Opinion: A terrible triage: How COVID-19 speaks to a future for Indigenous Elders

By Peter Globensky and Beverly Sabourin

From causes to cures, masks to missteps, instructions to regulations, economic impacts to lost livelihoods, the coverage of the coronavirus disease 2019 (COVID-19) pandemic has expropriated all social media platforms. The virus has become a dominant preoccupation in the lives of Canadians. This is especially the case in Indigenous communities, many of which are in complete lockdown. And with good reason: lives are being lost and we are disconnecting from all that we have taken for granted in a manner unprecedented in most of our lifetimes.

What is equally tragic and may well serve as a harbinger of an even darker future is the havoc wrought upon the elderly by this vicious visitor. As might be expected, the elderly are least able to fight the ravages of this virus – particularly if their immune systems offer any concession. One of our parents, a sprite and lovely but immunocompromised 90-year-old Indigenous elder, is in an assisted-care facility and the worry is constant – a worry which is more than justified. According to Canada’s chief public health officer, over 90% of COVID-19 related deaths are of those over the age of 60 and fully half of those were in long-term care facilities. We have all heard of the horrifying conditions, infection rates and deaths of the elderly in facilities across Canada. The Herron nursing home facility in Quebec is one of the worst examples. There, the wearing of a mask would have been essential. The stench of forgotten food and human excrement and the pain and suffering caused by this gross negligence of the most vulnerable must have been overwhelming.

The more cynical among us might conclude that this viral emergency has forced over-burdened health care professionals and ill-paid personal support workers to affect a “terrible triage”. Given the availability of insufficient resources, to whom are you going to provide the needed ventilator: the 22-year-old millennial mother of two with her future ahead of her or the 80-year-old senior with her past behind her?

Beyond this emergency, however, what does this “response” portend to the future of health care for the elderly and particularly for Indigenous Elders? The answers are not encouraging. Many Indigenous elders, particularly those who have rarely “walked in both worlds”, have little choice but to undergo a forced migration from their ancestral homes to urban communities where health care and assisted-care facilities are far more accessible.  The move to such facilities in urban centres increases the risk of social and cultural isolation separated as they are from these supports traditionally provided in their home communities. That is a sacrifice critical to the stability of their emotional and mental health.

According to a Federal Government report on the social isolation of Indigenous seniors, while Indigenous populations tend to be younger than non-Indigenous Canadians, the proportion of Indigenous elders 65 and older is also growing rapidly. In 2016, more than seven per cent of the Indigenous population was 65 or older, up from 4.8 per cent a decade earlier; that is expected to double within the next two decades. To compound the challenges facing Indigenous elders, over 85 per cent of Indigenous elders have been diagnosed with at least one chronic condition that can contribute to immune deficiencies – welcoming hosts for killer viruses like COVID-19. And if that threat is not enough, compared to the general population of seniors, higher percentages of Indigenous elders in population centres have inadequate incomes and have experienced food insecurity. According to the 2011 National Household Survey (NHS) and the 2012 Aboriginal Peoples Survey (APS), almost 50 per cent of female Indigenous elders in urban centres that were still living on their own and alone were in the low-income population.

Canadians over the age of 65 within the general population now represent the largest age demographic in the country. By the middle of the next decade, seniors could represent up to 25% of the projected population of 40 million-plus Canadians. That is almost 11 million elderly— over twice the number of a decade ago!

The critical question which we must start asking ourselves now is, “How prepared are we for this less visible, more measured but equally insidious ‘graduation’ of this ageing cohort into a future of assisted- and acute-care facilities?”

Currently, almost all such facilities have waiting lists for available rooms or “beds” as they are more often called. Assuming that the vision of most of our elected politicians rarely extends beyond their term of office, can we expect our governments to provide a sufficient number of “beds” to accommodate the substantial increase in the number of elderly requiring admission? Past practice does not augur well for future planning.

Are we looking at converting abandoned warehouses into ‘Seniors Storage Facilities’ with sheets for walls and refrigerated trucks at the end of the journey?  Will younger Canadians of the next generation consider the convolutions of current medically assisted death conversations as quaint and antiquated in the same way we seniors look upon bell-bottom pants and hula-hoops— a fad that enjoyed its time but has now become passé? Will “checking out” become commonplace and expected should our mental and physical functions become “compromised” as they so often do in our later years? These are uncomfortable questions made no less so by difficult answers.  Unless we begin planning for the “onslaught of the elderly” now, our sheer numbers may dictate this form of terrible triage – as much out of kindness as out of necessity.

Without question, the exceptional circumstances brought about by COVID-19 found all Canadians and the governments they elected woefully unprepared for its management and control. Hopefully, we will learn lessons from the many tragedies visited upon the elderly by this pandemic and which will permit us to prepare for a very uncertain future.  We do not want that perennial philosopher of our generation, Walt Kelly’s Pogo the Possum to prove prophetic: “We have met the enemy and he is us”.

Beverly Sabourin and Peter Globensky are seniors. Currently, they are apprehensive about getting older!