Failure to Thrive at Home: When the System Isn’t Enough

HCNHC Campaign — June 2026

Dennis and Julie had been married for decades and spent the last 25 years navigating health challenges side by side. Dennis became Julie’s full-time caregiver long before anyone officially recognized the seriousness of their decline.

Both lived with diabetes requiring insulin management. Both had experienced strokes. Dennis had survived a brain aneurysm at age 50, forcing early retirement, and now lived with only one functioning but failing kidney. His eyesight was poor, he suffered dizzy spells, and eventually, even driving became unsafe. Yet despite clear signs of cognitive decline in both of them, formal dementia diagnoses remained elusive.

Like many older couples, they tried desperately to maintain control and independence long beyond what was safe or sustainable.

Dennis insisted on managing both their medications despite increasing confusion and exhaustion. Julie frequently refused care or the help of paramedics. When she fell—usually sliding softly to the floor—Dennis sometimes covered her with a blanket until a friend could come help, occasionally leaving her there overnight. This was not neglect born of indifference. It was caregiver burnout, grief, exhaustion, confusion, and two vulnerable people quietly falling through the cracks together.

The health authority approved home support four times daily, five days a week. On paper, it sounded comprehensive. In reality, visits often lasted only 15 to 45 minutes, with transportation time deducted from the allotted care time. Workers came and went quickly, trying to complete impossible tasks within rigid schedules.

The subsidized home support alone costs them approximately $1,200 per month—more than $14,000 annually. Because Dennis had a small work pension and Julie earned approximately $15,000 annually, they were just above the threshold for fully subsidized care.

To fill the gaps, the family privately hired a caregiver-companion one day per week at a cost of more than $8,000 annually. After paying for home support, the couple effectively survived on $23,000 per year to cover additional costs of medication, food, incontinence products, transportation, and maintaining their aging condo. They increasingly relied on a line of credit against their deteriorating condo just to manage daily living expenses.

At the same time, the family worried constantly about Dennis’s future. They feared he would eventually be unable to afford a safe and comfortable assisted living residence after years of caregiving stress and declining health. Julie ultimately qualified for subsidized long-term care, where approximately 80% of her income would go toward her care costs. Dennis’s remaining savings, even managed carefully, were projected to last only a limited number of years at the minimum cost of approximately $5,000 monthly for assisted living, before additional medication management or personal care costs. If he outlived those resources, he too would eventually require subsidized care. Thankfully, they had owned a home. Many seniors do not.

If Julie refused to get out of bed, the staff often left. She could remain lying in urine- and feces-soiled bedding waiting for the next care worker—or sometimes into the next day—unaware of her condition. The house smelled. Dennis, overwhelmed and frustrated, would sometimes ask caregivers to leave because he felt they were “not helping anyway.” This care system can undermine any sense of self-worth or dignity, especially at this level of need.

Care workers changed constantly. Some built rapport; others did not. There was little continuity, accountability, or clarity for the family. Dennis often could not tell whether someone had come into the home if he had left for appointments before they arrived. They resorted to an electronic door lock system that the strata would allow to remotely monitor whether support workers had entered the home.

At the same time, the healthcare system unintentionally penalized them for struggling. If they cancelled care visits, they risked appearing “not in need” of long-term care placement. Yet the unpredictability of publicly funded care made it nearly impossible to coordinate consistent private support around it.

One day a week, they hired a trusted caregiver to spend four hours with them. The difference was profound.

She cleaned the home, prepared proper meals, engaged Julie enough to bathe, and was even able to give her simple comforts like a manicure or pedicure. She sat with them at the kitchen table for conversation and companionship. She treated them as human beings, not tasks on a schedule. Dennis and Julie trusted her. They felt safe with her. They were grateful. On those days, Dennis could cope with the remaining household responsibilities and laundry.

This was not simply a medical crisis. It was a failure-to-thrive crisis occurring quietly behind closed doors.

Eventually, Julie was deemed cognitively incapable of making decisions. Dennis still insisted he could manage her care despite his own severe decline. Finally, their grief-stricken daughter enacted a Power of Attorney and made the painful decision that her father could not.

Julie was admitted to the hospital for care and assessment. The family fought to keep her there until a long-term care bed became available because the condo had already been put up for sale. Their home was sold, and Dennis moved into assisted living. He now visits Julie three times a week while slowly recovering from years of caregiver burnout.

Their story raises an important question for British Columbia:

If we know what helps seniors thrive safely at home, why is meaningful, relationship-based support still considered a luxury rather than an essential part of care?

Barb Kirby - ILTCCABC