COVID-19 has exposed decades of elder neglect. Here’s how we can start to fix it

Bouquets of flowers line the sidewalk outside long-term care homes in many communities. Why did we never offer our support and encouragement to the residents and staff of these institutions until COVID-19 struck?

There are daily salutes to the caregivers who spend 12-hour days dressing, feeding and bathing dozens of frail seniors per shift, at risk to their own health. Why did it never occur to us before how hard they work?

We wonder - and worry - about elders who live alone in small apartments or empty houses. Why did it take us so long to realize how lonely and vulnerable they were?

If the COVID-19 pandemic has had one tangible benefit, it is that it has exposed the ageism embedded in our society. It's not overt discrimination; it is an unspoken assumption that individuals who can no longer contribute to society have little value.

It wasn't always like this. In Canada's not-too-distant past, multiple generations of the same family lived under one roof, elders were respected and cared for by their children and grandchildren. Farms and businesses were handed down from one generation to the next.

Today, that is a sepia-tinged memory for most of us. Our homes and apartments are not designed to accommodate aging parents. Both parents in most families work to pay the household bills, leaving no one at home to care for children or elders. We have turned to a government-regulated array of subsidized seniors' apartments, retirement residences and long-term-care homes - some public and some privately-owned - to take care of our seniors.

It is easy to explain why a disproportionate number of the COVID-19 infections and deaths have occurred in long-term-care settings.

The residents of these institutions typically have one or more chronic conditions. Many take medications that make them susceptible to infectious diseases such seasonal influenza, urinary tract infections and pneumonia.

According to the 2010 chief public health officer's report on the state of public health among seniors in Canada, more than half (56 per cent) have high blood pressure, 43 per cent have arthritis, 39 per cent have some form of cancer and 21 per cent have diabetes.

Many have a combination of diseases such as angina, asthma, bronchitis, emphysema and chronic obstructive pulmonary disease.

When people with underlying morbidities are concentrated in retirement or long-term-care homes, all it takes is one infection to precipitate an outbreak.

What is not easy to explain is why we allowed our political leaders to underinvest in facilities for elders for so long.

Most long-term-care homes are chronically understaffed. They can't afford to provide residents with healthy, nutritious meals using the funds they receive from governments. Their tight budgets don't permit them to stockpile high-quality personal protective equipment. Until recently, the wages of personal support workers and cleaners were miserably low and the turnover was high.

None of this is a secret. The Registered Nurses Association of Ontario has been sounding the alarm for decades. So has CUPE (The Canadian Union of Public Employees, which represents thousands of health-care workers.) There have been anguished calls for help from Canadians whose parents aren't getting the support they need. And there have been repeated exposi(C)s in the Star and other newspapers, on air and online of the conditions in the institutions.

For the most part, these warnings have gone unheeded. A few have prompted government inquiries and investigations, but even then, the followup has been minimal.

Families, neighbours and charities have tried to fill the gaps. But they're not trained or equipped to deal with complex needs of residents requiring round-the-clock care. Nor can they provide the resources to upgrade the quality of care in these homes.

What is saddest, perhaps, is that seniors have to line up to get into long-term-care homes - usually for months, sometimes for years. The median wait time in Ontario is currently 23 weeks.

This demographic imperative has been clear for years. But we looked the other way. There was no crisis.

Now there is. Nearly 100 senior-care homes in Ontario are reporting outbreaks of COVID-19. The death toll from the virus is rising three times as rapidly in these institutions as in the general population. So many caregivers are infected that some institutions are struggling to provide basic support to their residents.

Belatedly, governments have responded.

On March 29, after a prod from seniors' activists, Prime Minister Justin Trudeau announced $9 million in financial support to allow local United Ways to deliver groceries, medications and other essentials to isolated seniors and connect those who needed additional help to community organizations.

That was 18 days into the global pandemic. Ottawa had already injected $1 billion into Canada's hospitals; announced $82 billion in financial aid to businesses and families; closed Canada's borders; sent repatriation flights to Morocco, Peru, and various points in the United States to bring home stranded Canadians and launched a $30-million advertising campaign to promote physical distancing and enhanced personal hygiene.

Ontario Premier Doug Ford was slightly faster off the mark. On March 17, he declared a state of emergency in the province. Eight days later, he announced $243 million to provide "surge capacity" in the long-term-care sector. The following day, in his economic statement, provincial Finance Minister Rod Phillips announced that Ontario was doubling its guaranteed income system for the next six months, targeting the additional funds at low-income seniors.

What still hasn't happened is an acknowledgment from any level of government that Canada's long-term care sector is overstretched, underfunded and ill-prepared for the tsunami that will hit when baby boomers reach their vulnerable years.

What isn't clear - in Ontario at least - is whether long-term-care workers will be treated equitably when it comes to the distribution of personal protective equipment and respirators for gravely ill residents.

What we don't know is whether age will be a determinant of who gets scarce health equipment.

Assigning blame is not useful while people are dying. Yes, a handful of seniors' residences cut corners and put their residents at risk. It is clear, with hindsight, that policy-makers took too long to include seniors in their relief packages. And it is painfully obvious that we, as citizens, failed to speak up for Canada's seniors at budget time, election -time, indeed most of the time.

But in midcrisis, the imperative is to fix what we can and to vow not to let the long-term sector fall off the radar screen again, when this pandemic has passed.

• First, we can properly equip caregivers in nursing homes and retirement facilities and their colleagues providing home care to vulnerable seniors.

• Second, Premier Ford announced Tuesday that the province would rightly start preventing caregivers from working in multiple long-term-care homes. But if the province wants caregivers to provide consistent, trusted care to residents of just one long-term care facility, it will have to start providing them with a living wage.

• Third, we can applaud and donate to the organizations whose volunteers are out there ensuring that isolated seniors get groceries, medications, incontinence pads, diabetic supplies and personal notes.

• Fourth, we can take a hard look at our values and attitudes. Do we really want to treat our elders with benign neglect? Do we want to devote so few resources to Canada's seniors that we deprive them of their well-being and dignity? Would we be content with the kind of support our forebears are receiving?

• Finally, those of us with the luxury of time during this pandemic, can reflect on what we've lost: the wisdom, the life lessons, the stories and the principles of those who faced - and overcame - adversity in the past.

Flowers and placards and notes and cards help the survivors locked in retirement and long-term homes hang on. Waves and honks send a message of inclusion. Now we have to build on this small, tentative start.

Carol Goar was a Toronto Star columnist for 40 years.