‘Why Do We Have This Kind of Carnage?’: André Picard on Elder Care in Canada

·19 min read

André Picard likes to stay busier than most, if his new book is any indication.

The Globe and Mail’s health reporter and columnist penned Neglected No More during evenings, weekends and vacations away from his day job as more Canadians turned to him to make sense of the pandemic unfolding around them.

But he wasn’t interested in writing about the pandemic just yet — “the important book about COVID will probably be written in 10 or 20 years,” he told The Tyee.

Picard wanted to ask different questions. And there were big ones to answer, as thousands of elders and residents of long-term care died during the pandemic’s first wave.

To date, at least two-thirds of the 21,905 people who have died of COVID-19 across Canada lived in long-term care or assisted living facilities.

“What kind of excuses do we make to ourselves as a society that this is acceptable?” asked Picard.

The failures of elder care in Canada, as Picard argues, began long before the novel coronavirus arrived.

Readers may be surprised that Picard forgoes lambasting the easy villains in the devastating crisis — for-profit care providers, “bad apple” care staff — in service of a deeper indictment of Canada’s refusal to value elders in life as well as in death.

Ten months after we first spoke about health reporting, I reached Picard by phone in Vancouver, where he is spending the winter as an Asper Visiting Professor at the University of British Columbia.

We discussed the difficulty of writing about people who often can’t speak for themselves, what accountability for these preventable deaths could look like, and how his optimism that the pandemic will be a turning point for elder care has managed to stay alight.

Moira Wyton: You wrote Neglected No More during the pandemic, but it’s not really about the pandemic at all. Where does this story begin for you?

André Picard: If you’re worried about health care in Canada, you have to write about elders and you have to write about older people, because that’s who uses the vast majority of care, so I’ve always been interested in this issue. And to me, we know that COVID has shone a spotlight on a lot of failings. We’ve all known for a long time that the way we treat seniors in our health system is terrible. And this was just an opportunity to jump on that topic and use COVID as a launching pad to talk about these larger issues.

How do you approach reporting on an issue where the people who are most affected, the elders in care or seeking care, are impossible to reach? Can there really be any substitute for speaking to elders directly? And what do you think you might still be missing from this picture?

You can do it indirectly. Normally, if I get a book like this, I would be going to the homes and visiting and getting the colour, et cetera, so the book is more sparse in that sense. That’s always a challenge. It’s not unique to the pandemic. You always wish you could speak directly to everyone all the time.

I always worried the most about people with dementia, and my two parents who lived with dementia, so you really wish you could get inside their mind, to know what they’re thinking and get their real thoughts and not get them second-hand, but you do as best you can. And you try and represent their lives fairly via their caregivers and their care providers, and other things that you can see when you have that opportunity.

With the pandemic, we’ve seen a rise in opinions about COVID-19, saying, “Oh, it’s not that bad, it’s ‘only’ killed people who are quite elderly.” I’m curious whether you think this failure that we’re seeing, and have been seeing for many decades, amounts to ageism and discrimination?

I think there’s no question that our public policies are just rife with ageism, it’s just ingrained. What other people in society do we send off to live in these prison-like facilities just because they’re old? And again, I think COVID sort of highlighted this, as you mentioned, with all the people just saying, “Oh, they’re old, they were going to die anyhow.” That’s just an appalling thing to say. Not only is it not true, but it’s appalling in itself.

And I think something like COVID, what happened in our home care — our long-term care system, specifically — is this perfect intersection of ageism, sexism and racism. The vast majority of workers are racialized. The vast majority of people living there are women. They’re not just older, but they’re women. It’s these three marginalized communities coming together in one spot. It’s just like triple the bad treatment. And so that’s why it’s a lot of focus on the homes, because there’s just so much wrong with them.

How do we as a society, and as journalists, even begin to address ageism, sexism and racism in elder care?

I think the starting point has to be a pretty profound philosophical shift. The countries that treat their elders the best have a philosophy that we don’t. You have to have that fundamental starting point... that you’re going to do everything in your power to keep people in the community and have a dignified life.

Now, we have a policy where the default mechanism is once you get a little sick, you can’t live in your home, we shoot you off to this home, out of sight, out of mind and out of dignity. There are good homes, I repeat that many times in the book, there’s lots of good care. But should people be there in the first place? That’s the larger issue.

I think we have to ask ourselves this really profound question about what kind of excuses do we make to ourselves as a society that this is acceptable. And it’s an uncomfortable question to ask because I don’t think there’s a good answer to it. It’s pretty appalling what they’re doing, and we have to confront it.

As you write in your book, better care is possible, and already exists for veterans in Canada through well-funded home care and long-term care for veterans who really need it at Sunnybrook Veterans Centre in Toronto. And in certain cultures, such as many South Asian cultures, staying in a multigenerational home is a lot more normalized and expected. How do you think those in charge of elder care in Canada can learn from these other perspectives and from what we’re already doing for some people?

We can learn a lot from cultural diversity. Canada has the benefit of being able to benefit from that, and we should do a lot more.

Respect for elders is what it comes down to in a lot of cultures. You wouldn’t dream of sending your grandparents off to live somewhere else. But the flip side of that is there are realities of modern life. Chinese culture is really seen as respecting elders, but we still have long-term care homes that are for the Chinese community, just because of the practicalities. Their kids now live 4,000 kilometres away; they don’t have five kids, they have one.

Regardless of your culture, I would think one issue that cuts across every culture is we should respect older people... for the knowledge of what they’ve given us, their sacrifice. I use the Sunnybrook Veterans Centre example because nobody ever argues that we shouldn’t treat veterans, right? If it’s good enough for veterans, why isn’t it good enough for everyone?

We have the solution. There’s no reason everyone in Canada couldn’t be treated like those at Sunnybrook. But before we do that, we should also make sure that only people who need to be in the home are there. That’s the other great thing about Sunnybrook: nobody’s there by default, they’re there because they really need the care that’s provided.

Over the last 11 months, for-profit care has been like a universal punching bag, being blamed for many deaths. But you’re a bit easier on for-profit care providers, pointing out that issues stem elsewhere. Why do you think that widespread anger against for-profit care is misplaced?

I decided deliberately to not write a lot about that, because I just think it’s almost a dogmatic political issue. I think there are some good private homes and some good public homes, or some terrible public homes and some terrible private homes.

Now, that being said, if there is no private care in Canada, will we be any worse off? No, I don’t think we need it. I think it’s been there for so long, it’s hard to get rid of it. And I think we would serve ourselves better to understand why it’s there, rather than just saying “get it out now.” I just think there’s a lot more to resolve before privatization. To me, the worst thing is not privatization in itself. It’s that we have a bunch of owners who are essentially property managers — they’re not care providers.

I understand why people are angry at private care when the data is yes, more people died in private homes. But again, there are explanations for that: the homes are older, they’re bigger, they have different clientele. So, what do we do with these “excuses”? We ask what’s happened there, but it doesn’t make it right. I just think that it distracts from doing other things that have to be done much more urgently.

You spoke to a number of staff and personal support workers in care facilities for the book. What stood out to you from your conversations? What do you think will be really surprising to readers about what they said?

I think people will be surprised at [the number of] people who are really dedicated to this work and really want to do better. And I’d say what would surprise the public is that the staff are just as angry and frustrated as families and recipients of care. People really want to be able to have time to care, and they don’t. So they leave their shifts, and they’re angry at themselves that they just couldn’t do what they know needs to be done... because there’s no hours, they don’t have the equipment, they don’t have the time.

I hope you’ll forgive me for asking about the pandemic a little bit. For this book, you analyzed data ending around Sept. 30, 2020, before the second wave had taken hold, and you sang the praises of B.C.’s handling of long-term care. Yet since the end of September, B.C. has had at least 1,000 more elders die in long-term care homes in a tragic and fatal second wave. What do you make of the fact that the second wave was so much worse?

Yes, first of all, the frustration of deadlines is real, especially for a daily reporter. That was always driving me crazy, knowing that the book would have to be done in September and wouldn’t be out till March. You hedge your bets a bit, so I focus mostly on the first wave, because nobody could predict exactly what would happen.

I said some positive things about B.C., but it’s all relative. I think B.C. has some policies, has some newer infrastructure, that made things better. Proportionally, probably today, B.C did a little bit better in the second wave too. But I think it’s just a reminder that nobody did a good enough job of learning the lessons of the first wave. Quebec made a big show of hiring 10,000 more workers. And in the end, how many did they get? Maybe 5,000. B.C. did the same thing, made big announcements about hiring more people, but they lose almost as many as they hire. Also, we let down our guard, and I think that’s true everywhere in the country. It’s doubly tragic that the second wave was worse than the first wave because it just reminds us we didn’t do enough to correct [the mistakes]. The horrors that happened the first time around just got repeated — and then some.

Does this make you think differently about what you wrote or the capacity of the elder care sector to have learned and enacted changes during the summer’s lull in cases?

To me, the most frustrating and angering thing I see comes where they’ve now had two and three outbreaks. How can you not learn from that? Fifty people die in your home and then you bury them, and then you make the same mistakes? It just seems so unthinkable.

And I think the larger [issue], the one we’ve known all along, is the way to prevent cases and deaths in long-term care is to get control in the community. That’s been our biggest failure, because we just never got control of the pandemic within the larger community. The homes are not isolated. We can do our best to isolate them, but they’re not ever going to be isolated from the community. We forgot that the way to solve this was to solve the larger problem of the virus.

The second part is, we could have done better on testing. We know we banned workers working in more than one home. But there were exceptions to that rule every day. The locking out of caregivers — it’s a big mistake to the degree and the length of time we did it, it’s just horrible. People suffered a lot from the isolation and the loneliness, as much as from the pandemic. We should have found ways to make it safer for caregivers because they’re so essential to the care.

And then the big one is: we never solved the fundamental problem of the labour issue. There are just not enough bodies in there to provide the care. The lack of good care makes it easier for diseases to spread and more people working with large numbers of people... you have them being less cautious because they’re in a hurry.

All these things all feed into each other. I hear from families every single day about how frustrated they are, and you can’t argue with them. It’s awful, what’s still going on.

In the beginning of the book, you said you were skeptical that there would be any accountability for the mass deaths of vulnerable seniors that we have seen. Why is that?

We’re not ever good at accountability in Canada, because we don’t have a system. Nobody’s really in charge. It’s hard to figure out who’s accountable [and] there’s a structural way of avoiding any accountability, which is unfortunate.

Are people going to go to jail for this? Are they going to be losing lawsuits? I don’t know. If you look at Canada’s history, that’s very unlikely to happen, unfortunately. What we have to focus on is building a better system, so it doesn’t happen again.

What might accountability look like in that better system?

On the ground, at that level, we need better inspection, better regulation. But I try to be careful to say not more regulation, because we have so much regulation and people work in these homes, but they don’t measure the right things. We make sure that the fridge is exactly at the right temperature, but there’s not really any measure of quality of care. So you’re going to have someone wallowing in their feces for 10 hours, and as long as their milk is the right temperature, the home passes with flying colours.

And then there has to be political accountability, and I think that the political accountability comes from putting someone in charge. A lot of these elder care issues go across four or five ministries in most provinces, and no one’s really in charge and there’s a lot of buck passing. I’m a big fan of having a serious ministry of seniors, or of elders, or whatever you want to call it, and put them in charge and make sure they’re accountable.

B.C. stands out in that it has the seniors advocate. I think that’s a really good step, even though she doesn’t have any power. But she does have at least the ability to kind of embarrass the government and put them on the spot, so there’s some accountability there.

When I asked you in April whether you thought the pandemic would trigger structural changes to health and social safety nets, you said no except for “some hope on the seniors’ care side, just because it’s so, so devastating.” Are you still optimistic things will change?

I think there’s a real opportunity to fix things. I think there has to be a certain amount of guilt in politicians, and seeing how horrible this is, and wanting to fix it. So yes, I do have some hope. I despair at the fact that it took this much to make us even talk about change — it should have never have come to this. When we see countries that have zero deaths in long-term care, you just shake your head and say, “Why? Why couldn’t that be asked of one of the richest countries in the world? Why do we have this kind of carnage?” I’m hopeful, but I think hopeful with an asterisk on it.

You have been open that your parents both lived with dementia in long-term care. What is the personal impact of this reporting been for you? Is there a part of this process that stays with you?

First of all, I’m old. So that gives me a personal stake in this, I’m getting up there in age. But on a more serious note, anyone who’s had parents who have gone through “the system,” who’s had parents with dementia, with these chronic illnesses in long-term care, they lived these frustrations. And they stay with you, they anger you, and that anger never really goes away.

I think you see some of that in the book, that I understand and empathize with what a lot of the families are talking about, because I lived it too. And then I just have the benefit of knowing the system from having written about it a long time. And I hope that combination makes it a little more powerful.

For people without that personal connection and or that lived experience, how do you think we rally or engage them in pushing for more investment and transformation?

I think you have to remind them that everyone’s going there eventually. We’re all on a fast stream to taking care of our parents and our grandparents. This is simple demographics — there are fewer children born, our parents are living longer, and it just means there’s going to be more and more caregivers, and they’re going to be younger and younger. There’s going to be a lot more pressure to do this on everyone. Even younger people really have to take this to heart. It’s going to be a lot more people caring for their parents and their grandparents.

One of the most interesting trends in the caregiving data is grandchildren caring for elders. That’s a fairly new thing. So I think this issue is expanding, and it’s touching much more people across society. I hope that will give impetus for governments to act, knowing that people are really going to want change, and they’re not going to be part of our neglect of elders.

The younger people, I think, are more outspoken, and they’re more adept at doing that, and they’re more willing to speak out. It’s not the same as my parents’ generation, where you would never even question the government, you don’t question your health-care provider. That stuff’s all going out the window.

One of the first lines I highlighted in the book when I was reading was you saying that an aging population is a success, and it’s something to honour and to cherish in our country. What would be an indication to you that Canada is moving in that direction?

The way to honour people is to make sure they live in dignity, that they live where they want and how they want. Once that becomes the guiding principle, everything flows from that. We just don’t have that principle. We talked about this respect of what veterans have given, the sacrifice. And not to undervalue the contributions of veterans, but that applies to that entire generation. They’ve made sacrifices that we’ve built on, and we owe them. They’ve paid their taxes for 40 and 50 years. And now it’s time to cash in. We are already reneging on that basic social contract in a really horrible way.

Thank you so much, André. I actually lied, I have one last question. Where on Earth did you find the time to write this book?

People keep asking me that. I always keep busy, I’m a very regimented person. So I sort of decided to do this fairly late in the process. Publishers were approaching me to do some books about COVID, and I wasn’t interested. Because to me, I think the important book about COVID will probably be written in 10 or 20 years when we have the proper perspective. And then suddenly, someone said, “Well, what are you interested in?” And after I said elder care, they said, “Go for it.” So then from that it went really rapidly. I had in my mind what I wanted to highlight, and I said I’m just going to do it in a regimented way, I have 60 days, I have 1,000 words a day to write after my day job. I didn’t want to take time off work, other than anything I took from my summer holidays to do this, because the pandemic was already keeping me very busy

Moira Wyton, Local Journalism Initiative Reporter, The Tyee