The financial resources many older adults need to age with dignity are enormous, and mostly accessible to the wealthiest among us. Our system, at this point, largely assumes that the funds required for a person to grow old is a personal responsibility, instead of a collective one. If one is unlucky enough to develop a condition that requires constant care and doesn't have the money, our current system treats you as if you subpar, giving you little options to receive high-quality healthcare at a low cost. Never mind that the burdens of illness are carried more heavily by those who are racialized and economically marginalized. Never mind that many have never earned enough in their lifetime to have accumulated savings for this sort of care in the first place.
There should then be little surprise that we have constructed long-term care homes as undesirable. Historically they were deemed as a last resort destination that was meant to provide the bare minimum of care. The legacy of long-term care homes is steeped in them being places we, as a society, warehouse people who can afford little else. If anyone living within long-term care needs anything beyond what is offered, getting it depends largely on the depths of their personal pocketbook, or better known as their income or wealth.
Canada desperately needs to create a system for aging seniors predicated on equitable access rather than fee-for-service. Creating that system requires an ambitious commitment to a universal program similar to that of Canadian medicare. And that commitment to universality requires both better public funding and a cultural recocking, that no longer accepts privately-funded models.
The legislative mechanisms we need to expand coverage for the care of seniors needs public deliberation. Issues to be considered are complex, including federal-provincial cost sharing agreements; setting standards for accountability; and, pragmatics of transitioning for-profit interests out of the sector. Just as the adoption of medicare transformed a nation, transforming long-term care will too require courage, even in the face of reluctance.
While there are exceptions, access to good quality care in long-term care homes remains inequitable. And we should be paying far more attention to creating an equitable, public system rather than the charitable whims of private operators.
As we assess the aftermath of long-term care home deaths during the COVID-19 pandemic, we continue to leave our elder adult patients vulnerable to future pandemics and/or virus outbreak. We cannot wait for another disaster to occur; a paradigm shift is needed.
Budget 2021 allocated $3billion over 5 years to “ensuring standards for long-term care are applied and permanent changes are made”, but more needs to be done. Taking a firm stance against for-profit-care, by creating more and investing in non-profit care homes, increasing pay and incorporating decent work standards, is the sort of ambitious leadership we need to stand firmly behind.
Dr. Amina Jabbar is a geriatrician in the Greater Toronto Area. With a focus on populations
that have been traditionally marginalized, Dr. Jabbar has facilitated anti-homophobia workshops in schools and community organizations with Teens Educating and Confronting Homophobia, delivered sexual health services at Planned Parenthood Toronto, and created tools to research neighbourhood-level health issues at the Centre for Research on Inner City Health
