A holding cell as a proxy for health care

It was a crying shame that Joe McLeod, an elderly man with Alzheimer's, was hauled off to a holding cell after an altercation with his wife last month -- better planning, as they say, may have avoided that. But the fact he sat in the remand centre more than a month with no idea of his future is absurd.

McLeod is caught up in a legal and medical web. He requires 24-hour care, sometimes does not recognize his wife Rose and is at risk of getting lost outdoors. His condition deteriorated but his family was reluctant to have him declared incompetent. This has not been without consequence: his son Ron, 39, says his dad withdraws money from the bank and Rose has not been able to get his name off the joint account.

For two years since his diagnosis, Joe McLeod has been cared for by his wife, which became a 24-hour vigil that sparked discussions about a nursing home placement and waiting lists. He was never placed on a list for a bed. Joe resisted change, although the couple did move a year ago from their neat little home and carefully tended garden on the Pine Creek reserve to Transcona so Joe could get better health service.

Early last month, in the maddening fog of dementia, he forgot who his wife was and he pushed Rose who was holding up their picture and marriage certificate. She fell, cut herself and called police. Both were taken to the Concordia Hospital where she was stitched up and encouraged to lay a charge of assault -- otherwise, Rose said police told her, it would make it tougher the next time she called for help. Ron says his father was found to be physically healthy and released to police.

The cascade of unfortunate events came to a halt at the remand centre, where Joe McLeod sat until Friday, dealing with repeat court appearances. Rose McLeod, initially forbidden as the "victim" of a domestic assault to see him, says they couldn't get him released because no one in the family can give him 24-hour care.

Liberal Leader Jon Gerrard is blaming "the system" for the mess -- there should have been a plan to get him into a nursing home, he insists, and indeed that's true. But that relies heavily on a family's efforts and, needless to say, a sophisticated understanding of how the elderly make their way through the maze of waiting lists and into a home. And now, in a seasonal crunch, the Winnipeg Regional Health Authority has told nursing homes to hold off on admitting stable people directly from the community -- those who at least have beds somewhere -- and place only those who are taking up expensive health-care space.

But Joe McLeod clearly was an emergency case when he landed in hospital the most recent time (a heart attack saw Joe taken to Concordia in January). Was it not the perfect chance to assess him as an emergency candidate for a nursing home bed?

Because an Alzheimer's victim wasting away in the remand centre on a simple assault charge hit the news, the WRHA, which stresses this was a unique case, found him a bed.

But why did Concordia not hold him until a bed could be found? Ron McLeod says hospital staff knew of his father's condition.

The WRHA is still investigating, and setting up a meeting with police to avoid a repeat.

There ought to be emergency services for such people because, regardless of long-term plans or lack thereof, sudden breakdowns in care or competence can and do happen. Joe McLeod's mental health was failing rapidly. Families should not be left stranded.

There is heavy reliance upon families of those with Alzheimer's, dementia and other debilitating illnesses to cope, to care and to bear the burden. Rose McLeod did so with little complaint until her husband became a danger to himself and others.

It is tough to navigate a complicated system, especially one under pressure, and clearly the network of nursing homes is under stress -- the homes in Winnipeg run at 99 per cent capacity. The system is showing its cracks. How else to explain how Joe McLeod was not listed as a candidate for emergency placement, but rather a man better suited to a holding cell?

catherine.mitchell@freepress.mb.ca

Republished from the Winnipeg Free Press print edition October 9, 2010 A21