Long-term care and ‘the great revealer’

What has the pandemic shown us about how we care for the aged?

First in a two-part series

By Amy MacLachlan, special to the Anglican Journal

When military personnel were deployed to long-term care homes in Ontario and Quebec during the pandemic’s first wave in the spring of 2020, they encountered a system that some had said was in dire need of change even before the pandemic. But COVID-19 brought increased public attention to the system’s shortcomings as it spread through long-term care homes across the country.

Nearly four-fifths of the Canadians who died during the pandemic’s first six months were residents of long-term care and retirement homes. COVID-19 is, admittedly, an especially dangerous disease for the elderly, but this proportion was high even by global standards. By February 15, 2021, it was 69 per cent—still much higher than the international average of 41 per cent, according to the Canadian Institute for Health Information.

A May 2020 report detailing what the army found spread shock and outrage across Canada: untrained and insufficient staffing, poor virus prevention and management practices, and, in some cases, extreme neglect and a lack of basic sanitation and hygiene—resulting in, as summarized in one CBC story, “cockroaches, rotten food, patients with ulcers left bed-bound, staff moving from unit to unit wearing contaminated gear.”

To many Canadians, it seemed the pandemic had proven the long-term care system in Canada was broken. But exactly how to fix it seemed a more difficult question. In late September, as this article was being prepared for publication, Canada had just seen a federal election campaign in which major parties had proposed solutions ranging from abolishing for-profit care (the NDP) to offering tax credits to people who take care of their elderly relatives at home (Conservatives and Liberals), among other measures. The Trudeau government was re-elected on a platform that included $9 billion in spending on long-term care over five years, as well as a plan for a national standard for long-term care.

Some Canadian Anglicans and other Christians whose work has connected them in one way or another to the pandemic or long-term care have a similar range of views on fixing the system. But they also wonder whether the questions Canadians have been asking about it run deep enough.

The Rev. Michael Garner is associate incumbent of St. Thomas the Apostle, Ottawa. Previously an infectious disease epidemiologist at the Public Health Agency of Canada, Garner has advised the church on its response to COVID-19 during the pandemic. He says the virus has raised uncomfortable questions about apathy and denial in Canadian society as it has made its way through the long-term care system.

“The pandemic has exposed our lack of care, to be quite honest,” he says. “It’s exposed something that was there, and that if we really thought about it, we probably knew was there all the time but perhaps were willfully ignorant of.”

Garner says when he used to make pastoral visits to long-term care homes, he would reassure himself that the government was keeping watch over them. But the comfort he took from that, he now says, was misguided. “Even when they were beautiful, spiritual visits,” he says, “there was this overarching oppressiveness of these places. And the way I got myself off the hook was, ‘Well they’re regulated. And it must be okay because these places are regulated.’ And that, to me, is an indictment of me.”

Many argue that government oversight has been lacking. And according to a Dec. 20, 2020 report released by Ontario’s own Long-Term Care COVID-19 Commission, the province proactively inspected fewer than two per cent of its 626 long-term care homes from March 1 to October 15 of that year.

The Rev. David Pfrimmer, professor emeritus at Martin Luther University College’s Centre for Public Ethics and a Lutheran pastor, agrees that a “willful ignorance” in Canada of the plight of the old and vulnerable has had terrible consequences.

“Ignoring the elderly has gone on for many years,” he says. “Underfunding long-term care has been a long-term problem.”

Pfrimmer was part of the Ecumenical Health Care Network, a now-defunct advocacy group of the Canadian Council of Churches, in the early 2000s during the Romanow Commission hearings on health care in Canada.

“The original sin was not to include long-term care in Canada’s Heath Act,” he says.

Pfrimmer argues for a return to the idea of the public good, saying that most Canadians are willing to pay more taxes for better health care—and to more creative thinking about economics and care. He says the pandemic highlighted inequities that have been in place for decades, and “shone a light on the assumptions of how we organize our world.”

“We keep hearing we can’t afford things. But we can’t afford business as we’ve had it in the past,” he says. “People are saying, look, the pandemic has shown the flaws of the system. We have to fix the environment, the economy, and the health-care system, so we can safeguard the health and well-being of the vulnerable.”

Four of the five Ontario homes described in the military’s report were privately owned, and Pfrimmer believes moving away from privatization is a good place to start.

“We think of COVID as the great revealer—it revealed that for-profit long-term care outside of the Canada Health Act has been a death sentence to so many elderly and senior people in Ontario,” he says, noting that dividends continued to be paid to shareholders while standards of care were all but ignored.

There are 2,039 long-term care homes— facilities that provide 24-hour care—in Canada. Of those, 54 per cent are privately owned, according to the Canadian Institute for Health Information.

Acknowledging that a private system isn’t perfect, Garner is wary of abolishing it completely. “The scope of the problem is so massive—but then if we leave it to the government, I’m not sure that they’re the people who should be trusted to do the sort of reform that’s necessary,” he says. “If the public system was this well-oiled, functioning machine, I think it would be easier to make an argument [for abolishing private care]. I think the public system needs to be reformed, and maybe until it can demonstrate that it’s functioning, I’m not sure that I would say that everything needs to be publicly administered.”

Taking care of those in need of long-term care, he says, is “a strangely demanding job, emotionally, and I’m not sure that we’re providing all the supports.” Having part-time, ill-equipped staff working in multiple homes was a huge part of the problem during the pandemic, he adds. “We set up a system where a disease could rip through those long-term care facilities. But it’s this job and this caring that we don’t really want to do. So we outsource it—to the lowest-cost way, too often. I think it should challenge the way we see what our society values.”

In April 2021, an independent commission released its report on the pandemic and long-term care homes in Ontario, saying decades of neglect by successive governments had left the province’s system unprepared.

The pandemic has spurred provincial governments to pledge billions to improve conditions at long-term care homes. According to Ontario’s ministry of long-term care, the province has spent, or is committed to spending in coming years, $9.6 billion on long-term care in response to the pandemic—money intended to, among other things, increase the number of daily hours of care per resident, create new long-term care spaces and make it easier for seniors to remain at home. g

In our December issue: Does the problem go beyond dollars and cents? The second and final part of this series will look at faith, society and long-term care.

—with files by Tali Folkins