Part of a news headline ‘Should long-term-care homes be ‘old-person storage’ or places to live?’ put the horrific situation uncovered by the pandemic into perspective. Care home environments are not the pretty picture management sells you. Those who have loved ones in senior residences (not just long-term care or nursing homes) or have ever visited someone in these facilities will have encountered some rather unsavoury incidents. It is the degree of neglect and abuse unearthed that was shocking perhaps, not so much the fact that it is prevalent. That is how serial-killer Elizabeth Wettlaufer went unchecked for a decade, no?
Media reported that by the middle of June more than 6,000 Canadians had died in long-term care homes from COVID-19, compared to 29 in Australia. It was felt that ‘Canada’s troubles’ and ‘Australia’s success’ came down to the lack of a detailed plan to deal with a pandemic. And that some long-term care workers here worked in multiple facilities to make a living. But the transgressions go beyond the pandemic response.
When Ontario called in the military to seven homes struggling to deal with COVID-19 outbreaks, the Forces observed cockroach infestations, aggressive feeding that caused choking, bleeding infections, and residents crying for help for hours. According to the Ministry of Long-term Care all of the homes were stabilized by the time the soldiers left in July. It’s not that simple.
Also, by that time the story had changed in Australia where emergency medical teams were being sent into coronavirus-ravaged nursing homes. Care staff brought into a private residential home in Melbourne made similar observations to the Guardian Australia. Basic hygiene had fallen by the wayside, with some residents not cleaned for days. Faeces were found on the floor. Some residents went without food or water for 18 hours. Management said their struggles were caused by sick staff and the government providing no assistance to fill staffing gaps despite having raised the issue repeatedly.
So much for pandemic planning!
The abhorrent conditions in care homes caused (or unearthed!!!) by the pandemic was a worldwide phenomenon. In May, the BBC reported that 45% of COVID-related deaths in Scotland were in care homes, as were 25% in England and Wales. Spain had already recorded more than 16,000 deaths in care homes by the end of April.
The Canadian Institute for Health Information (CIHI) later reviewed how different countries managed COVID-19 in long-term care settings. The international analysis released at the end of June revealed 28 deaths in Australia, 30,000 in the United States, and more than 10,000 in each of France, Italy, Spain and the United Kingdom. With 80% of COVID-19 deaths in long-term care, it was felt that Canada had fared abysmally in comparison.
But it would be a mistake to simplify care home issues as pandemic related.
A friend remembered being assailed by a stench of urine every time she visited her father in a long-term care home more than 20 years ago. Fearing the repercussions her dad might have to face, she never questioned the management about it. The situation with long-term care homes during the pandemic revived some rather painful memories for her.
Another friend talked about the treats and gifts he would take for care home staff so that his parents would be treated well. He also shared how he would punctuate conversations with references to his employment in the health ministry to keep staff in check. The swanky-looking place and sweet-talking staff, which I’ve visited, did not give the impression of any sort of neglect. But the bruises on his parents told a different story.
A neighbour shared how her father was subtly bullied by his roommate for over a year while the management did nothing to stop it.
A friend who was a care worker gave up her job after two years on account of the neglect and abuse in the facilities she worked at. She said staff constantly falsified reports about residents’ food intake and activity schedule to paint a rosy picture for the family. Any attempts to right the wrongs resulted in the ire of her colleagues and management. So she quit.
Careless hiring, high staff turnover rates, little administrative oversight, stressful working conditions, poor pay and uncaring staff contribute to the abuse and neglect in elder facilities and care homes.
According to the World Health Organization rates of elder abuse are high in institutions such as nursing homes and long-term care facilities, with 2 in 3 staff reporting that they have committed abuse in the past year. A report stated poor staff training and remuneration as well as low care standards and policies in favour of the management to be the cause.
Elders are as vulnerable as children. But despite elder abuse being in the public eye for many years, progress in all areas of research, causes, consequences, and interventions has been terribly slow.
The toll the pandemic took in care homes is a reminder that the government must get and stay involved. Stricter protocols, greater government oversight and quick intervention can help prevent future neglect and abuse.