Do you remember?
Four months ago, on Sept. 23, when Parliament resumed following its summer hiatus, Prime Minister Justin Trudeau went on television and made a promise to the nation: “We will start working as of today with the provinces and territories in order to establish new national standards for long-term care.”
A second wave of the COVID-19 virus was looming then, and political leaders at both levels were determined to do everything within their power to prevent the pandemic from cutting a swath through the country’s nursing homes and seniors’ residences, as it had in the first wave. Yet today – with the nation locked in a deadly battle with the second wave – the situation in the long-term care (LTC) sector is as desperate as it was before.
Canada had worst record among the world’s wealthy nations in protecting residents of LTC facilities in the first wave – 80 per cent of the deaths occurred in those homes – and the percentage looks as though it will be about the same in the second wave. Every province has attempted steps of one sort or another to reduce the toll – Premier Doug Ford promised an “iron ring of protection” around Ontario’s LTC homes – but they have all been too little, too late.
As for a national strategy or Trudeau’s “new national standards” – nada!
The inaction is partly, but only partly, the product of constitutional protectivism – the provinces will take Ottawa’s money but will not surrender a centimetre of control or authority. The reality is that all governments have been overwhelmed by their daily struggle to protect the entire community, not LTC residents alone. They are not able to look beyond today and tomorrow – to the challenges of getting people to stop travelling, to stay at home, to wear masks, and to vaccinate millions of people as the supply of vaccines becomes unpredictable.
Putting the LTC crisis on the back burner means only one thing: it will get worse. Two steps need to be taken on a priority basis. One will be politically difficult, the other hugely expensive.
The first, politically difficult one, is to get rid of for-profit LTC homes. They are a major industry. Twenty-eight per cent of Canada’s 2,039 LTC facilities are operated for profit – for Ontario, it’s 57 per cent – yet that 28 per cent have had twice as many residents infected with COVID-19 as non-profit homes and 78 per cent more resident deaths.
A Toronto Star investigation of private for-profit homes in Ontario revealed that they employ 17 per cent fewer staff than non-profit and publicly owned homes. In the first three quarters of 2020, these companies took in at least $138.5 million in government COVID relief money while paying out $171 million in dividends to shareholders.
Conclusion: for-profit LTC operators take in public funds, cut costs to the bone, fail to replace old homes where patients are packed in wards, record an unconscionably high rate of deaths, and pump out dividends to their owners. Where is the sense – or justice – in that?
It is a question being asked these days by some pension funds that are beginning to divest themselves of their holdings in LTC companies. A notable holdout is the Public Sector Pension Investment Board, which owns 100 per cent of Revera Inc., the country’s second largest (after Extendicare) owner of LTC homes. The PSPIB is a federal crown corporation, owned lock, stock and Revera by the government in Ottawa.
The second, and expensive, priority step is to radically reform the long-term care system by replacing nursing homes – to the fullest extent possible – with an expanded, muscular system of home care. On the face of it, this reform looks economically attractive.
According to the Canadian Institute for Health Information, it costs the public purse $730 a day for hospital care for a patient in Ontario, $201 a day in an LTC home and just $103 a day to provide home care and community services. This last figure is based on the current – woefully inadequate – level of available home care. A proper system that would enable frail, elderly citizens to be cared for 24/7 in their own homes, close to family and friends, would be hugely expensive, and it would not eliminate the need for institutional care for those with advanced dementia and other debilitating conditions.
Still, most seniors who not need to be in a chronic care place would be happier, more comfortable, better cared-for and safer in their own home than in the warehouse of an LTC facility. Surely the safety and comfort of vulnerable Canadians in their final years cannot be approached solely as a dollar-and-cents calculation. It is a defining moral issue, and it is staring the nation – and its leaders – in the face today.
Cambridge resident Geoffrey Stevens, an author and former Ottawa columnist and managing editor of the Globe and Mail, recently retired from teaching political science at the University of Guelph. His column appears Mondays. He welcomes comments at [email protected]