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‘Warehouses like this are not the answer’: Exposing the crisis of long-term care in Manitoba

82% of Canada’s COVID-19 deaths have been in long-term care

Canadian PoliticsHuman RightsCOVID-19

Staff stand in a dormitory at the Manitoba Developmental Centre. Image courtesy of the Archives of Manitoba.

Vietnam, New Zealand, China and Canada’s Atlantic provinces have demonstrated that once a population gets to low levels of COVID-19, it is easier to stay there. This is proof that ongoing strict public health measures work. By contrast, Manitoba went from being the province with the lowest levels of COVID-19 through the first wave of the pandemic to having the highest recorded infection rate in the country. How could this happen?

Throughout the summer, the Manitoba government led by Premier Brian Pallister flouted its success over the virus’s first wave—launching a tourism campaign, vilifying CERB and those who used it, and pushing for the provincial economy to be the first to reopen. Pallister’s failure to reign in the spread of the virus is a direct result of government inaction which has resulted in outbreaks across the province’s already strained personal care homes. At the time of writing, ICUs are at 96 percent capacity, and the province has recorded 172 deaths.

Recently, Health Minister Cameron Friesen received backlash after he stated that deaths in personal care homes are “unavoidable,” and for failing to take any responsibility for his government’s role in neglecting the unfolding disaster in those facilities. In an interview with Canadian Dimension, long-term care resident and patients’ rights advocate Shoshana Forester Smith said, “I want people to remember that it is not just seniors in long-term care: it is people in their 20s, 30s, 40s, and 50s too. People can live for years in care with a good quality of life. Long-term care is a place you go to live, not to die. It is not hospice.”

The minister’s morbid claim that deaths in long-term care are simply inevitable is rooted in the capitalist logic that renders certain lives less important than others. If these deaths have become “unavoidable,” it is due to austerity measures expedited under the Pallister government, the mismanagement of public health measures, and an overreliance on institutionalized models of care.

Personal care homes in Manitoba are underfunded, overcrowded and in high demand, particularly within the Winnipeg Regional Health Authority. In 2016, the Pallister government promised 1,200 new beds, but his administration has only provided funding for 258. Homes are already filled to capacity, despite a rapid increase in demand projected for the next 15 years.

Manitoba has more public personal care homes than other provinces hit hard by the pandemic, including Ontario and British Columbia. However, private personal care homes are expanding in Manitoba—the most recent investments into personal care homes by the province were to Winnipeg Mennonite Seniors Care Inc., a small private personal care home provider. Throughout the crisis, private care homes have suffered higher rates of outbreaks and fatalities compared to their non-profit or public counterparts. The Manitoba government has known this for decades. A 2002 report by the Manitoba Nurses Union found that “the rationing of gloves in some for-profit facilities, as an example, sends the message that the most important factor in operating a personal care home is cost and profits and that safety and health are secondary.” The same report found that respiratory infections were widespread in personal care homes, particularly for-profit institutions.

While private homes are particularly attentive to profit margins, under Pallister’s austerity regime, public care homes have been forced to undertake cost-cutting measures. In 2017, public care homes had to make cuts of 0.25 percent to their budgets. This was repeated in 2018, forcing homes to make an additional spending reduction of a quarter percent. These reductions have forced public care homes to operate more like their private-sector counterparts, rendering decision making processes contingent more on margins than patient safety.

Manitoba has among the lowest hours of home care in the country, despite the fact that 95 percent of aging people say they would rather spend their later years at home. While the government defended its lack of personal care home expansion on the premise that they increased aging-in-home programs, this was a mirage. Manitobans have access to only 55 hours per week of home care service, compared to the 120 hours provided in Ontario. Minimal access to home care in the province guarantees an overuse of personal-term care facilities, particularly for younger disabled people.

Tyson Sylvester is a 25-year-old disability advocate who is currently forced to live in a personal care home in Manitoba. In 2018, Tyson sat inside a makeshift prison cell in Winnipeg’s Old Market Square to protest government policy that he claimed “locked him out of life.”

Increasing infection rates in Manitoba and other provinces means that personal care homes have had to lockdown. These measures are particularly concerning given the critical role played by families in care work, and the importance of connection to the outside world in maintaining mental health. Many personal care homes do not provide WiFi to patients, and have low levels of staffing and access to recreation. Sylvester called these conditions “actual torture,” and cautioned, “pray that you never ever end up in this place.”

Like Sylvester, Forester Smith is appalled by the quality of the care she is receiving after months of delay and inaction:

My long-term care facility is in the midst of an outbreak. I am immunocompromised so the threat of COVID is a real scary possibility. It’s hard because we are stuck in our rooms 24/7 and only allow one visitor a few hours a day. I am very lonely. Lots of rules and restrictions make it feel more like a jail than a long-term care facility.

Similar conditions are being reported inside Manitoba jails, where incarcerated people have been in lockdown for several months. Institutionalized populations throughout the province are sharing the same grim reality: lack of access to testing, protracted isolation, and a general lack of basic human rights. While the outcome and goals differ between personal care homes and jails, they are united by a carceral dimension that sees people as balance sheet items.

There has also been a lack of government enforcement of COVID-19 protocols, leaving individual homes responsible for adhering to sometimes confusing and contradictory public health advice, or being the target of surprise inspections. At Sylvester’s home, Actionmarguerite in Winnipeg’s St. Boniface neighbourhood, he found out there was an outbreak among staff from a Facebook message, not from the facility’s administrators. To add insult to injury, residents were never tested for COVID-19. This created a significant amount of stress.

“My biggest fear is that staff are going to keep testing positive,” he says. “For me it only seems like a matter of time before residents do.”

The Manitoba Developmental Centre, originally built in 1890. A 2018 lawsuit alleged that staff at the facility beat residents and used food deprivation and the use of nudity as punishment. Image courtesy of the Archives of Manitoba.

Forester Smith shared the impact of this uncertainty on her overall health. “I am losing sleep,” she confirms. “My health has gotten worse. I have lost over 30 pounds. It’s also hard to access my specialists and sometimes the care I need because of COVID overrunning the health care system.”

Reliance on institutions for disabled people puts them at increased risk for infection. Both Sylvester and Forester Smith argue that institutionalization is only one way of responding to disability, and far from the best option.

“I wish I could live in the community and get 24/7 care,” explains Forester Smith. “Warehouses like this are not the answer.” And yet, Manitoba has two of the last residential institutions for disabled people in Canada: the Manitoba Developmental Centre and the St. Amant Centre.

The Manitoba Developmental Centre (MDC) was built in 1890 as the Home for the Incurables. By 1932, it was renamed the Manitoba School for Defectives, and operated by a leading eugenicist. According to Mary Horodyski, a researcher at the University of Manitoba, “It is difficult to understand why the MDC has remained open. In 2004, as most other institutions were closing or had closed already, the NDP announced a $40 million commitment to MDC for renovations. It is ridiculous to say that segregating and restraining people with disabilities in institutions could be for their own benefit. Who does it benefit then? The employees, especially those in unionized jobs, and the nearby urban centre, in this case, Portage la Prairie.”

Meanwhile, Forester Smith wonders whether the pandemic will have any lasting effect on institutionalization in the province. “As a society, we will be judged by how we treat our most vulnerable members,” she says. “What do we want our legacy of the COVID-19 pandemic to be? That we failed our most vulnerable or that we did all we could to protect them?”

Luckily, Manitoba health care workers have a rich history of striking to resist neoliberal cuts to essential public services. In 1933, the first doctor’s strike in Canada erupted when, according to the Royal College of Physicians and Surgeons of Canada, “Winnipeg’s medical community refused to continue providing free care to municipal relief recipients in the city’s hospitals.” In the 1990s, Conservative Premier Gary Filmon introduced wide-ranging government reforms that would mark the beginning of neoliberalism in Manitoba. The Filmon government is largely responsible for inaugurating the current trend of overcrowding in Manitoba’s hospitals.

Then, in January 1991, the Manitoba Nurses Union held the longest and largest nurses’ strike in Canadian history, with over 10,000 nurses and 150 International Union of Operating Engineers (IUOE) workers. They won this strike in the face of austerity, and health care workers continued to use the picket line to secure victories.

Today, health care workers hold power in the face of the virus, and unions need to fight for both residents and workers, recognizing that liberation is only possible through collective action and solidarity. Yet, unions, particularly the Manitoba General Employers Union have been responsible for upholding institutional settings.

Institutionalized people in Manitoba are experiencing the brunt of COVID-19—from jails, to long-term care homes to hospitals. Our demands for a just recovery must centre those most impacted by the virus, and this requires a movement away from neoliberalism towards a system of rapid decarceration and deinstitutionalization.

Megan Linton is a disabled, occasional writer and graduate student based in Winnipeg and Ottawa. Her research interests focus on sexual citizenship, institutions and disability, with a commitment to disability justice. Find her tweeting about sex and disability @PinkCaneRedLip.


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