by Roger Ali (March 30, 2021)
Neglected No More: The Urgent Need to Improve the Lives of Canada's Elders in the Wake of a Pandemic, André Picard, PenguinRandomHouse Canada, March 2, 2021, 208 pp., $19.95
Neglected No More by André Picard is a compelling read about the urgent need to improve the lives of Canada’s elders in the wake of the pandemic. He makes a heartfelt plea to stop dehumanizing elders, to reimagine long-term care and to fix a broken system. Sadly, it took a coronavirus pandemic to open our eyes to the deplorable state in long-term care homes.
Picard paints a bleak picture in the first part of the book.
I couldn’t stop reading the horrors, startling facts and disturbing reality of neglect of our elders. The stories of inadequate personal care and proper hygiene, over medication, physical abuse and unpalatable meals have persisted for what felt like decades, all of which were “observations” in the 21 page memo to the Minister of National Defence.
Picard best summarizes Eldercare in Canada as “so disorganized and so poorly regulated, the staffing so inadequate, the infrastructure so outdated, the accountability so non-existent and ageism so rampant, there seems to be no limit to what care homes can get away with.”
The story begins with André Picard’s insightful prediction that seniors were especially vulnerable to COVID-19 outbreaks. That came true in a matter of weeks when we learned the severity of the long-term crisis in the facilities in Ontario and Quebec. He showed the statistics of the top fifty hardest hit facilities, of which thirty-six were in Quebec and the rest primarily in Ontario. What’s even more shocking is the revealing statistic of a much bigger issue we face. As of September 30th, Canada had recorded 9,262 Covid-19 deaths, and of that total 7,609 were in residential care homes.
Picard provides a historical account of milestone moments and significant details on Healthcare Acts that shaped the state of eldercare today. Of note, a watershed moment for Medicare occurred in 1984 when Health Minister Monique Bégin tabled legislation creating the Canada Health Act. Picard describes the five conditions provinces were required to meet in order to receive health care dollars from the federal government. Those preconditions, public administration, accessibility, comprehensiveness, universality and portability came to be viewed as the principles defining modern Canadian medicare.
I found the stories of many elders and their families dealing with long term care shocking because, unlike hospital care, it is not fully covered by medicare.
Picard’s uses clear, simple language to distill the nomenclature of the types of care facilities in less complicated terms. He describes long-term care homes as facilities that provide nursing care and personal care 24/7. In comparison, retirement homes are assisted living facilities, continuing care homes, lodges, supportive housing and more, where varying levels of care can be provided, but not 24/7 and rarely with nurses on site. Canada has a mix of state-owned, not-for-profit and for-profit care homes, roughly in equal numbers.
In the news and articles on eldercare, I see a global trend to build care homes on a much smaller scale integrating them in the community, with a more familiar, homey physical environment. Picard gives examples of alternative models that are relationship based care rather than transactional care. Unfortunately, the legislation in Canada is highly prescriptive and very restrictive, not giving opportunities for innovative approaches to eldercare. If only, we could put the person first. He continues to paint a daunting picture on the challenges with expanding access to home care. It is difficult to calculate home care spending with any precision because there is no common definition. The COVID-19 crisis exposed many problems in long-term care homes, but home is a safe place to be and where people want to be.
The stories on dementia overwhelming families, the access to palliative care at the end of life, the challenges of low wages for PSWs, the short supply of nurses, the overburdened caregivers complicate the goal of aging gracefully and having access to reliable and individualized eldercare. André Picard emphasizes that during the pandemic, home care services were cut drastically out of fear that PSWs could spread coronavirus to patients, so even more duties fell to caregivers. He points out that only one in six Canadians can get palliative care at home. Further, there is a dire shortage of specialists in palliative care and family physicians have taken the gauntlet with little training in pain management. Yet, people who get palliative care not only live better they live longer.
Where do we go from here in what is a long overdue rethink of eldercare in Canada?
I am a big believer in “Houses with Purpose”, André Picard describes as multi-generational, freewheeling homes where people choose who they live with and set their own rules. The concept is simply to bring together people, young and old, with similar interests or values, and they would share the chores and expenses. The other examples described are aging-in-place initiatives that combine low-cost housing and community care. Picard sums up the rethink well, “We have to consider the place of community care, of supportive housing, of aging in place. There’s nothing more important than where people live.”
I enjoyed reading the digestible “Around the World” models of eldercare, the benefits and challenges with each one and the best place to grow old. Denmark rose to the top of the list as the country to make healthy aging a priority, and this included rejecting institutionalization. How then can we reform Canada’s health system? Why haven’t many recommendations to improve long-term care ever been implemented?
Staffing, work environment, caregivers, long-term care homes, home care, palliative care, funding structure and regulation are areas where the biggest problems exist. We have an opportunity to do things differently, to do them better, post pandemic and post vaccine. Fundamental change must be reflected in our public policies and the environments where elders can thrive. Can the neglect end?
(Roger D. Ali, MBA, C. Dir., is a recognized nonprofit leader and a book reviewer of The Charity Report since 2019 @fundraiseroger)
Other reviews by Roger Ali
Covid-19: The Pandemic that Never Should Have Happened November 12, 2020