In the last couple of months, we have been inundated with media accounts framing older people in long-term care (LTC) as uniquely vulnerable to COVID-19. They are a “risky population” that needs extra protections from the virus. Indeed, long-term care residents make up close to 80 percent of the COVID-19 death toll in Canada and in many other countries around the world.
What is mentioned less is that age and health status are only a small part of the traumatic events unfolding in LTC across Canada. Older people are extremely vulnerable, not coincidentally because they are in LTC.
It is no secret that LTC in Canada has been in crisis for decades now, as a result of ruthless austerity and an inexorable privatization agenda that have left the continuing care sector (care for people with chronic health challenges and permanent disabilities) in tatters.
While there is significant variation across institutions, particularly depending on whether or not they are private or non-profit facilities, in early 2019 the Health Care Coalition reported that Ontario LTC residents receive on average around two hours of total care a day and frequently work with significant staff shortages. Staff regularly experience burn-out and violence, and families and volunteers are relied on heavily to supplement care.
Residents do not choose to live in these conditions. LTC is often a last resort for disabled and older people who cannot afford adequate levels of care in their own homes or to live in comfortable retirement homes. Most do not have the social supports needed to supplement what meagre home care provision they might have access to through the government.
Healthcare unions and advocacy organizations have been sounding the alarm for more than a decade about the devastating impacts of LTC staff shortages and grossly underpaid and precarious frontline workers—ranging from care aides to cleaners. The vulnerability of LTC residents and workers is mutually reinforcing. Residents are forgotten and devalued in our society just as their care providers are denigrated and poorly paid. It is impossible to improve the conditions of care without improving the working conditions of those who care for them.
To understand what makes people vulnerable in a pandemic, then, it is crucial that we look beyond individual health characteristics and towards the deep contradictions that structure these crises.
Under capitalism, there is a terrifying and disturbing history of “caring” for people who are not productive in normative ways, or who have experienced first-hand criminalization, hyper-exploitation, eugenics and genocide. This history shows us that capitalism always values profit over people and is thus at odds with the forms of economic, social and political organization that are necessary to adequately address the current crisis of care.
The people who live and work in long-term care are canaries in a coalmine. The acute crisis they currently face is emblematic of the gaping and life-threatening social inequalities in many sectors and communities. Drug users and harm reduction workers, racialized and Indigenous peoples, people with chronic disabilities, trans people, criminalized and migrant workers are just a few groups that are deemed, effectively, disposable in a crisis. Each of these communities have experienced long histories of violent care practices under capitalism, where poor women, disabled, stigmatized and racialized people have been institutionalized in a variety of residential formations ranging from almshouses, workhouses, asylums and prisons.
At various points in time, struggles for more just forms of care have intersected and have constituted significant challenges to capitalism. Some of the more progressive care models in place today—such as harm reduction, reproductive rights, independent living, and even public healthcare—are a result of care organizing within these communities.
In the 1960s, the Black Panther Party Survival Programs established community clinics and breakfast programs for poor black communities. The anarchist history of needle exchanges in the 1970s and 1980s paved the way for many of today’s harm reduction models. Finally, disabled activists have criticized the violence of capitalist care institutions for decades, resulting in the present-day independent living model of user-directed home care services.
More recently, precarious care workers—predominantly racialized migrant women—have demanded pay equity, job security and sick leave leading to many important legislative protections for workers. These models, which Alan Sears calls “health-from-below”, value justice, collectivity, dignity, self-determination and solidarity with other oppressed groups.
We know that profit-driven, capitalist care with its various forms of medical rationing, dehumanizing institutional approaches and individualistic medical lenses threaten all of us when a crisis hits. Now, it is more important than ever to build on existing successful models for anti-capitalist care, knit them together, and demand a society where people, and their care, are central in our political, social and economic organization.
Mary Jean Hande is a postdoctoral fellow at the Nova Scotia Centre on Aging at Mount Saint Vincent University. Her research uses aging and disability studies, historical materialist and feminist methods to explore the political economies of care work in homes, institutions, transnational diasporas, and social movements.