The Haunting of Long-Term Care, Part One. A Suspicion of Healthcare Aides Experiences with Death and Dying as a Kind of Institutionally Mediated Testimony

Abstract

This paper is the first 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 opening 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 first chapter, the story begins with suspicion. I describe how I first encountered it, and how I came to regard healthcare aides’ testimony as institutionally mediated, shaped by institutional forces and the hiddenness of death and dying in long-term care. I then offer a philosophical discussion of suspicion, and how I made sense of it through both Gadamer and Ricoeur. Finally, I discuss the long-term care home as an uncanny house with a dark history, how I came to understand it as haunted, and the COVID-19 pandemic as a haunting by both familiar and unfamiliar ghosts.