We ignored the elderly long before COVID-19. It’s on all of us that they’re dying now

OPINION: Public-health officials and politicians weren’t prepared for the spread of COVID-19 in long-term-care facilities — and they should face some hard questions. But so should the rest of us
By Matt Gurney - Published on Apr 22, 2020
Minister of Long-Term Care Merrilee Fullerton speaks at a press conference on April 22. (YouTube)

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A tragedy is unfolding in our long-term-care and nursing homes. A series of tragedies, really. It has developed almost entirely out of sight. And this should not come as a surprise.

One of the strangest parts of this pandemic has been the sudden, belated realization that some of our most vulnerable people have been dying by the dozens. Canadians have been consumed in recent days by reports of a mass-killing spree in Nova Scotia — and understandably so. The shock of the high number of victims — 22, at latest count — is enough to catch your attention. But, if we're talking about numbers, and this is in no way intended to detract from the horror in Nova Scotia or the grieving there, there has already been a series of such incidents in our care homes. In Bobcaygeon, 29 residents and the spouse of a resident died at one facility. In Scarborough, 34 died at one facility. Just this week, word emerged of another disaster: in Pickering, 31 are dead. On Wednesday, Ontario announced as many new deaths from the previous 24 hours in care homes as police currently believe died in the Nova Scotia massacre, and officially requested help from the Canadian Armed Forces, which will send troops to five care homes, as yet unidentified, in the most need of aid. Five to start, anyway.

I could easily go on, but the point is made — mass-casualty events in our care homes that would once have led national news coverage are now just little sidebar stories of the pandemic. The first incidents in Bobcaygeon and Dorval, Quebec, made the news in big ways. There's been a diminishing return of news interest when it comes to the others. And it's taking days for some of these outbreaks even to be noticed and reported on.

Some of the explanations for this are banal. News-gathering organizations, even in the big cities, are operating with reduced staff and with less efficiency than normal, due to limits on travel. Further, the gradual and brutal erosion of newsrooms in recent years has simply left fewer reporters available to cover all the urgent stories that need such coverage. A smaller corps of people reporting the news will inevitably mean that more news gets missed. This isn't good. It's also not mysterious.

But we can't content ourselves with the innocuous explanations. There's another, uglier truth underlying what's happening in our care homes. These are places that our society tries very hard to not think about. Most of the time, we succeed.

Years ago, when I was just leaving university and beginning my first go-round as a freelance journalist, I had a friend who was working at a retirement residence in London. She told me that the residents would enjoy it if someone with my mix of interests and skills — a historian heading into the news business — could come in to talk to them. She had an entertainment budget, so, once a month, I'd go in, give a lecture on something currently in the news, do a Q&A, and stick around for coffee and cookies, chatting with the residents. This eventually grew into a small part-time business for me; I kept it up until I landed a full-time job in journalism and simply didn't have the time. As part of drumming up business, I must have visited every care home in the GTA (or near enough). I’d hand out a business card and make my pitch.

It's astonishing now to remember that long-ago era (which ended only last month), when anyone could literally just walk into a care home, bringing with them who knows what kind of germs or viruses. But it was then that I learned just how awful some of these facilities were.

Some, to be clear, were delightful. Seniors with deep pockets, or those who had children with deep pockets, could live very comfortably and well, even with advanced-care needs. (The costs could be massive — up to $7,000 a month, and this was almost 15 years ago.) The reader will not be surprised to learn that these were the places most likely to agree to have me come in for a lecture: they could afford to. For everyone else, or for those whose medical needs were the most serious, the only option was institutional care — either in a public facility or whatever they could afford.

These places were, at best, grim. They were warehouses for the infirm. Even the clean ones, with enough staff on hand, were not places you’d wish to spend your time. Many were obviously struggling to cope with the daily demands for time and attention among the residents. I talked enough with staff to discover that many of the people living out their final days in these facilities had no regular visitors. Their family, if they had any, either lived too far away to visit regularly or simply chose not to. Those with regular family visitors were the best looked after. The others? They got by as best they could.

When this is all over, there are going to be a lot of hard questions asked of government and public-health officials concerning our state of preparedness. In Ontario, we told ourselves for years that, thanks to SARS, we were one of the best-prepared jurisdictions in the world. It's hard to think that today. There were huge gaps in our planning, and our care homes were obviously one of them. Steps that could have saved lives could have been taken earlier, and, indeed, could have been part of the pandemic-response plans drawn up well in advance. They weren't. That's a failure of imagination that will land heaviest on the public officials, but, really, it should land somewhat on us all. I've written extensively about the health-care system and emergency preparedness over the years. I have more hands-on experience with care homes than most. And it never occurred to me, either.

We didn't have enough PPE. We didn't have enough staff. We didn't have policies in place to limit viral spread by part-time staff who worked shifts in different facilities. We didn't have a plan to surge extra help to the care facilities when disaster struck. If we’d had these things, we wouldn’t be calling in the military now. These are all problems we can fix. But it’s the fact that we don’t care all that much about the thousands of people slowly waiting to die in grim conditions — don’t even think about them much at all — that’s the underlying problem here. And I have no idea what kind of royal commission or blue-ribbon task force it would take to begin to address it.

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