Long-term Care Homes: The Axe-Blow of the 21st Century
Monique Peters, Online Staff Writer
November 21, 2020
For much of our evolutionary history, ancient elders, while enjoying the intimacies of community and the intricacies of social hierarchy, often left the most vulnerable to suffer terribly (1). Vulnerable populations, including the old, were often slain and left behind. While the idea that an elder might inconvenience someone to the point of deserving an axe-blow to the head has mostly been buried with our ancestors, our social distaste for elders has not. COVID-19 has had widespread impacts on many of Canada’s long-term care homes; unveiling the consequences of living in a culture that avoids the topic of ageing. Eighty percent of all deaths caused by COVID-19 were in long-term care homes, even though these homes comprise less than one percent of the Canadian population. In this context, however, COVID is less to blame than the broken systems of long-term care.
Ageing is a centuries-old dilemma. In the early 20th century, in Europe and America, the elderly who did not have a child nor independent wealth were left to shelter in poorhouses. Poorhouses were often grim places, meant to punish groups such as the elderly, poor immigrants, and the mentally ill for their shortcomings through meaningless tasks. Illustrated in a 1912 report from Illinois State, Charities Commission described poorhouses as “unfit to decently house animals.” In 1935, the passage of Social Security and pensions aimed to end these poorhouses, but the problem persisted. It soon became evident that economic dependency was not the only factor bringing this population to poorhouses— it was frailty. Instead of social security measures, it became the rise of the hospital that allowed poorhouses to empty. With the elderly unable to afford proper housing, their increasingly high residence in hospitals led to an initiative to create separate units for those in need of extended care. This leap was the beginning of the modern nursing home. While the intentions were just, these nursing homes were not meant to help people cope with old age—they were created to clear out hospital beds. Hence, we are left with the ill-designed nursing homes’ systems, where the intent is to pacify the elderly as they dwindle.
Dr. Sinha, Head of Geriatrics at Toronto’s Sinai Health System, describes these systems as “designed to fail.” Canada’s national health insurance does not cover long-term care, and when Canada established Medicare in the 1960s, long-term care was barely considered. Up until 2001, efforts to dedicate a federal transfer for long-term care services were never implemented. Thus, not only are homes often riddled with high rates of up to 40% depression, but a division of for-profit and not-for-profit care means that these populations are drastically underserved.
The extreme social aversion of ageing, coupled with historical context makes the atrocities of Ontario’s long-term care homes almost expected. In Ontario, federal government assistance in long-term care homes quickly revealed long-known truths. Cockroach and bug infestations, seniors calling out repeatedly for help, rotting food, COVID-19 infected patients put in the same room as healthy seniors, and seniors left in soiled diapers and linens are all cries to fix a system has been in crisis for centuries.
When Ontarians awoke one morning to a military report that exposed long-term care for their egregious malpractice, the shock that riddled young faces brought a figment of irony with it. Who can expect the elderly to be well cared for when nursing homes are the axe-blow of the 21st century?