Start Early, Stay Late: Planning for Care in Old Age

Socialist Register 2021 authors Pat and Hugh Armstrong

Covid-19 has exposed too many weaknesses in the neoliberal capitalist system to count, especially when it comes to the most vulnerable. For 10 years our international, interdisciplinary research team has been documenting the profound weaknesses in nursing home care within Canada, Germany, Norway, Sweden, the UK, and the US. Many of the current deficits in resident care originate in various forms of privatization central to neoliberalism. Especially in Canada, the UK, and the US, nursing homes that are heavily funded by the public purse have been handed over to corporations, providing them with guaranteed pay and often guaranteed full houses.

The lines between for-profit and not have become increasingly blurred by various neoliberal strategies. One of these involves non-profit and state-owned homes contracting out services to for-profit firms as – in denial of the literature on the determinants of health – services such as food, housekeeping, and laundry have been defined out of care and dismissed as ancillary. This contracting out has not only undermined teamwork, but has also resulted in poor food, inadequate cleaning, and limited laundry – all of which threaten health. At the same time, fewer and fewer spaces are available in these homes with government funding. The result is twofold. All those who manage to get into these homes have high care needs, and those who cannot are either forced into the for-profit sector or rely more on unpaid care, most of which is provided by women. For too many, neither of these is an option. Another strategy blurring the lines is the promotion of for-profit managerial strategies within the non-profit and public nursing homes that remain. This means the lowest possible staffing levels, the shifting of as much work as possible to those with the least formal training, limiting workers’ autonomy, pay, hours, and benefits, and relying on a labor force already made vulnerable by gender, racialization, and immigration status.

Barely enough services pre-pandemic have proven to be not nearly enough during the pandemic – which has exposed the disastrous life-altering or lethal consequences of all these developments for those elderly requiring care.

Pat Armstrong is Distinguished Research Professor of Sociology at York University. Hugh Armstrong is Emeritus Professor of Social Work at Carleton University.

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