The Nursing Home-Industrial-Complex

In a post at the beginning of April, I addressed the way that vulnerability was naturalized in reports in the mainstream press, on bioethics blogs, and elsewhere about the dramatically increasing number of COVID-19 outbreaks in nursing homes in Ontario, across Canada, and elsewhere. My argument in the post drew attention to the systemic ageism and ableism that this naturalization of vulnerability concealed and the specific material atrocities within these institutions, including bland food with little nutritional value, rigid bed and bath routines, the lack of activity and socialization, and their overall disciplinary character. I directed these criticisms at both the for-profit nature of most nursing homes in Ontario and elsewhere in Canada and the institutionalized ageism and ableism that the nursing home-industrial-complex reinforces and reproduces.

In a subsequent post, I admonished the Canadian Broadcasting Corporation (CBC) especially for its uncritical and uninformed coverage of the situation in nursing homes and other congregate institutional settings and its persistent reliance on so-called experts who themselves seemed unaware of the actual living conditions in nursing homes, lacking any critical analysis of these conditions. I thus attempted to fill in some of these gaps in the growing critical discussions about nursing homes that had begun to take place in Canada, the United States, and the U.K., referring to the circumstances surrounding my father’s placement and eventual death in a Chartwell-owned nursing home in Ontario.

A great deal seems to have happened with respect to the public and political consciousness about nursing homes since early April, when I first wrote about nursing homes and the pandemic. But has it really?

Discussions about how the institutionalization of certain populations has increased their susceptibility with respect to COVID-19 have now become common practice in mainstream reporting about the pandemic and in the public statements of government officials, policymakers, and researchers on aging and public policy. The sheer number of deaths in nursing homes has demanded that this be so. With respect to  nursing homes, in particular, the CBC, The Rachel Maddow Show in the U.S., and other mainstream venues now seek to participate in a discourse that disabled activists and theorists (among others) have articulated for a number of years, a discourse that these mainstream media outlets and government officials have in the past ignored.

Although this increased attention to the institutional living arrangements of elders and younger disabled people might seem to be an unquestionably good thing, I think that disabled academics and activists and nondisabled allies must not uncritically and wholeheartedly accept this new attention to the incarceration of these people.

In particular, I think that we must remain vigilant against the tendency of mainstream media, governments, and policymakers to explain the preponderance of positive cases within nursing homes and other “care” facilities with reference to an allegedly inherent vulnerability of elders and younger disabled people rather than their institutional vulnerabilization. At times, these conclusions are indirect or implied rather than explicit, often embedded in remarks that acknowledge the problematic character of aspects of the institutions.

For example, news segments about how the architectural design of nursing homes has enabled rapid transmission of the virus are often accompanied with reference to seniors, elders, and younger disabled people as society’s “most vulnerable members.” In these cases, the outrage about the deaths of these members of society is channeled at the failure of governments to protect them with appropriate design strategies and built structures rather than at the ways in which these institutional settings themselves vulnerabilize these people. To date, I have seen no data to indicate a disproportionate number of COVID-19 cases amongst seniors and elders who reside in the community.

The vast majority of COVID-19 deaths in Canada have occurred in for-profit nursing homes. In Canada, therefore, there have been increased calls for the Canadian government to take control of “long-term care.” The Ontario government has already taken control of several nursing homes (5 of 6 of which are for-profit) which were subject to grave criticism in a whistle-blower report filed by medical personnel of the Canadian military. The soldiers had been deployed in these nursing homes because the situation in them had become so dire, in terms of under-staffing, living conditions of residents, and the spread of the virus. Among the violations that these medical personnel cited were the following: cockroaches and rodents in some facilities, lack of PPE, lack of hygiene, under-staffing, inadequate cleaning and sanitizing of resident rooms, slow response to resident calls for assistance, dirty linen or no linen on resident beds, and inadequate staff training with respect to infection control.

The CBC and other media outlets have stepped up their investigations into the chain of command with respect to for-profit nursing homes, focusing in particular on the shareholder and managerial interests of Chartwell-owned and operated homes whose CEO is the former neoliberal premier of Ontario, Mike Harris. Under Harris, the Ontario government increased the funding to “long-term care” by several billions, most of which went to the for-profit sector of the nursing home-industrial-complex.

Should publicly funded nursing homes be advanced as the solution to the decades-old crisis in nursing homes? On Friday, CBC’s The National aired a segment that compared the nursing-home system in Australia with the nursing-home system in Canada. While more than 6,000 people (close to 1800 in Ontario alone) have died from COVID-19 in nursing homes in Canada, only 29 people have died from COVID-19 in nursing homes in Australia. Australian nursing homes, both for-profit and government-operated, are subject to considerable government regulation and inspection. In short, living conditions are reportedly better in nursing homes in Oz, whether publicly owned and operated or privately owned and operated.

Yet, I submit that even well-maintained and adequately staffed nursing homes cannot be the response to the question of how society should provide to seniors, elders, and younger disabled people. On the contrary, the nursing home-industrial-complex must be recognized as a mechanism that contributes to the reproduction of ableism and ageism. Indeed, I want to argue that we should in fact regard up-scaled regulation and renovation of nursing homes as a kind of gentrification of these apparatuses of power, gentrification designed to ease the minds of the community-at-large about the fact that it has removed a sector of the population from its surroundings; in other words, gentrification that effectively leaves intact these apparatuses and the systemic injustices that they comprise.

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