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January 20, 2012

Struggle for decent care in Toronto

Reuel S. Amdur

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For several years ending in 1992, I worked at Seaton House in Toronto. Operated by the City of Toronto, the facility has a shelter section and a residence, for short- and long-term users.

While the number of beds varies somewhat with space reorganization, the number is probably upwards of 700, making it the largest facility of its kind in Canada.  For most of the time I was there, I was a counselor, and one of my responsibilities was in arranging alternative accommodations for residents, either because they could no longer function there or because there was something better for them elsewhere.

One important resource was the city’s homes for the aged division.  As well, there are other homes that are privately run, with a tie-in with the city’s homes–called satellite homes.  For Seaton House, referrals, including for satellite homes, was through a single application point, though at least some satellites would have preferred a more direct approach. 

Just before I began working at Seaton House, there was a major scandal at the city-run homes.  The Canadian Union of Public Employees (CUPE) local issued a damning report on conditions, forcing major improvements to be put in place.  Referring residents from Seaton House to the homes, for clients who needed the kind of care that the homes could provide, was however a major problem, even in case of serious need.

Consider the set-up at Seaton House.  The direct service staff, outside of intake and supervisors, are not expected to be trained in health and social services.  There was a nursing station open during the day.  A physician and a podiatrist had scheduled visits.  The facility was not able to serve people incapable of self-care, and when Seaton House found itself with such people it was necessary to move them to more appropriate locations as quickly as possible.  That fact made the bottleneck between the homes and Seaton House a real problem.

While I was at Seaton House, Toronto closed one of its homes, located outside the city, in Newmarket.  It was claimed that families did not want their loved ones that far away.  That facility was turned over to York Region, in which Newmarket is located.  One section of that home specialized in care of Alzheimer’s cases.  On one occasion, a woman who ran a private rest home dumped someone with Alzheimer’s at Seaton House.  I contacted the homes for the aged people to arrange a transfer to Newmarket.  He was admitted, but it took a week to unwind the red tape, and they thought that they were doing Seaton House a favor by acting so quickly.

With their empty beds, one would have thought that they would have expedited Seaton House requests for placements.  Not so.  Let’s look at a couple examples.

Police like to leave people at Seaton House because it is more convenient for them than taking them to a hospital, where they have to wait a long time during admission.  On one occasion they dropped off a 92-year-old man in the middle of the night.  He spoke only Yiddish and Polish and was somewhat demented.  When I came to work I called the homes to try to get him admitted.  I was informed that the case was clearly “urgent”.  That is not what you think it means.  In this context it means “not an emergency.” 

The man and his family were on the caseload of Jewish Family and Child Services, and when they learned that I was unable to get a quick placement in a home, they put him back in the family home where he was being abused, intensifying their involvement with the family. 

On another occasion, there was a resident at Seaton House who had a wooden leg, with amputation at the hip.  Beds were on the second and third floors, meals served in the basement.  The elevator broke down.  Could a home take him at least till the elevator was fixed?  No, he wasn’t an emergency.  “But Seaton House has an emergency,” I argued.  No go.

Rather than working cooperatively with the homes, it was necessary to scheme to get help for people.  An uncle from out West landed unexpectedly on the doorstep of a woman who was unable to take him in.  When she called her city councilor, he suggested sending him to Seaton House.  Seaton House clients in the residence are for the most part people who have been hard living–alcohol abuse, mental illness, a history of homelessness, etc.  It was not the place for him.  She called and asked me what could be done.  “You seem like a calm, reasonable woman, “ I replied.  “That will not do.  If you want your uncle to get out of here into a home for the aged, you need to muster all of your anger and call that councilor back and say, ‘What do you mean having me put my uncle in a place like that?’” The uncle was soon transferred to a satellite home.

On another occasion, an elderly man was admitted in the middle of the night, like the uncle, someone who did not fit in the Seaton House milieu.  I do not recall exactly how it was that he suddenly became homeless.  He came to my office the next morning totally freaked out by his stay overnight.  I told him of a home for the aged in walking distance. “I’ll say that you sent me,” he said.  “If they know you were here,” I warned, “they’ll send you back.”

In retrospect, it seems to me that the fix was in.  They wanted to get rid of Newmarket, and accepting referrals from Seaton House would just get in the way.  Since I left, there have been major improvements at Seaton House.  There is now a floor in the residence section for fragile men, with medical support provided by St. Michael’s Hospital.  The old bathhouse next door has become a wet house.  Men going in must turn in their Chinese cooking wine and aftershave.  Instead they are given controlled amounts of wine. 

I wonder if the bureaucracy in the homes is any more reasonable these days.  People relying on the city for residential care deserve good care, whether they enter a home directly or through Seaton House first.  Provision of inadequate care when good care is available– that is just not acceptable.

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Dotan Rousso. Holds a Ph.D. in Law—a former criminal prosecutor in Israel. Currently working as a college professor in Canada.

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