Deaths inside Vancouver supportive-housing sites rise amid conflicting rules and with stakeholders at odds

Elyse Ola Mary’s parents thought she was Christmas shopping when, on December 22, 2015, she was really visiting a friend in Vancouver’s Downtown Eastside.

“We pieced together the story later on,” her mother, Deb Bailey, said in a telephone interview. “They went into Tellier Tower. We have a video of her going in there. You can see them go into the building, going up the elevator, up to the third floor, and then they disappear.”

Izzy, as most people knew her, was found the following morning in the third-floor stairwell of Tellier Tower, one of the Downtown Eastside’s larger supportive-housing projects. The 21-year-old girl died of a fentanyl overdose, the B.C. Coroners Service later confirmed.

“There were no cameras in there [in the stairwell],” Bailey told the Straight. “So nobody knew she was there.”

Located at 16 East Hastings Street, Tellier Tower is operated by PHS Community Services Society (PHSCSS). It consists of 90 units plus a primary-care clinic and offers support for “those residents with mental health, addiction, and chronic disease issues”, according to a PHSCSS website.

Whether or not to install surveillance cameras in government-funded buildings, how many cameras to install, and where to point them, are difficult questions for nonprofit service providers. Today, there are security cameras that let staff monitor activity in the Tellier’s 10-storey stairwells. But residents aren’t thrilled with them, several told the Straight. Nobody likes to feel that they’re being watched.

Security cameras are one of many tools that supportive-housing providers in B.C. use to save people’s lives. The night Izzy died, there was a PHSCSS staff member watching video feeds from cameras that were installed in other areas of the building. If only there had been one covering the third-floor stairwell, Bailey often thinks. “If somebody had seen her there, she could have been saved.”

Other tools include regular health-and wellness checks and collecting guests' photographic identification to log who is inside a building at a given time.

But all three of these tools are controversial in different ways. Depending on how they’re implemented, they can even stand in violation of the B.C. Residential Tenancy Act (RTA), in buildings where it applies.

Leaders of Vancouver’s nonprofit-housing providers told the Straight that there is no simple solution.

The RTA does not allow access to a resident’s unit without 24 hours' notice, for example. But Vancouver is experiencing an overdose crisis, many Downtown Eastside residents use intravenous drugs like heroin and fentanyl, and regular wellness checks can help building staff prevent an overdose from ending in a death.

Should a housing operator like PHSCSS bend the rules or even break them if it means more of the organization’s tenants will remain alive?

Deaths inside supportive-housing sites on the rise

On December 14, the Straight reported that more than 330 people had died inside government-partnered supportive-housing projects across the Lower Mainland between January 2016 (the oldest date for which statistics were available) and May 2019.

Using freedom-of-information legislation, the Straight collected data for 90 addresses operated by the provincial government’s four largest social-housing partners: PHSCSS (formerly the Portland Hotel Society), Atira Women’s Resource Society (and its property-management company), Lookout Housing and Health Society (formerly Lookout Emergency Aid Society and Keys Housing and Health Solutions), and RainCity Housing.

Deaths appear to be on the rise, the numbers revealed.

At the 90 buildings analyzed, there were 62 deaths recorded in 2016, 106 the year after that (when B.C.’s overdose crisis intensified sharply), 109 in 2018, and then 62 during the first five months of 2019 (when the Straight first requested this information).

The apparent increase in deaths is not the fault of staff, everyone interviewed for this story agreed (and emphasized). Buckling under the worst health emergency B.C. has experienced in a generation, nonprofit-housing staff are routinely performing heroics, sometimes successfully responding to multiple overdoses in a single shift.

What is likely contributing to a rise in deaths, housing managers say, are political and policy tensions that contradict one another in ways that make balancing privacy and safety a complicated challenge.

[Read part one: No one is monitoring deaths inside Vancouver's supportive-housing projects and the numbers are going up]

Safety and security versus autonomy and privacy

Janice Abbott is the founder and CEO of Atira Women’s Resource Society, which, along with its property-management company, operates some 40 buildings throughout Metro Vancouver. “Nonprofits are really caught between a number of regulatory bodies that have conflicting expectations of us,” she said. “For example, the Residential Tenancy Act does not allow us to collect visitor IDs…but we have to manage guests for a whole variety of reasons and—in this current climate—to, hopefully, keep people alive.”

Other examples are health-and-wellness checks and security cameras, Abbott continued. “We have increased scrutiny from WorkSafeBC which, rightly so, demands our staff are safe,” she noted. “But in order to do that, we need some tools that [privacy] advocates don’t want us to have, like cameras.”

Tenants’ families are another factor, Abbott continued. Tenants might not want regular wellness checks, and the RTA even forbids them without advance notice. But if a tenant dies, their family might demand to know why staff were not looking in on their loved one often enough to prevent a fatal overdose.

“We have all these kinds of conflicting regulations, and it’s the nonprofit, which has the least amount of authority in this equation, which is the one who wears it,” Abbott said. “This sort of squeeze is creating a lot of stress on organizations.”

Supportive-housing residents’ relationships with authority are complicated, Shayne Williams, executive director of Lookout Housing and Health Society, said in an interview. He drew attention to systemic issues such as the extreme fear with which a tenant with a long-term addiction sometimes fears hospitals and the health-care system as a whole.

“Someone will discharge themselves [from hospital] and say, ‘I want to die at home,’ ” Williams told the Straight. ‘I don’t want to die in the hospital system that has treated me like shit for most of my life.’ So there is a lot of stuff in terms of the greater broken structure that has led to this….When people have been systemically marginalized for so long, there is an inherent mistrust with anyone with perceived power.”

A level above the nonprofit agencies that operate most supportive-housing sites is B.C. Housing, a provincial agency that provides funding and negotiates operating agreements. In a telephone interview, its executive director of strategic initiatives, Dominic Flanagan, acknowledged the conflicting goals and contradictory orders that can place housing providers in a tough spot.

“We are aware of that inherent tension between privacy and the welfare and health of the tenants,” he said in a telephone interview. Flanagan, however, argued that safety and security are “paramount”.

“We make it a contractual requirement to do those regular welfare checks,” he noted. “We recognize that sometimes there is a tension between health and welfare and privacy…but we have to guarantee the safety of the environment that we are working in.”

Flanagan maintained that this does not necessarily mean that there is always a conflict between the RTA and operators’ efforts to ensure staff and residents’ security. He suggested that contradictions can be resolved with agreements between housing providers and tenants that exist outside of the Residential Tenancy Act.

“I’m not a lawyer, but there is an argument to be made that program agreements are separate from the RTA process,” Flanagan said.

A 2015 decision by a B.C. Supreme Court judge said that Atira Property Management was wrong to prohibit guests who not did show photo ID. But in interviews, Abbott subsequently argued that that ruling only pertained to the one tenant who brought the suit. Guests restrictions at Atira properties and most supportive-housing sites in Vancouver remain in effect.

Danielle Sabelli, a lawyer with the Community Legal Assistance Society (CLAS), said there can be a wide gap between policies on paper and how rules are interpreted and implemented in the real world. “It is not uncommon for us to see theory and practice out of step with one another,” she told the Straight. "What is stated in a program agreement or a tenancy agreement is often not what is actually happening on the ground.”

Sabelli explained that supportive-housing buildings that do fall under the RTA will sometimes ask residents to sign addendums that include additional rules. “Landlords can add addendums to tenancy agreements; however, those are not always in compliance with the act,” she added. “A landlord cannot provide someone with an addendum that says, ‘I can come into your unit whenever I want.’ Even if the tenant signs it, it is not enforceable because it is not in compliance with the Residential Tenancy Act.” But that’s what is happening, Sabelli said.

Housing providers face compounding challenges

A death inside a supportive-housing project does not always mean that something went wrong, stressed Tanya Fader, PHSCSS’s director of housing.

“We have people aging in place more,” she explained. “That’s a good thing.”

However, Fader continued, “It also means that there are different supports we need that haven’t previously been needed in this neighbourhood and with this population.

“Over the years, by giving people stable housing and supports and community, now we’re running into other sets of problems: the inability to refer seniors on to an appropriate level of medical care within their housing, for example,” Fader said. “There are so many things that could be done at all levels of care that I believe people are entitled to but that they are not getting.”

Then, in addition to those sorts of systemic issues, there is the overdose crisis, Fader said.

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There were 823 illicit-drug overdose deaths across B.C. during the first 10 months of 2019 and 1,542 the year before, according to the B.C. Coroners Service. That compares to an annual average of 204 deaths each year between 2001 and 2010.

“Our staff are responding to so many overdoses—not just within our buildings but out on the streets, in parks, on sidewalks, in back alleys, and next to our buildings when they’re on their way home from work,” Fader said. “This situation is really, really difficult.”

Sabelli pointed a finger at higher levels of government and a need for more funding for supportive-housing that would allow for operators to tailor care to individuals.

“It is very difficult for the nonprofit-housing sector to ensure that residents’ rights are protected, observed, and that there is security as well—no doubt, that is a difficult situation,” Sabelli said. “But there are ways to manage a building without having to take away all rights of tenants.”

[Read part one: No one is monitoring deaths inside Vancouver's supportive-housing projects and the numbers are going up]