The Canadian Forces report outlining the shocking conditions in five long-term-care homes in Ontario has caused an uproar among health-care professionals, political leaders, and the public. Questions remain about how COVID-19 patients were able to walk freely or reside with COVID-negative residents, why there were insect infestations and shortages of diapers and other supplies, among other examples of neglect and abuse — and how we move forward to keep residents safe and healthy.
TVO.org spoke with physician and former federal minister of health Jane Philpott — who just finished a stint at Participation House, a group home in Markham for people with disabilities — to discuss how the systemic issues in LTC homes, the government’s approach to health care, and society at large contributed to the vulnerabilities of LTC homes during the pandemic.
TVO.org: I was wondering what your reaction to that report was when you first heard about it and when you went through the details of it.
Jane Philpott: Well, it was quite devastating. I mean, yes, we were aware of how dire the circumstances are in many places, and it’s certainly been accentuated through the pandemic. But to see some of the specific details about the circumstances that were found in these homes is still pretty shocking. It’s just something that as a society, we let this happen. It speaks to, I believe, some of our attitudes toward aging and seniors. We have not treated elders with the dignity and respect that they deserve.
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TVO.org: How much has what you read in the report matched up with your experience working at Participation House? If it hasn’t, has it matched up with what you’ve heard from personal support workers, nurses, or doctors in other facilities?
Philpott: Well, no, it hasn’t been aligned entirely. Just for clarification, Participation House is not a long-term-care facility. It’s a group home. But my experience with the caregivers there has been that they work extremely hard to provide very loving, good-quality care. I think what has been lost in the reporting about the situation in the homes is the realization that there are good people everywhere, and there are some really outstanding long-term-care facilities. But there are outliers, and I think there’s work to be done to determine how many of them have been allowed to function, for a variety of reasons, with absolutely less than adequate staffing. And it leads to the horrific circumstances the military discovered.
TVO org: Some of the problems in the report, such as those involving infection control, have been exacerbated by COVID-19. But some seem unrelated to the pandemic. I don’t think the pandemic brought cockroaches or a lack of diapers or instances of verbal abuse to these homes, to give some examples. Does it seem odd that this is being played as a watershed moment when we’ve known so much, for so long, about the state of these homes?
Philpott: I think the watershed moment is that we’re paying attention to this report as it happens. Literally thousands of seniors have died. I think if there had not been that massive amount of death, that there would not be the same kind of attention to the issues. But I think we have to be frank, too, that an unexpected report from the military landing on the desk of the federal minister for public safety is a big deal. So, yes, these things have been known for a long time. But this report has really brought attention to the issue. You don’t want to comment on the sort of specific things that were written about in the report, like the abuse, etc. But the pandemic certainly may have exacerbated situations [of abuse or neglect].
These workers have lived through something horrible themselves and are probably experiencing fairly severe trauma. One of the realities that we know about trauma is that hurt people hurt people. So workers who have been traumatized themselves — who perhaps have been mistreated over time — sometimes they are the ones who will then go on to hurt others. That’s not an excuse. But there are stories to be told. What needs to be explored is, what is the root cause? Are these people trained properly? How many hours a week have they been working? What are they dealing with in their own home situations? And why have they not had the support or the training it would have taken to ensure that they provide loving quality care?
TVO.org: Many of the people involved in the sector may have good intentions. But we’ve let this whole group of people down in such a profound way. How do we explain to Canadians what exactly happened here?
Philpott: There are so many reasons that lie at the root of this. I referred earlier to ageism, and I think that’s a very real thing. These people are not only elderly — I believe the statistics are that something on the order of 90 per cent of people living in long-term-care facilities have some form of cognitive impairment, if not full-on dementia. As a society, we often judge people’s value by what they’re quote-unquote contributing to society. André Picard was in an interview earlier this week, and he described the concept of disposable citizens. And it was a shocking turn of phrase, but, in a sense, there’s an unspoken assumption perpetuated that these aren’t our top-priority citizens.
But I think another cause that I and others have pointed to is this jurisdictional mess where everybody says it’s somebody else’s problem. Long-term care, even in Ontario, is now a separate ministry from health. But even when it was part of the ministry of health and long-term care, it’s fair to say that long-term care was sort of seen as the lesser-valued part of that department. Those are sort of unspoken biases, so I don’t think it’s had the same kind of focus.
I’ve said for some time that there is a big role for the federal government in this to set standards. We do have some provincial standards in place, but, as you know, there has not been proper oversight. So I think that it’s time to look at national standards and that funding for facilities should be tied to whether or not these standards are met. And that includes regular inspections and accreditation.
TVO.org: On the topic of jurisdiction: Obviously this is a provincial responsibility, but, when you were minister of health, were problems in long-term care on your radar? You’re talking about setting a national standard, but I’m just curious whether this was ever brought up or being pushed.
Philpott: It’s not considered to be part of the federal health portfolio, so it was never discussed. But it now seems opportune for the federal government to have a role in this. There are certainly mechanisms by which the federal government can be involved. I maintain that the really great things we’ve done in health care in the last century have been at times when the federal government has stepped up to the plate and said, “We’re going to set some national standards or principles.” The best example of that is the Canada Health Act, in 1984, where we decided that there were certain principles like universality and accessibility that had to be matched or the provinces wouldn’t get money from the federal government. And there’s no reason similar legislation couldn’t exist to establish some baseline expectations of the way that we care for the elderly.
TVO.org: You have a unique perspective, given that you were federal minister of health and are now on the front line. People on the front lines knew about this. Doctors, PSWs, and journalists have been reporting about it. There have been public inquiries. Where was the line of communication lost between them and the people in power making decisions? Why did it take this report for the issues finally to be taken seriously?
Philpott: You’re totally right that family members of those who have lived in these less-than-adequate facilities have been trying to make their voices heard and haven’t been successful there over many years. Similar reports have been tabled by various organizations. There’s certainly no excuse. I don’t know that there’s a great explanation. What we need to do at this point is obviously focus on going forward and ensuring that, now that we know the full extent, we do take the collective obligation to respond and change. We’re hearing that from leaders, and we will all have to hold the current decision-makers to account for following through on their vows in recent days to fix the system.
TVO.org: On the flip side of that, it’s one thing to talk about the political system, but we also have to think about the fact that we, as the public, elect our leaders. What is the role of the public in maintaining accountability or demanding better?
Philpott: That’s a really good question, because it is easy to place all the blame on political leaders and public officials — the bureaucracy, as it were. But, in fact, I do believe that citizens can and should make these issues a big priority. We have the ability to do that through our democratic process. Long-term care is not generally the top issue in an election. But I wouldn’t be surprised if, in the next provincial election, it will have to be. People will be looking out for what the various parties say they’re going to do, and they’ll look for what steps have already been taken by the current government. That’s the mechanism that we have to try to speak with a collective voice and to act through democracy. But there are other mechanisms as well. The discourse taking place in the media is a really important one. And Canadians are speaking up loudly about their dismay, and, in recent years, I can’t remember when issues of either public health or long-term care have had the same kind of focused, intense attention in the way that they have over the last two months.
This is a positive thing. No one will be able to cut public-health funding for the foreseeable future.
TVO.org: Lastly, because of COVID-19, our governments have had to roll out new policies every day. I’m wondering how we should think about government’s responsiveness when we aren’t in a global-health crisis. I think of long-term care, Indigenous health, and living conditions, especially in our northern communities. How can we respond quickly to social problems when we aren’t in a health crisis like this?
Philpott: Well, what this pandemic has demonstrated is that the failure to focus on social issues has had devastating economic consequences. For too long, we have measured our success as a society by whether or not we have a growing GDP. That is not actually the measure of a healthy society. This has shown us that, if that’s what you care about, well, then, you’d better care about what it takes to make people healthy. What it takes to make people healthy is that they have adequate housing, that they don’t live in poverty, that they get their nutrition taken care of, that they have a job, that they have decent access to education. Those factors are where we really should be focusing. If we don’t, it can lead to the kind of public-health disaster that we are living through right now, and it will then have a ripple effect on the economy that we’ll be paying for for a generation or more.
This interview has been edited and condensed for length and clarity.
This is one in a series of stories about issues affecting northeastern Ontario. It's brought to you with the assistance of Laurentian University.
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