The Carceral Character of Nursing Homes and How Eugenics in Canada is MAiD

This post comprises an excerpt from my article “Philosophy of Disability, Conceptual Engineering, and the Nursing Home-Industrial-Complex in Canada,” which is forthcoming in Philosophies of Disability and the Global Pandemic, a special issue of The International Journal of Critical Diversity Studies of which I am guest editor. Additional posts about nursing homes and about MAiD can be found on BIOPOLITICAL PHILOSOPHY by using the Search function located at the bottom of the screen.

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On January 5th, 2021, there were outbreaks in more than one-third of the nursing homes in Ontario, with close to 1000 nursing home-related deaths occurring during the previous three months (Front Burner, 2021) and close to 3000 nursing home-related deaths having occurred since the outset of the pandemic (Draaisma, 2021). In the first three weeks of January 2021, furthermore, several hundred more deaths of nursing-home residents in Ontario were added to the tally. By this time, however, many family members of Ontario nursing-home residents—under the leadership of Vivian Stamatopoulos, whose grandparent lived in a nursing home for several months—had begun to vociferously protest and organize against the outbreaks and living conditions in Ontario nursing homes, especially the outbreaks and conditions in for-profit nursing homes. Hitherto barred from many facilities due to infection-control measures and thus unable to provide vital care to their parents, grandparents, or other relatives and friends, these family members and advocates were now apprised of the economics of understaffing in these institutions and the hazards with respect to COVID-19 that the shared accommodations of older nursing homes pose; in addition, they were now somewhat more cognizant of the forms of social ostracism and isolation that nursing homes constitute.

Nevertheless, these family members and friends of Ontario nursing-home residents have continued to believe that transition to public ownership of all nursing homes in Canada, when combined with increased funding, better staff training, and national nursing home standards, will resolve the widespread abominations that prevail in these institutions (for example, Warnica, 2021; also, McQuaig, 2020). In other words, the seeming necessity of nursing homes and their covertly carceral character have remained uncontested and uncritically accepted by this cohort of family members, friends, geriatricians, and other advocates of nursing home residents. Furthermore, the modest challenges to the nursing home-industrial-complex—under the Twitter hashtag #JUSTICE4LTC—that these family members and advocates have advanced are concentrated, more or less exclusively, on the mistreatment of seniors and elders in for-profit nursing homes and “long-term care” facilities, neglecting attention to, or even acknowledgement of, the younger disabled residents in these (and other) institutions, a divisive neglect compounded by the lack of political analyses of systemic disability, ableism, and ableist eugenics in the public statements—including the Twitter hashtag #SENICIDE—that Stamatopoulos, geriatric physicians, and other advocates have made to the mainstream press, on social media, and in other venues.

Indeed, these family members and other advocates for seniors and elders in nursing homes have largely reproduced pervasive misconceptions about the character of nursing homes and other so-called long-term care institutions, misconceptions according to which these institutions are first and foremost sites of care, kindness, and concern, the dire current (and past) conditions of which are contingent features of them that can be improved or eliminated. When, for example, on February 12th, 2021, the mainstream press in Toronto (Espinosa and Talbot, 2021) reported that door handles had been removed from the living quarters of COVID-positive residents in a Verve-owned retirement and assisted-living residence in southern Ontario, Stamatopoulos and other advocates for seniors and elders expressed astonishment and outrage. While this outrage was justified, the astonishment that accompanied it seemed rather hyperbolic given that almost all nursing homes and so-called long-term care institutions in Canada include a section (“locked unit”) from which residents cannot freely exit.

When the news broke on January 29th, 2021, that Chris Gladders, a 35-year-old disabled Ontario man, had accessed a medically-assisted suicide (MAiD) on the previous day in part due to the squalid living conditions of the privately owned, for-profit institution in which he had been placed, his death went virtually unacknowledged by these family members of senior and elder nursing-home residents and other opponents of private, for-profit “long-term care” facilities in Ontario and across Canada. Even André Picard, the health columnist at one of Canada’s leading national newspapers and author of a book on nursing homes and the pandemic, seemed not to notice this event nor recognize the more general eugenic impetus that links nursing homes and MAiD (Picard, 2021). Disabled scholars and activists have, however, repeatedly attempted to draw attention to the connections between the neoliberal agenda of the Ford government; nursing homes, supported-living facilities, and other institutions in which disabled people and elders are confined; and the history of ableist, racist, and eugenic government policies and practices in Canada, including the Canadian federal government’s policies and practices of extermination and assimilation of First Nations, Métis, and Inuit peoples.

Only about 60 percent of nursing homes and so-called long-term care facilities in Ontario operate on a for-profit basis; however, many of the remaining facilities in Ontario are managed and operated by, that is, outsourced to, privately-owned nursing-home corporations—such as Chartwell, Extendicare, Revera, Sienna, and Southbridge—licensed to do so under contracts with the Ontario provincial government (Roy and Huynh, 2021; Warnica, 2021). Indeed, this state of affairs likely goes some distance to explain why 85 percent (not merely 60 percent) of Ontario nursing homes and other “care” institutions have been repeatedly cited for abuse and neglect of residents, as well as medical error. Although funding for nursing homes in Canada falls under the jurisdiction of the various provincial governments, a significant portion of this funding derives from federal government transfers to the provinces (Warnica, 2021; also Stall et. als., 2020). It is important to note, therefore, that, at present, the Canadian federal government allocates to the operation of nursing homes and so-called long-term care institutions in Canada only 30 percent of the money that other Organization for Economic Cooperation and Development (OECD) countries allocate for the operation of these institutions in their respective countries (Sinha, 2020; CBC Radio, 2021).

By the end of January 2021, more than 14, 000 residents of nursing homes in Canada had died COVID-19- related deaths. Although the collection of COVID-19-related data for group homes and supported living centres (the congregate settings in which most institutionalized disabled people are segregated) has been sparse throughout the pandemic, manifesting the myriad ways that the federal and provincial governments of Canada have in general neglected disabled Canadians since the outset of the pandemic, the issues with respect to staffing and crowded living quarters are similar across all of these institutional settings. By February 4th, 2021, 1195 outbreaks had occurred in Ontario nursing homes since the outset of the pandemic and, in addition, 459 outbreaks had, during this period, occurred in Ontario group homes and the other Ontario institutions in which most institutionalized disabled people have been placed (Canada Tonight, 2021). Nora Loreto, an independent journalist who has diligently collected data throughout the pandemic on the number of outbreaks and deaths in all residential settings across Canada, reported on February 6, 2021, that 14, 867 of the 20, 702 COVID-19 deaths in Canada by that time had occurred in 1,484 of these institutional settings (Loreto, 2021a).

Loreto emphasizes the fraught nature of the data (personal communication). In Canada, as Megan Linton and Allen Mankewich (2021) point out, no disaggregated data has been released on the impacts of the pandemic on disabled people. This “statistical dearth,” Linton and Mankewich argue, has set the stage for a vaccine rollout that will leave behind many people who should be prioritized in the process. Indeed, whether it be COVID-19 vaccines, data collection, financial supports, or housing and food security, disabled Canadians, a sector of the Canadian population that is disproportionately dying from COVID-19, have been systematically and consistently left out of the Canadian government’s policies and planning during the pandemic. As Loreto puts it, “Of all the systemic issues that have been exacerbated by COVID-19, none has been more significant than ableism. Ableism,” Loreto writes, “is the thread that has run throughout every aspect of this pandemic” and explains why Canada’s response to it has been negiligently inadequate (Loreto, 2021b). For Loreto, the COVID-19 deaths in nursing homes and other institutions across Canada in which elders and younger disabled people are segregated is tantamount to mass murder. I call it genocide.

On January 13th, 2021, Extendicare was hit with a CA$300 million class-action lawsuit stemming from COVID-19 deaths on its premises and, on the same day, Chartwell, Extendicare, and other nursing home corporations in Canada, along with provincial governments and the Canadian federal government, were hit with a CA$500 million class-action lawsuit, alleging negligence on the part of these nursing-home corporations and culpability on the part of the various branches of government (Perkel 2021). In the early hours of January 26th, 2021, furthermore, Doctors for Justice in Long-term Care, a group of more than 200 Ontario doctors and researchers issued an open signed letter with a list of nine demands for the Ford Ontario provincial government, in which they dismissed the Ford government’s pronouncements about the “humanitarian crisis” in Ontario nursing homes as “empty words” and its treatment of the crisis as “reactionary,” calling for (among other things) an end to for-profit nursing homes (Doctors for Long-term Care Justice, 2021; Paling, 2021)..

Yet even well-kept, adequately staffed, publicly owned and operated nursing homes and so-called long-term care facilities cannot be the adequate response to the question of how societies should provide to elders and younger disabled people. On the contrary, such apparently genteel institutions should rather be recognized as the window-dressing of the nursing home-industrial-complex, which is a carceral network of power that operates in the service of ableism, ageism, and racism, while underwriting a neoliberal socioeconomic and political environment in which productivity and profit are steadily prioritized and elders, seniors, and younger disabled people are devalued, disenfranchised, and deemed disposable. Nursing homes and other institutions that segregate seniors and younger disabled people (whether for-profit or non-profit), though not the direct cause of certain ways of treating seniors, elders, and younger disabled people, do institute and expand the scope of the ableist and ageist practices and technologies of normalization that brought them into being in the first place. Indeed, government-owned and -operated nursing homes are no more ideal alternatives to privately owned, for-profit nursing homes than government-owned and -operated prisons are ideal alternatives to privately owned, for-profit prisons, the latter of which institutions also operate in the service of forms of power that disenfranchise and render disposable certain populations, especially racialized, Indigenous, disabled, poor, and trans populations.

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