Neglected No More: The Impact of the Pandemic on Seniors
André Picard: I started following this very early. I remember reading a tweet, I spend way too much time on Twitter, but it was December 31, it was New Year's Eve. During the day, there was my colleague Hellen Brownswell, who works for Stat News, in Boston. She tweeted, "Oh, there’s an interesting pneumonia going on in China, a few cases, it reminds me of SRAS in 2003." Hellen and I had covered SRAS a lot and it really looked very similar. It put us on our toes. We said, "This is interesting, is this another SARS?". So we started tracking that early on. And eventually, we saw that, yes, it was another coronavirus very similar to the one we saw 15 years ago, which hit Canada hard. So, we were interested very, very early and by February, we saw all the deaths in Spain, Italy and China. All the dead were among the elderly, so we knew very early on that it was going to hit the elderly, the seniors in Canada hard too.
Vardit Ravitsky: Your latest book, Neglected No More, takes a look at the living conditions revealed by this crisis, especially in older Canadians living in residences, long-term care homes. What are the facts on the ground that we should know about older people in Canada during the pandemic?
André Picard: I think the most important thing is that we knew there was a risk, a very, very big risk and we did nothing to prepare. We prepared our hospitals in Canada very well and we left long-term care residences to their own devices, we left seniors to their own misfortunes. To me, that's the most serious thing. Much, much of what happened could have been prevented, but we didn't act fast enough. But in this situation, why were seniors at risk? Because they live in ideal conditions for the spread of the virus. They live in facilities with 200, 300 people. They often live 3 or 4 to a room, share toilets. They eat together. They're not very mobile, they have chronic diseases. It's a perfect storm. It's ideal for a virus while we knew it was a problem. And viruses are a year-round problem in these residences. But this one was much more serious because it was new, we'd never seen this virus, so everyone was at risk.
Vardit Ravitsky: Apart from these living conditions which, frankly, seem difficult on an everyday basis, what other vulnerabilities did you notice in the system? What other problems could have been avoided?
André Picard: It's really a systematic problem. As you said, it's a little, a little, a lot of ageism in our public policies. Older people are a bit stuck, are a bit forgotten or very forgotten, except in institutions, we don't have adequate home care. Our cities are not built for people who become less mobile, etc. So it's really a very, very broad societal problem. And we've just seen the intensity of it in the residences in particular.
Vardit Ravitsky: And I'm sure you've looked at what's happened in other countries when you compare Canada to other places around the world. Did we have a particular problem? Were the issues shared by everyone? What do you think?
André Picard: I think the risk was pretty much the same everywhere. But in Canada, we had the worst death tolls by far. About 80 per cent of all our deaths in Canada are among seniors. In most countries, it’s 20%, 30%,40% of deaths. In the US it’s 40 per cent. But in Canada, 80 per cent. It’s really a catastrophe. It’s shameful what happened. So what have others done better? They protected their seniors before we did, but more importantly, they have systems that are better. There's less movement between residences, there are no three-bed rooms, four-bed rooms, etc. So it's really the system that was the big flaw in this.
Vardit Ravitsky: What could we have or what can we now learn from the way things are done elsewhere? What should we adopt at home?
André Picard: I think, mostly, we need to think of where our seniors should live when they lose mobility, etc., when they have chronic illnesses. Is it our philosophy to keep them in the community? I think so. It should be our no. 1 philosophy. Everyone should live in the community. We adapt the community to people’s needs. We can’t just send them to a home. And when people need really critical care, then these residences should look like homes, not prisons. So these are two major philosophical changes that need to happen. And in each of these elements we need practical things, we need more staff, better staff training, a better infrastructure. All very practical things. But once you have a philosophy of changing seniors’ treatment, details are fairly easy.
Vardit Ravitsky: I absolutely share any perspective on the change in philosophy and cultural change from an ethical standpoint. It is extremely troubling, the reality that has been exposed by the pandemic, but the solutions you mention cost money and our policy makers often tell us it is a matter of resources. I wonder if you agree, that there’s a limit to resources. And even if it’s true, what should our priorities be? What do we need to focus on?
André Picard: Of course, there’s a limit to resources, but we have to make choices. We must make political choices. We have to make societal choices. And for me, this should be a priority. We should take care of our seniors out of respect. The other issue, I find, is the issue of money resources. It is often an excuse because in reality, we spend a lot of money, but we spend it badly. So if we start spending our money better, that's a great start. After that, it's choices. So how much will we spend on the COVID response? I think so far it’s 500 billion, some 500 billion. We could repair, we could really improve elder care with, what? 3 billion? 4 billion? Really, when you look at the big picture, it’s a bit petty cash in all this. So money isn’t the real issue for me, it’s the desire to make these priorities happen.
Vardit Ravitsky: The pandemic is described a lot as a "teachable moment," a moment of learning and a moment of reflection for the future of our society. What can we do to keep the attention of the younger generation? To that question, so that it doesn't go away after, after the pandemic?
André Picard: Yes, it's a very big risk. We have very, very short memories in politics. So how do you keep the focus on this issue? I think it's very essential as I do. The way to do it is to do what we do in journalism: tell very personal stories. And I think, at the end of the day, the bottom line in all of this, is that nobody wants to live in those conditions. So, we should insist that everyone lives in the same conditions that we want to live in. So, you ask, we do surveys, 100% of people don't want to live in long-term care residences. It tells us that there is a problem, so there should be a political answer to this issue and we really need to insist on every failing. We have to talk about it, we have to contact our MP, we have to say that it is not acceptable anymore.
Vardit Ravitsky: But do you think that from a political point of view, there is not enough impact? That's part of the reason behind this abysmal failure.
André Picard: I think a little bit. Seniors, those with chronic illnesses, don't really have a voice. They're in a system, they have a lot of other issues besides politics. But there are many, many seniors who are healthy and we know that they vote. They vote in huge numbers. They need to put their emphasis on these issues and other things. So I think there's a very general interest in this issue. One of the things that has struck me most during the crisis is that young people are very interested in this issue. They are sick and tired of seeing how their parents, their grandparents are treated. And there is really a mobilization of young people on this issue of the treatment of the elderly. That's going to make a big, big difference in policy as well.
Vardit Ravitsky: Another issue that was very present in the media and public debate was the staff. We realized the conditions under which they do their daily work. We realized the lack of protective equipment. We realized that the staff is going through several facilities to make more money. Tell us a little bit about what you discovered for your work, for the book in relation to staff issues?
André Picard: The working conditions are really horrible and we know that the working conditions are going to be a direct reflection of the treatment conditions. So if employees are mistreated, we're never going to get good care. So it's essential to recognize this very direct connection. In Quebec, for example, caregivers were paid as little as $13 an hour. No benefits, no full time work, they worked in many different residences, etc. They were horrible working conditions.
André Picard: There is a problem also that most of the people are people – immigrants, refugees – people who don't really have a voice in society. They are mostly women. Long-term care, it's women taking care of women. Sexism is part of it, racism, it's all people in society who live in the margins, who are forgotten. And all this multiplies the problem.
Vardit Ravitsky: Workers passing between institutions must have exacerbated significantly the spread of the virus.
André Picard: No question. People in residential care do not walk around in their residence. All the infections came in via the staff and I'm not saying that to blame the staff too. They were victims of the system, they didn't want to work in five different institutions, but they needed that to feed their families. They had very little, as you mentioned, very little protection. All that protection went to the hospitals. The hospitals were well protected and the others were left out.
Vardit Ravitsky: Another issue that has been debated a lot is the existence of private long-term care facilities and institutions. It has become very controversial. How do you see this relationship between the public and the private in the context of institutions?
André Picard: It's a complex issue. I'm afraid people will see this as a simplistic solution. "We just need to get rid of the private and everything will be better." But that's not true. So I'm trying to answer that question in two steps. First, do we need private residences? No, we don't. But we must ask the question, why are they there? They are there because the government refuses to invest in infrastructure. So they have become necessary. So the question becomes, not getting rid of them, but finding a way to regulate them properly. Also there are different levels of private. There are a lot of small long-term care residences that are families. They are very nice, very nice residences. There are big chains. They have very good residences and they have not so good ones. We have public residences that are horrible. We have some really good ones. So it's not as simple as public/private. Even in Quebec, we have private residences with agreements, which means that they receive money from the government. And some without agreements, no money from the government. Those two categories are very, very different too. So it's a complex issue and we risk making it just a simplistic political issue. And we have to ask ourselves, if there were no private residences today, would the care be better? And the answer to that question is no.
Vardit Ravitsky: So, for you, the ideal would be to have all institutions in the public domain?
André Picard: If we started from scratch maybe, many countries do this, many countries have a mix of public / private residence. I think the "ownership" issue is not important. There are many, there are 50 other things that need to be addressed before we talk about who owns a home. But let’s say we start anew today. If we started building this system from scratch, no, we don't need private, we could do it like our hospital system. There are no private hospitals in Canada, all hospitals are government funded, managed by non-profit corporations, etc. That’s a good system. We don’t need private. But once we’re there, the question becomes, "How can we get rid of it and is it necessary?" Etc.
Vardit Ravitsky: There is this deep desire, that people call getting back to normal life. And when I think of the elderly, of course, there's the desire to see their grandkids, to get out, for those who are healthy to travel, to get back to a social life, but from the descriptions you offer, it's not really a desire to get back to the old life. So how do you see Canada’s future in terms of our approaches towards older people?
André Picard: Yes, I think so. It's not about going back to normal. It's about understanding what the pandemic has taught us, what we should fundamentally change in the way we treat seniors. So we need to invest a lot more in home care, and when we have institutions, those institutions should look like homes, not prisons. Yes, all solutions exist. They exist in Canada. So we have very good long-term care residences. One example in my book is Sunnybrook. Sunnybrook is a residence for Word War Two veterans. It’s a very elderly, mostly male population, 96 years old on average. It's not a pretty sight as far as infrastructure goes, but the care is really exceptional. And what's special about them, they’re really patient-centered. And there are many similar residences in Canada. I think that's what gives me hope. The most hopeful thing is that we know the solutions very well and we know how to do it. And it's doable. It's affordable. Sunnybrook is a public, government-funded establishment. It’s not much more expensive than others. This is what should give us hope.
Vardit Ravitsky: I share your hopefulness. Thank you so much for shedding a light on reality and possible solutions for us. Many thanks, André.
André Picard:Thank you.