Aging with (in)equality: Hard Lessons from the COVID-19 pandemic and its aftermath

Large-scale crises can impact social equality in two ways. First, they directly contribute to social inequalities, including disparities in the population’s livelihood and health conditions. Second, they affect governments’ fiscal positions (Beland, He and Ramesh 2023). There is a growing body of work that addresses how COVID-19 has exacerbated inequalities by attending to gender, race and other factors related to marginalization (Albader 2022; Germain and Yong 2020; Couture-Ménard, Bernier, Breton and Ménard 2023). Inequalities have been increasing – even before COVID-19. One could argue that "pandemic-exacerbated inequalities intersect with those associated with other disadvantaged social locations – leaving the lives of those at the intersections in particularly precarious post-pandemic positions" (Mauldin et al 2023). Less scholarly attention has been devoted to inequalities associated with aging and disability. Older adults, especially older adults with disabilities, have been disproportionately and negatively affected by the COVID-19 pandemic (for example, Lewis et al 2023). Further, the public discourse during COVID-19 misrepresents and devalues older adults (Fraser et al 2020). Besides ageism, the unequal effects could have been, and indeed in some countries were, mitigated or avoided through better preparation. Governments responded differently, and those with higher rates of social inequality and less generous social security systems experienced a more unequal pandemic (Bambra and Lynch 2023). Poor (even deadly) care in long-term care homes (also known as nursing homes or aged care) around the world (for example see Béland and Marier 2020) is just one example of how government action (or lack of it) worsens systemic inequality. This paper concerns inequality on the basis of age and disability in the health and social care systems in Canada as an example of "liberal welfare state". Policymakers in the past made decisions that led to many of the pandemic’s unequal impacts in the present, and once the pandemic began made further choices about how to address emerging inequalities (Bambra and Lynch 2021). The focus is on the regulatory aspects of health and social care because states across the globe attempted to respond to the pandemic through rules and regulations. The research methods include review of government documents and legal research. The paper will first highlight measures (implemented via law) that purported to protect older adults. Then it will describe cases where older adults with disabilities and/or their families challenged measures such as 'no visitors' policy in hospitals (e.g., Sprague v. Her Majesty the Queen in right of Ontario) and sought remedies from the courts. It aims to explain how law was mobilized to "protect" older adults from the spread of the coronavirus while undermining their rights under human rights legislation, the Canadian constitution and the United Nations Convention on the Rights of People with Disabilities. Violations of the human rights of older disabled adults must be examined within a larger context of under-investment in the health and social care systems in Canada. The paper will end by what we can learn for future pandemics. The lessons learned will be of interest to other OECD countries.