COVID-19 has infected nearly 60,000 Canadians as of May 3 but has a disproportionally deadly effect on our elders. While there are many excellent, well designed and operated Long Term Care (LTC) facilities across Canada and in Nova Scotia, there are too many that have fared poorly from government funding austerity and weak regulation.

Putting a loved one in long term care is likely the most difficult, gut wrenching decision ever made by families. It is for many the only remaining option, often overdue by the time exhausted spouses or children confront their circumstances. It is one of the rawest examples of the conflict and guilt created between our basic need to be a social, caring, inclusive species and the unemotional external rules of our economy.

COVID-19 revealed our decades old slide into accepting precarious employment, cheap products, minimal regulation, ‘efficiencies’, and corporations influencing (and controlling) us more than our democratic governments. But then in February and March, we realized that we valued our health and safety more than our consumer economy. All of us were suddenly in the same boat and we urgently needed a country-wide system to address the threat. The government, funded by taxpayers, had to take care of us.

The anticipated demand for acute care and ICU beds drove the response. Provincial lockdowns with reduced emergency-only healthcare services were necessary because the healthcare system had no surge capacity. Due to ‘efficiencies’ it was already operating at 98-100 per cent.

Although there was evidence from China and Italy that seniors were at grave risk from the virus, it was not until mounting deaths in Canada that governments started to mobilize the Armed Forces, increase wages and redirect resources to help besieged LTC facilities. But for many it was not enough.

As our LTC disaster continues to unfold, the rate of finger-pointing and blaming will increase. Losing a loved elder or disabled family member in LTC due to COVID-19 is clearly horrible and undeniable. While many errors and omissions have definitely been committed, reacting to each one with punishment or shaming, more money, or new policy will simply address the surface problems – the roots will remain intact.

We have known for many years that LTC is poorly funded, grossly uneven in its luxurious to inferior facilities with often poorly compensated or under-appreciated staff. The result is vulnerable residents. It has been a society trade-off, like poverty, homelessness, or child hunger – collateral damage in the pursuit of economic growth and balanced budgets. Our economy has been squeezing most of us harder every year – to work harder and spend more. We have been blind to the growing disparities, until COVID-19 found a near perfect setting in LTC facilities. The viral biology of rapid spread has forced us to confront a long-ignored reality. There is no possible public relations spin.

So far one-third of all Nova Scotia COVID-19 cases involve residents and staff at LTC facilities. As of May 3, 35 of the 37 deaths in Nova Scotia were residents in LTC. Trying to ‘fix’ what we have is not the solution. Quick money, facility renovations, token wage increases, telephone surveillance apps and slick technology will not address the deep system problem. Warehousing our old and disabled people is not acceptable.

COVID-19 has ironically revealed some wonderful things about us as well. It has taken all of us back to the most basic first principles; when everything is stripped away, when we all feel vulnerable at the same time, our reflex response is to say, “hey, we are all in this together.” Neighbours leapt into action to ensure those in isolation have food and other supports. Restaurants are making take-out meals, gyms are providing mental and physical health classes on-line, and people are raising funds to support elders and local businesses. Everyone is recognizing our usually invisible healthcare, frontline, and supply chain worker ‘heroes’ who are putting themselves at risk to keep us fed and safe.

This must be the essence of the blueprint for the future care of our elders. As a wise elder said, “I make sure I have friends in every decade.” This is only possible if we create dynamic inter-generational living hubs where families, singles, and students, of all age ranges and income levels, can interact and look out for each other. Another option is following Denmark’s lead where effectively supporting elders in their homes negates the need for nursing homes and lessens the burden on the healthcare system. They have made social and financial commitments to elders that have served them well during the COVID-19 crises.

Some other jurisdictions have attached senior homes to schools, where part of the school curriculum integrates meaningful interactions with elders. Encourage the full age spectrum to mix – breakfast and lunch making, reading, gardening and playing is a win-win-win experience for people and the system. Let kids learn real history from elders. Give each a sense of purpose. Ask elders to mentor youth. Get youth to keep elders active – mentally and physically. There are some local examples of this in Nova Scotia – it needs to be province-wide and not dependent on fighting for limited annual grants.

Our elders are offering us a teachable moment with their lives. Let’s not waste it. “When the tide goes out,” Warren Buffett once said, “you discover who has been swimming naked.” COVID-19 has revealed some profound system problems. We all own the LTC pandemic-revealed fiasco. It is a symptom of a deeper system problem that we all went along with. A better balance of market economy and government is required. Our participation in community needs to grow. Hey, we’re all in this together.

Dr. John Ross

Halifax

Dr. Robert Martel

Isle Madame