Andre Picard - Neglected No More: The Urgent Need to Improve the Lives of Canadas Elders in the Wake of a Pandemic

When eldercare makes headlines in Canada, its usually news of the worst kind.

On June 26, 2017, former nurse Elizabeth Wettlaufer was sentenced to life in prison for murdering eight vulnerable elders in care homes where she worked in southwestern Ontario. The inquiry that followed concluded that, had she not confessed, Wettlaufer would never have been caught.

Just after midnight on January 23, 2014, a blaze broke out in the kitchen of the Rsidence du Havre nursing home in LIsle-Verte, Quebec. Thanks to a lack of sprinklers, the absence of staff to help frail residents escape and the inept emergency response that followed, thirty-two residents suffered horrific deaths. No one was ever charged.

On January 20, 2019, 93-year-old Hlne Rowley Hotte, the mother of former Bloc Qubcois leader Gilles Duceppe, left her seniors residence in response to a (false) fire alarm, without anyone on staff noticing. The emergency exit door locked behind her. That night the temperature in Montreal dipped to minus-21 degrees Celsius, and Hlne Rowley Hotte froze to death. A coroners inquest ruled the death was preventable but accidental. No one was charged.

Then came Covid-19.

As the novel coronavirus slithered into unprepared long-term-care homes, elders were no longer dying one at a time, or even by the dozens, but by the hundreds and thousands. Those deaths too were largely preventable. You can bet your lunch that no individual or organization will be held to account for the mass death of vulnerable seniors.

Eldercare in this country is so disorganized and so poorly regulated, the staffing so inadequate, the infrastructure so outdated, the accountability so non-existent and ageism so rampant, there seems to be no limit to what care homes can get away with.

Of course, there will be the obligatory inquiry. When a gross societal failure occurs, you can always count on Canadian politicians to embrace obfuscation and foot-dragging in lieu of action. In her 1,491-page report, Madam Justice Eileen Gillese, the Ontario Court of Appeal judge who presided over the Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System (the Wettlaufer inquiry), said the reason a killer can run amok, undetected, is systemic vulnerabilities. She concluded that assigning blame to individuals or organizations is counterproductive.

Thats pretty much the conclusion of every coroners report, judicial inquiry and investigation that has ever been conducted into failings such as those cited above. And, remember, those cases are just the tip of the iceberg, the spectacular failures that generate media attention and political hand-wringing, not the everyday neglect that is deadly too. Yet the systemic vulnerabilities that are exposed time and time again never seem to get corrected. In Canadian health care, it seems, no screw-up, no matter how big or small, how sickening or deadly, is ever anyones fault. Its always the fault of the system.

So lets fix the damn system.

Neglected No More isnt a book about Covid-19, except peripherally. Its a plea to stop dehumanizing elders, and to reimagine long-term care (LTC). It tells of families frustrated by their inability to access the care their loved ones want, the angst of dedicated workers who dont have the time or resources to deliver the care elders want and need, and how a combination of history, changing demographics, political inertia and a health system with other priorities created a proverbial perfect storm that allowed a pathogen to ravage a vulnerable population.

Its not a call for heads to roll that will never roll. Its a stark expos of whats wrong and a rough blueprint for what we need to do to fix eldercare.

When I first wrote about AIDS in 1981, the acronym had yet to be coined; the strange new illness, which seemed to affect only gay men, was dubbed GRIDgay-related immune deficiency. In the four decades since, AIDS has become, arguably, the most deadly pandemic in human history. At least 36 million people have died of AIDS, and another 40 million are still living with HIV, the human immunodeficiency virus that causes AIDS. (Of course, nothing compares to the Black Death. The bubonic plague killed somewhere between 75 and 200 million people between 1346 and 1353. But that was long before the advent of medicine or public health measures such as sanitation and clean water.)

AIDS has not only described the arc of my career in journalism, it has spawned in me a long-standing interest in pathogens more broadly: the viruses, bacteria, fungi, parasites, worms and prions that have been the scourge of humanity since the dawn of time. I have written about all manner of infectious micro-organisms, from the obscurely rare to those that casually kill millions a year, everything from sleeping sickness to tuberculosis, chicken pox to Ebola, polio to influenza.

Outbreaks rarely generate much media attention. The exception was Severe Acute Respiratory Syndrome (SARS). In 2003, SARS-CoV killed forty-four Canadians, devastated the economy and exposed gaping holes in our public health infrastructure. It was a dress rehearsal for a real pandemic.

The formal name for the pandemic virus that causes Covid-19 is SARS-CoV-2. When it arrived in our midst, someone (I wish I could remember who) said, Youve been training for this moment your whole life. Thats true. For me, infectious diseases are fascinating not because of their biology, but because they almost always have wide-ranging social, economic and political implications.