Ageism contributes to poor care in long-term facilities

The COVID-19 pandemic has made it clear the disparity of care for residents in long-term care compared to that in hospitals. An indicator of that disparity is the fact that 80 per cent of COVID-19 deaths have been in long-term care homes so far.

image: mybetternursinghome.com

I’m avoiding the label of “the elderly” for these residents for reasons I’ll explain later.

The reduced long-term care is not for lack of dedication by workers but for political reasons. Barb Nederpel, President of Hospital Employees’ Union, told me:

“The pandemic has brought the problems in how we treat seniors and those who care for them into sharp focus. Twenty years ago, workers in long-term care earned the same wages and benefits regardless of their employer. Through privatization and contracting out, the BC Liberals forced thousands of these workers into lower paid jobs. Many took second or third jobs to make ends meet. To keep seniors and workers safe during the pandemic, public health officials are limiting workers to single sites and we’ve secured agreement from government to increase those wages back to the industry standard.”

For ideological motives, the BC Liberals argued that private care facilities could operate more efficiently. Privatization created a multi-tiered system where those who could pay more got better treatment.

The trouble with this model is that in this market where there is a labour shortage, workers will go to where they are paid more -leaving places that pay less short-staffed. The residents who call those places home suffer.

Ageism is at the heart of deaths in long-term care homes. The reduction in worker wages reflects the degree that we care about the residents of those facilities. The death of “the elderly” is seen as no big deal. People get old and die. The meme “Boomer Remover” that has been circulating reflects the dark humour of ageism.

To dismiss residents as “the elderly” robs them of their dignity as fathers and mothers, grandfathers and grandmothers, brothers and sisters. Let’s call them persons; persons who love and are loved, who laugh and cry, and make a difference in the world. Age should be just one aspect of anyone’s life, not a defining attribute.

Hospitals are relatively well-prepared for the pandemic in contrast to long-term care homes says Rona Ambrose, former Conservative minister of health and minister during the Ebola crisis in 2014:

“Our hospitals are ready. Doctors and nurses have been properly trained and are waiting to be called in for COVID-19 duty. Personal protective equipment is available, and, if not, it’s on its way.

“Meanwhile, caregivers in many long-term care homes are underpaid, lack training and don’t have PPE. How could this have happened when we knew from day one that long-term care homes would be centres of COVID-19 infection? How could we have failed our care-home residents so badly? There are hundreds of these facilities dealing with outbreaks across Canada (Globe and Mail, April 13, 2020).”

Post-pandemic, we will need to reset our values so that workers’ wages coincide with the value that we place on them. It’s too bad that it takes a pandemic for that disconnect to sink in. There has been an outpouring of appreciation for workers who have put their lives on the line to serve us. Let’s back up that appreciation for long-term care workers with a living wage.

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Re-humanizing work

Machines do many things better than humans –except at being human.

image: This Caring Home

Advances in technology have always generated anxiety. Workers during the Industrial Revolution of the 18^th century thought they would go “the way of the horse.” Steam-powered tractors had replaced horses and they feared, with spinning frames and power looms, that they were next.

The fear of job-loss due to automation is unavoidable. However, humans are better at “empathy jobs” and that’s where the future of work is heading.

A recent report from Canada’s Brookfield Institute studied Canada’s labour market and found that 42 per cent of Canadian occupations are at high risk of automation in the next 10 to 20 years (Working Without a Net: Rethinking Canada’s Social Policy in the New Age of Work from the Mowat Centre.)

The jobs most at risk are in the trades, transportation, equipment operation, natural resources, agriculture, sales and service, manufacturing, utilities, administration, and office support.

Some of these jobs in the trades, often done by men, are mind-numbing and dangerous –in locations isolated from families that lead to alcoholism, self-medication of drugs, and death from drug overdoses (the trades are over-represented in  fentanyl deaths in B.C.). Other than good wages, these are jobs that won’t be missed.

Jobs at the least risk are in arts, culture, recreation, sports, management; professional positions in law, education, health and nursing. We won’t see robots playing hockey or robot actors on the stage any time soon. Humans are still the best at jobs where the human touch is necessary like health care, child care, and care for the growing number of seniors.

However, not all empathy jobs pay equally. While some jobs are well-paid because they are unionized -such as teachers and health care workers- others like private child-care facilities are not. Some work, usually done by women, such as a daughter caring for her aging parents or a grandmother caring for grandchildren, is not paid at all.

Another source of job-growth is the hybridization of machines and humans. In the gig economy of piecemeal work, technology directs workers. Some workers like these hybrid jobs because they offer flexibility. Employers like them because workers are “contractors” not employees. As such, companies don’t have to pay benefits.

Britain is making changes to the working conditions of workers in the gig economy by ensuring that “vulnerable workers,” as defined by low wages, have access to basic holiday and sick pay.

Workers in low-paid empathy jobs and workers in the gig economy are in the same predicament –low wages with few benefits. That’s where the Canadian government could help with programs like employment insurance, sick leave and universal Pharmacare.

Investments in childcare and home care for seniors would not only employ more empathy workers but improve the conditions of all low-wage workers including those in the gig economy.

Governments stepped in during the Industrial Revolution to implement labour laws. Governments must step in now to strengthen programs to ease the transition into the digital economy.

Surely the things we value, like human interaction, can pay as well dangerous works like resource extraction. Surely workers the gig economy can have both flexibility and security.

 

Let’s finish the job and implement Pharmacare

Medicare is a good idea but incomplete without Pharmacare. Let’s finish what we started in the 1960s. The plan was always to finish our health care system but realization of that dream got lost in perennial federal-provincial squabbling.

image: Green Party

Canada is an anomaly among nations. We are the only industrialized country with a universal public health care system but no Pharmacare.

Every study of Canada’s health care has identified the lack of Pharmacare as a major gap in our system.

Medicare without drug coverage doesn’t even make sense. What good is a health care system that prescribes drugs but doesn’t cover them?

What we now have is a mess. Drug coverage in Canada consists of a patchwork of 100 public and 100,000 private insurance plans. Some working Canadians are covered by employer-funded private plans. Seniors and those on social assistance are covered by publicly-funded provincial plans. Indigenous people, military members, federal inmates are covered by federal plans. Low-income Canadians struggle. In B.C. they have to pay up to the deductible amount.

Studies show that some low-income Canadians go without prescribed drugs because they have to buy groceries and heat their houses first. Women typically suffer more than men. Nearly two million Canadians reported not being able to afford one or more drugs in the past year. Unfilled prescriptions result in an additional burden on our health care system –patients end up going back to their doctor or to the hospital.

What we have is a mess and it’s ridiculous. When I go to the hospital, prescribed drugs are covered by Medicare and dispensed from the hospital pharmacy. When I walk out the door of the hospital, I’m on some other plan if I’m lucky, no other plan if I’m not.

The model of Medicare provides a good template for Pharmacare. While Medicare is universal in that it covers everyone, it is not universal in that it covers everything. This is especially true for Pharmacare as technology offers ever more expensive remedies. Pharmaceutical companies are coming up with new, expensive, drugs. Some are only marginally better, some no better than generic drugs. Pharmacare should not cover every conceivable pharmaceutical.

Drug spending in Canada has grown significantly over the past few decades, from $2.6 billion in 1985 to $33.8 billion in 2017, and the share of GDP spent on drugs has more than tripled from 0.5% to 1.6% over this period.

Pharmacare will reduce the amount we pay for drugs. Canadians pay among the highest prices and spend more on prescription drugs than citizens of almost every other country in the world. Among Organization for Economic Co-operation and Development (OECD) member countries, only the United States and Switzerland spend more per person each year on prescription drugs and pay higher patented drug prices than Canada.

The bickering between the federal government and the provinces over Pharmacare must stop. Now’s our chance. The federal government has opened a dialogue. What do you think? You can answer the questionnaire and make a submissions until September 28.