Running a long-term-care home in Ontario is an attractive enough business that private equity funds are being set up to invest in the opportunity.
That may sound somewhat surprising in the middle of a pandemic that caused such death and devastation in some homes that the provincial government rushed in with legislation to shelter them from lawsuits. As a long-term investment strategy, though, it’s not that surprising.
There’s currently a shortage of beds — and that’s even before the boomer generation starts to turn 75 next year. On top of that, Ontario has committed $1.75 billion to help operators renovate old homes and build new ones and promised to invest significantly more by funding higher care and staffing levels.
But news that an Ontario investment fund is advertising “stable long-term cash returns” through the purchase of government licences for nursing home beds is deeply concerning to many seniors’ advocates. They argue that the profit motive has no place in long-term care and is incompatible with providing the quality and dignified care seniors need in their final years.
This is far from a new argument but it’s taken on an increased level of urgency — and been backed by very troubling data — during the pandemic.
Overall, for-profit homes have just over half the province’s long-term care beds. But they account for more than 70 per cent of the COVID-19 deaths in the first wave and nearly 79 per cent in the second wave, according to an analysis by the Star.
The concentration of cases and deaths in for-profit homes, over non-profit and municipally run homes, is a shocking difference that demands an explanation.
Is it simply a sign that those homes are older and crowded with more people to a room? Or is it also related to the leaner way they’re run in order to turn a profit?
It’s welcome to see the Ontario Long-Term Care Commission into COVID-19 asking pointed questions about the different ownership models and the future of corporate investment in the sector. “Do we need three different types of homes?” commission member Dr. Jack Kitts asked during one meeting. “Is there an ideal model?”
That’s a longstanding question and it would be valuable to have a comprehensive answer to it before Ontario embarks further on its planned expansion of the sector and must live with its choices for decades to come.
In the meantime, though, let’s focus the blame for poor outcomes in long-term care where we already know it absolutely belongs: Queen’s Park.
The provincial government sets the standards and regulations for all long-term-care homes, no matter the ownership model. It provides funding and is responsible for inspecting them.
It’s up to the government to set long-term-care standards that are high enough to ensure quality and dignified care for seniors and back it up with an enforcement system tough enough to ensure those standards are met.
If the provincial government actually did that, concern about for-profit models of care would lessen.
The real problem is that government — not just this one but others before it, too — have never been particularly good at ensuring either of those things.
Two weeks ago, Premier Doug Ford promised to provide seniors in long-term care with four hours of daily hands-on care by 2025. Advocates have been calling for that for years and it’s desperately needed. But it could still be years away given the government’s disappointing budget last week, which backed its expensive commitment with exactly zero dollars.
And Ontario’s requirements for long-term-care homes, which are too lax already, aren’t even always followed. When homes violate the rules the government does far too little, in some cases nothing at all, about it.
This all can, and must, change. It’s time government held up its end of the bargain and ensured quality care in long-term care, no matter who owns the homes.
https://www.thestar.com/opinion/editorials/2020/11/16/care-not-profit-must-come-first-in-long-term-care-homes.html
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