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Merritt Healthcare Community Consultation

June 15, 2017 – Merritt Civic Centre

Summary Report prepared by Edward Staples
Support Our Health Care (SOHC) Society of Princeton

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Background

Rural healthcare delivery is complex. Each community, shaped by a unique
history, geographic location and social context, has strengths and needs that collectively
make up its capacity for care - capacities that shift in relation to population and
resources. As healthcare needs change, communities reach transition points which
cause them to find ways to enhance their capacity for care. Such has been the case in
the community of Merritt, British Columbia. As Interior Health, First Nations Health, and
strategic partners seek to solve the complex healthcare issues, Merritt City Council has
tried to better understand and support the necessary change. As part of their efforts,
members of the City Council organized a community consultation to solicit the
perceptions and experiences of the citizens of Merritt and area. This was not a fact
finding mission in that no attempt was made to verify participant’s claims. Rather, the
purpose of the consultation was to glean the “story” from the community’s perspective,
recognizing that this story is an insight into the collective wisdom that forms an essential
part of the solution to such a complex challenge.

Merritt
Merritt is a city in the Interior of British Columbia with a population of 7,139 and a
median age of 44 (2016 Canada Census). The city is located in the Nicola Valley at the
confluence of the Nicola and Coldwater rivers. It is a major transportation hub at the
intersection of Highway 5, 5A, 8, and 97C. Merritt’s economy is dominated by the
primary industries of forestry, agriculture, tourism, mining, and service.

The Merritt Local Health Area (LHA) is located at the southern end of the
Thompson Cariboo Shuswap Health Service Delivery Area. The total population of the
Merritt LHA is 11,724 which includes the City of Merritt, neighbouring communities of
Quilchena, Nicola Lake, Nicola Canford, and five First Nations communities: the Upper
Nicola, Lower Nicola, Shackan, Nooaitch, and Coldwater Indian Bands.

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Healthcare Facilities
The City of Merritt is serviced by the Nicola Valley Hospital and Health Centre, an
acute care facility with eight acute care inpatient beds and includes a 24/7 Emergency
Department, Rehabilitation and Physiotherapy, Public Health, Mental Health, Home and
Community Care Nursing and Home Support, and Laboratory and X-ray services.

There are currently six General Practitioners and one Nurse Practitioner
providing healthcare services to Merritt and surrounding communities. The General
Practitioners work out of three private medical clinics and the Nurse Practitioner works
out of the Conayt Friendship Centre. The Upper Nicola Band has a Community Health
Nurse that provides a wide range of heatlhcare services and the Lower Nicola Band has
a Health Centre with a staff of 14, providing health and social counselling programs.
Healthcare services to the Coldwater, Nooaitch and Shackan are provided through
Scw’exmx Health Services.

Consultation Process
The community consultation was held on June 15, 2017 at the Merritt Civic
Centre. The event was organized by Kurt Christopherson, Merritt City Council, and
coordinated by Edward Staples and Nienke Klaver of the Support Our Health Care
(SOHC) Society of Princeton. Assistance was provided by Dr. Barbara Pesut, UBC
Okanagan School of Nursing.

Seventy-four community organizations were invited to send a representative to
the consultation (see Appendix 1 for list of invited organizations). Fifty individuals
responded and participated in the consultation. These individuals were provided with
information beforehand (see Appendices 5 and 6) and were asked to solicit feedback
from the constituency which they represented.

The evening began with brief introductions and an explanation of the consultation
process. Participants were divided into five pre-assigned focus groups that met
separately for a 75 minute discussion period. A facilitator and recorder led each of the
five groups. The focus group session began with each participant writing down the

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single idea or thought that came to mind when they thought about healthcare in their
community. Participants were then asked to identify Areas of Strength, Areas for
Development, and Suggestions for Change.

Participants were encouraged to share their own views and the views of their
constituents while respecting the views of others without debate. Recorders
summarized strengths, weaknesses, and suggested changes on flip charts so that
participants could ensure their points had been captured accurately. Groups were audio
recorded. At the conclusion of the focus group sessions, participants reconvened in a
larger group to hear the summary of each group. Participants were provided with five
voting stickers and were instructed to place those stickers on a single item or multiple
items they perceived to be most significant to them. This exercise allowed participants
to identify noteworthy areas of strength and prioritize areas for development.

A summary of this exercise is located in Appendix 2, 3 and 4.

Important Limitations

It is important to recognize that the information gathered in this consultation is
based on the perceptions of the community representatives that participated in the
consultation process. It is understood that everyone’s views and stories are valued and
form an important sample and vivid picture of the current healthcare strengths and
challenges within the community. Although participants shared ideas or suggestions that
might provide solutions to identified challenges, it is recognized that without additional
research and verification it would be inappropriate to make any recommendations
based on these suggestions. Every effort was made to interpret participants’ comments
accurately from information written by the focus group recorders and audio recordings
made during the focus group sessions.

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Strengths of Current Healthcare Delivery
The following is the list of strengths as identified by the focus groups. They are arranged
in order of significance, determined by the number of groups that identified a particular
item and the number of voting stickers received (shown in parentheses).

Items identified by all five focus groups:

• Emergency Services (ER) at Nicola Valley Hospital (4)

Items identified by four out of the five focus groups:

• School District relationship with healthcare community - school programs
• Seniors services and programs - Gillis House
• ASK Wellness - range of services (1)

Items identified by three focus groups:
• Transportation - public system; medical bus to Kamloops & Kelowna
• Ambulance services - paramedics, transfers
• Nicola Valley Hospital - staff & services

Items identified by two focus groups:
• Hospital expansion - new emergency room facilities
• Community Pride - cohesive and committed
• Pharmacists - collaboration with doctors
• Doctors - cohesive group working together
• Community funding - Hospital Auxiliary; Nicola Valley Health Care Endowment
Foundation
• Laboratory and X-ray services
• Visiting specialists

Items identified by one focus group and receiving priority stickers:
• Nurse practitioners (3)

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Note: All remaining items that were identified by only one focus group appear in
Appendix 2 on pages 20 and 21.

Mental health was a common topic of discussion in all five focus groups. Various
organizations, services, and programs were praised for their critical role in helping
people with mental health issues. The First Nations mobile healthcare clinics,
collaborations between the five First Nations communities and the City of Merritt, and
counselling for high school students provided by a public health nurse were identified as
important examples of these efforts.

Participants in all five groups expressed a high level of satisfaction with the
healthcare providers serving the community. General Practitioners, Nurse
Practitioners, Locums, Nurses, and Professional Staff were all commended. Healthcare
providers were described as committed, collaborative, positive, and confident, providing
excellent care often under difficult and stressful conditions. One participant stated, “You
can’t beat our hospital for staff. They are overworked, over run, but always a smile on
their face and pleasant - absolutely unbelievable.”

Many participants mentioned the excellent relationship that exists between the
School District and the healthcare community. Several programs and services were
identified, including the high school youth clinic, the Health and Wellness Coordinator,
and counselling for high school students provided by a public health nurse.
Collaboration between schools and various community agencies were seen to be critical
in meeting the needs of the child and family.

Gillis House and its professional staff were identified as an important strength.
One participant stated that “The communication and collaboration between the hospice
and Gillis House is excellent.” Several programs and services for the elderly were also
identified, including the Seniors Helping Seniors program and daily recreational and
cultural activities. Several participants recognized the quality of the community’s
assisted living program.

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The ASK Wellness program was recognized for its client-centred approach and
personal touch. Participants identified a wide range of services provided by this
organization, including housing, employment, counselling, and harm reduction. It was
mentioned that this service is presently running at 99% capacity. One community
representative commented that “ASK Wellness Society is very committed to their
clients.”

Other areas of strength included Laboratory and X-ray, BC Ambulance, Tele-
health, and Pharmacy services. Several participants mentioned the work being done
by the Hospital Auxiliary & Nicola Valley Health Care Endowment Foundation to
provide funding for healthcare services in the community.

It was clear that there is a great deal of community pride in Merritt. Participants
commented on the excellent relationships, good communication, and strong
commitments that exist in the community. Much of the positive character of the
community was attributed to its small size which contributes to a cohesive, “community-
minded” approach.

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Areas for Development
The following is the list of the areas for development as identified by the focus
groups. They have been divided into categories that appear in order of significance,
determined by the number of groups that identified a particular item and the number of
voting stickers received (combined group numbers and sticker votes shown in
parentheses). Within each category, identified areas are also arranged in order of
significance.

It is important to note that the data collected in this area often duplicates data
collected for the Suggested Solutions and Innovations section of this report. This is to
be expected since the identification of a concern or challenge was often coupled with a
suggested improvement or solution.

Mental Health and Substance Use
• Need for more and improved access to mental health services (34)
• Children at risk and mental health services for students (8)
• Addiction issues - alcohol and drug use (7)

Emergency Services - ER
• Stress on ER - high volume, insufficient facilities and staff, inappropriate use/
misuse of services (10)
• Effect of doctor shortage (6)
• Ambulance concerns (5)

Seniors Issues
• Seniors’ access to housing and services (7)
• Home care and seniors’ assistance (6)
• Long term residential care concerns (3)

Practitioner and Healthcare Providers
• Practitioner (GP and NP) shortage (7)
• Service access (5)

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• Recruitment issues (2)
• Healthcare professionals issues (1)

Maternity
• Service provision and access (6)
• Alternative care (2)

Transportation - Access to Services
• Lack of transportation for seniors (3)
• Local and regional transportation service issues (3)

First Nations
• Coordination of services (1)
• Equity of service provision (1)
• Cultural Safety (1)

Individual Concerns and Issues
• All remaining items are uncategorized and listed in order of significance as
determined by the combined total of groups that identified the concern and the
number of sticker votes received. They are listed in Appendix 3 on pages 25
and 25.

The main area for development identified during the consultation centred on
Mental Health and Substance Use. Concerns regarding mental health were raised
several times by all five focus groups. Seniors and youth were identified as groups that
were most in need of improved services. Access to mental health services was viewed
as a serious problem and all groups felt there was a need for more mental health
workers in the community. Three focus groups raised the issue of alcohol and drug
addiction and noted the need for increased detox and rehabilitation services.

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All five focus groups pointed out concerns regarding Emergency Services. The
fact that Merritt is a major transportation hub at the intersection of 4 major highways
was identified as a primary cause of stress on emergency services, pointing out the lack
of ER beds, too few ambulances, and high response rate for paramedics, police and
firemen. A representative from the RCMP indicated that “Our ER takes more calls per
capita than other BC communities of this size.”

Seniors issues were discussed in all groups. Due to reduced mobility, seniors
rely on transportation provided by others to access health care services. Transportation
options are often inconvenient and costly for some users. There is a “medical bus” that
provides service to Kamloops and Kelowna once a week, but it was felt that some
people are unaware of access procedures. It was also felt that there were problems with
the schedule which made the return trip difficult. Some transportation costs were viewed
as prohibitive for some seniors. Elderly people living on the reserves were identified as
a group that is underserved by the transportation system.

Other seniors issues included a shortage of residential care beds, financial
vulnerability, isolation, lack of assistance for daily needs, and a lack of housing options.
The Seniors Helping Seniors program was identified as an important service but one
participant felt that the program is very limited in scope.

There were several concerns raised regarding access to healthcare services
provided by practitioners and other healthcare providers. The most common
perception concerned a shortage of general practitioners and nurse practitioners. One
group observed that even with a full complement of doctors it was difficult to get an
appointment and another suggested that health personnel (nurses, allied health
workers, and doctors) were overworked. One individual lamented the fact that there
were no home visits by doctors. There was general agreement from all groups that
there were not enough doctors to service the community’s needs. One participant stated
that “Every citizen should have a family doctor.”

Maternity care was discussed in all but one of the focus groups. The lack of
maternity services and the absence of a delivery room was viewed as a deficiency. A

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need for pre and post natal care was identified. Concern was raised about the lack of
home birth options and no midwives in the community.

Three of the five focus groups identified transportation as an important area for
development. Reliance on local and regional transportation was viewed as essential to
accessing healthcare service. Concerns were raised regarding the lack of affordable
transportation options especially for seniors and at-risk youth.

Several concerns were raised regarding healthcare services for members of the
First Nations community. They included a need for coordinated discharge planning,
addressing cultural safety at the hospital, and disparity between on-reserve and off-
reserve healthcare services.

There were several individual concerns and issues identified in all groups.
Health related issues were viewed as important to the overall health of the community
and included a need for more short term housing, a bigger food bank, and a disconnect
in after hours reporting between RCMP and Vancouver. Other concerns included long
waits for physiotherapy services, the elimination of sexual assault kits, the lack of a
recruitment and retention strategy, and a need for more visiting specialists.

The complete list of Areas for Development is included in Appendix 3 on pages
22 to 25.

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Suggestions for Change

Participants were asked to share ideas and innovations that might provide
solutions for the community’s healthcare challenges. The following is a summary of this
information. Suggestions are arranged in order of significance, determined by the
number of groups that identified a particular item and the number of voting stickers
received (shown in parentheses).

Items identified by four out of five focus groups:

• Specialists to Merritt - more specialty care clinics (5)

Items identified by three focus groups:

• Information on healthcare services available to the public (5)
• Emergency services - improved ambulance and ER (4)

Items identified by two focus groups:

• Treatment centre for mental health & substance use (11)
• Walk-in clinic (9)
• Community Paramedicine program (7)
• Residents and Medical students supervised by local doctors (5)
• Nurse Practitioners - more needed and better utilized (4)
• Ultrasound service returned (3)
• Perinatal service - midwives and doulas (1)

Items identified by one focus group and receiving priority stickers:
• Provincial government funding to meet demand for services resulting from
highway hub (7)
• Community care aides (7)
• Increase supply of doctors (6)
• Nicola Valley Institute of Technology offer courses in health care professions (5)

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• After hours care for everyone (5)
• Helipad (5)
• Better at Home program (4)
• Collaboration and networking between Merritt and surrounding communities (3)
• Primary care - team oriented model (3)
• Advocates working on behalf of seniors, youth (2)
• Navigation of the healthcare system (1)
• Increase number of acute care beds (1)

Note: All remaining Suggestions for Change that were identified by only one
focus group appear in Appendix 4 on pages 26 and 27.

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Summary and Conclusion

The purpose of this consultation was to gather collective community wisdom and
perceptions about the strengths and challenges of healthcare delivery in Merritt. The
consultation demonstrated that there were substantial levels of agreement within the
community on issues of importance.

In the discussion on current strengths1, the consultation process revealed a
high level of satisfaction with a wide range of services. Participants revealed a network
of organizations working together to meet the healthcare needs of the community. All
focus groups shared their appreciation for the continuity of care provided by Emergency
Services and singled out ER staff (doctors, nurses) and first responders (paramedics,
RCMP) for their dedication and professionalism.

Discussion on current challenges and concerns revealed many areas for
development2. The issues were evaluated and divided into the following categories:
Mental Health and Substance Use, Emergency Services, Seniors, Practitioners and
Healthcare Providers, Maternity, Transportation, and First Nations. Individual issues
were numerous and formed a separate category.

Participants in the consultation were given the opportunity to offer solutions and
suggestions for change 3. Several suggestions were presented that provided insight
into the variety of challenges presented and the diversity of expertise and experience
that exists within the community.

This report provides a basis for future planning and should be viewed as one
contribution to a much larger strategy to solve the identified issues. In the words of Dr.
Barbara Pesut, “It was encouraging to see the dedication of the citizens that has
resulted in so many strong areas in Merritt’s health and social care. I look forward to

1 see Appendix 2
2 see Appendix 3
3 see Appendix 4

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seeing how this community consultation process might assist in closing some of the
remaining gaps.”

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Acknowledgements

Several individuals and organizations contributed to the success of the Merritt
Healthcare Community Consultation. Their contribution is outlined below.

Barbara Pesut, PhD RN; Associate Professor, School of Nursing, Faculty of Health and
Social Development, UBC Okanagan. Focus Group leader. Dr. Pesut’s extensive
knowledge and experience with the consultation model has been effectively utilized in
the coordination of this consultation. Dr. Pesut’s summary reports for earlier community
consultations provided a model for the writing of this document.

Kurt Christopherson, Merritt City Councillor. Organizational lead.

Diana Norgaard, Merritt City Councillor. Member of the organizational committee and
focus group recorder.

Allen Peters, retired Imaging Technician at Nicola Valley Hospital. Member of the
organizational committee.

Bill Day, Vice-President of SOHC. Focus group leader.

David Durksen, Co-chair of the Ashcroft Wellness and Health Coalition. Focus group
leader.

Fran White, Co-chair of the Ashcroft Wellness and Health Coalition. Focus group
leader.

Lynn Wells, Hedley community leader and Director on the SOHC Executive. Focus
group recorder.

Kellie Sullivan, Knowledge Translation and Exchange Manager, UBC Okanagan.
Focus group recorder.

Madeleine Greig, Research Assistant, UBC Okanagan. Focus Group recorder.

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Nienke Klaver, Secretary of the Support Our Health Care (SOHC) Society of Princeton.
Organizational support to members of the Merritt City Council, focus group recorder,
and data analysis.

Edward Staples, President of SOHC and member of the Princeton Health Care
Steering Committee. Community consultation coordinator, focus group leader, data
analysis, and report writer.

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Appendix 1: Invitees

BC Ambulance Service
Thompson Nicola Regional District - Area M
Merritt Emergency Services
School District #58
Hospice Society
Nicola Valley Hospital Auxiliary
BC Lung Association
Rotary Club
Ministry of Children and Family Development
Senior's Association
Retired Teacher's Association
NV Hospital Chief of Staff
Healthcare Practitioners
Scw'exmx Health
First Nation's Health Authority
Stockbreeder's Association
LNIB Fire Chief
City of Merritt Fire Chief
Heart and Stroke Foundation
RCMP
Community Police Officer
Merritt Recreation
Nicola Valley Arts Council
Business Association
Ask Wellness
Nicola Valley Healthcare Endowment
Merritt Chamber of Commerce
Nicola Tribal Association
Upper Nicola Community Health Services
Nicola Valley Institute of Technology
Honeypot Daycare
Whitebear Daycare
St Michael's Anglican Church
Sacred Heart Catholic Church
Latter-day Saints
NV Evangelical Free Church
Kingdom Hall
Crossroads Community
Seventh-day Adventist
Sikh Temple

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Trinity United Church
Child and Youth Mental Health
Conayt Friendship Society
Metis Association
Lii Michif Otipemisiwak Family & Community Services
Search and Rescue
Merritt Victim Services
Food Bank
Journeys into Tomorrow Transition House
Community Futures Nicola Valley
Aspen Planers
Highland Valley Copper
Lower Nicola Backhoe
VSA Highway Maintenance
NMV Lumber
Nicola Meadows
The Florentine
Retired Professionals
HAS
MYFRS
Scw'exmx Child and Family Services Society
Interior Community Services
Lower Nicola Indian Band
Upper Nicola Indian Band
Nooaitch Indian Band
Shackan Indian Band
Coldwater Indian Band
Stoyoma Dental Clinic
Cascade Dental Care
Merritt Counseling
Nicola Family Therapy
Phoenix Centre
Doctor's Eyecare
Interior Health

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Appendix 2: Areas of Strength

Area of Strength Identified Number
by Focus of
Group # Stickers
Emergency services - hospital emergency services are excellent 2, 3, 4, 5 3
- fast response on serious issues - emergency works well -
coordination of services is phenomenal
School District relationship with healthcare community - high 1, 2, 4, 5
school youth clinic, Health and Wellness Coordinator in schools
(IH funded), and counselling for high school students provided
by public health nurse - smoking cessation, birth control, and
mental health - collaborative work among several agencies with
a focus on meeting the needs of the child & family
Seniors services - Gillis House - “fabulous”; Seniors Helping 1, 2, 3, 4
Seniors program; activities daily; assisted living; footcare for
elders; end of life care; communication & collaboration between
hospice & Gillis House
Nurse Practitioners 1 3
Ask Wellness - helping vulnerable individuals with a wide range 1, 2, 4 1
of services (housing, employment, counselling, harm reduction)
- high quality due to cooperation, client-centred approach, and
personal touch - presently running at 99% capacity
Transportation - public system; bus to Kelowna & Kamloops for 1, 2, 3, 4
medical appointments - 1 or 2 days day a week (?); community
bus is good
Ambulance services and Paramedics - quick response transferring 1, 2, 4
patients from paramedic care to ER care
Nicola Valley Hospital services - excellent nurses & staff with great 3, 4, 5
morale; positive health environment - great staff at hospital -
overworked but smiling, pleasant - free parking at hospital
Emergency department staffed with ER doctors and ER locums 1, 5 1
- takes pressure off GPs
Hospital expansion, new emergency room coming - 2018 1, 2
Community - small town with good relationships, good 1, 3
communication, deeper commitments compared to big centres,
people are community minded, cohesive community - inspires
people to “go above & beyond” (mentioned 3x)
Pharmacist services - good relationship with customers - 1, 5
collaboration between pharmacists and doctors
Doctors - available & willing to go above & beyond - cohesive group 1, 5
that works together - new physician currently taking new patients;
happy with GP services - long term relationships provide good
diagnosis

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Hospital Auxiliary & Nicola Valley Health Care Endowment 2, 4
Foundation - provide funding for health services
Physiotherapy - physiotherapy is good 2, 4
Lab and X-ray services - timely service for routine tests, 2, 5
extended hours
Visiting specialists, e.g. urologist & gynaecologist 3, 5
Methadone clinic 1
Referral to specialists at larger hospitals 1
Logan Lake physicians are providing service to Merritt residents 1
Telehealth - technology 1
Nurse Practitioner who partners with CONAYT (Nicola Valley 2
Aboriginal Friendship Centre), First Nations & IH - working well -
service to native population on & off reserves
Nicola Valley First Nations have 3 mobile clinics that alleviates 2
strain on services provided by IH
First Nations mobile healthcare clinics - addiction & mental 2
health, public health, maternal & child health - mobility important
- go into high schools
Dental screening and auditory screening for kindergarten students 2
Food bank 2
Thrift Shop 2
Transitions from acute care to long term care - seamless; good 2
assessments & good placements
Community health & wellness facilities and programs - arts 2
programs, sports clubs, seniors outdoor group, community
gardens
Arts Community recruiting younger individuals - therapeutic & 2
selfcare
Dry climate - good for arthritis 3
Outdoor activities - easy access encourages active lifestyle 3
Services are easy to access because of community’s small size 3
Nurse Practitioner can write prescriptions 5
First Nations healthcare - potential for community to benefit from 5
shared resources
Mental Health - Merritt City Council working with 5 First Nation 5
bands on mental health issues
ER diagnosis - less than 24 hour transfer to Kamloops 5
quick transfer for operation 5
Proximity to Kamloops - equipment & specialists only 45 5
minutes away
new IH MyHealth Portal - people can be more in charge of their 5
own health; 24-hour access to personal health information
Infant Development Program (IDP) 5

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Appendix 3 - Areas for Development

Concerns, Challenges Identified Number
by Focus of
Group # Stickers
Mental Health and Substance Use
Mental Health Services - large client load - need more 1, 2, 3, 4, 5 12
resources, i.e. specialists/psychologists; access to mental
health services - need more mental health workers; mental
health solutions are lacking; not enough focus on mental health;
no support for follow-up for mental health - further options for
care needed
need a secure room at the hospital for people who are mentally 4 5
ill
access to mental health and addiction services in off-hours 4 3
psychiatric issues - privacy requirements vs knowledge needed 1 1
makes it difficult for school professionals to adequately support
child
lack of consistency in assessing children at risk for suicide 1 1
lack of psychiatrists 3 1
need detox, rehabilitation services 4 1
more attention to mental health issues, especially in school 5 1
where more problems appearing - nurses are very busy, can’t
deal with it all
Mental Health First Aid for caregivers is lacking 1
Mental health for youth - options lacking - “busting at the seams”2
no community/mental health observation beds available 2
mental health & addictions suffering 2
significant population of at-risk youth with mental health issues - 3
wait list for mental health worker because Merritt is sharing with
Ashcroft and Logan Lake
need life skills workers, assisted living for people who are 4
mentally ill
major issue of prescription drugs, alcohol addiction, and fentanyl 4
overdose
treatment centre for mental health & drugs is needed 5
more communication is needed between doctors and school 1
counsellor regarding information on violent or suicidal children
who get sent back to school and school is not informed about
the dangers

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Emergency Services - ER
3 major highways - stress on the ER - not enough beds, not 4, 5 2
enough ambulances - stress on paramedics, police, firemen -
hub for Greyhound bus - rowdy passengers end up in Merritt
ER used as a walk-in clinic - viewed as only access point by 1, 2, 4, 5
non-attached patients - leads to abuse, misuse of the system;
compromises emergency services - ER overused partly due to
doctor shortage
there used to be two ambulances and two full time staff and now 1 2
only one full time staff - need another ambulance and staff
ER staff overworked - attributed to lack of doctors 5 1
ER department is small and very outdated 1
lack of privacy during triage at ER - vulnerable cases/ 2
populations - everyone can hear what they’re there for
two ambulances not always fully staffed 3
one hour waits for ambulance do happen 5
Merritt’s ambulances run to other towns leaving community 5
short

Seniors Issues
Long term residential care - lack of options for seniors (looking 1, 5 1
to the future); lack of affordable assisted living options; hospital
beds are being used for long term care - not enough beds
available for extended care; Gillis House in need of upgrading
lack of assistance for seniors e.g. cleaning, running errands, 1 1
getting groceries, transport to appointments
Better At Home program - allow seniors to live at home longer 1 1
Seniors - many are financially vulnerable - average annual 1
income for female seniors is $16,000 if they have CPP
Seniors - some who do not have friends or family to rely on for 1
care
Seniors Helping Seniors program is very limited 1
housing options for seniors are sub-standard & not affordable 2
need to improve communications between hospital and families 4
of seniors (or caregiver)
seniors need specialists, e.g. for dialysis 4
lack of availability of geriatric care - question of local access 4
need advocates for seniors, handicapped youth, mental health 5
patients

Practitioners and Healthcare Providers
not enough doctors - need more family doctors, more nurse 2, 4, 5 1
practitioners
no home visits by doctors 1
overworked health personnel (nurses, allied health, doctors) 2

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difficult to get an appointment even though there’s a full 2
complement of doctors
perception that people can’t change doctors 3
doctors are retiring - concern over continuity of services 5
who controls/employs doctors? - recruitment and certification 5
process should be easier
long waits to see a GP because of doctor shortage 5
everyone needs a family doctor 5

Maternity
no maternity services (delivery room) in Merritt - prenatal 1, 2, 3 2
practice, birth delivery in Kamloops
no midwives 2 1
need pre-natal/post-natal care - including depression 2, 5
home birth services not available 1

Transportation
Transportation - Lack of transportation for seniors both locally 1, 2 2
and regionally - seniors are the most vulnerable with regard to
mobility which effects other health issues; for various reasons
there is a lack of transportation for children who need to access
health care services; elderly people on reserves can’t access
transportation and don’t have family to call on;
Transportation - local bus goes once a week to Kamloops and 2
once a week to Kelowna - people don’t know how to access
transportation - sometimes costly for seniors
Transportation - community health bus needs tweaking at the 3
other end - how to get back home
Taxi service costs - can add up 1

First Nations
First Nations - coordinated discharge planning for those on & off 1
reserve
working on cultural safety at hospital - First Nations 1
differences between on-reserve and off-reserve services - 1
disparity

Individual Concerns and Issues
short term housing needed - jail cells become shelters 4 5
Physiotherapy - one physiotherapist at hospital but it’s too hard 2, 4, 5 2
to get appointment - long waitlists; physiotherapy is
underfunded - have to go to Kamloops - better local services
would help patients & physicians, especially with the aging
population

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no longer doing sexual assault kits - community/RCMP not 2 3
informed
lack of social worker at hospital - no funded position 1, 3 2
need visiting specialists, e.g. obstetricians 4 2
Outreach Worker for youth is an asset but position is not stable 1 1
lack of community understanding for the purpose of harm 2 1
reduction
youth at risk - children who fall between the cracks - no beds, no 4 1
solutions - filters down to the police. Need local solutions,
weekends, evenings, shift work
location of services - difficult to access for many people - public 1
health located at hospital - difficult for youth to access - not
private
poverty and the effect on the ability to access healthcare 1
services
public perception of equipment being purchased for the 2
community and then moved to another community
strategies for recruitment and retention lacking 2
Food bank - needs to be bigger 2
equipment sterilization not to standard for some procedures 3
RCMP - disconnect with Vancouver reporting in after hours 4
after hours, 24 hour response crisis response needed - suicide 4
intervention
pharmacists should be able to fill certain prescriptions instead of 5
having to go to doctor
qualified doctor had problems coming to Merritt 5
nurses need more hands-on training on wards 5
equipment available but no certified staff to run it - not enough 5
effort to train staff
not enough preparedness e.g. training for accidents 5
Infant Development Program person is over-worked 5
more preventative health services needed, e.g. diabetes 5

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Appendix 4 - Suggested Changes - Innovations
Innovations, Ideas Identified Number
by Focus of
Group # Stickers
Treatment centre needed for mental health & substance use - 2, 5 11
alcohol treatment centre; detox; rehabilitation
Walk-in Clinic with visiting specialists; walk-in clinic - alleviate 1, 2 9
challenges seen at hospitals
highways contribute to volume of healthcare & emergency 4 7
needs; provincial government should be asked to give more
funding to meet the additional need
Community Paramedicine program; Community responders 1, 3 7
(paramedics) to take care of elderly who are not taking their
medications or who need help with other healthcare issues, e.g.
changing dressings; paramed pros
Specialists to Merritt - “one day a week” specialty care clinic; 2, 3, 4, 5 5
services (speciality therapists) coming to the community - come
together with a package to recruit, i.e. “business plan”; need
specialists to come once a week; visiting specialists; visiting
certified staff to run various services
education of public on available services - social media links 3, 4, 5 5
connected to City website; health care map; List of available
healthcare services - hardcopy and online; community education/
training on health care issues; inform people of what’s available
- appropriate use of online information
care aides - community care aides; Community Health 3 7
Coordinator - money may be available from Doctors of BC
need more doctors 5 6
residents/medical students - supervised by local doctors; 2, 3 5
medical students doing three month term in clinic
Emergency services - third ambulance is needed; new, larger 3, 4, 5 4
emergency ward; increase BC ambulance service; better
ambulance services; look at trends for staffing and equipping
emergency services; one more ambulance needed
more Nurse Practitioners - trained in sexual assault - ability to 2, 5 4
use assault kits - good because usually more of a female
workforce - they have specific training in using sexual assault
kits; Nurse Practitioners should be utilized more, especially for
“easier” issues; need more Nurse Practitioners; more
practitioners needed
NVIT encouraged to have health care professionals courses 3 5
after hours care for everyone 4 5
need a helipad 4 5
Better at Home program for older adults 1 4

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return ultrasound service; ultrasound - need someone qualified 4, 5 3
networking community & community resources to serve the 2 3
health care needs of all the surrounding communities - working
together to solve problems (collaboration)
Primary care; shift towards a team oriented structure - continuity 2 3
of care - must be community driven - what our community
needs? who do we want on our team?
advocates - on behalf of seniors, youth, etc. 5 2
innovations around perinatal support (doulas & midwives); need 1, 3 1
midwives
make it easier for people to access/navigate the healthcare 2 1
system - to find the services available; be able to connect with
one person to access the healthcare system - hugely
complicated system - would be good to have help with
navigation - need intimate details of the system - how to get
correct information through one person
more acute care beds 4 1
Community Living BC - no work for students with developmental 2
disabilities - transitions from school to “life” - ideally, there would
be sustained support for this
designate community as a “specialized centre” for a particular 2
specialty, e.g. hip replacement
Part time paramedics need to be full time 3
Healthcare Traveling Roadshow return visit 3
short term, properly staffed housing - year round need 4
mental health & addiction needs/services - free up services for 4
other health problems
doctor recruitment - need to free up the system that’s controlled 5
by the College of Physicians & Surgeons; look at trends for
staffing and equipping emergency services
provide funding to assist healthcare staff with qualification 5
upgrades with return of service requirement
handicapped sheltered workshop is in jeopardy - need 5
something to replace this program, e.g. group home

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Appendix 5: Invitation to Community Representatives

___________________________
Name of Organization/Individual

May 26, 2017

To:________________________

In partnership with the City of Merritt, Interior Health Authority, the University of BC
(Okanagan), and the Merritt Community Health Coalition, you are invited to attend a
Community Healthcare Consultation to be held on the evening of June 15, 2017
beginning at 7:00 pm at the Merritt Civic Centre. The purpose for this consultation is to
identify the challenges and opportunities facing health care in Merritt and area and to
provide information that may be used in the development of an improved healthcare
model for our community.

The workshop will be conducted by Dr. Barbara Pesut from UBC Okanagan who will
lead us in the consultation process. Dr. Pesut has been involved in healthcare since
1982. She is presently Associate Professor in the School of Nursing at UBCO and holds
a Canada Research Chair in Health, Ethics, and Diversity. Dr. Pesut’s current research
looks at healthcare delivery models for end of life care in rural communities.

Participants will be divided into focus groups of 6 to 8 individuals. A facilitator and
recorder will be provided for each group

We would like to invite you or a representative of your organization to participate in this
event. Please let us know at your earliest convenience if you or a designate will be
participating in this community consultation process. It is important that our community
has a representative voice in determining health care in Merritt.

Please respond as soon as possible. You may contact me directly at 250-378-4909 or
by e-mail at kchristo@ shaw.ca, or by dropping off a written response addressed to me
at City Hall.

Yours truly,

Kurt Christopherson
Councillor, City of Merritt

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Appendix 6: Email Sent to Participants
On behalf of the City of Merritt and in cooperation with Interior Health I am attempting to
contact a broad cross-section of the community in an effort to request your participation
in a community consultation process to consider how we, as a community, can be
more proactive in health care matters in Merritt and area. A small working committee
has been established to coordinate a community consultation process. We have
prepared a contact list of agencies and individuals that we hope is representative of the
community in an effort to ascertain the needs of this area. A consultative workshop is
being organized for the evening of Thursday June 15 from 7 to 9 pm at the Merritt Civic
Centre. We hope that you or a member of your organization or a designate of your
choice will be able to participate in this activity. Please read the attached letter. If you or
a designate is able to attend the meeting, return the completed letter to City Hall in care
of myself, or contact me personally by e-mail or phone (250-378-4909). Because of
space and organizational limitations, attendance is limited to invitees only at this stage
of the process. Your participation will be appreciated. Thank you.

Kurt Christopherson

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