Since the outset of the COVID-19 pandemic, and especially since its effects began to be more directly experienced in Canada, I have carefully watched growing discussions about the pandemic, “seniors,” disabled people, “vulnerability,” and nursing homes unfold on social media and in the mainstream popular press. In particular, I am attentive to the ways that the multiple deaths that occur in nursing homes, in one province after another, have framed discourse about the pandemic in Canada. In addition, I have paid attention to how mainstream media coverage of these deaths has naturalized the circumstances that surround the deaths, treating them as an understandable consequence of a “vulnerability” inherent to the residents of these institutions themselves, due to their age and, in some cases, an apparently inherent characteristic repeatedly referred to as an “underlying condition.” In the current discussions of these COVID-19 deaths in Canadian nursing homes, furthermore, the deaths have been cast as a tragic consequence of the unique circumstances that surround the virus itself, attributed to its specific features and etiology, the speed and efficiency with which it circulates, and lack of epistemic authority about it rather than attributed to and regarded as a consequence of the very nature and function(ing) of the nursing homes in which the deaths have occurred.
Insofar as these deaths in nursing homes continue to be naturalized and depoliticized in the current discourse about the COVID-19 pandemic, the terrible living arrangements that prevail in these institutions—most of which institutions are, even in Canada, owned and operated by large corporations such as Chartwell—remain obscured and are effectively perpetuated. These often appalling arrangements include: facilities that are understaffed and underfunded; skeleton staffs that are poorly trained and under-trained; limited attention to the hygiene of residents; lack of socialization and activity for residents; nutritionally inadequate and bland food; rigidly scheduled meals; restrictive bed and bath routines; and so on. Indeed, this institutionalization of seniors and younger disabled people is a grievous social injustice designed to remove these inconvenient and inconveniencing subjects from the daily lives of nondisabled, younger people, constituting a form of social ostracism that contributes to the naturalization and reproduction of ageism and ableism.
In an important intervention into current critical discussions of social policy with respect to the pandemic, Dr. Amina Jabbar, a geriatric physician and social policy activist, has drawn attention to the ways in which the social circumstances that condition the institutionalization of seniors have been naturalized, depoliticized, and rationalized. In a Twitter thread, Jabbar (@AminaJabbar) wrote:
A family member of mine works in a nursing home. I work in a hospital. When we swap stories about how each of our work places has been handling the pandemic, the resource gaps are HUGE. #COVID19 #onpoli
They tell me about massive shortages of PPE, people feeling pressured to work while sick, unclear protocols about what to do if one of the residents tests + for COVID19, etc 2/
Meanwhile, hospitals can organize & mobilize big drives for PPE & supplies. Hospitals own all the expertise in resource management & pandemic response. And, ultimately, that leaves smaller institutions & community-based organizations in the dust. 3/
Am I surprised at what happened at the nursing home in Bobcaygeon? — Nope AND I think we’ll see similar cases again soon. 4/
What’s the problem? How do we fix it? @kellygrant1 & @jillmahoney do an incredible job pointing out some of the gaps. I’ve added a few of my own here. 5/
What makes nursing homes vulnerable to #COVID19? 1. Shortages in baseline levels of staff (i.e. sanitation, PSWs, RNs), 2. An absence of resource to manage chronic illnesses in nursing homes (w/o transferring to hospitals), 3. Poor protocols for infection control… 6/
4. Unclear advanced directives among individual residents, 5. Shortages in PPE equipment, 6. Lack of broad #COVID19 testing, 7. Logistical difficulties in cohorting #COVID19+ within nursing homes 7/
This list isn’t complete. Most items above are SYSTEMIC & reflect provincial-level gaps in standards of care for nursing homes. Our govt’s have perpetually thinned health resources for DECADES. Nursing homes & our elderly are paying the price for it now. End/ #COVID19
Notice that almost all of Jabbar’s remarks concern systemic institutional failures that have prevailed due to neoliberal austerity measures that the Conservative provincial government of Ontario has introduced and the increasing privatization of social services. Nevertheless, the situation is almost universally and comprehensively the same with respect to nursing homes across Canada and throughout the U.S. Although Jabbar implies that a combination of increased funding of Ontario nursing homes and better staff training is the solution to the widespread problems that prevail in these nursing homes, I maintain that these (and other) problems are inescapable and irreducible aspects of the institutions themselves.
In other words, the outbreaks that continue to occur in nursing homes across Ontario (and Canada more generally) are not due to some characteristic or property inherent to the senior populations of these nursing homes that better funding and staffing could manage. On the contrary, the rising number of COVID-19 cases and deaths in these nursing homes, like the rising number of COVID-19 cases and deaths in prisons, is testament to the insidious nature of the institutions themselves and the dehumanizing and outdated roles that they increasingly serve in society. Indeed, COVID-19 has thrown into stark relief that nursing homes, like prisons, must be abolished.
Seniors and elders in nursing homes and elsewhere aren’t inherently vulnerable; nor are disabled people in institutions inherently vulnerable. Both of these groups (among others) are rendered vulnerable. That is, they are made vulnerable. Vulnerability isn’t a characteristic that certain individuals possess or embody. Like disability, vulnerability is a naturalized apparatus of power that differentially produces subjects, materially, socially, politically, and relationally. In short, it is by and through the contingent apparatus of vulnerability and other apparatuses that certain members of the population are vulnerableized.
With few exceptions, feminist philosophers have not engaged in sustained critical examination of the concept of vulnerability, but rather have taken for granted and valorized its allegedly prediscursive status. My argument is, however, that vulnerability, rather than an intrinsic property of individual subjects, is a contextually specific social phenomenon whose artifactual character could be recognized and acknowledged if feminist philosophers (among others) were to take up Foucault’s idea of “eventalization” (Foucault 2003). Foucault used the term eventalization to refer to a procedure of analysis that amounts to a “breach of self-evidence,” one that puts into relief the singularity of a given practice or state of affairs where otherwise there would be a tendency “to invoke an historical constant, an immediate anthropological trait, or an obviousness that imposes itself uniformly on all” (249).
Eventalization aims to show that things are not as necessary as they seem. As Foucault remarked, “It wasn’t as a matter of course that mad people came to be regarded as mentally ill; it wasn’t self-evident that the only thing to be done with a criminal was to lock him up; it wasn’t self-evident that the causes of illness were to be sought through the individual examination of bodies; and so on” (2003, 249). No one is a criminal, but many people are criminalized. No one is an illegal immigrant, but many people are illegalized in this way. No one has a race or a disability, but people are racialized and disabled. No one is a vulnerable (to use Eva Kittay’s term), but many people (including seniors, disabled people, and prisoners) are vulnerableized.
In short, seniors (and younger disabled people) in nursing homes are incrementally made vulnerable, that is, they are vulnerableized through (for instance) the asymmetrical relations of power that discipline virtually every aspect of their (institutionalized) daily lives; they are rendered vulnerable by the governments that under-finance the services and additional resources that would otherwise enable them to live in the community; and they are vulnerableized by the family members and communities that put them in these institutions only to neglect them.
The COVID-19 pandemic has shone a spotlight on the fatal consequences of this ruthless vulnerableization. We must ensure that these deadly consequences spur on larger and more critical cultural discussions about the institutionalization of various constituencies, discussions that in turn must motivate significant social and political changes of the practices and policies that govern the lives of the subjects who make up these constituencies.
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