An analysis of Ontario’s long-term care (LTC) sector, involving nearly 100 interviews with residents’ families and frontline staff from across the province, has shown the structure and funding of nursing homes—over half of them for-profit—shaped the trajectory of the COVID-19 crisis.

The study, recently published in the journal Medical Anthropology, documents the first wave of the COVID-19 long-term care crisis in Ontario and its extension into the second wave in late 2020 and early 2021.  According to the most recent statistics provided by the province, nearly 3,800 LTC residents have died due to the pandemic.

“I was really troubled by the fact that so many people in long-term care were dying without adequate hydration and nutrition, let alone proper palliative care and a human presence to accompany them,” says Ellen Badone, a professor of Religious Studies and Anthropology, author of the study.

“The crisis did not happen out of the blue.  It was the result of decades of policies from successive governments and social attitudes about the elderly that made it acceptable for long-term care to receive insufficient resources and staffing,” she says.

The homes with the most serious outbreaks and highest number of deaths were found to be for-profit. Many of them are older residences which do not meet requirements for layout that changed decades ago.

Policies which favoured for-profit, corporate ownership of long-term care homes failed to require homes that did not meet 1972 design standards to modernize, diminished frequency of comprehensive inspections, and generated a staffing  crisis. These problems were compounded by an aging population with increasingly high levels of physical disability and Alzheimer’s or related dementias.

For the study, Badone interviewed 94 residents’ families, administrators, nurses and personal support workers, documenting their stories.  She also consulted numerous reports based on public inquiries into long-term care and research conducted by groups such as the Registered Nurses’ Association of Ontario.  The experiences of four families and one staff member are highlighted through detailed narratives in Badone’s article.

The picture they paint is not one of sudden crisis, but of ordinary lapses in institutional care prior to COVID-19, which were mitigated     by residents’ family members’ efforts to provide additional care, often requiring hours devoted to feeding, hygiene and social support for long-term care residents.

“Family caregivers were helping to keep the system going prior to the pandemic. With the lockdown, the staffing problems became exacerbated and spiraled out of control,” she says.

Badone is careful not to demonize the staff at LTCs, who expressed deep concerns and despair about not having the resources to spend time with residents, being overwhelmed by the sheer volume of residents requiring care each day, and who themselves felt fearful and vulnerable.  The long-term care sector also grappled with inadequate supplies of personal protective equipment, difficulties with infection prevention and control, and little access to COVID-19 testing.

“The thing I’m concerned about is the recognition of the personhood of the elderly.  I think too often those who enter LTCs are seen as being socially dead.  In other words, they are alive but no longer part of the community, part of the social world of the living,” says Badone.

“We’ve got to stop thinking of institutions as places of social death and during the pandemic, places of physical death.  We need to devote adequate resources to the physical and psychological care of the frail elderly,” she says.