One old person’s thoughts about caring for old people

I’m not shocked at what military medics found in some long term care facilities. Saddened, but not shocked.

Anecdote: I was in a conversation, a few years ago, about PTSD. One fellow said something that stuck with me. ‘It wasn’t,’ he said, ‘the fighting or the killing that got to me. My training prepared me for that … prepared me well, I knew what to do, how to do it and why to do it. It was the place and the people. The dirt, the poverty, the squalor, the casual disregard for others, for life itself … how could people live like that? How could they be like that? They didn’t seem quite human.’ I remember shaking my head in agreement. The traumatic shock wasn’t caused by bullets or high explosives, it was caused by where we were … when US President Trump called many parts of the world “shithole countries,” many soldiers knew exactly what he meant. I suspect we may see some PTSD cases amongst military members who served in Canadian long-term care homes. I’ll understand that.

I grew up as the world was changing. When I was a small boy many of our neighbours had been born, grew up, married, raised families and grew old in the same area. Their parents had lived there, their children lived there. Two, three and even four generations lived under one roof or very near to one another. Yes, people got old and maybe granny or old Uncle Dick got ‘barmy‘ but the family looked after them … it had to, there was nothing else. Notwithstanding Bismarck and Mackenzie-King, in Canada, in the late 1940s and into the 1950s only the well-to-do could afford to send grandpa to a “retirement home.” There were asylums for those who were mentally ill or disabled. Some churches ran “infirmaries” to look after those who had no families. But, for most Canadians, the family, not the state and certainly not some corporation provided care for the elderly.

But in the 1950s and ’60s, everything changed. The once stable family was shattered by economics and mobility.

Another anecdote: I recall conversations at a class reunion. They went something like this: “Where are you living now?” “Ottawa.” “How many kids? Where are they?” “Two sons, one in Halifax the other is in Australia.” “How is your Mom, still alive?” “Yes, but we moved her to Ottawa to be close to us.” “Oh, good for you. You’re lucky you can do that.” Everyone just assumed that my family would not end up “together.” It was normal for all of us to have our kids living all over the world. We had all had to make decisions about caring for our parents ~ uprooting my Mom so that we could take better care of her was not thought to be strange or, in any way, wrong.

In fact, my late wife and I made provisions for my Mother’s decline. We agreed that she should be cared for in her own home … to make that work she needed a smaller home, close to us, where my wife, a nurse, could arrange and manage (hire) help for her. I would hate to tell you what it cost. But, just a few years ago, The Star said that “Caring for aging parents costs Canadians $33 billion a year in direct out-of-pocket expenses and time off work, a new study by CIBC says.” At the time, the report said, “close to two million Canadians, or 14 per cent of those with parents over the age of 65, incur care-related out-of-pocket costs of $3,300 per year.” I can assure you that 24-hour-a-day, in-home nursing care costs much more than $3,300 per month. A family that needs only 12-hour-a-day nursing care for someone can, easily, spend $10,000 a month on that, alone. Most Canadian families don’t even earn $10,000 per month after taxes.

Since home care, even when those wonderful Filipina “live-in-caregivers” were still allowed to come to Canada, is still unaffordable for many Canadians and since the traditional family model, like that for funding newspapers and broadcasting, is broken, then it was only natural that someone would offer a service. Governments ~ healthcare is a provincial responsibility ~ were glad to see many entrepreneurs stepping up to provide services for a fast-growing population of senior citizens who needed. care.

But they needed affordable care …

Do you have any idea of how much it costs to run a “care” facility? You need a place, first: Here's to retirement!chartwell-lord-lansdowne-retirement-residence-28-fbthumb-33949real estate and furniture and heat and light. That all costs money. Then, you need to feed them. That costs money, too. Your “sales pitch” (to the families who will pay you to look after granny) needs to include images that show a nice place that serves good food. You need some medical staff ~ a few nurses, at least, and you need cleaning staff. The reality is that many, many seniors must live in plain, even unnamedaustere and often less than clean accommodations with only adequate food and are tended to by too few, poorly paid and, therefore, not very well-motivated people. Should we blame the owners who cut corners to save money? Yes, of course. Should we blame the staff who are often uncaring and even cruel? Yes, we can do that, too. Shall we blame the regulators, the bureaucrats who didn’t inspect often enough or well enough? Yes, that’s a good idea, we can always blame the system. How about the politicians who licensed these places and encouraged more and more to open up? Yes, let’s blame them, too.

But what were the alternatives?

Screen Shot 2020-05-28 at 18.40.14How were we going to provide decent, first-rate, high quality “care” at a price that ordinary people could afford? Unicorn farts are not real. There are no fairy godmothers. People can only afford so much. No one wants granny to lie in her own filth and slowly starve to death … but who is going to pay? Do I hear anyone saying that they want a point added to the HST? No, I thought not.

So, instead, let’s blame someone.

First, it is NOT Justin Trudeau’s fault. The Government of Canada does not look after your health. Despite the fact that Pierre Trudeau saddled Canadian provinces with an incredibly stupid system for paying for health insurance ~ a system that only Stalin and Mao could love ~ you have to look closer to home. Premiers Horgan and Ford and Ball and all the others need to answer for some of this. But setting and enforcing standards is tough and expensive … and some government have cut back.

Let’s close ’em down.

There’s an idea. We’ll send grandpa to live with … who? You? The reasons the poor old duffer is in the “home” is that you haven’t the room or the resources to care for him.

Let’s send someone to jail.

That’s a good idea, too. But we will, almost certainly, send the wrong people to jail. Yes, there are a few criminally careless owners and a few cruel employees who deserve jail or, better, a flogging, as we might find in Singapore, but a public one, but maybe we should, first, ask union leaders: why are the wages for a cleaner so high that hospitals, not just nursing homes, cannot afford to hire enough cleaners and still have nurses? But, wait! Cleaners are “front-line heroes” in the COVID-19 world. We can’t blame them or the unions that represent them.

Screen Shot 2020-05-28 at 19.18.11The simple fact is that the nursing home cleaner is a “low value” employee who is, probably, in any sane world, already overpaid when compared to, say, an X-ray Technician or a Nurse. But (s)he, like the nurse, is a member of the precariat and (s)he is also looking for a safe place to put granny who is starting to show the warning signs of senile-dementia. We need to find ways to get people to take low skill, low values jobs while not losing their social assistance. Work, even dirty, menial work should always leave the worker measurably better off than someone on welfare. That doesn’t happen now.

Maybe we should look a bit more closely at what we ask from society.

I am not taking any political or religious position when I say that the family is the bedrock of society. For thousands and thousands of years, even before we had kings and emperors, presidents and prime ministers we lived in family units. We cared for our own. It is only within my lifetime that we decide that society, at large, should care for our family members.

Maybe we are right to do that. Maybe society needs to do that. Maybe the modern economy with its requirement for a mobile labour force requires that. If that’s the case, if that’s what we want then we need to be prepared to pay for it. If we want good care 100866130_10158292000134450_7023587906371452928_oworkers then we need to pay them appropriately, don’t we? Is there anyone, besides maybe Justin Trudeau and few other Marxist dreamers who believe in “from each according to their ability, to each according to their need“? No? I thought not. If we are going to pay people to do something for us to a high minimally acceptable standard then we need to expect, for example, an increase in our provincial income tax or sales tax. Or we need to be ready for more of what the military has just exposed.

I suspect there will be considerable pressure to bring long term care facilities into the public domain … to get rid of the private homes. I doubt it will help. I do not think that public facilities, if that’s the way people want to go, are going to end up being any better than (in fact, they are usually not as good as) private ones. The staff ~ the nurses, the “caregivers,” the cooks and servers and the cleaners ~ will be the same, maybe a bit better paid since public-sector unions are a bit more militant than their private sector confrères. Management is going to look about the same, too ~ and the managers will be looking to cut costs. Only the ownership will differ … and we will not accept that we set the spending levels through our political preferences.

 

 

6 thoughts on “One old person’s thoughts about caring for old people

  1. No easy answer, other than bringing in foreign workers, who will make less than a worker her, but more than they would at home. Give them a safe and inspected workspace, make sure they know what is expected of them and reporting problems won’t get them black listed.

      1. Excellent statement of the problem, Ted: including the point that there are no easy solutions.
        Pardon my profound ignorance of the CHST, but how did “Pierre Trudeau [saddle] Canadian provinces with an incredibly stupid system for paying for health insurance”? I’m not arguing, just displaying my ignorance.

    1. In Italy, almost none of the live-at-home health/home care staff (the federal government there gives an allowance to families who need 24/7 care for a loved one, even in a country where people move away for work are far fewer than here) that I’ve seen were Italian. They were Ukrainian, Romanian, Georgian, Polish … As Ted said, doing work Italians don’t seem to want to do. That could be a good part of the solution – even if “the usual hyper-partisan suspects” would attack any party supporting that for stealing jobs from Canadians.

  2. Phil: See my comments here (13 Feb 16): https://coloneltedcampbell.blog/2016/02/13/the-800-pound-gorillas/ and here (17 Mar 17): https://coloneltedcampbell.blog/2017/03/17/that-800-pound-gorilla-again/ It’s about the funding model which ties provinces hands and forces them into a single-payer system. Most OECD countries have lower health-care costs and better health outcomes than Canada and NONE use our single-payer system. But Mao would have loved it.

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