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Rob Shaw: How B.C.'s first Seniors Advocate transformed elderly care

Isobel Mackenzie leaves behind a legacy of advocacy that led to meaningful policy changes in seniors care
B.C.'s first Seniors Advocate, Isobel Mackenzie, retired from her position this month, garnering praise from both sides of the aisle. | Darren Stone, Times Colonist

When B.C. first announced it was creating a new seniors advocate office 10 years ago, the big question was: How useful could that advocate be in critiquing government when they aren’t truly independent from government at all?

The answer, a decade later, is clear: Very useful. Extremely effective, even. Consistently one of the most thorough and respected watchdog offices in the entire province, despite being located inside the very Ministry of Health it was holding to account.

Much of the praise can be directed at the first person to hold the job, Isobel Mackenzie, who retired this month. She left widely respected by all sides at the legislature, inside the Ministry of Health and even amongst the seniors care groups she has occasionally clashed with in her reports.

“I think it is reflective of my work, but also the work of effectively two different governments,” Mackenzie said in an interview, crediting the former BC Liberals and current BC NDP for never trying to exert control or influence over what she did.

“They could have done any number of things if they’d wanted to constrain the office in any way. Never in 10 years have I felt political pressure. Never in 10 years I heard, ‘Don’t say that, don’t do that, don’t look there,’ from any government people.”

That was always the worry. When Mackenzie was hired in 2014, then-Opposition NDP seniors critic (now Minister of Finance) Katrine Conroy was skeptical.

“It's tough being the person that is supposed to monitor what your boss is doing,” Conroy told me in 2014, as I covered Mackenzie’s appointment. “Let's wait and see if that can happen. But I don't know how realistic that is.”

Nobody is skeptical now. Premier David Eby, BC United Leader Kevin Falcon and BC Green Leader Sonia Furstenau all sang Mackenzie’s praises as she retired.

Mackenzie’s work highlighting care hour shortages in long-term care homes, first-bed refusal policy problems, partners split up in assisted living, consent and admission concerns and the underperformance of private long-term care facilities using public funding have all led to government reforms. She created a useful and relevant database on care homes. And she’s still fighting for a hike to the Shelter Aid For Elderly Renters (SAFER) rates.

“We’ve seen an increased focus on making sure that people in long-term care have a voice, that they have the staff they need, the staff are appropriately trained and monitored, and that people are living in single rooms as much as possible,” she said.

“And, if they have to be in a care home, they are in a care home they want to be. Yes, we’ve seen progress on all that. Still lots of ways to go, but we’ve seen progress.”

The seniors advocate’s office was given few special powers under law, other than to compel information, and it was not given a consumer protection role. Mackenzie did not end up writing reports that focused on individual cases as examples of larger concerns, like the Children’s Representative or the Ombudsperson. That was by choice, she said.

“I do take a more rational approach and some people would have preferred a more emotional approach,” she said. “Some people thought I focused on the numbers too much.

“But one person’s story is just one person’s story … everybody experiences differently. Everybody’s view is different. So I’ve tended not to focus on releasing a report about John Doe and this is what happened to him and point out all the various points where things went wrong for John Doe.

“I’ve tended to focus more, OK in the system overall, what are the shifts we’re seeing and not seeing and what should we be seeing.

“At the end of the day, that is what informs public policy.”

Then there was COVID-19, a three-year stretch in which access to long-term care homes was mostly locked down to prevent infection to the vulnerable elderly. It produced some of Mackenzie’s most interesting work, grappling with existential questions about whether it is preferable for a senior to die in care of an unrelated illness having not seen their loved ones but been protected from COVID-19, or to have had time with those loved ones even if that resulted in a higher risk of death by COVID-19 infection. At its core, it questioned the definition of quality of life.

“It highlighted this issue of agency and the paternalism we have in our health-care system, without a doubt, towards seniors,” she said.

“It’s always been there, percolating below the surface, and still is. But we saw the extreme consequence of that during COVID when for all the right reasons, to protect them, we just unilaterally stepped in and said you can’t go in and see your mother for a year, basically.

“I think when we started down that road, if we knew that’s what we’d be saying, we would have rethought it. Part of the challenge was it was very incremental. Nobody, I don’t believe, expected the length of the time that it took in order to come out of it, and the nature of the restrictions. “

Terry Lake, who as health minister in 2014 hired Mackenzie, said she has proven the worth of the office over and over again during her tenure.

“You can't underestimate that work, to stand it up [her office] from scratch,” he said. “It required an awful lot of thought and a lot of work to say what are the most important things, how do I get that data, how do I make sure I’m consistent in recreating the data year over year so those comparisons are meaningful.

“She’s done a stellar job.”

Lake has worked on both sides of Mackenzie, first as a minister (who to his credit, took a hands-off approach) and later outside of politics as the CEO of the BC Care Providers Association, which represents the private long-term care operators that Mackenzie has often criticized.

“There have been times when working with the BC Care Providers I’ve found some of the reports have been at odds with what our view of the world is, but that creates room for discussion,” said Lake.

He also said Mackenzie can be “stubborn” and “a bit of a pit bull,” qualities that have been necessary to have her voice heard, but could also be tempered by future advocates to work more collaboratively with the province and the sector.

Mackenzie said she spent at least 40 per cent of her time travelling the province speaking to seniors directly, finding their personal stories and experiences much more valuable than those of the many advocacy associations that lobbied for her attention.

“I found it particularly rewarding,” she said.

“It’s always interesting to approach these things with a lifetime of experience, and it’s always amusing to watch situations where the 34-year-old is talking to the 80-year-old and projecting what they need, and the 80-year-old is sitting there with their additional 50 years of experience, which can sometimes be dismissed.”

It’s part of a larger conversation about ageism in society, and the different standards put on seniors, who can face restrictions out of so-called benevolence that aren’t very different from restrictions placed on someone out of malevolence, she said.

Her replacement, Dan Levitt, is the former CEO of KinVillage in Delta. Mackenzie said she’s pleased at his appointment, and feels the office is in good hands.

On her way out, Mackenzie said she’s not advocating for any legislative changes for the job. The advocate’s position has unique access to health data by being located inside the health ministry, which would actually be more limited if it were a fully independent office of the legislature, she said.

“We can get in there and see the raw data and much about and find the pattern,” said Mackenzie, returning to the focus on statistics, analysis and data-based reports that defined her tenure.

“I think the public craves information and people are capable of forming their own opinions.”

Rob Shaw has spent more than 16 years covering B.C. politics, now reporting for CHEK News and writing for Glacier Media. He is the co-author of the national bestselling book A Matter of Confidence, host of the weekly podcast Political Capital, and a regular guest on CBC Radio