She died on May 12, almost two months to the day after she moved in. Because the province strongly encouraged that non-essential, in-person visits be banned on March 14, her family only saw her one final time, they describe in in a news release, through a window in the courtyard of the residence. It was Mother’s Day.
Da Cruz’s final weeks are not unique. In early April, I started tracking deaths from covid-19 in residential facilities, using public health data, media reports, family information, obituaries and data from the residences themselves. Based on my tracking, I have found that covid-19 has killed more than 5,900 people in residential care, including assisted living facilities, correctional facilities and homeless shelters. This amounts to approximately 86 percent of Canada’s confirmed coronavirus death toll, the vast majority of which have been in long-term-care and retirement residences.
In April, when the Montreal Gazette broke news about the conditions in the private, for-profit facility the Herron in Dorval, Quebec, it became clear that we were only at the beginning of what would become a new, tragic normal for Canada’s long-term-care homes. At least 27 people had died at that residence, and the paper described it as having “concentration camp”-like conditions.
Despite the fact that Canada has national public health care, the long-term-care system is a mix of public and private institutions, and not nationally coordinated. As people lived longer and had increasingly complex health needs, the system evolved to rely on low-wage workers, understaffing and exorbitant fees that, in many cases, have made shareholders lots of money.
The problems that plagued long-term care in Canada were well known before the crisis. In 2016, Elizabeth Wettlaufer admitted to a mental health nurse that she had murdered eight people and tried to murder six others while working at a nurse in two long-term-care facilities in Woodstock and London, Ontario. A subsequent public inquiry made 91 recommendations to improve long-term care in the province. Among the recommendations were that these facilities need more funding to improve the administration of medicine and to address a crisis of understaffing.
But there’s been little political will to solve this crisis. In February, the Ontario government struck a committee into staffing levels. While there was no one appointed to the advisory group to represent staff, the committee included several owners or executive directors of facilities. At least one owner on the committee had donated significantly to a political campaign of a provincial leader.
Like regular health care, long-term care falls under provincial jurisdiction, so many of the fixes to the system must be made at the provincial level. In Quebec, the province hit hardest by the crisis, the mix of public and private homes that have had double-digit death counts shows that the system needs to be reformed from top to bottom. Government austerity, combined with low staffing levels, low wages and staff who must work at multiple facilities to make a decent living, are driving this crisis, and part of the solution must be to inject money into the system.
But more than that, Canada needs long-term care to be included in the Canada Health Act, the funding framework that ensures that all Canadians have access to public health care, regardless of province or territory of residence. If the long-term-care system were subject to a robust system of national standards, and had access to more money, many of the problems driving the crisis could be solved.
There is also a more fundamental problem: People who live in long-term or end-of-life care have not been a priority of successive governments, and the result has been deadly. We need to restore the value to the lives of people who live in long-term care, take out the profit that can be made off their living conditions — particularly in Canada’s facilities owned by publicly traded companies — and force politicians to fund many people’s final years so they can live and die in dignity and peace.