André Picard is a health reporter and columnist for the Globe and Mail, and author of six bestselling books including his latest, Neglected No More.
Mr. Picard spoke with Respect editor Jeff Gaye about the book, which chronicles the history of elder care in Canada, and offers us choices for the future.
“It`s a bit of a depressing book, I admit that,” he said. “But I like to think of it as a hopeful book, too. The real hope comes from the fact that we do have a lot of good care in Canada. We have too much mediocre care, but we have a lot of good care.
“Our only real challenge is taking our successes and scaling them up… the most hopeful thing is all of this is really doable with what we know already. There shouldn’t be really any impediment to this except the political will.”
Should we have known all along about the substandard care, the neglect, and the outright abuse of older Canadians that were exposed by the pandemic? Or did we know, but choose not to look?
In any case, we know now. The revelations have been heartbreaking and infuriating. They have shown us not just shocking isolated incidents but widespread and predictable failings in the many systems that are supposed to protect vulnerable elders.
André Picard’s newest book, Neglected No More: The Urgent Need to Improve the Lives of Canada’s Elders in the Wake of a Pandemic doesn’t shade our eyes from the historical horrors of elder care in Canada. His narrative guides us from the 19th Century, when residences for seniors were set up along the lines of a Victorian workhouse, right up to the episodes of cruel neglect we witnessed in 2020.
It would be relatively easy to compile a litany of our failures in caring for our elders. Picard also shows us that a better way is closer at hand than we think—all we have to do is begin it.
The title Neglected No More is reflected in the two parts of the book: Neglected, which catalogues the current state of affairs; and No More, which offers a way to a better future.
But as the subtitle suggests, the need to act is urgent.
“We can’t afford to be at a slow pace anymore,” Picard said.
“The pandemic has really exposed just how bad things were. It’s sent the message that there’s really no excuse for us to tolerate this anymore.”
In practical and political terms, he said, “it means starting to act right now. Don’t expect everything will be done overnight, but there’s no better time to start than immediately.”
If history shows our attitude toward elders as lacking, how hopeful is Picard that we can get to “no more”? Do we have the will to make things better?
“It is strange how we allow ourselves to see elders as disposable and not important and second-class citizens,” he said. “We know in the back of our minds we are all going there, God willing. We’re all going to get old. And I think some of that disconnect has to do with nobody wants to admit that.
“You know, we have this youth-centred culture. No one wants to admit they’re going to get old or that they’re going to get a little bit rickety. So I think we put on these blinders.
“But the other part of it is I think that people do profoundly respect elders, especially their parents and their grandparents. And the other disconnect is well, you do it individually. Why don’t we do it collectively?
“And I think that’s the leap we have to make. I don’t think it’s a very big leap, we just have to give people that opportunity.”
Picard shows examples of successful approaches in Canada and elsewhere that offer elders better care and better lives. He talks about the difference that staffing, caregivers, long-term care, home care, palliative care, and community bring to the lives of older people; and he discusses how funding, structure, and regulation can support better care and better lives for them.
But all of this is amid fears that society will not be able to deal with its aging population. Picard refuses to buy into excuses for inaction.
“There’s a lot of nihilism about this,” he said. “You know, one of the expressions I hate the most is the ‘grey tsunami’ or the ‘silver tsunami’ because to me, the aging of the population is something we should be celebrating. It’s really a miracle of science, of medicine, of social policy.
“We’ve done a lot of great things so that people can get old and we shouldn’t see that as a bad thing. We should see it as a great thing and we should figure out how to deal with it, how to allow people to keep living a good life as long as possible.”
And it’s not as if we didn’t see it coming. We’ve known about the demographic swell of the Baby Boom generation for fifty years, and we kept kicking the problem down the road. Our lack of planning and preparation will cost us, Picard says.
“The reason we have to spend more money is because we’ve neglected this sector for four decades, so there is some reckoning to be had. There’s some catching up,” he said.
But it could cost us even more if we don’t change our thinking. Many positive measures, such as improving home care and encouraging people to age in their communities, could actually save money. And, Picard says, there’s no point paying for bad care when that same money could be used to provide good care.
“Overall, it’s not unaffordable, for a couple of reasons. One, we spend a lot of money now on bad care. And if we spent that money smarter, there’s a lot of little things that can be done that don’t cost a lot of money and that can have a big impact. So spend what we do now better, and spend a little more.”
Some attitudes, like some decades-old care homes, will have to go. In the book, Picard says that “after decades of duct tape solutions, Canada’s provinces need to make judicious use of the wrecking ball.” He said he means that literally—big housing towers should be replaced by smaller in-community homes—and figuratively.
“I think philosophically, we need to tear some things down. We have to stop with this attitude that elders are dispensable and they can just be shoved off into institutions and forgotten,” he said. “We have to take the wrecking ball to our attitudes and say ‘we value our elders, and we’re going to prove it in policy.’
“The other part, practically, is a lot of our infrastructure is old, outdated, and inappropriate. You know, these big 300-bed facilities that look like prisons that were built 50 or 75 or 100 years ago, those are the ones we need to take a wrecking ball to quickly and then eventually replace all these with homelike care.
“We talk about giving people care, but it’s hard to do that if the place you live looks like a prison—and was built like one.”
The federal government has signaled it wants to work with the provinces to develop national standards for long-term care. Some provinces, including Alberta, have not shown enthusiasm for the project.
Part of the argument is that healthcare is provincial jurisdiction, and provinces shouldn’t be bound by federally-imposed standards. Picard says jurisdiction is a non-issue and Canadians are fed up with excuse-making.
“I think people are fed up with governments, federal and provincial, using jurisdiction as an excuse to not do things or to pass the buck. People are tired of that. They want them to work together,” he said.
“And what I’m saying is we need national standards. That doesn’t mean federal standards, it doesn’t mean Ottawa dictates, it means that governments have to sit down together and have some common expectations that every Canadian should have more or less the same expectation of care.
“That’s why we do that in hospitals. When governments say, ‘oh this can’t be done,’ we do it all the time. If you go into a hospital in Medicine Hat or Moncton, you have the exact same standards of care. There’s no barrier to that, constitutional or political or otherwise.”
Then, he said, Ottawa’s role would be to insist that federal funding be applied to its intended purpose.
“It’s not anybody treading on anybody’s territory, [it’s] just sitting down and agreeing to things. And then if you want to move things along, what I say is Ottawa transfers a lot of money to the provinces and it should use the money as a cudgel.
It should say, ‘listen, we’re going to egg you on, and we’re going to encourage you to cooperate and we’re going to do it by giving you money—and not giving you money if you don’t cooperate.’ That’s how all countries that have this mixed federal/state or federal/provincial system do it.”
The answers, Picard says, are all there. This problem has been the subject of endless studies, inquiries, and commissions; and they all have excellent recommendations to make life better for aging Canadians. Now it’s up to us.
As he says to close the book:
Ultimately, fixing eldercare is not about writing more reports, building more beds, spending more money or adopting new standards. It’s about giving life to our values. If we love and value our parents, grandparents and great-grandparents—and, across the political spectrum, there is no question we do—then that must be reflected in our public policies.
It’s long past time for the neglect to end.