Part 1: Our Elders

By Alison Taylor

As we enter the second month of social-distancing and self-isolation, and as curves ‘flatten’ in some parts of Canada, there’s speculation about how our communities will ‘get back to normal.’ It’s a good time, therefore, to reflect on what parts of ‘normal’ life are not worth reviving post-COVID 19 and what issues in higher education give pause for thought.
The pandemic has brought to light, for greater numbers of people,[2] the cracks in our social systems. Notably, it has brought into sharp relief the flaws in societal supports for the elderly and those living in poverty. At the same time, it has diverted public attention from the failure of governments, corporations, and individuals to respond to climate emergency. This 4-part series of blog posts addresses these cracks and what is to be done, before turning to thoughts about higher education stemming from my current research.
The fact that almost three-quarters of the deaths due to COVID-19 in Ontario have been in long term care facilities[3] is unsurprising. For some time, advocates have been calling for change as they document the effects of marketization policies on nursing homes across the country.[4] In 2013, for example, over half of Long-Term Care facilities in Ontario were for-profit.[5] In Vancouver, fees for private long-term care beds are often double those of public beds, based on my investigations. Reliance on private providers means that access to care is increasingly based on income. The number of public beds has not kept up with the demand and wait lists are long. In Ontario, for example, my family waited over two years (mid-2017 to early 2020) for my mother to be offered a bed in a local facility.
Tight provincial funding also means that staffing in nursing homes is bare bones and the staff mix is heavily weighted toward the cheapest staff. Racialized women are over-represented at the bottom of this health care hierarchy, often working as health care aides or personal support workers in challenging working conditions for low wages across different worksites. Because the number of care hours per resident is limited by tight budgets, it’s common for families who can afford it to buy extra help from personal companions.
So, what is to be done? Canadian researchers refer to models from Europe. Norway, Sweden, and Germany which, while also affected by marketization, seem to have been more resistant to the intensification of work in healthcare.[6] This research suggests that staffing levels in nursing homes are higher in Denmark and working conditions for care aides in Nordic countries are better overall.[7] Improved working conditions, in particular, a shared philosophy of care, interdisciplinary support, thoughtfulness about the physical environment, and support from leaders are among the factors likely to improve “person-centred” care[8] in residental care units. Accountability mechanisms that move from task-centred care toward person-centred care are desirable.[9]
Canadian society also needs to reconsider our cultural attitudes towards the elderly, in my opinion.[10] For example, a recent article about end-of- life care in Hong Kong suggests that the institutionalization and medicalization of death have alienated elders and families as they try to serve and care for each other within residential care contexts. Authors call for institutional changes that enable Chinese elders to die with “social dignity.” [11]
Similarly, research with Indigenous elders in First Nations communities on memory loss and memory care highlights the importance of intergenerational relationships and high esteem for Elders in culturally sensitive approaches to care.[12] I think that such research, which is “with” not “on” elderly community members, provides additional models for improving person- and community-centred care.
[1] Writing this series of blog posts provided a welcome opportunity for me to muse on topics related to the personal and political. Comments are welcome.
[2] The cracks were already apparent for many who work in these systems.
[3] See article by Rob Ferguson:
[4] See, for example, work by researchers Armstrong et al. Caring for seniors the neoliberal way, in M. Thomas et al. (2019), Change and continuity; Daly (2015), Dancing the two-step in Ontario’s long-term care sector, Studies in Political Economy, 95; MacDonald (2015), Regulating individual charges for long-term residential care in Canada, Studies in Political Economy, 95.
[5] See CIHI. Residential Long-Term Care Financial Data Tables, 2013.
[6] Listen to podcast of interview with Pat Armstrong on the Sunday edition:
[7] Cited in Armstrong et al. (2019).
[8] See, for example, Sjögren, K., Lindkvist, M., Sandman, P., Zingmark, K., Edvardsson, D. (2017), Organisational and environmental characteristics of residential aged care units providing highly person-centred care, BMC Nursing, 16(1), 44-9.
[9] In 2019, only nine out of 626 homes in Ontario received comprehensive resident quality inspections (RQIs). See CBC story:
[10] See, for example, Sokolovsky, J. (2009) (3rd ed.), The cultural context of aging: worldwide perspectives, Westport: Praeger.
[11] For example, see article about Kong, S. T., Fang, C. M. S., & Lou, V. W. (2017), Organizational capacities for ‘residential care homes for the elderly’ to provide culturally appropriate end-of-life care for Chinese elders and their families. Journal of aging studies, 40, 1-7.
[12] Also, see: Hulko, W., Camille, E., Antifeau, E., Arnouse, M., Bachynski, N., & Taylor, D. (2010), Views of First Nation elders on memory loss and memory care in later life. Journal of Cross-Cultural Gerontology, 25(4), 317-342.