When the doctors told Joan Pondo that her husband Adam’s dementia had progressed too far for him to come home, she was reluctant to let him go. They had already walked such a long road: they’d been married since 1956, raised a daughter, built a life and settled into their golden years together.
And Adam was "the nicest person," Joan says. After he retired from a long career with MTS at age 55, he took on an endless slate of volunteer jobs, helping people with cancer, or people who are blind. He never said no to a chance to help someone else, Joan says; but by 2017, it was Adam who needed more help than she could give.
Soon, they found a spot for him at Maples Personal Care Home. From the start, Joan says, she found she had to be there daily to check on his care. She would find that he reeked from a diaper left unchanged for hours. She’d find his mouth full of old food, his teeth unbrushed. Early on, she had to argue to get him a suitable bed.
"They just told me they were always understaffed," Joan says. "He never got the proper care the two-and-a-half years he was there. He went in a healthy man, and eventually he was never looked after... I think they just shuddered when I came in every day, because it was always something."
To advocate for her husband, Joan says, she had several conference calls with the head office of Revera Living, the for-profit company that runs Maples PCH and dozens of other facilities across Canada. Revera is a subsidiary of the Public Sector Pension Investment Board, a federal Crown corporation.
Those calls, Joan says, seemed to have little effect.
"They said, that’s all the help they could have in that area, that he’s adequately looked after, that I’m just being overly fussy," she recalls. "I just couldn’t win. My niece finally said ‘let’s quit, you’re never going to win.’ But that’s why I went every day. He was my lifelong partner. He deserved better than that."
After Adam died in August 2019, Joan thought her journey with Maples PCH was over. But when she read about the crisis at the COVID-19 stricken facility last week, and heard a Revera officer insist in a news conference that staffing had been sufficient, she decided to reach out to some of the family members who had spoken out.
She wanted to tell them that she’d been through the same things, even before COVID-19. That she’d seen the same problems with staffing then. That she too knew what it was like to have to daily ensure that a loved one was receiving all the care they need. And she wanted, too, to say a few pointed things about Revera.
"They’re using the pandemic to cover their rears," she says. "What they do is they try to see how much money they can make and they don’t hire enough staff. There was no reason two-and-a-half years ago they shouldn’t have had full staff. Now with the COVID-19 we have, I can see it now being bad."
Joan’s story stands out, not because it is unusual, but because it is so familiar. For years, family labour has been the hidden glue that helps hold Canadian nursing-home care together; it’s little-reflected in official statistics of care hours or costs or the work that must be done, but it is always there, propping the system up.
Earlier this year, when COVID-19 cases were low and Manitoba had not yet seen the kind of big outbreaks that had ripped through nursing homes in Ontario and Quebec, I asked readers to tell me about their experience with nursing homes. The responses painted a broad picture of successes and failures.
On the positive side, family members told me about loving staff who made their relatives’ days brighter. They told me about facilities they had been pleased with and that they trusted. But many also told me about the work it took, every day, to ensure their relative was getting enough care in places where staff seemed perpetually stretched thin.
That advocacy can be gruelling. The pandemic has made it worse. Over the last week, I’ve listened to Maples PCH family members weep from stress and exhaustion, as they fight to get facts from Revera and monitor their relative’s condition. As the crisis deepened, they raised their voices in media to demand better.
They did a heroic job, those family members. They have done their loved ones proud, and for the bravery to stand up and tell Manitoba what they have seen and heard, this province owes them much. But not every resident in long-term care has family who can advocate for them. This is where the system must step up.
Here are the facts: the story of COVID-19 in Canada is a tragedy, above all, of long-term care. About eight in 10 of the country’s deaths to the virus are linked to nursing homes, and those numbers are built not just on the particular effects of the virus, but on decades of funding that doesn’t keep pace with facilities’ or residents’ needs.
To underscore that point, a study of 618 Ontario nursing homes released earlier this week found that in homes with low levels of crowding — more single bed rooms, for instance — COVID-19 mortality was less than half that of more crowded facilities. In Ontario, the most crowded and aged facilities are more likely to be for-profit ones.
Taken to a logical conclusion, this means that if all nursing homes had been funded enough to reduce crowding — or even, perhaps, if all nursing homes had been public or not-for-profit — the country could now have hundreds or even thousands fewer COVID-19 deaths than it currently does.
This should be an alarm bell. This should wake us up. But the hard fact is, if society cared that much about how our most vulnerable elders live, and how they die, then long-term care wouldn’t have been in this state in the first place. Too many facilities were teetering on a brink, waiting for a crisis just like this to send them toppling over.
It was easy to pretend we didn’t notice, for a while. For years, dedicated staff and determined family members poured enough heart into nursing homes across Canada to hold them together. But we have now seen that underneath their labour is a system aching for more staff, for better facilities, for enough funding to meet the full need.
When the worst of the COVID-19 pandemic is over, Canada must convene an urgent public look at long-term care. We will have to ask how some homes fared better amidst the crisis, and some far worse. We will have to understand the cost it exacted from families, from staff, from those who survived. We will have to mourn those who died.
It won’t be easy to look at the depth of this crisis. But it has already been too long in the making.
Melissa Martin reports and opines for the Winnipeg Free Press.