Introduction: Re-imagining the House of Old / Réinventer la maison de vieillesse

I know this placethis grey and mineral kingdomits mineral animalsits static hours

—"Nursing Home" by P.K. Page, 1997¹

Across Canada, an estimated quarter of a million people currently reside in long-term residential care (LTRC) (Statistics Canada 2011), institutions that we variously refer to as care homes or nursing homes. Nearly half of the women and men residing in the House of Old are 85 years or older, and more than 80% are over 65. These are some of our most disabled and vulnerable citizens. With an aging baby boom generation and increasing numbers of older people living longer with complex health conditions, our LTRC population—and the team of (mostly female) nurses, care aides, rehabilitation therapists, family members and friends, cooks, cleaners, and dietary and laundry workers who support them—is expected to double over the next two decades (Léonard 2012). There are similar trends across high income countries (Colombo et al. 2011).

In 1973, the House of Old was a grey reality for poet P.K. Page, who was obliged to move her beloved mother and aunt, both showing signs of dementia, to a Victoria, British Columbia, nursing home. But it is a forgotten kingdom today for many Canadian academics, policy-makers, and members of the general public. The prestigious Trudeau Foundation lists 199 Trudeau Foundation scholars; only one of these has research interests in the field of aging, but not in LTRC. The Romanow Report, commissioned at the start of the millennium to make recommendations on the future of health care in Canada, did not address LTRC (Romanow 2002). The last time the Journal of Canadian Studies published a theme issue on the topic of old age was in 1993, nearly a quarter of a century ago (Marshall and McPherson 1993). The responses of governments across Canada have been no different. With the current focus on aging in place and home care, today's policy-makers are wary about investing in LTRC. Indeed, many regard LTRC citizens as a "silver tsunami" that poses a threat to the sustainability of our health care system (Rozanova, Miller, and Wetle 2016). The public does not want to know about this institutional representation of our failure to care for our elders, this dreary location still linked to poor law places of last resort, this domicile of diminishment and death. When articles about LTRC appear in the mainstream media, the frequent focus is on scandals occurring within the facilities (Rozanova, Miller, and Wetle 2016). The policy response is often to increase regulations in the sector, with far less attention paid to structural issues such as funding shortages and understaffing (Lloyd et al. 2014).

The authors contributing to this issue of the Journal of Canadian Studies disagree with this discounting of the House of Old. We are part of the Re-imagining Long-Term Residential Care project, an international, multidisciplinary team of scholars and practitioners who aim to shed light on this neglected institution by locating, exploring, and publicizing promising practices in LTRC (see http://reltc.apps01.yorku.ca). Led by Professor Pat Armstrong of York University and fuelled by funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, and the European Research Area in Ageing 2, researchers from Canada, the United Kingdom, Sweden, Germany, Norway, and the United States have engaged in a process of rapid site-switching ethnography. This methodology allowed us to gather a rich set of documentary, observational, and interview data in a limited time frame. Between 2012 and 2016, 27 Canadian and international facilities were studied in this fashion, with researchers and students spending up to a week at each facility.

In addition to focusing on a neglected institution, this project is a push-back against the insertion of neo-liberal logics into health care, highlighting the ethical and practical issues of making care a profitable business. We have found that profit-taking strategies threaten the capacity of our long-term care institutions to provide equitable care to frail and often disempowered...