Houses of Horror

Disease. Starvation. Staff walkouts. Since the pandemic started, more than 2,000 residents in Ontario’s seniors’ homes have been left to die alone and afraid. But the problem with our long-term care dates back more than 30 years. We should have seen this crisis coming

By the time Bob Thoms, a retired engineer, entered long-term care, he had already experienced a series of harrowing health crises. He was diagnosed with lung cancer in his late 50s, then lymphoma a few months later. In the wake of chemotherapy, his cognitive abilities began to deteriorate. Doctors chalked it up to “chemo brain.” “He just wasn’t him anymore,” his younger brother, Bill, says. Around the same time, undergoing surgery for a perforated ulcer, Bob flatlined on the operating table and was technically dead for six minutes.

Bob lived alone in an apartment on Wellesley Street. Bill and their sister, Susan Hynes, checked in on him several times a week. After Bob inexplicably tossed a lit cigarette down the garbage chute of his building, causing a fire, they realized they couldn’t provide the level of care he needed. He hated the first home they put him in—too many old people, he said—so they moved him to Guildwood, a long-term care facility in Scarborough. It seemed comfortable and clean, and was a convenient 10-minute drive from their respective homes.

But Guildwood was built in 1967 and, in the parlance of long-term care, was a C-bed home. That is, it only met the design standards set out in the 1972 Nursing Homes Act, which permitted smaller ward rooms with up to four residents, making infection control difficult. The one-storey complex housed 159 people, employed 225 staff and was run by Extendicare, a for-profit corporation that owns 120 retirement homes, long-term care homes and home health care operations across North America. Most rooms had two beds and a shared bathroom, and 80 per cent of residents suffered from cognitive impairments and exhibited behaviours related to dementia.

In October 2019, Bob moved into a room with one other resident. Susan, then working as a house cleaner, visited her brother three or four times a week; Bill, a foreman at a sheet metal company, dropped by whenever he could. Things started off relatively well, but after a couple of months, Susan and Bill noticed that Bob’s cognition had eroded precipitously. Before he’d moved into the home, Bob could carry on a conversation. Now, when someone greeted him, he would just parrot their words: “Hi, Bob! Hi, Bob!” He fell more often. He developed a mysterious rash over his entire body, and when Susan complained to the care staff, they claimed not to have noticed even though Bob was supposed to be bathed twice a week. The rash was still there several months later. The home’s doctors put him on Seroquel, an antipsychotic, which caused strange tics: his tongue darted in and out of his mouth like a lizard’s. When Susan tried to talk to one of the home’s doctors about taking Bob off the drugs, he was dismissive. “He had no compassion,” she says, “no bedside manner.”

At the beginning of the year, moving Bob to a different home would have been a difficult and maddeningly lengthy process. By early March, it was impossible. On March 11, the day the WHO declared the coronavirus a pandemic, long-term care homes began actively screening visitors, volunteers, staff and residents. A few days later, the Ministry of Health recommended that facilities only permit essential visitors. And then, the day after Doug Ford put the province on lockdown, an outbreak was declared at Pinecrest Nursing Home in Bobcaygeon. Within three weeks, almost half of that facility’s 64 residents had died.

Tara Barrows lost her grandmother, Dorritt Paul, at Weston Terrace, a long-term care home near Jane and Lawrence. At 102 years old, Dorritt Paul loved candy, jewellery and piña coladas. Her family liked to joke that she was aging in reverse. “Every day, she seemed to look more fresh and beautiful than the day before,” says her granddaughter Tara Barrows. After Covid hit, her family made plans to remove her from the home, but she contracted Covid before they had a chance and died days later. “I always thought she’d be in the paper for breaking longevity records, but here we are,” says Barrows. “I hope her story helps change the future of long-term care in this country.”

Places like Guildwood and Pinecrest are familiar with respiratory infectious diseases. Every year, the seasonal flu wreaks havoc on long-term care homes. But Covid arrived like a wolf, insidious and mercurial, and long-term care homes provided the perfect environment for its predations. Covid disproportionately targets older people with chronic health conditions, and our homes, by law, house the most fragile subset of this population—people who are nearing the end of their lives and who require round-the-clock care. Residents often sleep, eat and bathe in close proximity to one another, sharing common spaces and cramped rooms. Making sure that residents are bathed, toileted and fed also requires constant contact on the part of health care workers.

By April 23, when Guildwood had its first Covid cases, the home was in chaos. Senior staff had stopped coming in, as had the person in charge of infection control. “That facility was a sinking ship,” Bill says. “And there was no one to captain it.” Four days into the outbreak, 11 residents had tested positive. Hand sanitizer dispensers were empty, disinfectant wipes non-existent. The confused and exhausted staff seemed unfamiliar with proper masking—some wore N95 masks when they didn’t need to, others wore two surgical masks at a time. Soon, there would hardly be any staff at all: over the course of the outbreak, more than a quarter of the home’s employees became infected, while an additional 78 resigned or refused to come to work. Guildwood was a kind of hellscape, complete with a lousy HVAC system that made the building uncomfortably warm.

When Guildwood went into outbreak mode, Susan called immediately. She was told that the infections had been confined to the east wing of the home; Bob was in the west. She continued to call daily to check on her brother. Each time, she heard that he was fine, that he had tested negative. After a few weeks of this, the family learned—not from staff but rather through a page other families maintained on Facebook—that they could arrange a window visit with him. Bill and Susan hadn’t seen their brother in nearly two months. They went immediately.

The man they glimpsed through the glass barely resembled the brother they remembered. Bob had lost more than 30 pounds, his cheeks were sunken, his mouth perpetually open, as if in a silent scream. He lay in a fetal position in bed, hardly able to lift his head. He tried to talk but no words came. An oxygen cannula, which should have been in his nose, rested in his mouth. Periodically, one of the care staff would try, and fail, to move it up with some kind of medical device, unwilling to even touch him. “It was like a horror film,” Bill says. They stayed for several hours. Susan held up her phone to the window, playing the country music her brother loved.

They were told that Bob had been refusing food and water. That made no sense to them, given how well he ate before, and when they returned the next day, Susan demanded proof. She had the staff fill a Styrofoam cup and put it to Bob’s lips. He drank it all. She had them get more. He drank that too. The staff received orders to keep giving him water every 20 minutes, but when Susan called back later that night, the nurse told her, again, that he was refusing. It was an emotional call, with both Susan and the nurse in tears. The nurse said that she didn’t think Bob was going to make it through the night. He died the next morning.

Bob’s siblings were devastated by his death. They were furious they hadn’t been told he wasn’t eating. They were furious that no one had taken any steps to ensure he received some kind of nutrition. They were told Bob likely died of Covid, but they had never been told he tested positive, and, as far as they could tell anyway, he hadn’t exhibited any of the common symptoms—no cough, no confirmed fever. They were certain that he starved to death. Bill didn’t think the home intentionally starved him, but in their lack of action, in their abandonment of those in their care, he and Susan saw a cruelly pragmatic negligence. “They let the people who were weak die,” she says.

When I reached out to Guildwood’s management, they declined to comment on specific cases, but expressed condolences for Bob Thoms’s family. “Nothing is more important than the health and safety of the people in our care. The aggressive and unfamiliar nature of the Covid-19 virus made it extremely difficult to combat in the early days of the pandemic.”

On the surface, Ontario’s long-term care system seems deceptively simple. Long-term care homes, often still described as nursing homes, are divided into three ownership categories: for-profit, non-profit and municipal.

In Ontario, all three types of long-term care homes are regulated and funded by the provincial government. The province covers the costs of all nursing and personal care provided by the home, while residents pay an accommodation fee, which can range from roughly $2,000 to $3,000 a month, depending on whether they have a private or semi-private room. If a resident doesn’t have enough money, they can apply for a subsidy from the ministries of health and long-term care that covers the cost of a basic room, which might house up to four people. Retirement homes, by contrast, are for seniors who are fairly independent. They are regulated by the government, but are private enterprises that operate like rental apartments, with rooms that can run anywhere between $1,500 and $12,000 a month.

Long before Covid, long-term care homes were considered a grim last resort, a place few would willingly choose to spend the final months or years of their lives. Last June, a report on the future of long-term care by the Royal Society of Canada detailed the distressing, often scandalous conditions in many Canadian homes. Residents assaulted by staff or dying from infected bedsores. Severe staffing shortages. Dementia patients being overrun by mice. These appalling accounts span a decade of research, but reforms have been extremely slow to come. Just as individuals don’t like to think about aging, so too have we, as a society, tended to ignore, diminish and defer the care of the elderly. “We’ve seen long-term care as a sign of failure,” says Pat Armstrong, a York University professor who has studied the sector for decades. “The failure of the medical system to fix you. The failure of your family to care for you. The failure of you to care for yourself.”

June Morrison lost her father, George Morrison, at Orchard Villa, a long-term care home in Pickering. George Morrison, born in a farming community in Scotland, was a family man, a music lover, a boxing fan and a sharp dresser. His nickname was “Gorgeous George,” and he and his daughter June loved going camping and on road trips together. In 2016, George was diagnosed with Alzheimer’s and Parkinson’s, and moved into Orchard Villa the following year. Every Friday until Covid, he and June had father-daughter date nights, listening to live music in the lounge. In mid-April, June learned through the media that the home had a Covid outbreak, and she sang her father his favourite songs from outside his window. His condition deteriorated and he was transferred to hospital in late April, where he tested positive for Covid two days later. He died within a week.

This failure is due to the fact that long-term care isn’t part of the health care system as Canadians understand it. When medicare was devised in the 1960s, the median age in Canada was only 26, and long-term care was barely given consideration—most seniors lived with their extended families, and few lived long enough to develop the cognitive ailments that are common today. In 1983, when the Canada Health Act was developed, the administration and regulation of homes was left to the provinces and territories, leading to a patchwork system. As the population has aged and the needs of seniors have grown more complex, the provinces have continually failed to allocate enough resources to ensure safe, comfortable care. Ontario’s health care spending is about $63.5 billion per year, just $3,903 per person, the lowest of the provinces. Only seven per cent of that, about $4.4 billion, goes toward long-term care.

In 2007, the Ontario government introduced its so-called Aging at Home strategy. This made more funding available for home care, but also made it tougher to get into a long-term care home—to be eligible, a person has to have “high” or “very high” needs (physical disability, cognitive impairment, challenging behaviour and so on). As a result, the seniors who entered long-term care homes were older and frailer and required more care than ever before. In Ontario, 86 per cent of long-term care home residents need extensive help with daily activities: turning over in bed, eating, using the bathroom. Ninety per cent of residents have some form of cognitive impairment.

There are currently 78,800 long-term beds in Ontario, the second fewest per capita (after Newfoundland and Labrador) in the country, and a third of these beds are C-beds. (There are also about 1,300 D-beds, which don’t even meet 1972 standards.) An eligible person or their family can choose to go on wait-lists for up to five long-term care homes. The median time it takes to get a bed currently is 161 days, and there are about 37,000 people on wait lists. Like other premiers before him, Doug Ford promised to build 30,000 new long-term beds over the next decade. But by last January, nearly two years into its mandate, the government had built only 34. Even if those beds had been built, however, growing demand will continue to outpace supply. Just to maintain the current wait-list number, the province will need to add 55,000 new beds to the system by 2033 on top of the ones that have already been promised.

And if by some miracle of political will and number-crunching the province builds enough beds, a pressing question remains: who will take care of the people in them? For decades, the sector has been plagued by a chronic and calamitous staffing shortage, mainly due to low wages and minimal benefits, inadequate regulation and the increasing difficulty of the work. For Ontario’s 70,000-odd long-term care residents, there are only about 100,000 employees; more than half are personal support workers, who are paid the least and tasked with the most unpleasant grunt work.

No one in long-term care predicted the coronavirus, but everyone knew that the system could be devastated by something just like it. In early January, when Covid began its march across the globe, ravaging populations in many countries, experts watched with growing dread. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network, is blunt: “The ways we’ve organized and financed and staffed these homes—they have so many vulnerabilities. They were sitting ducks.”

In August 2019, a 56-year-old truck driver named Terence Van Dyke was sharing his one-bedroom apartment in Mississauga with his father, William. William had split from Terence’s mother and didn’t have enough money for his own place. Terence was on the road a lot, and William, who was 84, required an increasing amount of care—he had borderline dementia, and his mobility was rapidly declining. After a bad fall, he ended up in hospital and then a retirement home in Simcoe. It was a relatively luxurious place, but also expensive—about $3,000 a month just for room and board, though Terence had negotiated a discount. Worried that the rate could go back up at any moment, Terence put William on the wait-list for three facilities closer to home.

At the end of January, he got a call saying there was a bed available at Eatonville, a five-storey home that opened in 1971, just up the street from the Etobicoke Civic Centre. Terence didn’t know the place, and with just a few hours to make a decision, he didn’t have time to visit in person. After a quick Google search, he accepted, and moved William in a couple of days later. But within minutes of arriving, he realized he’d made a mistake. Eatonville felt more like a hospital than a home. William’s two-person room was cramped and dark, the only window on the other side of the space, beside William’s roommate’s bed. A thin curtain separated the two men. William’s side was furnished with little more than a bed and a cupboard. Where does he put his stuff? Terence thought. How does he breathe? When he asked an administrator where William could put a TV, she told him he could pay to have one mounted on the wall. “I was thinking, Oh, my God, what did I do? I felt that I let him down.” Terence drove home, crying.

William adjusted as well as he could. On some visits, he and Terence talked about sports like the old days. At other times, though, he would get agitated—he fought with another resident over a TV remote control—and Terence would give him colouring books to calm him.

He never got a chance to install that TV. William’s condition declined, and he developed a hernia, fevers, diarrhea, depression. Covid ripped through the long-term care homes, and by March Terence was no longer able to visit in person. The trucking company he worked for made its employees take their vacation days, and Terence spent all his time in front of the TV, waiting to hear if there was an outbreak at Eatonville. At one point, William told Terence that his roommate was coughing a lot, but when he asked to be moved, the home refused. “I’m going to be gone soon,” he told his son over the phone. Terence tried to brush it off—he hadn’t heard of an outbreak at the home, and his father said he was still eating with other residents in the dining hall.

But what Terence didn’t know was that Eatonville had experienced a Covid outbreak in March. By late April, PPE was being rationed as well, with routine supplies—fluid bags, gowns, gloves—kept under lock and key. Staff, in turn, weren’t adequately informed about infection control and at times didn’t even know which residents had tested positive. Some of Eatonville’s staff and doctors fled, and those who remained—frightened, cut off from their own families, burnt out—were overwhelmed. Residents were consequently neglected. Some developed bleeding fungal infections from hasty or improper catheters, while others were given expired medications. In one instance, a depressed resident complained of being scared and alone. Instead of being comforted, he was sedated.

On April 11, after a long shift, Terence woke up to 21 missed calls on his phone. Two were from Eatonville, and the rest from St. Joseph’s Health Centre. To Terence’s bewilderment, his father had been admitted. A doctor told him that there had indeed been an outbreak and William was infected; he had a high fever and had trouble breathing. He passed away within hours. Terence didn’t understand. It had all happened too quickly, with almost no communication from the home. The fevers and diarrhea William had experienced—had those been Covid? He had no idea what his father’s last moments were like. Was he in pain? What did he say? Was there anybody there to hold his hand?

Terence Van Dyke lost his father, William Van Dyke, at Eatonville, a long-term care home in Etobicoke. In 2016, William Van Dyke moved in with his son, Terence. He loved jazz, rice and beans, and the Raptors—the two of them never missed a game. After William had a bad fall, Terence moved him into Eatonville. Just two months later, the home had a Covid outbreak, and William died alone in hospital. “The other day, I talked to my cousin, who said that when she thinks of my dad, he’s on the dance floor,” Terence says. “That’s how I want to remember him, too.”

Like Guildwood, Eatonville declined to comment on specific cases in their facility. “Once we were notified of the first positive Covid-19 test result,” their representative wrote, “a number of measures guided by Public Health were put in place to contain this outbreak.” They claimed their staff had, in fact, had access to appropriate personal protective equipment at all times.

In the first wave, more than 80 per cent of the Covid deaths in Canada occurred in long-term care homes, more deaths proportionally than in other developed countries including the U.S. and U.K. Within Canada, Ontario and Quebec fared much worse than other provinces—around two-thirds of Ontario’s 2,800-plus Covid deaths were in long-term care homes. “It was a humanitarian disaster,” says Amit Arya, a palliative care doctor who served as part of a rapid response team—the province’s so-called Covid-19 SWAT teams—in homes throughout the GTA. During Arya’s shifts, PSWs would walk out the door and never return, nurses were regularly working double shifts, and there was not enough guidance on infection control measures. When the virus hit a home, it would spread quickly, and there would suddenly be several residents requiring palliative treatments—things like oxygen and pain relief—with no one to properly monitor them. “I’m so traumatized by what I saw,” Arya says. “Not a day goes by when I don’t think about it.” Because regular staff often didn’t even have time to pick up the phone, there were many moments, he says, when he would be the very first person to tell a family that their loved one was dying from Covid.

Arya was lucky to have a large house where he could isolate himself from his family. The residents and many of the staff didn’t have that luxury. In the spring, the province restricted the movement of health care workers to single facilities, theoretically preventing infected but asymptomatic staffers from carrying the virus between homes. But even when this was done, a loophole was left open: PSWs who work for agencies, for example, rather than being on staff at particular homes, are still able to work at multiple locations.

Other factors worsened the situation in Ontario long-term care. Ontario’s homes tend to be older, with more residents sharing rooms, and thus sharing illnesses. And for the last two decades, comprehensive, unannounced inspections—an absolute necessity according to industry experts—have been inconsistent at best: the Ford government only conducted nine such inspections in 2019. The province also expected a surge in hospitalizations and, fearful of exposing residents to the virus, at least one home was reluctant to send them to hospital when they got sick. One PSW told me of a resident at a home in Durham who desperately needed medical treatment. The resident pleaded with the home’s doctor to send him to hospital, and the doctor refused. “By the end of my shift,” the PSW says, “the resident was grey in the face. When I returned the next day, he had passed away.”

This horror became appallingly vivid in April, when a desperate and overwhelmed Ford government called the Canadian military for help. As part of the Canadian Armed Forces’ response to the pandemic, more than 1,600 soldiers were deployed to 54 long-term care homes in Quebec and Ontario, including seven homes in the GTA. To the public, it was like the Allies finally arriving at Auschwitz. Residents were malnourished and dehydrated, in some cases sleeping on mattresses that were soiled or on the floor. Dozens of residents had untreated wounds. Insect infestations were common. Staff, even some doctors, didn’t know how to properly use PPE.

Adam Baker, a 34-year-old lieutenant, was part of a relief team sent to Hawthorne Place Care Centre in North York in June. Before he’d arrived, it was bedlam. Nurses and PSWs regularly moved between resident rooms without changing their PPE, and thermometers and blood pressure cuffs were shared without being disinfected. Rooms were spattered with feces, and there were ants and cockroaches in the halls. Patients cried out for help, unheeded, at times for hours. Some hadn’t been bathed for weeks. By the time Baker arrived, the residents, battered and depleted, were in dire need of human contact. He spent much of his time simply talking to them and taking them for walks. Baker was confident that he and his team had restored Hawthorne Place to some level of normalcy. But was this good enough?

After Terence Van Dyke’s father died at Eatonville, he realized that, sooner rather than later, he was going to have to find care for his 82-year-old mother, Thelma. He couldn’t, in good conscience, put her in a home like Eatonville, nor would she agree to move into one. Terence tried to be optimistic. Maybe, with all the public scrutiny long-term care was finally receiving, there would be positive change. But Thelma was unmoved. “Before I go there, I’ll walk out on the street and get hit by a bus.”

Eatonville and Guildwood, where William Van Dyke and Bob Thoms died, are for-profit long-term care homes. In August, the Canadian Medical Association Journal released a study showing that these kinds of homes, usually owned by corporate chains, had larger and deadlier Covid outbreaks. More than half the deaths at Ontario homes were in facilities run by just six companies: Sienna, Revera, Southbridge, Chartwell, Extendicare and Rykka, which operates Eatonville.

Susan Hynes and Bill Thoms lost their brother, Bob Thoms, at Guildwood, a long-term care home in Scarborough. Susan and Bill spent years taking care of their brother, Bob, an engineer who loved his job almost as much as he loved burgers and doughnuts. His cognition started to slip, so they moved him into Guildwood, a long-term care facility where they could visit regularly and bring him his favourite meals. When Covid hit, they could no longer visit him, and he died several weeks into the pandemic. His siblings believe it wasn’t Covid that killed him, but starvation.

These statistics revived a long-held debate: should companies be able to profit from long-term care at all? A basic tenet of the free-market economy—competition makes corporations more efficient while improving quality and choice—doesn’t seem to apply to long-term care. “There can be little competition when it’s so hard to get into nursing homes in the first place,” argues Pat Armstrong, the York professor who’s studied the system for years.

Ontario started subsidizing long-term care in the early ’70s, and by the end of the decade, the business was a gold mine for corporate chains. When former premier Mike Harris began to fund new long-term care beds—20,000 of them between 1995 and 2002—he also introduced a competitive bidding process that tended to favour large, for-profit corporations. Harris is now the chair of Chartwell, the country’s largest operator of seniors’ residences and a real estate investment trust.

Currently, nearly 60 per cent of long-term care homes in Ontario are owned by for-profit companies, many of which are large corporations that also manage non-profit homes or provide them with food or laundry services. Eighty per cent of C homes—the ones with the antiquated design standards, like Guildwood—are owned by for-profit companies. Until the pandemic exposed its vulnerabilities and boosted expenses, long-term care was considered a solid investment—not in the health care sector but in real estate. Companies owned their buildings and had a growing market. Over the last decade, Chartwell, Extendicare and Sienna collectively paid out more than $1.5 billion to shareholders.

When the public learned about the hellish conditions in some of these homes before and during the pandemic, there was understandable outrage. If these companies were profitable, shouldn’t they be using some of those funds to better protect the people in their care? If homes were no longer safe, wasn’t the onus on their corporate owners to make them so? Like so much in long-term care, it’s more complicated than that. In our hybrid system, companies require government permission to rebuild their outdated homes, and regardless of ownership type, they have to finance that work themselves. Guildwood, for example, has applied three times since 2015 to replace their C-class home with a modern facility, most recently in July. Homes can’t get financing until they’re guaranteed a licence, and licences expire. And the homes can apply for government assistance, but that money won’t come in until the building is ready for occupancy, which can take three to five years. For many companies, just keeping their facilities up to date is a circuitous maze of red tape.

And, of course, there’s an irreconcilable tension between providing care for the most vulnerable and maximizing profit. Lowering labour costs is obviously a key way for any business to make more money, but elder care, just as obviously, requires a trained and well-compensated labour force. When Harris introduced the competitive bidding process, he also eliminated the minimum staffing requirement. To access provincial funding, a long-term care home need only “meet the assessed needs of residents” and have a single registered nurse on duty at all times. The majority of care given to residents, about 58 per cent, comes from PSWs, who, unlike nurses, are completely unregulated: there is no governing body or college to ensure consistent training, discipline or wages. A PSW’s responsibilities include waking residents, getting them out of bed and dressed, brushing their teeth, getting them to meals, taking them to the washroom, bathing them. Some residents need to be convinced to eat. Others may be terrified of the shower.

Pre-pandemic, PSWs performed these tasks multiple times a day, for up to 15 residents at a time. For this work, they’re paid, on average, $22.69 an hour (registered nurses, meanwhile, are paid $44.14). And because it’s cheaper to hire part-time and casual labour, only 41 per cent of PSWs actually get full-time hours; before the pandemic, PSWs usually had to work in two or three homes just to make enough money to live on, a strategy that became impossible once they were limited to working at a single location. Asona Kirton, a Toronto PSW, says she can now go a week between shifts at her GTA home. Another PSW told me that her for-profit home has cut the number of staff on each shift. After several residents passed away during lockdown—they “failed to thrive,” she says, when visitors were no longer permitted—the home struggled to fill the beds and, consequently, began running short-handed shifts with just two PSWs for 26 residents to make up the shortfall.

There were a number of proposed solutions to the PSW crisis—a regulating body, retraining programs, more health care spending. Some were inspired by Quebec, which announced in June a plan to recruit 10,000 new PSWs through a three-month intensive training program and the promise of $26 hourly wages. More than 7,000 have been recruited so far. But resolving the profit issue was arguably more difficult. Not all for-profit homes are bad, of course, and many not-for-profit homes are terrible. Some for-profit homes might pay their PSWs $35 per hour, while non-profits might treat their PSWs abysmally. Holding a home’s leadership to account, therefore, is perhaps more crucial than focusing on ownership itself. For-profit homes have regularly faced class-action lawsuits for many years, and since the pandemic began, at least 10 have been sued in separate class actions. Terence Van Dyke is part of a class action against Eatonville, and Bob Thoms’s siblings are part of a tort suit against Extendicare. Their argument: companies that collect hundreds of millions of dollars of revenue every year have an obligation to protect the residents in their care, and those that don’t—especially given the advance warning Canada had with Covid—should be held responsible.

But more than the homes and their owners, government too needs to be held accountable. Full inspections need to be reinstated. Licences for substandard homes need to be revoked. In June, the Toronto firm Koskie Minsky commenced a class-action proceeding against the province, alleging that it failed to properly regulate and oversee long-term care homes in Ontario. And in October, the Ford government introduced a bill, the Supporting Ontario’s Recovery Act, that critics said retroactively shielded both long-term care providers and the province from lawsuits. “They’re in partnership, these homes and the government,” Terence told me. “They’re a revenue-generating stream. The government writes the regulations, and the homes don’t follow them. The government says even though they may have been irresponsible, they’re still not accountable. Who’s responsible for this? You shake your head.”

In early March, just before lockdown, my oldest, dearest friend was looking for a long-term care home for his father and took a tour of Vermont Square, a for-profit home in the Annex. His father is in a retirement home, but has dementia and will need to move into long-term care soon. My friend was appalled by Vermont Square. “It looked like the set of One Flew Over the Cuckoo’s Nest,” he says—grubby, grim, with a persistent, cloying odour of steamed vegetables and cleaning products. When he discussed the coronavirus with a staffer, he says she told him it was a man-made flu created by China, although Vermont Square’s executive director, Abiola Awosanya, denies that anyone on her staff made such a comment. About the condition of the home, she says, “Vermont Square is an older building. We deal with repairs as they come up and are committed to providing a safe and engaging environment for our residents.”

A few months later, eight residents had died from Covid at Vermont Square, and the home’s management—the operating partner of Rykka, the same company that runs Eatonville—was facing its own class-action lawsuit. By late October, Toronto was fully in the midst of the pandemic’s second wave, and Vermont Square was one of the worst hot spots in the province, with 59 cases—38 residents, 21 staff, plus eight dead. At the same time, there were 82 other long-term care homes with active outbreaks in the province.

Cathy Parkes lost her father, Paul Parkes, at Orchard Villa, a long-term care home in Pickering. Paul Parkes, an avid outdoorsman, spent much of his childhood at his family cabin in Temagami, where he learned to fish, canoe and live off the land. He passed that love of nature on to his children, and first took his daughter, Cathy, camping when she was six months old. At 82, Paul started having mobility trouble and was diagnosed with Parkinson’s disease, though it was later revealed to be a condition called water on the brain, or hydrocephalus. The family moved him into Orchard Villa in November 2019, figuring they could visit regularly and keep tabs on his well-being, but this was impossible after the pandemic started and long-term care homes went into lockdown in mid-March. A few weeks later, Paul was unresponsive and struggling to breathe. He died of Covid on April 15.

Despite the summer reprieve, long-term care homes were still imperilled. The lives of those most vulnerable—the homeless, the incarcerated, those in long-term care—seemed, once again, the least valuable. In response to calls for an inquiry into why long-term care homes had been so susceptible to Covid, Doug Ford had instead created an independent commission. It seemed designed to prevent future outbreaks but in no way fix the system. There were glimmers of hope—Trudeau promised to amend the Criminal Code to penalize those responsible for neglecting seniors in long-term care homes; Ford said he would invest $52.5 million in recruiting and training more health care workers, including 2,000 more PSWs—but as the second wave crested, I began to feel as cynical as Terence Van Dyke’s mother.

We often hear that as a culture, as a country, we disdain the old. That we consider the elderly disposable. The state of long-term care homes is ample evidence of this. But as demographics shift, will such attitudes change with them? In 2012, almost one in seven Canadians was a senior. By 2030, it will be nearly one in four. Seniors are the fastest growing age group in Ontario, with a quarter of the population projected to be 65 or older by 2041. As a culture, as a country, we’ll all be older. “These aren’t other people,” Amit Arya, the palliative care doctor, says. “This is a reflection of ourselves, our parents, our grandparents, our colleagues. We could all end up in these facilities.”

On one of his rounds, Arya was in a home that had about a hundred cases of Covid. It was his first day there, and he saw a resident in a bed at the end of a long hallway. She had dementia, spoke only Spanish, appeared sick and dehydrated. Arya and his team gave her some fluids and called her family, who hadn’t seen her in months, to prepare them for her possible death. They were devastated but grateful that anyone was calling them. She used to eat well, they said, but when the family stopped visiting, she lost weight, became withdrawn, started crying out for them.

When Arya checked on her the next day, he was surprised: the fluids had helped and she seemed healthier. He called the family again, and they started crying. It was the woman’s birthday, a celebration that they’d never before missed. She was 90. It was the end of a 12-hour shift for Arya, he was still in full PPE, exhausted and hungry, but he and his team got on a computer, went on YouTube and learned how to sing “Happy Birthday” in Spanish. They returned to the woman’s room and began to sing. Her face brightened. She sat up. “Gracias,” she said, clapping and smiling broadly, “gracias.” Arya never saw her again, but she reminded him what was at stake. That it was never too late. That long-term care homes, even filled with people who were facing death, were still places of rich, complicated, important life.

This story appears in the December 2020 issue of Toronto Life magazine. To subscribe, for just $29.95 a year, click here.