
The disastrous outbreak of Covid-19 infections in Canadian longterm care facilities was the stimulus for the Globe and Mail health reporter to write this critique of a uniquely Canadian problem in our health care system. From home care services to hospitals, psychiatric facilities, nursing homes, hospices, and various levels of ‘alternative care’ the fragmented, inefficient and bureaucratic systems that have developed over decades are not serving those who need longterm care well.
Picard documents the extent of these problems exceedingly well with many sobering interviews with patients and frustrated families across the country. He goes on to an unflattering comparison of the situation in Canada with that in many other countries, and closes by making sweeping if tentative and sometimes vague recommendations for reforms.
The case for ‘aging in place’ by providing more home care services is at least 35 years old but the inefficiencies in doing so, tangled up in bureaucratic rules are a challenge and few family members faced with a sudden crisis have the savvy to negotiate through the many sites and agencies that are supposedly available to provide care. And the rules in longterm care institutions, whether public or private are no better. “Models of care based on completing as many tasks or procedures as possible in a shift and ticking all the boxes are not how you deliver quality care. We need to move away from regulating the number of scoops of powdered mashed potatoes each resident receives if we want to make progress.” Not included here, but I know that in some palliative care facilities in Ontario, you will be moved out if you fail to die within 30 days. How asinine is that?
The philosophical and ethical issue of providing assistance to those sometimes very rational individuals who want to die, even if not terminally ill, is discussed only briefly. Most old codgers like me still want to at least seem to be doing something useful, and when that is no longer possible, a quiet exit may be totally reasonable. I often think of George Eastman’s (of Eastman Kodak fame) terse suicide note: “My work is done. Why wait?” From an existential point of view, his suicide is completely reasonable, even if we find it repugnant. As for myself, I would like to live just long enough to be sure no one would be too upset at my funeral.
With both personal and professional interactions with Ontario’s frustrating Community Care Access Centre with a more than 30% overhead administrative cost, and having lived and worked in both a chronic care psychiatric hospital and a municipal nursing home during my medical training, I was keen to see how much has changed in the last 55 years (not enough) and how much has remained the same. I can relate one personal example of very inappropriate home care. Just home from having had a cancer operation, I was provided the mandatory nursing visit. The nurse knew nothing about me except my recent surgery, and promptly related that I had not needed that operation, as he could have supplied me with a Mexican drug to cure my cancer. He took only a cursory glance at my surgical wound. My wife’s experience with postoperative home care visits after very radical surgery was just as useless, as no personnel with the specialized help she needed ever arrived, in spite of multiple requests.
With the strong possibility of spending some of my last months or years in a longterm care facility, I read this book with a mixture of dread and hope. I still think that dying at home is vastly overrated and being in some facility where professionals relieve family members of the messy and unpleasant necessary care is far preferable.
This is a well researched, carefully thought out documentary. Highly recommended. Unfortunately, like those of countless other commissions, inquiries and research reports, the recommendations here are likely to be ignored.
Thanks,
Lois


















