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A fire rages, and your mom is in the middle of it, alone, trying to find her glasses and her walker in the dark, scared, and desperately praying for you to come save her.

Anyone who has ever had a loved one in institutional care has woken up in a cold sweat from that nightmare, one that became horrifically real for dozens of families this week in Isle-Verte, Que.

In response to that disaster, there will be much talk of fire safety, and the importance of sprinklers in particular.

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That is an important discussion to have, but it should lead to a much broader reflection on how, in an aging society, we care for our elders and, in particular, how we ensure the safety and dignity of the 400,000 seniors living in so-called "care facilities." La Résidence du Havre – where eight are confirmed dead and 30 are not accounted for – did not have a sprinkler system in all parts of the building. It also had only two staff on overnight overseeing all the residents.

In light of what happened – dozens of people with limited mobility, dementia and other serious health issues who had no real chance of escaping a fire – that seems outrageous.

It is also the norm.

Barely half of the elder-care facilities in Quebec have sprinkler systems, and it is not much different elsewhere in the country. There are no mandatory staff-to-patient ratios either. The home did not have a registry, which is why the exact number missing is not known.

The words "patchwork" and "bureaucracy" are being used a lot to describe the regulatory environment. "Contemptuous" would be more precise.

There is a national fire code – it says sprinklers should be mandatory in every institutional residence – but most provinces have not made that recommendation law. And even the jurisdictions that have mandated the installation of sprinklers have grandfather clauses (a particularly egregious expression in this instance) for existing facilities and lag times of up to a decade for retrofitting.

It is cold comfort to know that granny's old-age home will finally be fitted with 20th-century safety equipment some time before 2025.

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The deaths in Isle-Verte, and other deaths in similar circumstances but on a smaller scale (13 dead in six nursing home fires since 2009) amount to a massacre by public-policy neglect.

And, unless urgent action is taken, the carnage will continue.

A cursory glance at the demographics of elder-care facilities underscores just how vulnerable this population is and how essential fire-mitigation measures are to their safety.

Only 1.6 per cent of people 65-70 years old live in seniors' facilities; by age 80, it's 30 per cent, at age 90, it's 48 per cent, and 66 per cent of people over 100 live in facilities. This is not a mobile population. They have no chance in a fire – unless the fire is put out quickly.

In the United States, sprinklers are mandatory in every nursing home, long-term-care facility and residence for seniors or people with disabilities.

Why? Because lawsuits forced the hand of legislators and institution owners. In the United States, when there are preventable tragedies like Isle-Verte, litigation against companies and the state forces immediate change.

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In Canada, we hold earnest public inquiries and then do nothing. Multiple coroners' inquests have looked at fires in institutional settings, and they have been recommending smoke alarms and sprinklers for at least three decades.

This inertia is sadly typical of almost all policy planning related to our aging society.

We have known for more than half a century that the post-war baby boom was going to result in a much older society in the future and, as the years passed, it became abundantly clear that one of the biggest societal challenges would be how to house and care for them.

But what have we done in preparation?

Aside from moaning about how boomers are going to bankrupt the health system, very little.

We have not re-engineered our cities to make them more senior-friendly, we have not modified our labour policies to make caring for our parents and grandparents financially viable, and we have not created a decent home-care network.

We have instead adopted a de facto policy of mass institutionalization – with eight per cent of seniors already warehoused and that number soaring. If that were not enough, many of these institutions have questionable staffing policies and dubious safety standards.

Why does it take an atrocious fire to get us even to start to talk about this situation? And what will it take to actually spur action?

It is no wonder we have nightmares.

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