20 Jun 2025 7 min read

They Promised Care

What We Got Was Containment

The Lie of Long-Term Care
From the Table Series: Replacing Senior Housing with Human Infrastructure

It began with the best of intentions.
Secure buildings. Trained staff. Shared resources.

But the institutions we built to protect elders became the very reason they disappeared.

This is the story of how “long-term care” devolved into warehousing—how we replaced kin with corridors, connection with compliance, and called it compassion.

THE ORIGIN OF THE LIE

Long-term care was never designed to be home.
It was built to be a holding zone.

Built for efficiency.
Optimised for budget.
Engineered for minimal interaction.

What began as a system for managing frailty has become a factory for delaying death.

And everyone inside knows it.

WHAT THE DATA WON’T HIDE

Look past the architecture and into the daily reality:

Missed care is the norm:
6000+ care aides surveyed by TREC say they regularly skip basic care due to time and staff shortages. Hygiene, emotional support, feeding—all sacrificed under pressure.

Elderspeak is standard:
Residents—many with full cognitive capacity—are spoken to like children. Not out of malice. Out of cultural decay.
Deference has been replaced with directives. Adults are infantilised, then ignored.

Invisibility is designed in:
From staffing ratios to meal prep to visiting hours, the system does not bend for the elder.
It bends the elder to the system.

CASE STUDY: ONTARIO’S BILL 7

If the architecture wasn’t cruel enough, the law now codifies it.

Under Bill 7, elderly hospital patients can be placed in long-term care homes they did not choose.
If they refuse, they can be charged $400 per day to remain in hospital.

Choice has been erased.
Preference criminalised.
Families sidelined.

This is not eldercare.
This is elder exile.

TRAUMA, TRACKED AND IGNORED

TREC’s trauma studies are blunt:

Care aides are regularly retraumatised by residents’ untreated trauma histories.
Information on trauma is rarely recorded properly.
Even when it is, most staff are not trained to access or apply it.

So what happens?

Trauma recycles.
The wound deepens.
Everyone hurts.

THE PHYSICAL COST OF A SYSTEMIC FAILURE

Residents:

Isolated.
Undermedicated or overmedicated.
Experiencing “worse than death” conditions in 1 out of 5 cases.

Staff:

Underpaid.
Burned out.
Often leaving with psychological scars that last longer than their tenure.

Families:

Shut out.
Guilt-ridden.
Watching someone they love vanish behind layers of policy and resignation.

THE LIE: CARE IS A PLACE

They told us:
“We have a bed for your mother.”

What they meant:
“We have a vacancy in a system that no longer remembers why it exists.”

We are 50 years into an experiment that has failed.
It doesn’t matter how many audits we run.
How many handrails we add.
How many cameras we install.

A system built on containment cannot be redeemed.
It must be replaced.

ENTER THE TABLE

The Table does not “fix” long-term care.
It rejects the premise entirely.

Instead of locking the elder in, we build the system around the family.

Everyone lives in, by choice.
Clinical care is integrated, not added.
Trauma-informed design and daily practice.
End-of-life is handled with grace, ritual, and presence.
No one is institutionalised.
No one is abandoned.

THIS ISN’T A RADICAL IDEA

This is how we lived for millennia.
What’s radical is thinking care belongs to the state, and family is optional.

We are reversing the damage... one Table at a time.

Next Post:
Why Every Town Is Dying the Same Death — And How the Table Restores the Rural Spine of Canada.

Let’s build forward. The lie is exposed. The replacement is ready.

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Thanks!

They called it care.
It's containment.
Elderspeak. Missed care. Legal coercion.
Long-term care didn’t fail.
It was built to disappear people.

This is the replacement.

PS -