OP-ED: Not ending private long-term care would be a deadly mistake

Posted: February 11, 2021

(February 11, 2021)

On February 1, The Toronto Star published an opinion column titled “Ending private long-term care would be an expensive mistake.” Both on the facts and the ethics we disagree.

“Resident mortality has been more common in privately owned homes,” begins the op-ed by Dr. Bob Bell. This detached language obscures the painful reality that for-profit long-term care homes have vastly higher COVID-19 infections and deaths than public and non-profit homes.

A CBC analysis revealed the extent to which for-profit chains had the highest death rates during the pandemic. Southbridge lost nine residents per 100 beds, followed by Rykka with 8.6 deaths, Sienna with 6.5 and Revera with 6.3. The average COVID-19 death toll in for-profit homes was 5.2 per 100 beds. Non-profits averaged 2.8 deaths per 100 beds and publicly owned (municipal) homes averaged 1.35 deaths per 100 beds.

These numbers represent thousands of real human beings.

Ontario’s LTC homes are funded from residents’ fees and public taxes. Yet the financial details about how for-profit LTC operators spend their money are not obtainable for public scrutiny. What is clear, despite decades of attempts to regulate them, the choices made about how to allocate resources are much different in for-profit homes than in public and non-profit homes.

For-profit LTC operators tend to pay their staff less, hire fewer full-time staff and provide fewer hours of care. While Dr. Bell tries to argue that hours of care are not determined by employers, it is irrefutable that the employers determine how many staff per shift and whether they replace empty shift lines (which they often do not).

Dr. Bell claims that employers do not keep workers’ wages low and reduce hours of care in order to increase profits, contending that wages are duly negotiated with unions. He does not mention that LTC workers do not have the right to strike, nor that for-profit operators have chosen to bargain lower wages than their public and non-profit counterparts.

Dr. Bell also blames horrific death rates on facility design rather than for-profit ownership, claiming almost all of Ontario’s older nursing homes are privately owned. In fact, those LTC homes with 4-person rooms were built to standards that were outdated in 1998, twenty-three years ago. Decades of ever- increasing financial incentives funded by our taxes have been offered to LTC operators to get them to rebuild. While many have rebuilt, the for-profit homes to which Dr. Bell refers with 4-bed shared rooms, did not rebuild.

What Dr. Bell fails to mention is that for-profit homes have more verified complaints, more transfers to hospitals, as well as higher rates of ulcers and morbidity. Let us not forget the documented failure in for- profit LTC homes during the pandemic to provide PPE and institute sound infection control. Dr. Bell also fails to mention that the for-profit homes have, for years, lobbied against regulations to protect residents, including surprise inspections and fines.

Dr. Bell further omits that non-profit and public homes supplement care with their own fundraising and municipal funding. At the same time, for-profit homes dole out millions in monthly profits to shareholders and investors. In the first nine months of 2020 alone, the three largest publicly traded LTC operators in Ontario paid out $171 million to shareholders while taking millions in government funds.

Unable to hide from the horrific outcomes, for-profit advocates now try to claim it is “too expensive” to end for-profit care, saying thousands of beds need to be rebuilt and we cannot afford to do so. What they omit is that all rebuilt and new beds will be paid for by the public regardless of who owns them. Ontario’s government now pays $224,000 per bed to cover capital costs over 30-year licenses, plus capital grants, plus operating costs, capital repairs subsidies, etc. As the old outdated homes’ licenses come to an end over the next few years, why would we commit another 20-plus years of public funds to build and rebuild for-profit homes?

The evidence is clear on the inferiority of the for-profit LTC model. Preserving the dysfunctional status quo would be both immoral and contrary to the evidence. The worst mass causality event in our collective LTC history is underway and yet they say there is no alternative. We vehemently reject this claim. Not ending for-profit long-term care would be a deadly mistake.

Dr. Vivian Stamatopoulos is an Associate Teaching Professor at Ontario Tech University and cofounder of Doctors for Justice in LTC.
Natalie Mehra is the executive director of the Ontario Health Coalition and has advocated for improved care in LTC for 25 years.