Were Pandemic Elder Deaths Preventable?

S3E30 of The Conversation Piece

Black and white photo of André Picard over a template of The Conversation Piece podcast featuring a mic and outlines of other mics.

ANGELA (HOST): It’s been three years since we launched The Conversation Piece.

CAILIN (HOST): 90 episodes measured over pandemic years, launched because for a while there, we couldn’t CONVENE the way we love to – at The Walrus Talks. I’m Cailin Cooper, head of events..

ANGELA (HOST): And I’m Angela Misri, and this is our final episode of The Conversation Piece, and my final podcast for The Walrus.

CAILIN (HOST): Through three seasons, we’ve done our best to showcase some of the most compelling TALKERS who have wheeled, walked, and web-cammed onto a stage for The Walrus Talks.

ANGELA (HOST): Andre Picard started us off on this audio journey, with his talk on the epidemic of loneliness.

CAILIN (HOST): So it only felt appropriate to hand the mic back for our last episode, because this has been quite a time to be a health reporter, and Andre Picard is one of this country’s best.

ANGELA (HOST): Welcome to The Conversation Piece.

ANDRE PICARD: Hi, my name is André Picard and I’m the health columnist at the Globe and Mail. And I’m the author of the book Neglected No More: The urgent need to improve the lives of Canada’s elders. So what they were going to die. Anyhow, in March, 2020, after I wrote a column about the first pandemic deaths in Canada, which occurred in nursing homes, I received an email from a reader with that dismissive comment. At the time, you could count the pandemic deaths on your fingers, but with the novel coronavirus spreading like wildfire, we knew elders were in dire danger. Instead of acting, we started formulating our excuses like, Hey, they were going to die. Anyhow, Canada has recorded almost 39,000 pandemic deaths to date. And about 21,000 of those have been in congregate settings. Like nursing homes, the numbers are sickening enough, but how elders died during the pandemic is even more troubling.

In some parts of Canada, we had explicit policies saying nursing home residents should not be sent to hospital. They were left to die. That’s just one example of how ageism is baked into our public policies. Most elders during the pandemic died alone without palliative care. And sometimes without any care at all, their loved ones were locked out. Some nursing home residents died of starvation and dehydration. This happened in Canada in 2020. This is unconscionable. Yet these horrors are still dismissed with self-serving. Bromides like they were going to die. Anyhow, elders living in the community were victims too. About 70% of COVID 19 deaths in Canada have been people over the age of 70. And it’s not because of their biology. Let’s not fool ourselves. It’s because of their life circumstances, more difficult to calculate is the collateral damage of pandemic restrictions and people taking the pandemic for granted, isolation, loneliness, mental and physical decline.

All of these were deadly two to varying degrees. Well, so what they were going to die. Anyhow, the reality is that most of these deaths were preventable. At the very least, we could have prevented a whole lot of suffering. We didn’t put an iron ring around the nursing homes to borrow the rhetoric of Ontario, premier dog, Doug Ford. We didn’t even put a paper ring, heck staff residents, families weren’t even provided with personal protective equipment, not even a mask. We killed elders with systemic ageist indifference. Now the way elder cares finance delivered and regulated in this country was ineffective, inefficient, fragmented, and unsustainable. Well before the pandemic, all COVID 19 did was expose the gaping wounds to the world. Yet we seem to have learned no lessons. We’ve done very little to repair the broken system at the root of this massacre of neglect. Our response to COVID 19 was a brutal reminder of who matters in society and who doesn’t.

The pandemic occurred at the intersection of ageism, sexism and racism. The hardest hit were who one elders, most of whom are women, two working women, especially those caring for children and or their ageing parents, and three racialized workers who among other things do most of the heavy lifting in healthcare. The pandemic drove home. The message that old people don’t matter. Neither do the people paid and unpaid to care for them. So how do we fix this broken system? How do we move ahead? How do we ensure that a travesty like this never happens again? Well, it begins with a philosophical shift. We need to say in our policies, in our practises and in our everyday lives, that elders matter dispense with the catastrophizing about ageing and the nihilism that dominates every problem. And every solution is well known. Since the advent of Medicare, there have been 150 reports written recommending reforms.

The system is fixable doing so is affordable. We just need to start implementing what we know, works shift. Some spending from institutional care to home care, uh, invest in supportive housing and other initiatives to keep people in the community. Things like meals on wheels, support the army of family caregivers with practical training, respite care, dementia daycare. Now recent polling has revealed that between 80 and 90% of Canadians say they never want to live in a long term care facility. Some of them say they’d rather die than be in a nursing home. So why has the principal response to the pandemic been to announce the construction of more nursing homes that benefits developers, not elders. We have to stop warehousing people when they get a little rickety instead of elder apartheid, we need to give elders a choice, a real choice about where they want to live.

Now I’m not suggesting we don’t need care homes because we do, especially for people living with advanced dementia and those needing 24 7 care for other reasons, but at least half of the 200,000 Canadians in long term care today probably don’t need to be there. They’re there for lack of community support. When people need care, the homes they live in should be well homes. They shouldn’t look like prisons and they shouldn’t smell like funeral parlours. And the residents shouldn’t be treated like widgets on whom a checklist of tasks must be performed by overburdened care workers. That’s today’s reality. As sociologists pat Armstrong famously said, the conditions of work are the conditions of care. The starting point for better care is improving the work environment of personal support workers, social workers, nurses, and others who provide the bulk of elder care. Now I hope tonight I’ve convinced you of one thing that we’re going to die.

Anyhow, was a cruel lie that they were going to die. Anyhow was a cruel lie, but merely keeping people breathing is not enough. Either a new improved system has to be built on the bedrock of respect and dignity. Now I’m a realist. I don’t pretend people are going to live forever in perfect health. Yes, we’re all going to die. I hate to be the one to break it to, but elders shouldn’t be dying on mass of preventable infections like COVID 19. And they should definitely not be dying of neglect, not in a wealthy country like Canada, almost all of us are going to live to a ripe old age and die of chronic illnesses like cancer, cardiovascular disease, or C O P D. We’re gonna die in a largely predictable manner. We should live out our final years, months, and days in a homelike environment, surrounded by family, friends with ready access to the care we want and need.

That’s not too much to ask. It’s actually the bare minimum of what we should expect. So what they were going to die. Anyhow, these are words I never want to hear again, especially about our mothers and our grandmothers. Yes, death will come for us all, but it shouldn’t be anyhow or any which way in the future, we should all aspire to a good death at the end of a good life. This requires planning individually and collectively. We need to build a system that supports ageing in place and dying with dignity. An elder care system worthy of its name in the wake of COVID 19. There’s a moral and societal imperative to put the care back into elder care. Thank you. And goodnight.

ANGELA (HOST): That was health reporter and author Andre Picard, and he spoke at The Walrus Talks WHAT”S NEXT in Ottawa in April of this year.

CAILIN (HOST): And The Walrus Talks will be back in September with all new speakers, in person, hybrid and on-line.

ANGELA (HOST): This is our last episode of The Conversation Piece, but The Deep Dive, our podcast about everything we do at The Walrus.

CAILIN (HOST): Including Talks!

ANGELA (HOST): Continues. Head to thewalrus.ca/podcasts to subscribe to The Deep Dive. And thank you for listening to podcasts from The Walrus.

André Picard
André Picard is the health columnist at the Globe and Mail and one of Canada’s top public-policy writers.