Exploring the disaster in care homes

Maybe you’ve had this thought too: since sending in the army seems to have worked for overmatched long- term care homes in Ontario and Quebec, why aren’t we doing it a lot more often? Think of all the other institutions that don’t always seem to serve us so well! Do you live in an under- policed, crime- ridden neighbourhood that could maybe use a visit from Joint Task Force 2? Are you in a place where having military engineers build and operate public transit seems attractive? Do you cheer for a chronically lousy sports team that could benefit from the attentions of a grumpy colonel?

It would be hard not to notice about five minutes into this sort of daydreaming that you’re just describing a banana republic. The horrid truth is that the army was used to address the situation in failing longterm care homes just because its medical apparatus consists of young, healthy people who are conditioned to facing personal risk.

There was no question of expertise here: Canadian Forces personnel sent into the facilities had to be brought up to speed on problems and procedures of geriatric care before deployment. And the army wasn’t needed for its ability to use lethal force. If anything, the career military officer’s training in clear communications and practical politics proved much more useful. Brig.- Gen. Conrad Mialkowski’s frank report on the five Ontario care homes that 4th Division had taken over did not come before the public, or capture its attention, by accident.

But in t he ordinary course of events we already have an “army” with plenty of power to enter care homes and report on what it sees, and it does that. The real army came in handy here because there was the equivalent of a natural disaster, and care homes weren’t paying their own staff enough to expect them to risk their lives staying on the job. Thirty-nine soldiers, at last count, have been infected with SARS- COV- 2 at care facilities since the Forces were called in. That’s a pretty astonishing number, given that a military doctor’s or nurse’s training in the use of protective equipment has to cover hypotheticals like biological warfare or deployment to a zone of endemic cholera.

Very few of these people will have multiple comorbidities, or be obese, or even be very far over the age of 50. They were placed in the pathway of a particular sort of harm that they are physically and mentally well equipped to bear, and that civilian nurses and orderlies might not be. It is a justifiable response to an unforeseen challenge, but we definitely need to be careful not to make it a habit.

Is there something especially bad about the Ontario and Quebec systems that made this necessary, as it has not been yet elsewhere in Canada? CBC News has pointed out that in Ontario, the new long-term care ministry had all but stopped performing annual surprise inspections of care homes. This is made to sound like typical Tory rapaciousness, but the connection with the current crisis is slightly speculative.

The long- term care ministry had decided to drop surprise inspections in favour of a complaint- driven system, which would have the effect of concentrating inspections on homes where patients, employees and families noticed a lot of problems. If you read the reports, all of which are published electronically, you don’t get the impression of an under- regulated system: the concern you leave with is, if anything, that the system is so strictly regulated as to be dangerously fragile.

If a resident misses a scheduled snack and someone raises hell, there’s a review of his personal care plan, and the inspector makes sure the orderlies had access to the care plan, and checks that the plan was kept up- to- date and conformed to the patient’s preferences, and there might be a side investiga

THE CONCERN YOU LEAVE WITH IS, IF ANYTHING, THAT THE SYSTEM IS SO STRICTLY REGULATED AS TO BE DANGEROUSLY FRAGILE.

tion of what precisely happens to snacks that aren’t consumed. If one demented senior strikes or gropes another, investigative hell is unleashed: were you informed that Mr. So- and- So had a history of “responsive behaviour?” If you weren’t, whose responsibility was that? If you were, what was the exact date you were given the i nformation, and what were the specifics? A matter as modest as a funny- looking pill in a blister pack can lead to a half- dozen interviews and a public reprimand.

You are left imagining an environment of unbelievable rigour and endless checklists to control the behaviour of both workers and clients — because if everything weren’t regimented in such detail, old people would occasionally starve to death or die from infected bedsores. And there’s no “because of the profit motive” anywhere in that sentence.

But a complaint- based inspection system can only work if there’s someone to make a complaint — i. e., if family members and other visitors are allowed to circulate through the care homes and see their loved ones. This part of the system lost its eyes and ears the moment visitor traffic itself became a threat to the lives of care-home residents.