announcement made in February, 2022. However, these nurses will not graduate for another three to four years.

BC has the lowest number of family practitioners per capita in the country and the current fee-for-service model to pay family doctors and high administrative costs and burden is seen as a key contributor to younger doctors leaving their practices. Currently, one in three British Columbians don’t have a family doctor and many walk-in clinics have closed. That is putting tremendous pressure on urgent care clinics and emergency rooms are seeing increasingly long wait lists. Patients are putting off visits until they are seriously ill, increasing the acuity of patients in hospital and increasing the burden on those still working.

In November of 2022, the BC government, in partnership with the Doctors of BC (formally known as the British Columbia Medical Association), and BC Family Doctors developed new payment structures that launched in February 2023, changing the fee-for-service model: It is hoped that these changes will bring more doctors back into the workforce and slow the unprecedented rates of retirement. Changes are also being developed to bring more foreign-trained doctors into the system faster and opening up more medical school seats at the University of BC, and adding a medical school at Simon Fraser University.

The COVID-19 pandemic put the exodus of healthcare professionals on steroids. Those who might have held on for a few more years are now leaving in record numbers, often due to exhaustion and burnout.

And it is not just nurses and doctors who are retiring or leaving their professions in record numbers, it is also our highly trained allied professionals — physiotherapists, occupational therapists, speech language pathologists, medical imaging technicians, and laboratory technicians — as well as support staff such as porters, cleaners, food staff, and registered care aides. We have relied heavily on immigration and foreign worker programs to fill many of these gaps but this came to an abrupt halt during the COVID-19 pandemic and it could take years to catch up.

As our senior nurses and doctors leave in record numbers — not only due to age but due to burnout — the Baby Boomers are beginning their highest healthcare consumption years.

The shortage threatens to collide with the impending retirement of the baby boomers, all of whom will be 65 years old by 2030, said the survey titled A Challenging Decade Ahead. (https://www.njccn.org/wp-content/upload/2020/04/AMN-2019-RN-survey-report.pdf, accessed May, 2023.) People over 65 are hospitalized three times as often as middle-aged individuals, according to the Center for Disease Control and Prevention.

The Fraser Institute noted in its March 2021 Fraser Research Bulletin that Per-capita spending on health care is substantially higher for individuals aged 65 and older than for younger individuals, and the disparity increases consistently as [the] average age increases beyond 65 years. For example, the per capita expenditure for the 80–85 age group was more than twice the mean per-capita expenditure across all age groups in Canada in 2017.

The professional aging deadline and the evidence of the grey tsunami now on our doorstep has been ignored by every political party for the last 40 years. There has been a slow but significant decline in federal transfer payments to all of the provinces despite a call for an increase by all provincial governments across the country in recent years. There have not been significant increases in the number of professional and support staff in decades. The number of hospitals and residential care facilities being upgraded or built has not kept up with population growth.

Finally, British Columbia is a destination of choice for Canadians wanting to move to a more hospitable climate — and our worsening forest fires and flooding don’t seem to be a deterrent. We have the highest immigration rate of any province.

According to a Global News article titled Record number of people moved to B.C. last year amidst labour, housing shortages, from April 6, 2022, Statistics Canada found an additional 100,797 people came to B.C. from another province, territory or country in 2021 — the highest annual net migration total since 1961. Of that total, 33,656 people moved to the province from elsewhere in Canada, marking the highest number since 1994. Statistics Canada found B.C. saw the most arrivals from another part of the country than any other province or territory last year. The remaining 67,141 people who moved to B.C. in 2021 came from another country.

Our healthcare systems are buckling under all of this pressure. It has always been important to be an empowered patient but likely never more so than right now. If we are seriously ill, we have to rely on the healthcare system but it is also on life-support right now and, therefore, we must know how to do the heavy lifting in our own care.

4. Rights, Freedoms, and Responsibilities: From Individuals to Governments

If every person (from individuals to politicians) actually did what they are responsible for — no more and no less — we would save hundreds of thousands of lives, and billions and billions of dollars every year.

As children we are taught that rights and freedoms have to be earned: You have to eat your peas to get dessert; you have to do your homework and be home by 9:00 pm every night in order to have the privilege of having the car on the weekend; if you aren’t responsible, you will lose privileges.

As we became adults and had our first jobs, in order to earn rewards, we had to have responsibilities — if you do your job, you will get paid and you will get promoted — and if you don’t, you face being fired.

But, when it is a matter of taking care of our own bodies, sometimes we fall down in making important, responsible choices. No matter what we do to ourselves (ride a motorcycle without a helmet, drive a car without a seatbelt, eat a big piece of chocolate cake even though our blood sugars are borderline high, smoke cigarettes — or choose not to get a COVID vaccine), there are no repercussions (other than the possibility our choices will be life-altering, life-changing, and possibly life-ending). Our healthcare teams are to treat us all equally, even if we’ve made poor choices.

As an individual: Responsibility means not only taking care of yourself for your future self, but also for your family and their future, and to reduce your financial burden on society.

What we gain by being responsible for ourselves is increased health and vitality, the probability of a longer life, decreased use of healthcare dollars and, therefore, reduced taxes.

Not all of these are easy, so assertively and proactively seek help wherever needed:

• Wherever possible, eat a healthy diet, do your best to keep a healthy weight, and exercise regularly.

• Reduce or eliminate the use of substances (nicotine, alcohol, opioids, etc). A great place to start is through the free and thorough resources at HealthLinkBC.ca, or call the helpline at 811.

• Be proactive about your health care: Get regular check-ups and routine preventative care.

• Be compliant in maintaining prescribed treatments.

• Reduce risk to yourself, your loved ones, and your community by taking recommended vaccines.

• Plan for your future health care through advance care planning.

For healthcare providers, responsibilities include:

• Listen to the patient and the ones who know them best.

• Be nonjudgmental in providing care to everyone who walks (or is carried) through the door.

• Wash your hands before touching a patient — without exception.

• Ensure it is the right medication, test, or treatment for the right patient — without assumptions or shortcuts — without exception.

• Practice thoughtful, careful, and complete communication with all other healthcare team members — always.

• Pass the baton of care with intent and purpose, especially at transitions of care (discharge planning; alternate care such as the Cancer Agency, palliative care or hospice, or residential care).

• Understand and promote advance care planning to reduce unwanted and unnecessary treatment.

• Be an advocate for your patients. (It increases fulfillment in your job.)

Healthcare management responsibilities include:

• Advocate for your personnel so they can deliver the quality of care that patients need and deserve. Allow your staff to have the time to communicate with each other. (This increases patient safety and reduces caregiver burnout, increasing retention.)

• Understand and build systems to facilitate planned and appropriate discharge to increase success in staying at home and reduce the revolving door of readmissions.

• Lay