The Haunting of Long-Term Care, Part Two.  “All Families Banned from the Building”: Making Sense of Death and Dying in an Isolated House

This paper is the second 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 second paper, tension builds as the long-term care home shutters its windows and closes its doors to the outside world in an effort to keep the COVID-19 virus at bay, isolating those who live and work within its walls. I explore the idea of isolation and consider how this influenced healthcare aides’ position within the house and, in turn, their experiences of death and dying. I then describe how healthcare aides understood residents as dying in isolated ways in the absence of family members, revealing tensions in the common narrative that healthcare aides and residents are family. I then offer a philosophical discussion of how long-term care is perhaps not home for residents, despite them living there, but instead is a place of conditional hospitality and even hostility. Finally, I explore the consequences of this conditional hospitality or hostility for residents’ well-being.