In Quebec, the last few days have been marked by the total loss of control by bourgeois administrators and provincial authorities over the situation in the Centres d’hébergement de soins de longue durée (CHSLDs), where the coronavirus is causing a veritable hecatomb among residents. In these institutions, which house a significant fraction of the province’s elderly proletarians, there is now complete chaos. Since the beginning of the pandemic, protective equipment has been sorely lacking and managers have been unable to put in place adequate health protocols. As a result, a large number of orderlies and nurses have been infected with the virus and have unwittingly spread it among residents. At present, the number of staff available, already largely insufficient in normal times, has fallen to such a low level that the workers can no longer provide even basic care to the residents and they are left to fend for themselves in appalling conditions. For workers and the population of CHSLDs alike, it is the most total horror. Patients are dying in atrocious conditions and bodies are piling up at a rate that one would never have thought possible in an advanced capitalist country like Canada in this day and age. For several days now, the Government of Quebec has been desperately looking for volunteers to work in institutions for the elderly. During his daily press briefings, the Prime Minister has come up with a series of haywire solutions, such as sending specialist doctors to the CHSLDs to do the work of nurses and orderlies. Unable to solve the problem in an appropriate and rational way, the government finally resigned itself to hiring massive numbers of people without any training or experience in care and to asking the federal government to send 1,000 Canadian soldiers.
Since the beginning of the crisis, the Legault government, in a burst of uninhibited nationalism, has never ceased to pride itself on being one of the governments that best controlled the progression of the epidemic and to boast of having put in place the most responsible measures imaginable to fight the virus, the number of officially declared deaths in the province, as a proportion of the population, is now close to that of the United States – a country considered the “epicentre” of the pandemic and whose president had been widely criticized and ridiculed in the bourgeois media in Quebec and Canada for his management of the crisis. At a time when it is increasingly difficult for the Quebec government to deny that the disaster to which the Quebec state has led the masses of the people of the province is of the same order as that which has occurred in other imperialist countries (France, Italy, the United Kingdom, the United States, etc.), Premier Legault is now looking for new ways to create a diversion. In order to divert attention from his disastrous management of the crisis as well as from all the past decisions of the Quebec capitalist state, he has begun to appoint scapegoats. In particular, he publicly attacked the unions by accusing them in a completely demagogic manner of having prevented successive governments from raising the salaries of beneficiary attendants, which would be the cause of the current lack of personnel in the CHSLDs. He then made a pseudo mea-culpa in which he essentially apologized for not having imposed his will earlier on the unions in this matter! Finally, the Prime Minister invited Quebec society as a whole to conduct a collective self-examination of the way seniors have been treated for years in Quebec. He said in a falsely emotional tone and in a completely hypocritical way that we would have to “review”, as we emerge from the crisis, the conditions in which these people are plunged – as if all of this had not been perfectly known for all time and, above all, as if the health of aging proletarians would suddenly become a major concern for the bourgeoisie in the years to come.
In truth, it is not society as a whole that is responsible for the fate of elderly proletarians and the nightmare worthy of third world countries that we are currently witnessing in Quebec, but rather the Quebec bourgeoisie and its state apparatus. Under capitalism, the proletarian masses have no say in the organization of the society in which they live: they are therefore in no way responsible for the major orientations that society takes. On the contrary, they only suffer the consequences of the decisions of the ruling class. Thus, there is no “collective reflection” to be done on the conditions in which older proletarians find themselves in Quebec. It is simply necessary to denounce the bourgeoisie, which has never solved the problem, even though the resources to do so are available. Moreover, there is no reason to believe that it will do so in the future, despite the Prime Minister’s sentimental speeches.
The problem of under-staffing and Legault’s attacks on unions
Recently, the lack of personnel in the CHSLDs (and in the health network in general) has become the most pressing problem in the fight against the virus in the province. While orderlies and nurses are already understaffed under normal circumstances, the coronavirus pandemic has aggravated the situation. In fact, due to the lack of available protective equipment and the persistence of unsafe practices requested by health network managers (movement of staff between institutions, poor organization of space to separate infected patients from non-infected patients, recalling quarantined workers to work, etc.), a large number of workers contracted the virus and therefore had to be absent from their posts. In the health care system as a whole, as of mid-April, there were 9,500 absent staff members, of whom 4,000 had officially been infected with the virus (in reality, of the total number of missing workers, the proportion infected with COVID-19 was probably much higher than the official figures indicated). For its part, the government claims that many workers left the ship because they feared for their health – which is quite understandable considering the extremely difficult and dangerous conditions in which the bourgeois state placed them. The shortage of staff in the institutions has become so dramatic that in some cases residents have been left to fend for themselves for long periods of time in their excrement, starving, dehydrated and in kidney failure. Many have even literally died of hunger and thirst. A beneficiary attendant at CHSLD Fernand-Larocque in Laval reported: “We were told not to give baths anymore. Residents are left in gowns all day long and are not allowed to get out of bed.” This same employee also revealed that almost all patients were put in restraints: “For a while, we even put desks in front of their doors so they wouldn’t go out”. Another staff member at the same facility said, “Some patients have large, growing wounds. It’s appalling. Their fingernails have become so long, many have diarrhea, and they are found in their poo in the morning.” She adds about the residents: “They are scared. Some of them even shake.” At the CHSLD LaSalle, a student who volunteered reported that many patients were shouting at her: “I want to die, let me die in peace, I’m dying, I can’t take it anymore.” In a private CHSLD in Laval, a volunteer reported that wandering patients were tied to their beds. She also reported that meals were served late and that there were not enough hands to feed patients who were unable to feed themselves.
Faced with the magnitude of the disaster, many panicked bourgeois managers began to make completely senseless decisions. For example, at the CHSLD Manoir-de-Verdun in Montreal, management sequestered the workers inside the institution to force them to extend their shifts and to prevent them from leaving their jobs. In several locations, workers who had been in contact with the virus and placed in isolation were recalled to work before the end of their quarantine. At CHSLD Sainte-Dorothée, one of the institutions most affected by the virus, employees with symptoms of COVID-19 were even forced to work by management, which likely contributed to the sudden and deadly outbreak in this institution, since the tests taken by the employees in question turned out positive some time later. After showing up at the CHSLD Drapeau Deschambault in Sainte-Thérèse, at the call of attendants for beneficiaries in distress who had complained that they did not have adequate protective equipment, two activists from STT-Laurentides en santé et services sociaux-CSN were contacted by the police – obviously at the request of the establishment’s management – to be told that they were no longer allowed to return to the site. Workers everywhere are subjected to threats, intimidation and emotional blackmail from managers who blame them, accuse them of being responsible for the problem and put pressure on them. In addition, for the past few weeks, several CIUSSS/CISSS employees working in hospitals, CLSCs and at home have been deployed on an ad hoc basis in CHSLDs considered “hot zones”. They then return to their facilities without being placed in isolation for 14 days. For the same employee, there are multiple comings and goings in more than two institutions. It should be noted that these reinforcements do not undergo screening tests, as was ordered for all CHSLD employees – an instruction that, moreover, was applied unevenly from one institution to another.
The health crisis forced the Legault government to admit that there was a serious problem in the CHSLDs and to recognize that this problem did not arise with the pandemic. However, instead of providing a real explanation to the public, the Prime Minister preferred to mystify it further by ignoring the past actions of his own government as well as those of previous governments and blaming the unions. According to the government, the shortage of staff in the CHSLDs is due to the low pay associated with the positions of beneficiary attendants, which would make it impossible for the institutions to attract candidates and encourage their employees to keep their jobs. It is true that this is an important part of the explanation: beneficiary attendants do earn starvation wages for doing extremely difficult work. In public CHSLDs, they earn $20.55 an hour at the first step and up to $22.35 at the last step. Notably, in private CHSLDs and in private seniors’ residences that are sub-contracted by the network or have a care offer, they often earn only $13 to $14 an hour, barely more than the minimum wage, and they are over exploited by crooked landlords who pocket large sums of money in profits. For years now, however, beneficiary workers and the unions representing them have been fighting for significant wage increases – a demand that successive governments, including Legault’s, have never wanted to meet. The Prime Minister’s attack on the unions was therefore particularly odious. The trade union centres were quick to react. FTQ President Daniel Boyer, for example, said, “What is stopping the government from paying the beneficiary attendants well? Nothing. For years we have been decrying the conditions of employment and remuneration of these workers and telling elected officials that the whole system will break down if nothing is done. Well, that is where we are now.” As recently as last December, the FTQ demanded wage increases for beneficiary attendants while the government turned a deaf ear: “Quebec likes to talk about the current negotiations, but the Treasury Board has yet to respond to our demands. On December 11, we presented the government with a wage structure that very accurately addresses the problems of beneficiary attendants. Yes, on December 11, well before the entire COVID-19 crisis. So let the government not come and tell us that it is our fault. Instead, Quebec should apologize to the workers who take care of us.” The President of the CSN, Jacques Létourneau, made a point of pointing out that despite the Prime Minister’s comments that the unions had refused higher wage increases for beneficiary attendants, the union has been calling for special measures to increase their pay for more than ten years: “For more than ten years, we have been calling for special measures to increase the wages of beneficiary attendants. No government, including Mr. Legault’s, has been willing to respond adequately to our demands.” In response to the Prime Minister’s misleading accusations, the President of the CSN added: “Mr. Legault repeats that labour organizations are allergic to differentiated increases. I would like to remind him that we agreed, during the last negotiations, to review the entire wage structure of the public sector and thus rework more than 135 pay scales. There are hundreds of differentiated increases as a result of this wage relativity work.”
In his recent statements, the Prime Minister spoke as if he had just discovered that elderly proletarians in Quebec live in miserable conditions. All this was already well known before the current crisis. The problem of under-staffing in CHSLDs – and in the health care system in general – has long been denounced by workers and their unions. As the president of the Fédération interprofessionnelle de la santé (FIQ) stated on April 13: “What is currently happening in CHSLDs has been known for a long time. When a nurse has to cover several CHSLDs, care for more than 50 patients or already has to choose the care she will be able to provide, how could we believe that such institutions could face a pandemic?” And the truth is that the Legault government has refused to solve the problem since it has been in place. For example, as recently as last February, CAQ deputies unanimously voted against the implementation of safe staff/patient ratios in the National Assembly – a long-standing demand by the FIQ, but also by FADOQ, an organization that defends the rights of seniors. Moreover, in reaction to the Legault government’s second budget tabled last March, the FADOQ stated the following: “Organizational abuse and working to exhaustion are direct consequences of ratio problems. It is necessary to implement methods adapted to the reality and needs of the Quebec population. Our organization is at a loss to explain why the caquist government is still turning a deaf ear to this issue.” Also in reaction to the government’s last budget, the FIQ president, who asked for $600 million for the gradual implementation of safety ratios throughout the health network, deplored the lack of investment to hire more staff: “By ignoring this request despite the budget surpluses recorded, the government is cruelly ignoring the reality of thousands of professionals who are tired of working to make themselves sick. Minister McCann had nevertheless committed to significantly improve the conditions of practice of health care professionals. Despite the growth in health care spending, we are still looking for a concrete record of this commitment!” In February 2020, the FSSS-CSN denounced a government plan tabled by the Minister of Health and Social Services Danielle McCann to deal with the problem of staff shortages in the health network. The union denounced the fact that the plan did not contain any concrete measures to end the shortage of beneficiary attendants in the network as well as the fact that it had been developed without taking into account the demands of workers. According to the union, the solutions put forward by beneficiary attendants and health and social services auxiliaries (ASSS) to avoid overwork and retain staff included the hiring of new staff and reducing the workload; the integration of patient attendants and ASSSs into care teams; the enhancement of part-time positions and the granting of guaranteed hours to staff; the raising of the wages of attendants in private seniors’ residences to $15 per hour – all demands that were ignored by the government’s plan.
The lack of personnel in CHSLDs has had disastrous consequences on the quality of care provided to residents and their living conditions since well before the start of the pandemic. In fact, the spread of the virus has only worsened – dramatically – a situation that was already completely unacceptable and revolting before the crisis. In September 2018, the FTQ unveiled a list of services that beneficiary attendants who responded to a form circulated by their union (the Syndicat québécois des employées et employés de service) said they had not had time in the previous months to provide to residents of the institutions in which they worked because of their overwork. This list included baths, partial washrooms (washcloth), repositioning of residents, cleaning of surfaces (tables, wheelchairs, etc.), rounds to change incontinence panties, resident walks, beard shaving and nail clippings. According to the workers, the main causes of their inability to provide services were under-staffing, the non-replacement of absentees, and the use of agency staff in the institutions, which slowed the pace of work. Among the demands then expressed by the SQEES-FTQ in response to this inhumane situation were the valorization of staff, notably through a salary that reflects their tasks; the creation of full-time positions, without atypical schedules; the reduction and gradual elimination of agency staff; and the reorganization of work in collaboration with workers’ representatives. But the “organizational mistreatment” of CHSLD residents has been denounced for much longer. For example, in 2010, the Syndicat des travailleurs et des travailleuses du CSSS Jeanne-Mance (CSN) denounced the abolition of positions and their impact on the quality of care provided and on the working conditions of orderlies: “It is not normal for our residents to remain in soiled diapers for hours on end. It’s not normal for them to go days without being washed. Some of our attendants end their day in tears because they are so dismayed that they are no longer able to meet all the needs of our residents.” The poor personal hygiene of patients, the lack of sanitary measures for the nursing staff and the insalubrity of CHSLDs and hospitals have had particularly disastrous consequences in recent years. In particular, it is probably one of the factors that contributed to the spread of the Clostridium difficile bacterium, responsible for an epidemic outbreak of deadly diarrhea in Quebec in 2003. Between 2003 and 2004, in the midst of the epidemic, the bacterium caused 1,000 deaths among the 7,000 infected patients in the province. In 2014, no less than 10 years after the epidemic of C. difficile diarrhea, there were still 500 to 550 deaths among the 3,500 patients infected annually in health network facilities. It can be said that there has been little improvement. Nosocomial infections are still very deadly for the elderly population of Quebec.
Quebec’s bourgeois state’s lack of preparation to face the pandemic
In addition to the lamentable state in which the CHSLD network – and Quebec’s health care network in general – was already in before the crisis began, the tragedy we are currently witnessing is attributable to the late and completely inadequate response of Quebec’s bourgeois state to the pandemic. First of all, it must be remembered that, in order to save money, the Quebec government has refused over the years to set up an emergency reserve of medical equipment that would be useful in the event of an epidemic, despite the fact that scientists have been alerting the authorities for years about the imminent risk of a pandemic, particularly since the SARS episode between 2002 and 2004. Moreover, while the threat of the virus had been known since last January, the Legault government waited until February 18 before taking steps to acquire additional stocks of masks. Because of the bourgeois authorities’ wait-and-see attitude, the health network is facing a serious shortage of protective equipment, a shortage that is itself largely responsible for the contamination of nursing staff and residents of CHSLDs.
Moreover, the Fédération de la santé et des services sociaux (FSSS-CSN) has been claiming N95 masks for its 30,000 members in CHSLDs since the beginning of the pandemic. Its president, Jeff Begley, emphasizes that “[i]t takes the best possible equipment to ensure that the virus is not spread.” Several doctors are even refusing to help the CHSLD staff who have been forbidden by the CISSS/CIUSSS management to wear this airtight, fine-droplet-proof protective mask. In fact, at the beginning of the crisis, doctors in hospitals were asked to put on N95 as soon as they approached a suspect patient. Two weeks later, the instructions had changed: no more use of this protection unless the patient was in respiratory distress or needed to be intubated. Today, it is only the last condition that allows doctors to wear it. But the situation is even worse in CHSLDs. In these establishments seriously affected by the epidemic, N95s are impossible to find or even prohibited, even in “hot zones”. The ministry and its apostles consider that in CHSLDs, no medical acts are performed that would result in residents being expelled in the form of aerosols. However, the care attendants provide multiple direct patient care services. The procedures they perform often last more than 10 minutes. They breathe very close to their patients and they breathe in the air they breathe out. In addition, the many residents who are carriers of COVID-19 cough profusely while being fed, watered, changed, washed and cared for, making them highly contagious to those who care for them. However, studies show that the virus appears to be transmitted not only through direct contact with a contaminated droplet or surface, but also through close and prolonged contact with an infected person who is coughing. Moreover, although this question is still not clear, many scientists believe that the fine droplets ejected during simple exhalation and which can remain suspended in the air for a long time have a role to play in transmission. In other words, a simple procedure mask is probably insufficient to adequately protect workers in long-term care facilities, which probably explains why so many of them have been infected with the virus.
In addition, the Government has been slow to put in place health protocols in centres for the elderly. For example, the cessation of visits to these facilities should have started much earlier – probably as early as January. The Legault-Arruda-McCann trio said in the last few days that they had been caught unawares by the speed at which the virus had spread in the CHSLDs: the efforts made in the hospitals had worked, but at the cost of much greater damage than expected on the CHSLD “front”. The government suggested that it had chosen to put these institutions on the back burner, not yet knowing at the time that the virus was as contagious and lethal as it was. However, it was clear from the outset that housing and care facilities for the elderly, by far the most vulnerable segment of the population to the virus, was a critical area where the most vigorous measures were needed to avert disaster. In fact, it is not surprising that hospitals were prioritized in the bourgeois state’s response to the pandemic: it is the hospital system that ensures part of the reproduction of the labour force (i.e. it ensures that the health of active proletarians does not deteriorate to the point where they can no longer work for the capitalists), not the CHSLDs (where inactive and non-productive people are cared for). The revival of the economy and the maintenance of bourgeois society thus depend in part on a functional, preserved and “unsaturated” hospital system. That said, resources are lacking everywhere in the health network, not only in CHSLDs. If hospitals have been relatively spared so far, it is mainly because a considerable fraction of the population is in confinement – confinement that the government is preparing to end “gradually” in order to revive the exploitation of workers and the accumulation of profits.
In truth, the authorities were perfectly aware of the extreme fragility of the CHSLDs. Already in 2006, the National Institute of Public Health (INSPQ), with the participation of Horacio Arruda himself, had developed a preventive plan to protect these establishments following the sad experiences of SARS in 2003 and the outbreak of Clostridium difficile infections in Quebec health care institutions in 2004. At that time, the INSPQ recognized that CHSLDs were areas of high vulnerability to outbreaks and the spread of deadly viruses and bacteria. That is why it recommended that, in the event of an epidemic, very strict measures be implemented in CHSLDs as soon as the first infected case is detected in the province. According to this recommendation, the institutions in question should, among other things, have, as of February 28, 2020 (the date on which the first case of COVID-19 was detected in Quebec), implemented virus control mechanisms such as requiring the wearing of a surgical or procedural mask indoors and restricting visits, screen visitors, prohibit entry to anyone who is symptomatic or who has been exposed, designate areas for affected or suspected residents, restrict movement inside, develop intensive care areas to avoid transfers to hospitals and notify authorities of any suspected cases. In fact, in Quebec, nothing was requested from CHSLDs until March 14, 2020. It was too late: the virus had most likely already entered the facilities. In short, the Quebec bourgeois state did not even follow its own recommendations – which were not particularly bold – to deal with the current epidemic! It is the province’s proletarians who are now paying the price for this criminal negligence.
Under-funding of the health care system and past government cutbacks
In his hypocritical speeches on the way seniors are treated in Quebec, Premier Legault has skillfully avoided explaining the real causes of the situation to the population and has not mentioned any concrete decision by his government or previous governments – as if the conditions of CHSLD workers and the living conditions of their residents were a natural phenomenon rather than the product of human actions (in this case, the actions of the Quebec capitalist state). In addition to his own government’s decisions, some of which have been mentioned above, the Prime Minister has not, for example, mentioned the major budget cuts in the health care system in recent decades, cuts that have played a major role in the deterioration of the working conditions of nurses and orderlies and the deterioration of services offered to CHSLD residents – particularly because of the numerous job cuts in the institutions. If he chose to ignore this important “detail”, it is perhaps because the Prime Minister himself and his entourage supported these austerity measures taken by the governments that preceded his own and he still believes that they were necessary! Recently, the cuts made by Philippe Couillard’s Liberal government between 2014 and 2018 have been widely denounced and blamed by the unions as being largely responsible for the current disastrous situation in CHSLDs and the rest of the health care system. If the CAQ had been in power at that time instead of the Liberals, it is almost certain that the same kind of austerity measures would have been applied. In fact, according to the financial framework that the caquistes presented in 2014 during the provincial election campaign, if they had formed the government instead of the Liberals, “their” austerity measures would have been even more severe than those of their Liberal counterparts. Indeed, among all the major parties in the National Assembly (PQ, PLQ, CAQ) – all of which were in favour of austerity – the CAQ was the one that proposed the most restrictive budgetary rigour to achieve a zero deficit. Spending increases would have amounted to 1.7%, in contrast to the 1.8% actually announced by the Liberals (who had announced 2.4% in their initial fiscal framework), and 2.1% with the PQ. The spending effort would have reached 56% with the caquistes, unlike the 54% of the Liberals (who announced 44% in their initial financial framework), and 49% with the PQ. This would have resulted in a surplus of $2.7 billion with the caquistes, while it was $2.4 billion with the Liberals in power. The bulk of the cuts planned by the CAQ, as was the case for the other political parties, affected labour and services to the population. In short, regardless of which party was in power, the cuts would have been very painful, and it would have been potentially more painful with the CAQ if we rely on their own promises at the time. It should be noted that it was on September 25, 2014 that Gaétan Barrette, then Quebec’s Minister of Health and Social Services, tabled his health bill, a major “sabrage” in the network (described as a “slimming diet”) seeking to make annual savings of $220 million. It is therefore a good bet that the CAQ would have acted in the same direction. In fact, Gaétan Barrette was a former caquist MP and even an aspiring caquist health minister. In 2015, Éric Caire, then MNA and Caquiste spokesperson for the Conseil du trésor, stated that austerity did not exist in Quebec and that it was simply “a view of the mind” of the unions, which, according to him, always find “excuses to disrupt social order for the benefit of their corporate interests”. For him, the 2014 election was the democratic expression of a clear majority in favour of rebalancing and fiscal adjustment. It should also be remembered that in 2002, during his brief reign as Minister of Health and Social Services in the PQ government of the time, François Legault shared the same kind of vision as Gaétan Barrette, which was focused on cleaning up public finances. At the time, he proposed an exercise to evaluate the performance and efficiency of hospitals, an exercise that finally did not come to fruition. In any case, for Legault, it was inconceivable that “Quebec” would invest $17 billion in the health network to which he wanted to bring “rigour” and accountability. At the time, he was criticized for managing health care as a true “company CEO”. Also, during the 2018 election campaign, François Legault proudly announced that he planned to open “seniors’ homes” if elected. One of the attributes of this project consisted in the fact that the spaces would be air-conditioned, unlike those of the current CHSLDs. The irony is that in 2002, when François Legault was Minister of Health under Bernard Landry in the PQ, he was fiercely opposed to air conditioning all CHSLDs, considering the expense unnecessary and too costly. This refusal to air-condition (or even ventilate) the rooms and common areas of CHSLDs cost dozens of residents their lives during the heat wave of 2018. The same was true for hospitalized residents during the same year of overwhelming heat, as the dilapidation of many institutions was pointed out.
Finally, it is also interesting to look at the case of the current Minister responsible for Seniors and Caregivers (and former Liberal Minister) Marguerite Blais. Before the pandemic we are experiencing today, on October 24, 2019, when she was questioned in the House about the critical shortage of staff at the CHSLD Villa-Bonheur in Granby, Marguerite Blais confessed that she had contributed to the weight loss program for seniors during the reign of Jean Charest’s Liberal government: “The person who knows that they cut staff is me. I know that because I was in the movie.” Worse yet, she defended herself weakly with the following appalling words: “Yes, I was minister for seniors for six years, but I was not given responsibility for the CHSLDs”. In fact, Marguerite Blais was the Liberal minister responsible for seniors under Jean Charest for five years, from 2007 to 2012. One of the key measures in her mandate to improve the quality of care provided to beneficiaries was the announcement in 2009 of funding over four years to hire clowns to entertain seniors in CHSLDs! She then sat as a backbench MP from 2014 to 2015 under the Liberal government of Philippe Couillard. Marguerite Blais finally retired to resurface in 2018, but this time with the CAQ. This newly elected majority political party reintegrated Marguerite Blais into the cabinet by entrusting her with her old file… which she still clearly has no control over, according to her recent public interventions.
In short, François Legault and the other members of his government are part of the same clique of scoundrel bourgeois politicians who in recent years have applied the violent austerity measures that the popular masses are suffering the consequences of today, austerity measures that were then dictated by the interests of big capital and that the Quebec bourgeois state would have implemented regardless of the party in power. In fact, it is the entire Quebec bourgeoisie that is responsible for the disaster we are currently witnessing. The proletarians must recognize their enemy and learn to fight him!
The fate of elderly proletarians under capitalism
It is not surprising that the capitalists in power attach little importance to ageing proletarians. For the bourgeoisie, proletarians are nothing more than tools for generating surplus value and profit. As long as they are still able to work or to raise the next generation of workers, capitalists must generally agree to pay them in wages what is necessary for the reproduction of their existence and that of their children. This amount of money is already very little compared to the amount of wealth produced in society, but it must still be sufficient, on average, to allow proletarians to “function” and participate in the social process of work – and thus to house themselves, to feed themselves, to move around, to communicate, to have sufficient hygiene according to the criteria of society and not to be constantly on the verge of death. But since the elderly proletarians have stopped working and raising children, they are no longer of any use to Capital and simply become a burden to the bourgeoisie. The ruling class is ready to give them the bare minimum so that the streets will not be overrun with homeless old men and cluttered with corpses, but nothing more. Also, the bourgeoisie cannot tolerate that too many still active proletarians have to take care of their elderly, sick and frail parents, which would greatly impair their ability to hold a paid job. Capitalists need a labour force at their disposal that is not hampered by too many unproductive tasks in the domestic sphere. The bourgeois state therefore agrees to deploy certain resources to take care of older proletarians who are no longer self-sufficient, but since it is a question of taking care of “useless” people, these resources are minimal.
The controversial statements by former health minister Gaétan Barrette that residents of CHSLDs did not need more than one bath a week were indicative of the value the bourgeoisie places on elderly proletarians in a country like Canada. When people are not even recognized as needing to bathe regularly, it is because they are no longer considered necessary for them to continue to function normally and are seen as nothing more than garbage. But the problem is far from the way capitalists subjectively view elderly proletarians. If that were all it was, the problem would be rather easy to solve. In fact, what must be understood is that the bourgeoisie, the social class that runs society, has no material interest in providing aging proletarians with the resources necessary for the “normal” reproduction of their existence – let alone providing them with what they would need to lead a fully fulfilling life. The economic laws of capitalism mean that the bourgeoisie is irremediably driven to underinvest in health infrastructure and services for older proletarians. As Gaétan Barrette eloquently revealed when he candidly spoke of the millions of dollars he refused to release to provide additional baths for residents, the care of proletarians in loss of autonomy constitutes, for the capitalist state, nothing more than an expense that must be reduced as much as possible. The state can reduce this expenditure by cutting services, cutting jobs and keeping the salaries of employees in care institutions very low. It can also reduce it by delegating the care of the elderly to the private sector, as the Québec government has been doing for years by reducing places in public CHSLDs and encouraging the development of care in private seniors’ residences. The latter solution also has the advantage of allowing the bourgeois state to offer golden business opportunities to wealthy homeowners.
The nightmare that is currently unfolding in the CHSLDs in Quebec (like the one that is also unfolding in other imperialist countries) is indicative of the contradictions inherent in capitalism. Quebec may be one of the richest nations on the planet, but the Quebec bourgeois state is incapable of setting up a functional health care system, of providing basic services to the popular masses and of responding in an organized manner to the spread of a virus. Whereas the bourgeoisie and its ideologues had been constantly praising the unlimited progress that the victory of capitalism and liberal democracy over socialism would bring in the last decades, we now see that it only takes one crisis to collapse like a house of cards and to create calamitous situations and humanitarian tragedies. In the imperialist countries, huge sums of money have accumulated over the years at the top of society while the majority of the population has been unjustly left in deplorable and often abominable conditions. In Quebec, this has resulted, among other things, in the almost complete abandonment of older proletarians and the refusal of the capitalist state to provide decent working conditions for the workers who take care of them. This situation should not lead us to want to “stick together” among Quebecers and roll up our sleeves “collectively” to put things back in order, as Premier Legault has asked, but rather to strengthen our will to overthrow once and for all the moribund capitalist regime under which we live. Instead of waiting passively for the Prime Minister’s promises of reform to be realized, we must prepare to actively fight against the bourgeois state, not only to force it to make concessions to us, but also and above all to eventually throw it down and replace it with a new state led by the proletarian and popular masses, which will organize the disappearance of the social classes. This new proletarian state will plan production with the aim of satisfying the needs of the entire population: all the resources available to society will be mobilized to raise the well-being of the majority instead of being used to concentrate wealth in the hands of a minority of bourgeois as is the case under capitalism. There will no longer be budgetary limits drawn by the interests of the big banks, billionaires and other similar parasites, and it will therefore be possible to invest massively to provide decent living conditions for all, throughout life – which means that the elderly will receive the best care that society can offer. But in order to achieve this, we must first of all start by coming together as exploited proletarians and begin the struggle for political power. Health care workers, who are currently in the midst of the storm of the health crisis and who are under particularly vile attack, are called upon to play an important role in this struggle!