The Haunting of Long-Term Care, Part Four.  “It is Hide-and-Seek”: Falling Back into the Status Quo and the Inauthentic

This paper is the fourth installment in The Haunting of Long-Term Care: Understanding Healthcare Aides’ Experiences with Death and Dying During the COVID-19 Pandemic, a serialization of my doctoral research published in the Journal of Applied Hermeneutics. What follows is not only an academic inquiry, but the telling of a story – one shaped by suspicion, hiddenness and the ghosts that refuse to remain in the shadows of the house. Guided by a philosophical hermeneutic approach, I interviewed eight healthcare aides working in long-term care to understand how they made sense of death and dying during the COVID-19 pandemic. As an institution meant to care for older adults nearing the end of life, the long-term care home is, unavoidably, a place of death and dying. Yet death and dying are often kept in the shadows of long-term care, tucked into dark corners where the experiences of those who receive and deliver care remain largely unacknowledged, unexamined, and unquestioned. When the COVID-19 virus entered these homes, it did so like a kind of ghost – claiming the lives of older adults in ways that were unfamiliar, sudden, and deeply frightening. Healthcare aides were the first to encounter these ghosts, and the strange yet eerily familiar forms of death and dying they brought with them. As such, I came to understand my research as a kind of story, a frightening one, and healthcare aides’ experiences as a haunting of long-term care. In this fourth and final paper, the story descends without resolution. In the years since the pandemic, long-term care appears to have returned to the status quo, with few meaningful changes made to improve death and dying. I return to the structural integrity of the institution—the haunted house itself—and to how healthcare aides locate their experiences within enduring institutional failures that prevent quality care for dying residents. Remaining in the house, healthcare aides are understood as playing a game of hide-and-seek, where the structural problems laid bare during the pandemic have once again been hidden in dark corners. To explore this, I describe the ongoing limitations healthcare aides had “seen” during the pandemic, namely inadequate staffing and limited support. I then move to the “hide” section of the paper, which serves as the discussion, where I explore how these issues are being concealed again, the ghosts of the pandemic banished to the shadows, threatening to reappear. Finally, I offer a philosophical discussion of healthcare aides’ positionality through Heidegger’s understanding of the uncanny, particularly authentic versus inauthentic experience.