A dying man was alone. No family; his only companion a cat.
Home-care workers cared for the man’s every physical need – feeding, toileting, bathing. But they refused to clean the cat’s litter box because that task wasn’t included in the care plan.
Quebec’s Protecteur du citoyen (Ombudsperson) Marc-André Dowd, in his annual report, cited this as a striking example of the troubling dehumanization of care caused by excessive bureaucratic rigidity.
He said that, under the circumstances, it was “absurd and inhumane” to not bend the rules a bit for humanitarian reasons, given the man’s loneliness and distress and the importance of having his pet nearby at end-of-life.
In a health system struggling with overflowing emergency rooms, lack of access to family physicians, interminable waits for surgery, mass deaths in long-term care homes, and much more, it may seem a bit absurd to get worked up about cat droppings.
But it’s all connected.
As Mr. Dowd points out in his report, health care administrators seem to have lost sight of the fact that there are actually real, flesh-and-blood people on the receiving end of care.
We all just feel like numbers now, cogs in the bureaucratic machinery. We’re supposed to feel thankful for the tasks performed on us and our loved ones once their turn in the queue comes, and otherwise shut up and be thankful.
The Quebec Ombudsperson highlights several examples of these depersonalized and dehumanizing approaches to care.
Mr. Dowd dropped in unannounced on a CHSLD (nursing home) that had been the subject of a complaint. He was troubled by what he saw. Workers were feeding elderly patients lunch in a robotic fashion, chatting with each other and watching TV, a scene he described as “brouhaha and indifference.”
Communal meals are supposed to be a “privileged moment that goes beyond meeting nutritional needs,” an opportunity for institutionalized residents to get a bit of human contact. Instead, residents were treated like widgets getting some oil.
It’s important here to not dump too harshly on the workers. The system cannot fully substitute for family and community. Workers stick rigidly to rules and act robotically because they, too, are treated as task-performers, not people.
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There is no incentive, and no time, to take a moment to scoop cat poop, or try to engage one of your charges over lunch, when you are given a long list of actions to perform in a set time frame and no autonomy.
In fact, Mr. Dowd bemoans this checkbox mentality that makes it near impossible for workers to care in a caring manner.
Compassion fatigue is real. Workers are overwhelmed and burned out. Constant turnover of staff means they don’t get proper training, or the opportunity to actually connect with their patients.
The quality, and especially the dignity, of care suffers as a result.
While the cat anecdote is generating the most media attention, the report tackles some far more serious matters, including the overuse of physical and chemical restraints.
In his report, which offers up some particularly egregious examples among the 24,867 complaints the provincial Ombudsperson tackled in the past year, Mr. Dowd highlights the cases of one patient with dementia who is tied to a chair, facing the wall, for long periods of time, and another who is strapped to his bed because he becomes agitated.
The Ombudsperson says physical and chemical restraint is used “Too long, too often … in an abusive fashion,” but the province does not even properly collect data on the practice.
Another troubling case is that of two departments in the same hospital fighting about who is responsible for a young man suffering from developmental delays and mental-health issues. Each was more eager than the other to wash their hands of him.
In that case, Mr. Dowd stepped in and negotiated a truce that led to the man getting proper care in the community. But how many of these cases of neglect, indifference and buck-passing go unaddressed?
The Kafkaesque, “Rules are rules,” approach to care sticks in our craw – and it should.
There is nothing more personal and intimate than medical care, especially when you need assistance with the activities of daily living, from eating to toileting and beyond.
We can’t use the rules, or complexity of care, or an increasing demand for services as excuses for negligence or indifference.
Care, ultimately, has to be about an individual’s needs, not the system’s.