10 March 2008

Oh Brother: the Ontario health minister joins the Soggy Bottom Boys

... nearly blowed us into shivers and smithers. ~ Charles Dickens, Our Mutual Friend, Bk. 4, Chapt. 13

Ontario's health minister, George Smitherman, was singing his own version of Man of Constant Sorrow last month. He made a bad mess worse when he responded to criticism of the treatment of the elderly in the province's nursing homes by blurting out that he was prepared to don an adult diaper — and use it — to justify his government's policies. Not surprisingly, this singular outburst didn't sit well with an outraged public. Advocates for the improvement of personal care homes have complained for years that standards are poor, that homes are understaffed, and that private companies such as Extendicare endanger patients by pressuring their employees to cut costs.

The Ontario Association of Non-Profit Homes and Services for Seniors says seniors in nursing homes should be getting at least three hours of personal care; it says the average in the province is now about 2.5 hours a day. The Canadian Union of Public Employees (CUPE), which represents many nursing home workers, says the standard should be 3.5 hours. Many studies have shown that without proper staffing and adequate standards the quality of care plummets. Front-line nursing home staff in Ontario report that residents are sitting in deplorable conditions. Incontinence products are often kept under lock and key, and many homes are directing staff to change residents only when the product is 75% soiled.

On February 27, two long-term care workers used four bottles of water to fill an adult diaper at a CUPE press conference in Toronto. They wanted to show how much urine had to be in a diaper before care aides were allowed to change it under current legislation. With stunning insensitivity Smitherman said in response that he was ready to test out an adult diaper to show criticism was unfounded. “I’ve got one of these incontinence products — albeit a new one, not the ones that tend to appear at committee — on my desk and I’m really giving this matter very serious contemplation,” Smitherman said. It wasn't only critics of the Liberal government who were angry. There were loud calls for the minister's resignation, even within his own caucus.

Wags and cynics sharpened their quills. March 1st's National Post published an imaginary Smitherman diary entry, with entries like this:

Major confession, diary. I tried out an incontinence diaper today. It was so ... freeing. I had three large coffees ... and then I sat through a three-hour meeting with a bunch of bureaucrats. No pee breaks! It was so much more efficient. Made a bit of a stumble at lunch, though, by having the side dish of asparagus. Won't make that mistake again! I think this will really help in my discussion with the nurses' union. Five hours seems to be the limit before things get a little soggy. I think I'll publicly float the idea tomorrow. Right after I shoot up an eight-ball of smack to get a better feel for drug addiction.
Of course, an apology followed immediately. "I wasn't trivializing the matter," Smitherman said. "I take it really, really seriously." Not surprisingly, the minister couldn't be reached for comment afterwards; but his "diary" entry gives us some insight into why:
After I came in from my night on the streets yesterday morning, Dalton [Premier Dalton McGuinty] called and ordered me to apologize for the diaper "stunt." I explained that I only thought it would gain a better understanding of the issue, but he wouldn't listen. "Also, George," he said, "please tell me you weren't wearing one in my office the other day. Because I thought it smelled like asparagus, if you catch my drift." I told him my cellphone was cutting out and I hung up.
Sam Solomon, writing in his blog Canadian Medicine, adds that this isn't the first time that "Furious George" has run off at the mouth:
Speaking about new building plans suggested by some hospital boards in Ontario, Mr Smitherman dismissively referred to the expensive proposed upgraded facilities as "Taj Ma-hospitals."

His most famous outburst was featured on Stephen Colbert's American parody politics talk show in 2005. Talking to none other than an assemblage of the Ontario Association of Optometrists, Mr Smitherman called optometrists "a bunch of terrorists, and I don't negotiate with terrorists." "Bravo, sir," Mr Colbert said. "Optometrists are a menace. You have to be careful with a group that gets their kicks blowing air into our eyeballs."
Smitherman’s bizarre antics were dismissed by Sid Ryan, president of CUPE's Ontario chapter, who said the minister completely missed the point. The problem isn’t the products, but the cruel reality that residents in long-term care facilities are forced to wear soiled diapers through the night and sometimes up until noon the next day. “If the minister wants to play silly games, well then, let him put on a diaper and sleep in it all night long and come into the legislature and wear it up until 12 o’clock,” Ryan told the Canadian Press.

Could the problems so clumsily dealt with by Ontario's health minister be related to the fact that in Ontario 60% of all publicly funded long-term care beds are in for-profit institutions, as compared with 15% in Manitoba [1]? There is ample research to show that public investment in not-for-profit, rather than for-profit, delivery of long-term care results in more staffing and improved care outcomes for residents [1,2]. Instead of experimenting with adult diapers, perhaps Mr. Smitherman should try absorbing some of these important statistics. There are a lot of excellent health libraries within throwing distance of the Ontario legislature.


1. McGrail KM, McGregor MJ, Cohen M, Tate RB, Ronald LA. For-profit versus not-for-profit delivery of long-term care. CMAJ. 2007 Jan 2;176(1):57-8.

2. McGregor MJ, Cohen M, McGrail K, Broemeling AM, Adler RN, Schulzer M, Ronald L, Cvitkovich Y, Beck M. Staffing levels in not-for-profit and for-profit long-term care facilities: does type of ownership matter? CMAJ. 2005 Mar 1;172(5):645-9.


Reina Grosvalet said...

Good grief! This is horrible! Thanks so much for bringing this to light, as people really need to know.

I'm completely urinary incontinent and am quite capable of changing my own diapers when needed. As a matter of fact, I change as soon as I wet. I would hate to think that if I were unable to care for myself someday that I could be treated this way. I'm so glad and grateful I am still able to care for my own needs when it comes to incontinence and diapers. I'm so glad I don't have to depend on anyone else to meet those needs. The thought of being forced to sit in a wet and soiled diaper for several hours and that diapers were kept under lock and key makes me shudder. Those poor people. Whoever made such legislation obviously as no heart, and those are the sort of things that outrage me deeply!

I like your blog a lot. You write well. I found you on accident but am very glad I did. I'll continue to follow you, as I'm eager to see more of what you write. Feel free to travel over to my blog at www.takeastandforincontinence.blogspot.com It is relatively new, but there I fight stigma and address concerns with living with incontinence. I also have a caregivers' blog stressing why it is important to keep people at home rather than putting them in a nursing home or other institution, such as for reasons like the one you wrote about. That blog can be found at www.keepthemhome.blogspot.com Is it alright if I feature you on that blog? I feel that your article will have a lot of impact on caregivers' decisions to keep their loved ones home.

I look forward to hearing from you, and keep up the good work writing! :)