by Bogumil Pacak-Gamalski

This is the third article on almost identical subject.  First was published on  April 2^nd. It summarized uneasy feeling: are we doing right by our seniors? Especially the ones totally helpless, confined to places called Long Term Care Centres.  How, as a society, we do really care about them?  Does what we preach reveals itself in what we do? And if it doesn’t – if our values have no meaning other than making us feel good about ourselves?

On the 16 of April, I published the second article. We were just beginning to understand the horrific scale of the tragedy that was going on behind the closed doors of many Long Term Care institutions. The ‘care’ was fully missing from them, the ‘long term’ was being shorten in a dramatic fashion.

In some provinces the percentage of all Covid-related deaths was in sixties, seventies and even higher percentage among the Long Term residents versus the entire provincial populations of Covid deaths. People were even dying not being infected but simply from lack of basic health. From abandonment.

There is a)moral culpability; b) political guilt and blame; and c) criminal negligence.

First (culpability) is the most important, although not punishable by law. In criminal cases the term ‘culpability’ is not the same as ‘guilt’. But we are not taking about law. We are talking about morals, ethics. An entire society (state) cannot punish itself. We can’t be a judge, a prosecutor, an accused, a defender and a jailer at the same time.  But it is the most important one. It does give credence to political and legal actions.  Moreover – it creates a path to action of all societal and state institutions.

Therefore without a tacit (at the very least) nod from us, from society – the state would not allowed things to disintegrate as much as they did. The state itself is void of morals. It professes them very often in its highest form, like Constitutions or Charts.  To a lesser degree in criminal and civil codes. But the state is not run by this high documents (except in very rare cases and most of the time it would be because of citizens appeal to a Court for remedy against actions the state) – a government and state is run every day by regular acts of parliaments, by decrees of government and (most often) by internal regulations of different ministries and state agencies. In that, the Government and Administration takes a clue from political measurement of the will or sympathies of electorate. Here comes point ‘b’: political guilt and blame.  What the government does in gauging the sympathies of electorate is a risky business. But you can’t govern without taking the risk. Generally speaking the government gets ‘away with a crime’ (in a manner of speaking) most of the time.  It is a game played in every state, democratic and authoritarian alike. In a democracy the government is more timid and careful with it. By judging the society feelings mistakenly – it would be judged severely by next election, which is never very far.  In dictatorships, the government can get away with a lot more – the only risk is a revolution, usually bloody and very dangerous, therefore very seldom taken up by society.

But the ‘guilt’ and ‘blame’ is something that every politician tries to avoid as much as possible. Careers and prospect of losing power is very real.

Last one is ‘c’ – criminal negligence. It happens very seldom in case of Government actions. But it can, by individual minister or high ranking administrator. In this case the price is political and criminal case, almost always supported by the State itself. This way the State (government) acts not as perpetrator but as a defender of morality of society and defender of the High Acts (Constitution, special Charts that are treated the same as the Constitution). But most of the time criminal negligence is a result of either private, individual citizens or private businesses, agencies. In both cases the peace of the state, the agreement between Society and the State is maintained. We, as a society, have manifested to the Government that such actions are not tolerated by us and the State instituted legislation and rules that prevent others from  breaking such rules. Under the duress of punishment, of course. Therefore we all can attest that there is ‘nothing rotten in the state of Denmark’. Or can we?

I think that all points (a, b and c) rise up to crimes (moral, political and criminal). Yes, it is true that we profess the dignity and care to all citizens; more than that – to all that reside even in a short period within our borders. We profess that the care of vulnerable and weak one among us deserve special care and help from the State. The tacit understanding is that the most important among them are the very young and the very old.

Then comes a test. Like a school exam. That test came to us in a form of pandemic of new, unknown and dangerous virus – coronavirus and an illness called Covid-19.

And we all failed miserably. But especially provincial governments. Of all and different political stripes: conservative, liberal and NDP alike.  I am not trying to absolve the federal government from all and any responsibility. But the simple truth is that these facilities and entire management of health system lies strictly at provincial doorsteps. With no exception. And it is guarded by them very jealously from interference of federal power.  After all, it costs enormous amounts of money that they must receive from federal coffers. And money is power in politics. Well, such is our constitutional devolution of power. 

But, specifically about long term care for seniors, our subject.  They too, like hospitals, fall under provincial jurisdiction, regulations and control. The institution itself is rather old. After the 2 world war they become regular part of our society. People lived much longer,  not only men but also women become regular part of workforce, therefore their time at home was very limited. More and more people moved to larger cities and old communal forms of help and looking after each other changed and become harder to come by. But the last 25 years skyrocketed in opening more and more of this institutions. Mainly because of the almost pandemic in itself spread of different types of dementia, with its most dangerous form: the deadly and untreatable Alzheimer disease.  We all become very familiar with them, if not our own mother or father, than someone we know ends up in these long term centres.  Something that a lot of us is not aware of, is the fact that there is growing number of residents there, who are much, much younger than typical seniors. Some in their late 30. or 40ies even.

Such a large number of this centres become a financial burden on provinces. As very intensive and specialized medical care is not really part of their operations, the governments decided to let them be owned and run by private businesses.  Of course, most of funds for the centres do come still from the provinces as the monthly rate usually is much higher than ordinary senior can afford. In most cases they do offer much safer and better setting for our seniors than would be possible, even under very  good conditions, at home.  Looked like we all stuck a good deal. Provinces still safe money than running their own care centres and we (society) had our parents and grandparents in safe place. Of course, over the course of many years we all have heard awful stories of bad care, lack of services, appalling conditions in some of them. That was not the norm, though.  Not uncommon, but not something we expected as a norm.  If we complained loudly and persistently enough – things get better. Maybe not for all, but at least for our close one.

But we always believed that there is (perhaps not very rigorously applied) a strong provincial oversight.

Especially if something bad was going to happened. Like, let say, pandemic or epidemic for example.  How could there be not? Yes, there were signs. Remember, very recently, Baptist college educated nurse Elizabeth Wettlaufer, who murdered eight and seriously injured six (that we know of) senior residents in the long term centres she was employed by? Her murders went on for years. Yet, nor serious investigation was ever (until  the last one when police was called in) conducted. If not for her ‘bad luck’, maybe she would have been working still and continuing her murderous calling?

But back to Covid.  At least very early in February everybody federally and provincially knew, that the new strange coronavirus seem to be particularly deadly among old people. Everybody working in the field of medicine and care. And administration of such.  What type of plans were prepared and issued to the care centres? How many detailed and practical seminars were given to administration and employees of these centres? How many special provincial watchdogs were given orders to regularly oversee each and every one of such centres?  Check documents, staffing level and preparedness of staff? Offer them the same, or similar, PPE for use?  Made sure that regular testing for virus by mobile units were available more or less day and night if needed? Required a full and immediate death certificate on any death in facility to be examined if it could have been due to a coronavirus? Made preparations for supplementing and augmenting existing care workers in such facilities in case of shortages ? Any? Seriously?  O, yes. We locked them. This way no one could have seen … .

Let me make a confession. Being, as millions of others nowadays, at home I watch a lot of TV. Mostly news, as I always was a news addict. Political junkie almost.  So I watch, day after day, week after week daily conferences of Prime Minister and Premiers of all provinces (Yukon and Nunavut – thanks Almighty! – do not hold them on national news). And listen to them. And listen.  We are not doing, as far as the illnesses and deaths are concerned, too bad in Canada with the pandemic. Not so good economically, psychologically but not very bad in strictly medical terms. The governments seem to be doing actually a good job. Starting with the right approach by Prime Minister and by far by most premiers, also.  Generally speaking.  We, Canadians.  Unless we are not weaker, often confused, oldest generation locked in the Care Centres. If we are – we are doing absolutely awful. Tragically awful.

So when I listen to the conferences, every day I’m waiting for the premiers, any premier, to actually admit and say honestly: ‘we have failed our seniors and I, as a Premier of my province, am very sorry for failing to do the job that I was entrusted to do. And I promise you all that as soon as the pandemic will end or would become manageable, I will order a full review of all regulations and laws governing Long Term Care Centres for Senior and undertake serious overhaul of the current system. Because the system has failed you’.  So far – none was issued. Instead, I listen as the premier admonishes me to stay at home, maintain social distancing and to remember that I have to protect not even myself but the most vulnerable in our society: the sick and old ones.  And I do. But you didn’t, Mr. Premier.

by Bogumil Pacak-Gamalski

In my last article I have shared my reflections on the situation of seniors in our society during the coronavirus pandemic. How we, as a society, have to or ought to revise our responses to it; re-examine our ethical compass. More or less, I have challenged us to check if our own beliefs in our own societal, (but also individual) set of ethical and moral values holds the water. Or is it just a lofty goal fare removed from reality. The weakest are often the first ones we shamefully discard from our Decalogue of ‘do’s and don’ts’.

That was at the beginning of the epidemic and just on the edges of a serious crisis, when we heard of the tragedy in North Vancouver’s senior care home. And the full closure of all of them resulting in a practical lockdown.

But that was than. What followed in ensuing weeks, is just a full scale tragedy and collapse of the system. As Doctor Theresa Tam, our Chief Medical Officer, noted – almost half of our reported deaths were linked to care facilities or seniors homes.

In Quebec and Ontario we have learned of appalling, almost concentration camp-like lack of care and, practically speaking, an abandonment of the seniors by the operators of these centres.

There is no reason to hope that in other provinces the situation is very different and drastically better. To the contrary. Just today we learned of many cases and deaths in Nova Scotia seniors care centres.  There is very strong argument to expect the same everywhere in these type of centres. If not worse. Why? Because it didn’t happened in a vacuum. It happened on our collective watch. Under the eyes of provincial regulators and government. As we found out, but should have known much earlier, these controls and ‘eyes’ of public health were most of the time closed. Or wilfully blind by design. Don’t see – don’t know. Therefore: if I don’t know, I can’t do anything about it nor to feel guilty or at fault.

But they should feel guilty. They are at fault. We all are. 40 years ago seniors full care centres were little known and not very numerous.  But with the advance of modern medicine, extended life spans of all of us, that changed.  Some of us (before we die) in an advanced old age loose gradually a lot of physical abilities to be independent or to require only basic care and help from family and friends. Some loose  gradually mental capacity to take care of ourselves. That is even more dangerous.  Advanced age means also that all of our children (if we have any) are not young either, by the time we become very old and in need of help. Majority of advanced age seniors children are … seniors themselves.

And let us not forget the various types of dementia, with Alzheimer being the most dangerous of them, that seem to spread like a wild fire in recent decades. These conditions and ailments require a specialized, non-stop medical and household care. The word ‘medical’ is paramount. Dementia and Alzheimer are medical ailments that require medical treatment. Not just the mundane cooking and laundry and help with personal hygiene.  A progressive disease with no cure. Lethal.  But the length of it often is very long – from mild form to  almost  vegetative state in some cases.  Ugly. Robing the person of almost every shred of personal dignity. Shall I go on? No. A lot of you knows it, because someone close to you is going through it or went through it before dying, when one by one, every organ of your body stops working. Not like in a heart attack. That would be considered almost merciful.  A majority of you, who never encounter it in a family setting – will know it.

Why am I writing about it in painful detail almost? To make you understand, that if not majority, a very sizable number of full care Centres they are there because they have no other choices. Not because it is just more convenient for them. You know – the food that someone else shops for and cooks, the plates and dishes that someone else cleans after you, the laundry, the cleaning of your room, changing of bedding, doing your hair, your nails, your showers and baths  (at the end it is just wet sponge and wipes ), the moving you from bed to wheelchair and back. The list goes on. It is medically necessary. Like a hospital is not a hotel we choose to go to for fun. Like a hospital. That is another term I want you to remember.

 So we have two terms now to pay attention to: 1) the reason  for senior being in a centre like that is of medical nature, not simply an age or convenience;

2) the care, nurse and doctors check offs, adjusting and giving out medicine (pills, shots and the likes), medical treatment in general. At the end it also serves as a palliative care institution.

Again – as in hospitals. The difference is that hospital is an active medical trauma treatment centre, with vast array of diagnostic tools, and possibility of very decisive medical intervention. By nature designed for relatively short  stay.  Full care senior’s centres are designed to be a residence. Usually extending beyond one year, or close to it. Regular hospitals would be absolutely way too expensive to operate under such conditions. Hospitals offer acute treatment, with a goal of a cure for patient. Seniors homes offer light medical treatment (with no practical nor even idealistic goal for curing residents), safer environment and at the end of resident’s stay – palliative care. Unless when there is an unexpected accident that require hospital intervention or specific family’s requests for transfer to a hospital for more active intervention.

But let’s not make any wrong distinctions: both are of medical nature.  One short term and expectation of curing patient (hospital); the other very long term stay (by nature – final) and no expectation of curing patient – just making her/him safer and relatively comfortable.  Neither is an extension of home.   They try to be as much as possible – but they are not.  Governments spent huge amount of money to subsidize most residents stays there. Some can afford to pay it themselves, but it would be a minority as the costs are in thousands of dollars every month.  All provinces decided many years ago that it is more economical to let the centres be in private hands, run as businesses, then in governments hands.  And we let them.  Yes, it would have been more expensive to run them by government.  Just the labour cost by itself – in hospitals professionally trained staff is paid much higher rate, than similar staff in the centres. Of course other costs, too. For example continuing training and education of hospital staff versus very limited training of similar staff in the privately run centres. Hospitals are not run on a business model. And they shouldn’t be.  The Centres – are. The operators/owners are running a business, not a charity.

The results, in an emergency situation of even lesser magnitude than the pandemic, are the way they are. Tragic. Shameful. Incomprehensible.  Existing model is wrong and is not working under stress. Barely under normal circumstances.  We are left powerless, not even knowing what is happening to our parents, aunts, family members and friends, who are locked behind these walls.

This can not be put squarely at the operators feet. It is a fault by design and if not equal, at least a partial blame is on the side of the government.  The regime set-up to control and supervise the centres by province’s Health Authorities failed. Again – be design. By not making it robust and strong enough. By not following own rules, which by themselves are minimalist and weak.

If the provinces can’t guarantee a fast and permanent fixing of the oversight – it should take over the running of the establishments under its own umbrella and ownership. It is an extension of medical care.

If the model of having them in private hands is honestly believed as a more efficient one and better – than an extensive overhaul of the Health Authorities effective control and oversight needs to be undertaken almost immediately. With the public being clearly informed of the process, it’s goal and timetable for conclusion.  Proper staff-resident ratio must be established by the province and remuneration for employees should mirror the importance and the professionalism that is expected of them.  You can’t expect the staff to be paid near minimum wage and do properly the extremely hard work they do. Extremely hard and difficult – of that I know, for I have spent hundreds of hours in such facility. During daytime, at night, mornings, evenings. On purpose, as I wanted to make sure that ‘good’ things are not happening only during typical visiting hours. Helped them wash residents, change them, feed them. I can’t say: I wouldn’t do it for any money. No, I have done it for free. But if I was to work there, I wouldn’t under any circumstance be paid less than minimum twice as much as they were paid.  None of the blame could be placed under their feet.  Of that I’m certain.

The pictures in my mind of the neglected and left to their own inability to do almost anything residents in some of the Homes in Ontario and Quebec (I am also certain that they are like that in every other province) are seared in my brain and heart.  Most of you probably listened or read the recent stories. I will not repeat the details here. Sufficient to say, they are horrific, inhuman pictures.

Something must be done and we (that means you too, dear Reader) must make sure that it will. Call, write to you MP, to your premier, minister of health, minister of social services, senior’s advocate. Please, do.  Our mothers, fathers, aunts, uncles, cousins, grandparents, our friends – deserve better. You deserve better in the future, when you might (which is becoming increasingly common) become a resident in one of them.