Last week, Ontario’s Progressive Conservative government gave itself the power to take over temporary management of long-term care homes that are unable to cope with the COVID-19 pandemic.
One might ask why Ontario waited so long. British Columbia, which has been more successful in holding off the coronavirus, made the same move six weeks earlier.
A comparison of the two large provinces is worth noting. Ontario, with three times the population of B.C., has reported 10 times as many COVID-19 cases and 13 times as many deaths (1,798 compared to B.C.’s 135, as of last Thursday).
British Columbia also appears to be well ahead of Ontario in recognizing the issues posed by for-profit operators in the acute-care sector.
The state of the B.C.’s long-term care system is reviewed regularly by the Office of the Seniors Advocate – essentially an ombudsman for B.C. senior citizens. On Feb. 4, just before the pandemic arrived, the Seniors Advocate published a report, A Billion Reasons to Care, on the funding of long-term care.
The report, which covers the 2017-2018 fiscal year, asked whether the province is getting value for the $1.4 billion a year it spends to subsidize LTC care homes when large chunks end up in the profit columns of some operators.
About 27,000 B.C. seniors live in 293 publicly funded long-term care homes. Of these, 38 per cent are owned and operated by regional health authorities, 28 per cent by non-profit societies, and 34 per cent by for-profit companies.
Although the non-profits and for-profits receive virtually the same per-patient subsidy (about $212 a day) from the province, the non-profits annually spend $10,000 more on per-patient care than the profit-based homes do.
The Seniors Advocate has another way to measure the difference: “The for-profit sector failed to deliver 207,000 hours of funded care and the not-for-profit sector provided 80,000 more hours of direct care than they were funded to deliver.”
Seventeen of B.C.’s for-profit homes registered profits in excess of $1 million in 2017-2018. Some of that came from steep management fees that the operators paid themselves out of the provincial subsidy. More came from paying low wages.
The report found that the for-profit sector paid its employees an average of 17 per cent less than the non-profit sector. For personal support workers, their wage rate could be as much as 28 per cent below the industry standard. That gap, as the Seniors Advocate noted, inevitably led to rapid staff turnover and difficulty in recruiting replacements.
“It could be argued that for-profit care operators are doing exactly what they are expected to do –look for areas where they can be efficient and achieve cost savings,” the report observed. But it emphasized that savings should not be achieved at the expense of patient care.
Long-term care is regulated in different ways in different provinces, but the provinces have three needs in common.
They need to find a way to prevent their LTC homes from becoming epicentres of the next pandemic.
They need to make sure that nurses, personal support workers and other front-line workers receive wages commensurate with the responsibility they accept and the risks they run.
And, if the anachronism of profit-making from chronic care is to continue, the provinces need to ensure – as the B.C. report recommended – that public money intended for patient care is, in fact, spent for that purpose.
That does not appear to be happening in Ontario. A report in the Toronto Star on the weekend looked at the earnings of the three largest publicly traded for-profit LTC chains in the province – Extendicare, Sienna Senior Living and Chartwell Retirement Residences.
Over the past decades, the three companies, which operate unsubsidized retirement residences as well as nursing homes, have paid more than $1.5 billion in dividends to shareholders, paid themselves $138 million in executive compensation and boosted their share prices through $20 million in stock buybacks.
How much of that money is coming out of LTC patient care is anyone’s guess, because there is a surprising lack of transparency in a sector fueled by public funds.
It is impossible to argue with a principle set down by the B.C. Seniors Advocate: that the revenues and expenditures of all publicly funded LTC homes should be made public. As the report stated: “The public is entitled to know how their money is spent, in detail, and residents and families are entitled to know how many care hours are delivered by their care home.”