Social Policy in Ontario

A Star analysis of public data on long-term-care homes shows the facilities have been hit by outbreaks at approximately the same rate, regardless of ownership. But once COVID-19 makes it into a nursing home, the outcomes have been far worse for residents of for-profit homes.

In homes with an outbreak, residents in for-profit facilities are about twice as likely to catch COVID-19 and die than residents in non-profits, and about four times as likely to become infected and die from the virus as those in a municipal home.

“I’m not one bit surprised,” said Sharleen Stewart, president of the SEIU Healthcare union, which represents personal support workers and other front-line staff in both for-profit and non-profit nursing homes.

Stewart said that based on the experiences of the union’s members, for-profit nursing homes use more part-time and casual staff and have lower staffing levels overall compared to non-profit homes. She said non-profit homes have better infection controls and for-profit homes are less prepared to handle outbreaks. “This is old news for us.”

Judy Irwin, a spokesperson for the Ontario Long Term Care Association (OLTCA), which represents about 70 per cent of Ontario’s long-term-care homes of all ownership types, questioned the Star’s analysis, saying “there will need to be much more rigour in both the data accuracy and the analysis before any conclusions can be drawn. To proceed down a path of loose interpretation of incomplete data at this point would not be responsible.”

Long-term care is the front line of Canada’s battle with COVID-19, accounting for as many as four out of every five deaths. In an international study released earlier this week, Canada had the highest proportion of long-term care deaths from COVID-19 among 14 countries. Those deaths are occurring at a disproportionate rate in for-profit homes.

The Star’s analysis is based on a home-by-home database of every COVID-19 outbreak in Ontario as of Friday morning. Using it, we took the total number of beds in long-term-care homes as reported to the province and sorted them according to the ownership: for-profit, non-profit and municipal. Then, using the number of cases and deaths reported in each home, we calculated the rate of infection and mortality per 100 beds for each type of ownership.

The results were stark.

A resident in a for-profit home has been about 60 per cent more likely to catch COVID-19 and 45 per cent more likely to die than a resident in a non-profit home. A for-profit resident has also been about four times more likely to catch COVID-19 and four times more likely to die than a resident in a municipally run home.

Non-profit and municipal homes have also suffered severe outbreaks, including the city-run Seven Oaks in Scarborough, which has 108 cases, including 40 deaths among its 249 beds, and the Salvation Army’s Isabel and Arthur Meighen Manor, where there have been 103 cases, including 42 deaths for 168 beds.

Overall, however, there are higher rates of infection and death in for-profit homes.

The province has recorded outbreaks — at least one lab-confirmed case of COVID-19 in a resident or staff member — in about a third of its 651 long-term-care homes, and for-profit, non-profit and municipal homes have been hit at about the same rate.

But where COVID-19 is present, the for-profit homes have fared worse in controlling the outbreak and preventing deaths: For-profit facilities with outbreaks had 16 cases per 100 beds, compared to eight in non-profits and four in municipal facilities. Likewise, there have been four deaths per 100 for-profit beds, compared to two per 100 beds in non-profits and one in municipal facilities.

Overall, for-profit homes make up less than 60 per cent of long-term-care homes in the province, but they account for 16 of the 20 worst outbreaks.

The Star’s data uses the cumulative totals of cases and deaths in each outbreak since the beginning of the pandemic. This approach differs from the counts published daily by the Ministry of Long-Term Care. The ministry says its counts refer to “active” cases and therefore exclude both deaths and resolved illnesses from each home’s current case count. The ministry says its data is meant as a snapshot in time, not as a record of total infections over the entire course of an outbreak.

Irwin, with the OLTCA, said the “type of home ownership is not relevant to the COVID-19 pandemic in long-term care.”

All types of homes have been affected by COVID-19 “and each has had a different experience with the disease based on a range of factors. These include factors such as whether the home has an aging infrastructure and shared washrooms and/or 4-bed rooms, the staffing situation both pre-outbreak and during, and how rapidly homes have been able to access PPE and staffing support when they need assistance,” she said.

Staffing levels in long-term-care homes are not publicly reported and the Star was not able to verify whether staffing levels are typically lower in for-profit homes. The claim has also been made in court filings, labour board applications and in academic research.

More than 190 residents at the 233-bed Orchard Villa long-term-care home in Pickering have been infected with COVID-19, giving the privately run home one of the highest rates of infection in Ontario. To date, 66 residents have died of the virus — the highest death total at a long-term-care home in the province.

 

A Star investigation published last week found that the home has a lengthy history of citations for failing to comply with provincial regulations.

Orchard Villa is owned by Southbridge Care Homes, which operates 37 long-term-care and retirement homes in Ontario. Orchard Villa’s executive director Jason Gay did not directly address the Star’s findings, but in an emailed response to questions said that COVID-19 is “an aggressive virus, especially among seniors who are immune compromised or have pre-existing conditions.”

“The impact across the long-term care community, in our home and to our residents, our families and our staff, is challenging and tragic,” he said. “Our singular focus at this time is on the safety and well-being of our residents and staff.”

The highest total number of resident infections — 209 — has been reported at the for-profit 240-bed Forest Heights Revera in Kitchener. There have been 45 deaths at the facility — the fourth-highest total as of Friday.

The home is owned by Revera Long Term Care Inc., a big player in the industry that runs more than 500 nursing and retirement homes across Canada, the U.S. and the U.K. Revera is owned by PSP Investments, the pension fund manager for the federal Public Service, the Canadian Forces and the Royal Canadian Mounted Police.

Asked to respond to the Star’s findings, Revera issued a press release criticizing “media stories attempting to draw a link between the ownership model for long-term care and the passing of residents from COVID-19.”

“This focus on an issue that is not core to the challenges facing the system is becoming a distraction from discussions about the real reform needed,” said Revera spokesperson Larry Roberts. “Long-term care has not been, until recently, a high priority, and our most vulnerable citizens have paid a heavy price.”

“We need to close the prioritization gap between acute care (e.g. hospitals) and chronic care (long-term),” he said in the release, by prioritizing PPE and increasing funding so that pay and staffing levels in long-term care are equal to those in hospitals.

The Camilla Care Community in Mississauga and the Altamont Care Community in Scarborough have among the highest infection rates in the province, with both homes at about 80 per cent. They also have the second (48) and third (47) highest number of deaths, respectively. Both facilities are owned by Sienna Senior Living Inc., a publicly traded company which runs 70 retirement and long-term-care homes in Ontario and B.C. and last year reported a net income of $7.5 million. In its latest report to shareholders, the company said it has generated a total shareholder return of more than 250 per cent since it went public in 2010.

“We have adhered to provincial directives and protocols prior to and during this pandemic,” wrote Sienna spokesperson Natalie Gokchenian in an email.

Gokchenian called into question the Star’s methodology, saying that deaths should not be included in the total of confirmed cases and suggesting that it would be more appropriate to use the metric of active cases, which exclude both people who have died of COVID-19 and those who have recovered.

“The data you have provided is not correct,” she wrote. “It is premature to draw conclusions on industry wide outcomes. Statistics are being collected in different ways and not all of them are up to date.”

Gokchenian said Sienna plans to hire independent experts to conduct an internal review of the company’s practices and protocols during the crisis. The company also suggests the provincial government should undertake a review of the entire sector.

Earlier this week, the Ontario Health Coalition did its own analysis of the outbreaks and deaths in long-term-care homes and came to a conclusion that corroborates the Star’s findings: for-profit homes are faring far worse than non-profits and municipally run centres.

“We can’t say definitively what the causal relation is for the higher death rates in the for-profit homes, but the key element is staffing,” said executive director Natalie Mehra. “(For-profit homes) have lower staffing levels, they have lower wages and worse working conditions. While there was a critical staffing crisis across all types of homes before COVID-19, now it’s beyond words.”

The provincial decision to limit staff to working in a single home has exacerbated problems at the for-profits, she said.

“Given that the staff have to choose one home to work in, very likely they’ve chosen a home where they have better wages and working conditions. And that’s having an impact on the homes with the most precarious, most fragile staffing, which are really in very serious trouble now.”

All types of long-term-care homes in the province have similar budget restraints: they receive funding from the province according to the same formula and their fees are capped at the same level, Mehra said. But the for-profit homes generally extract profits from their budgets, while the non-profits and municipally run homes often supplement their budgets with fundraising and local taxes.

“The differences are profound,” she said. In non-profit settings, “there are more staff and they can provide more hours of care for each resident.”

Staff working in for-profit homes have also been hit disproportionately hard by the coronavirus: For-profit home staff currently make up nearly 70 per cent of all front-line health-care worker infections.

Eatonville Care Centre in Etobicoke has to date recorded 104 cases of COVID-19 among its staff, the most in the province. The for-profit home also has one of the highest rates of infection among residents with 182 cases reported in the 247-bed facility. Hawthorne Place Care Centre in North York has the second-most staff cases with 83.

Both homes are owned and operated by Rykka Care Centres, a subsidiary of Markham-based Responsive Group Inc. The company also operates Anson Place Care Centre in Hagersville, where 27 deaths from COVID-19 have been recorded. That home also has one of the highest rates of infection in Ontario.

Linda Calabrese, vice-president of operations for Responsive Management Inc. and spokesperson for Responsive Group, said all long-term-care homes receive funding from the government in “envelopes” that are “complex, highly prescriptive and tightly regulated and monitored.”

“Every dollar for nursing and personal care, programs, and food is spent and if not spent, is returned to the province,” she said.

Calabrese added that many of the company’s homes where outbreaks have occurred are “turning the corner” and many staff members have been cleared to come back to work. She said the company is seeing “residents recover fully” and is hopeful the outbreaks at Anson Place and Eatonville can be declared over soon.

Responsive Group was named in a proposed class-action lawsuit filed in Ontario Superior Court two weeks ago alleging the company failed to “properly and adequately plan for and respond to the COVID-19 pandemic” and as a result, “the virus has run rampant through many of their homes,” the claim alleges.

Among the allegations in the statement of claim: that residents who had tested positive for the virus were being kept in the same spaces as healthy individuals, that the homes had inadequate staff, had failed to provide sufficient personal protective equipment and conduct proper screening.

The lawsuit has not yet been certified by a judge.

In a statement to the Star’s Betsy Powell, the company said it “recognizes the rights of individuals to advance their concerns through litigation.”

“It is equally important that all parties in such matters have the opportunity to present information to the court and for it to be reviewed and thoughtfully considered. The court will then have to determine whether a concern merits certification,” the company said.

Pat Armstrong, a sociology professor at York University who has researched long-term care in Canada for more than 20 years, said she was unsurprised by the Star’s findings.

The main reason, she said, is the incentive of for-profit companies to reduce labour costs. Her research has found that for-profit homes tend to have lower staffing levels, lower wages and a greater reliance on part-time and casual staff, she said.

“Managerial practices taken from the business sector are designed for just enough labour and for making a profit, rather than for providing good care,” Armstrong and her co-authors wrote in a report published last month by the Canadian Centre for Policy Alternatives. “These include paying the lowest wages possible, and hiring part-time, casual and those defined as self employed in order to avoid paying benefits or providing other protections.”

Armstrong said the expansion of privatized long-term care can be traced back to former Progressive Conservative Premier Mike Harris’s time in government when he removed minimum staffing levels and set up a competitive bidding process for government contracts.

Harris is currently the chair of the board of directors for Chartwell, one of the largest private owners of long-term care and retirement homes in the province.

Laura Tamblyn Watts, president of CanAge, a seniors advocacy organization, said the government needs to figure out the reasons for the disparity in the rates of COVID-19 infection and death between for-profit and non-profit homes.

“Is it staffing levels? Is it staff training? Is it availability of PPE? Is it something else? It’s not just about whether or not they’re making money, it’s about what is happening at each home that seems to have these outcomes and we need to learn what that is quickly.”

The main issue, she said, is the lack of national standards.

“If we had national standards about the quality of care, the funding of the care, the funding of the staff, then in the end, whether or not it’s provided by a for-profit or not-for-profit is not as important,” she said. “What’s important is that anyone who’s providing the care lives up to the standards.”

https://www.thestar.com/business/2020/05/08/for-profit-nursing-homes-have-four-times-as-many-covid-19-deaths-as-city-run-homes-star-analysis-finds.html