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To fix the long-term care crisis, we must hold government and ourselves to account

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Image: Myfuture.com/Flickr

On Wednesday, May 27, 2020, Ontario Premier Doug Ford stepped up to the podium to address the state of long-term care in Ontario. In recent weeks, COVID-19 had ripped through several long-term care homes in Ontario, forcing our country to face the ugly truth of long-term care in Canada.

It brought to light concerns raised as far back as 1966, when Herbert W. Herridge stood up in Parliament and suggested we needed to address shortcomings in long-term care. Sadly, there is a long history of such voices being ignored. 

Taken at face value, Doug Ford's speech had all the right statements. Yes, we need more robust regulation of LTC. Yes, the reports were horrifying and heart-wrenching. Yes, we need to do more to ensure that those in LTC are treated with dignity and respect. And yes, we need people to be held accountable for their actions and for the "deplorable" state of LTC in Canada.

The problem, however, is that these statements do little to address the systematic and societal flaws that led us here. Take for example Doug Ford's call for an investigation that could lead to criminal charges, directed at five long-term care facilities. It makes sense to want to hold people accountable. As someone who has a loved one residing in an Ontario long-term care facility, I want accountability too. The problem, however, is that we have missed the mark on who is responsible.  

Responsibility for this tragedy, for the inhumane state of long-term care, resides at a much higher level than the worker making $15 an hour. Individuals do not enter this field of work for wealth or power, and certainly not to treat others as anything less than human. Most long-term care workers put up with horrendous, even traumatizing, work conditions -- with little to no benefits or supports -- simply because they love and care deeply. 

Responsibility resides higher than the privatized long-term care homes which put profit over people, dollars and cents over lives. Make no mistake, privatized care is a major player in the state of long-term care in Ontario, as well as several other provinces. The emphasis placed on money over the quality of life for residents and their workers is directly related to the conditions found in some long-term care facilities. 

However, we must ask ourselves, how has privatized care become so prevalent in some provinces, despite the evidence that this model does not lead to better care? 

The responsibility for this tragedy, I believe, lies at two levels. Firstly, and perhaps most obviously, the responsibility lies with the government. The responsibility lies with Doug Ford and his administration, and the federal and provincial governments that preceded him.

The devastating impact of COVID-19 in long-term care is symptomatic of decades of ageist policies and austerity measures. These are the real diseases plaguing long-term care homes. 

Responsibility begins with the state excluding long-term care from the Canada Health Act, positioning the health of older adults as less important than the rest of the population. It can be found in the offloading of responsibility by the state, displacing its duty of care onto the private market.

It can be found in union-busting policies and legislation, designed to squash workers trying to improve conditions of labour, despite evidence suggesting that improved work conditions lead to improved living conditions for those in long-term care. 

Responsibility also lies with all of us as a society. Canada has a dark history that we must come to grips with. It is a history of colonialism, racism, sexism, ableism and homophobia, and it is a history of ageism and the devaluation of care. 

Ageism can be found in our policies and structures, such as transitions to e-government which assume that everyone owns or uses a computer, or the lack of transportation options of socially isolated older adults.

It can also be found in micro-aggressions that are committed against older people daily, often unknowingly. Ageism is evident when we address carers or family members of older adults, rather than the older adults themselves, or assume that all older adults are frail and unable to contribute to society.

This latter assumption ignores the fact that many older people are able and wanting to work. It also ignores the non-economic value of stories, experience, wisdom, love and kindness that older individuals bring to society.

Ageism is blatant in the portrayal of older adults as economic burdens. The growing cohort of older adults is often called the "silver tsunami," suggesting it is something to be feared rather than valued and respected.The result is a long-term care sector obsessed on stretching the dollar, rather than ensuring that individuals receive the best care possible, the care they deserve as human beings. 

This devaluing of older people has bled into our understanding of care and care work. When older adults are presented as economic burdens, the solution is to devalue that care.

This is often achieved through staffing: hire less staff and fill the gaps with volunteers; cut the wages and full-time positions; favour part-time staff to avoid costly benefits. In other words, our society asks, what is the bare minimum level of care we can give while paying the least for staff? 

Staffing shortages lead to rushed workers with no time to care for people the way they were trained to, the way their morals tell them to. Rushed staff leads to violence, both against the staff from residents and from the staff to residents, intentionally or not -- an impatient "hurry!" here, or a rougher than intended lift there. Some residents might react to being rushed the only way they can, with a scratch or a strike.  

The problem with developing a care system that neglects and perpetuates structural violence against its staff is that the system comes to embody this neglect. It inevitably trickles down, until it is the residents themselves who are being neglected. A system built upon the devaluing of people can do nothing more than that, no matter the good intentions of the workers themselves. 

So when Ford talks about laying criminal charges, I beg of you, ask the question, who is really to blame for this tragedy? Is it the workers who have had their passion and love trampled out of them by a system built upon violence and neglect? Or is the state that has criminally neglected its duty to care for its citizens?

And is it every one of us for being complicit in the development of such a system? If we want true change, then we must hold those truly responsible accountable. It is time for Doug Ford and his administration to take ownership over their negligence. And it is time we do the same. 

Jordan Grimsley is currently finishing his bachelor of social work degree at St. Thomas University. He has worked extensively as a child and youth worker and an early childhood educator both in Canada and abroad, and is passionate about structural social work. This piece of research and writing was supported and funded by the NBHRF research chair in community health and aging.   

Image: Myfuture.com/Flickr

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