Can long term care be fixed?

Bug infestations. Old food trays stacked inside residents’ rooms. Residents crying for help for hours. Staff reusing the same PPE for multiple patients, some with coronavirus, others not. Residents force-fed to the point of choking. COVID-19-positive residents allowed to wander through the facility. Key supplies locked away. Residents left lying in soiled diapers. Untreated bedsores. I wonder if Premier Ford regrets calling in the military to assist in five long term care homes overwhelmed by the pandemic. If instead he had just called in a bunch of nursing staff, and they had written a report, he could have quietly tucked it away along with all the other reports that have documented such issues again and again, over decades. But the Canadian Armed Forces report went straight to the Prime Minister, and made the national and even the international news. Conditions in long term care in Ontario have been appalling for a long time, but now that the whole horror show has been so publicly exposed, something will have to be done.

So what should be done? Opinions come with different political slants, but there is a lot of agreement on the basics. There have to be minimum standards for care and staffing, and they have to be rigorously enforced. Homes must be designed so that there are no more than one or two residents to a room, with an en-suite bathroom, and facilities must be available to isolate infectious residents. Staff should be permanent, and their work limited to one nursing home. They should receive wages high enough to attract qualified people to these positions, and benefits, including sick leave. Staff should be trained and competent to serve the complex needs of the elderly in nursing homes. The system must build more capacity to meet the needs of our rapidly aging population. Home care must be expanded too, so that as many seniors as possible can age at home and not have to go into long term care. And somehow the service must be made affordable, so that we don’t create a system only for the rich. What are the chances that all this will finally happen?

The failure is massive and cries out for change, but the obstacles are massive too. Long term care sits at a dangerous crossroads, where sexism, racism and ageism all meet. Long term care staff are overwhelmingly female and racialized, and are chronically underpaid. Our deeply ageist culture dismisses the elderly as disposable and wants long term care to be cheap. Historically we have turned a blind eye to the consequences. But the Armed Forces report has forced us to face those consequences. We don’t like to think of ourselves as cruel and will want to do something to end the abuses and ease our feelings of guilt and shame. But the fix is going to be very expensive. How much sacrifice is our still-ageist society willing to make? Long term care is a provincial responsibility, but health care money comes from federal transfers. The federal government will be very wary of treading on provincial toes. If we’re lucky, maybe they will set some general national standards and attach some new transfer money to long term care. But as it digs out of the pandemic, the federal government will have to face some hard choices about investing more dollars in health care. What would most Canadians pick: long term care or pharmacare? And the Ontario government, over the last few years, has set the stage for exploitation in long term care, with aggressive privatization, minimal standards, and virtually no oversight. The powerful long term care lobby, which makes lots of easy money out of this scenario, will do everything possible to ensure that their lucrative gravy train keeps rolling. They won’t want things to change.

Maybe we need to tweak Ontario’s Medical Assistance in Dying legislation, so that if we reach the point where we need long term care, we can choose MAID instead. It would be a great comfort, now that we’ve learned that ending up in long term care can be a fate worse than death.