Patient escorts are abusing N.W.T.'s $30M medical travel program, says report
Some escorts ask patients for money or leave to go gambling, health department told
People are misusing and in some cases abusing the N.W.T.'s costly medical travel program, particularly non-medical escorts who fail to remain by the side of travelling patients, a government review has found.
A report quietly released last week by the Department of Health and Social Services calls on the government to consider making all non-medical escorts sign an agreement that clearly spells out what's expected of them.
"Some of the escorts that have been with these patients are in need of an escort themselves," says Merlyn Williams, president of the Yellowknife Seniors Society.
Williams has been chaperoned by his wife to Edmonton's Larga House medical boarding home on trips to seek cancer treatment. At the boarding home, he's observed other escorts in action….or inaction.
"One of them had a chair aid to walk around," he said.
"Now, if they're acting as an escort to a person who's sick, can they pick that person up from the floor? Can they attend to them?"
Escorts leave patients to go gambling, shopping
Williams' anecdote was echoed and even trumped by many of the 212 people who attended public forums to talk about the travel program and escorts in late 2014 and early 2015.
"Many stakeholders provided examples of instances in which they had witnessed the patient escort support system being abused by escorts," according to the report.
"They spoke about elders being left on their own in the boarding home or hospital while their escort went gambling or shopping."
According to one forum attendee, "elders, because they are in such a vulnerable position...are being placed in situations in which they feel they have to give an escort money or they will not help them out."
An escort agreement form is currently in place in some, but not all, communities.
The report suggests making the agreement territory-wide, and people at the forums said the agreement should stress that "medical travel should not be considered a holiday for either the patient or escort."
They also said the escort should, among other things:
- ensure patient safety
- understand the medical condition of the patient
- be with the patient at all times
- help bathe patients
- assist with translation
- not leave the patient to go drinking, gambling or shopping
Though the agreement would not be legally binding, "it is believed that having reviewed the form and having asked people to commit to following the rules, that escorts are more likely to do so."
Non-medical escorts costs have gone up
The territory's medical travel program pays for airfare and, to a degree, meals, accommodation and ground transportation for patients who do not have similar coverage through their employer or another program.
It costs the territorial government between $25 million and $30 million a year. And that cost is expected to rise.
Of the total cost, about $5 million went to providing non-medical escorts in 2014-2015.
There are concerns that some escorts are being approved due to political interference.
"People spoke about the fact that if someone goes to their MLA and complains, they end up getting approval for an escort whether they really needed one or not," according to the report.
Even frustrated medical travel staff working in communities pointed to this during the forums.
"It undermines their authority and it leaves community members thinking that staff do not know how to do their job properly," according to the report.
Gov't needs to offer proper training: former MLA
Norman Yakeleya, the former MLA for the Sahtu region — and a vocal critic of the medical travel program — admits he has stepped in to help patients get an escort. He stands by those decisions.
"I've seen people in small communities leave and they don't have an escort, they get lost, they phone our office, they don't know what's going on," he said.
"The MLAs are there to fight for their people because all the bureaucrats do is they follow the policy and they read what's written down."
Yakeleya says he too has heard "more and more stories where some of the escorts are not doing what they're supposed to do."
But he says there's a lot more the government can do to counteract that, such as training and developing escort pools in communities.
To Yakeleya's disappointment, that option is not among those being recommended to the government.
"That's where you can tell where the priorities of Aboriginal people in the health system are," he said.
Instead, the report suggests that escorts who don't feel up to the task could seek training from Elders in Motion, a program meant to increase independence and mobility among older adults.
The report also points out that it is patients who choose their escorts.
But it's not clear whether the department does anything to screen patients' choices for their suitability as escorts. Williams claims the department does not. The program's website doesn't say anything about that.
CBC News sought clarity on that point from the department, but received none in time for this story.
Should escorts be paid for time away from work, home?
Yakeleya is also disappointed the department appears to be distancing itself from the thorny issue of whether to pay non-medical escorts for accompanying patients.
"It speaks to a much larger social and economic issue that requires consideration by the territorial government as a whole given the potential cost and changes to taxation," according to the report.
But Yakeleya — and many of the people at forums — say some escorts should be paid, especially those who leave their home or workplace to accompany patients for several weeks.
"Sometimes, the elders, they really want their family members," said Yakeleya.
"It puts them in a very difficult position because sometimes these family members are the only breadwinners in the family and not too many of them can take time off to go out for some length of time."
'Inconsistent and incorrect application'
Yakeleya applauds one of the recommendations: to make all patients aged 60 and over eligible for a non-medical escort.
"That should not be questioned. It should be automatic," he said, citing respect for elders.
Williams says the department has gotten better at communicating about the program over the years. Still, the report suggests that among medical travel staff, health care providers, politicians and the general public "there exists an overall lack of awareness and understanding of the [program] generally and more specifically as it relates to escort supports."
The result? "Inconsistent and incorrect application of the policy across the system by individuals within the health care system."
CBC News will be speaking to the Health department today about what the report is and isn't recommending.