Maya J. Goldenberg argues that long-term care is having a much needed reckoning in Canada after decades of policy neglect.
The COVID-19 pandemic has functioned like a stress test, exposing cracks in systems of governance. The extreme conditions of a global pandemic shine a harsh spotlight on the inequities and injustices that weak policies create or condone. This invites change. Long-term care is having a much needed reckoning in Canada after decades of policy neglect. The rates of COVID-19 deaths among elderly residents in these facilities are staggering, far outpacing any other vulnerable population disproportionately impacted by COVID-19. The staff are also getting sick, creating further staffing shortages in already understaffed facilities.
Canadians were stunned to learn of a Dorval, Quebec facility where its frail residents, some of whom were infected with the novel coronavirus, were all but abandoned by staff in late March of this year. Military were swiftly deployed as humanitarian crisis response in order to assist in several pandemic-hit facilities in Ontario and Quebec. A report by those military personnel released this week offered horrific witness to elder abuse and neglect in five understaffed and overwhelmed Ontario facilities. Ontario Premier Ford described the report as “gut wrenching”, Prime Minister Trudeau found the details “deeply disturbing”, and Deputy Prime Minster Freeland agreed to a major rethink of long-term care in this country, where “all options are on the table”.
This, of course, is political spectacle. Serious problems with long-term care are well-known, and well-researched, and numerous commissioned reports have offered solutions. Long-term care has never been a priority for Canadian Medicare. Medicare was established in 1957, a time when most elder Canadians were cared for by relatives in the family home, and rarely lived long enough to need the high levels of complex care that would require institutionalization. Even as the need for complex care facilities grew in the decades that followed, fiscal constraint was the government priority, and privatization was the solution for institutionalized elder care. Long-term care was never enshrined in the Canada Health Act. A 2009 report by the Canadian Centre for Policy Alternatives chronicles decades of policy silence on elder care in Canada, and the National Institute on Ageing identifies privatization as a dangerous solution to the problem. It is difficult to regulate and enforce meaningful standards in private care facilities.
The COVID-19 stress test has highlighted the precariousness of the informal “triangulation of care” model operating in Canadian long-term care facilities. Facilities use bare-bones staffing numbers and leave it to the families to contribute to resident care themselves or through the private contracting of health care aides. When COVID-19 physical distancing measures necessitated family and (in some facilities) health care aides to stay away, the staff were unable to manage the demands of care. Long-term care staff tend to work part-time in multiple facilities as a way for institutions to avoid the added cost of providing benefits like sick pay to full-time staff. This led to infected staff spreading the virus from one institution to another. Shortages of personal protective equipment added even more stress on this underpaid and undervalued “pink collar” labor force, mostly racialized, immigrant, and migrant women who do not have clout like the Canadian Armed Forces to draw public and political attention to this care crisis.
If all options really are on the table, provincial and federal agencies can draw from a wealth of research and reports calling for sustainable funding for long-term care facilities, more comprehensive inspections of facilities, better wages and working conditions, and federal jurisdiction instead of provincial control and privatization in order to ensure adequate funding to meet national standards of care. Why do this? Because elderly Canadians, and the essential workers who care for them, have always deserved better than this.