“Promise me one thing. You’ll never put me in a long-term care home.” My 68-year-old mom was resolute as reports emerged this spring about nightmarish conditions in facilities across Canada.
Residents, unbathed for weeks, were left crying out for help in soiled diapers. A 94-year-old blind woman, literally being eaten alive by bed bugs, was abandoned in a blood-spotted bed. Staff force-fed patients until they choked. Then there was the virus: COVID-19 was allowed to rage through facilities, so far killing over 5,000 elderly people and accounting for 81% of the country’s coronavirus deaths. The crisis became so acute the military was deployed in nursing homes in Ontario and Quebec. It was a national scandal. And yet, despite widespread media coverage, the crisis’ disproportionate impact on elderly women has been almost completely ignored.
Women make up the majority of long-term care (LTC) home residents (we are twice as likely than men of the same age to live in nursing homes). By default of our gender, we’re also exposed to poorer-quality care. “Women live predominantly in care homes that have lower standards and more problems, which reflects years of lower incomes than men,” says Ann Decter, senior director of community initiatives at the Canadian Women’s Foundation.
It’s a domino effect that starts with these lower salaries (the discrepancy is even worse for racialized women), continues with the motherhood penalty, compounds with a greater likelihood of being single later in life (in Canada, women live longer than men), and culminates with pensions and retirement savings that are, on average, one-third lower than men’s. Taking all of these factors into account, it’s no coincidence then, that women, mostly elderly, also account for over half of the nation’s COVID-19 deaths — another area in which the country is an outlier. Death rates are higher for men almost everywhere else.
While COVID-19 broke through the noise, these issues have existed for years. Caregivers knew it, workers’ unions knew it, government officials knew it, and outraged families knew it, too. However, like many women’s-rights issues, politicians looked the other way. “We’ve literally been working for decades to try and raise awareness around the need for a minimal measurable standard of care,” says Katha Fortier, assistant to Unifor national president Jerry Dias and the organization’s lead on healthcare. Unifor is a union that represents workers across an array of industries, including more than 30,000 healthcare workers across Canada.
Establishing that standard is an onerous task: While LTC homes are overseen by provincial ministries, there can be large discrepancies in quality of care. Canada’s for-profit private homes — which make up the majority of care homes and recorded higher death rates pre-COVID and COVID-related — tend to be most-problematic because they have more incentives to cut costs. Then there’s non-profit/charity, and public municipal LTC homes.
One of the easiest ways for for-profit homes to make more money is to skimp on staff, specifically personal support workers (PSWs), who, along with nurses, are the frontline healthcare workers responsible for everything from bathing to meal-planning to socialization. PSWs are already underpaid and overworked — most companies pay barely a few dollars over minimum wage and promise only part-time hours forcing staff to work at several facilities.
Even in the best of times, PSWs barely have time to do their jobs. In 2018, Unifor, which is advocating for four hours of care per resident daily, issued a #sixminutechallenge to the public to complete our morning routines in six minutes or less — the average amount of time PSWs have to wash, change incontinence products, dress, and complete other personal grooming tasks with each resident. Homes are chronically short staffed as a result of this, which means rampant worker burnout, compromised care, compassion fatigue, and a lack of experience, even in senior positions, leading to the disturbing situations that were uncovered this past spring.
COVID-19 made everything that much worse.
Many PSWs stopped showing up for their shifts, scared to interact with patients due to lack of masks. “These are not good jobs,” says Decter. “People weren’t turning up for work because there wasn’t enough personal protective equipment, they weren’t confident they could refuse unsafe work, and they don’t get paid sick days.” Some of those who continued to work became key virus transmitters — LTC staffers represent more than 10% of Canada’s cases. “Since many PSWs have to work in multiple facilities to make a living, they carried COVID-19 through them,” adds Decter.
Ironically, when it comes to LTCs, the mistreatment of women begets the mistreatment of other women. While the media reported on staffing issues at homes, it mostly neglected to mention that over 90% of nurses and PSWs are women. More than two-thirds of professional cleaning staff are women. While official stats aren’t available, the Canadian Women’s Foundation also reports many of these workers are racialized, immigrants, migrants, and/or undocumented individuals. They are also, not coincidentally, the communities most affected by COVID-19. “You could see it in the map of Toronto where they showed the higher caseloads in racialized neighbourhoods with more immigrants and residents with low incomes,” says Decter. “The piece we were missing from the mainstream analysis is this is where people who work in care homes live. They were bringing the disease home.”
As long-term care homes slowly re-open and we are allowed to see our mothers and grandmothers again, it’s clear that change has to come from government regulation, and it needs to happen sooner rather than later. In June, Ontario Ombudsman Paul Dubé announced a government investigation into the oversight of LTCs. But, with temporary pandemic pay for LTC staff ending and governments introducing measures that further strip workers’ rights, the situation is a risk of worsening despite all the recent media attention. The clock is also ticking ever closer to what insiders refer to as the 2030 problem — when aging Baby Boomers will put unprecedented pressure on an already-failing system.
The neglect and abuse of older women, and the largely female workforce that takes care of them, should be a feminist issue on the scale of #MeToo. Empowerment can’t just be for the young. The thought of my mom, or any older woman, being subject to horror-movie levels of neglect and abuse in a LTC home makes me rage as hard as I did when hearing the most-despicable Weinstein allegations. If Canada is truly a nation that cares about women’s rights, it’s time to end the long-term care crisis.