Day after day after day, the toll of death in Ontario’s long-term care homes continues to climb.
Consider just this past week. On Tuesday, the province announced that 24 more people in care homes had died of COVID-19. On Wednesday, 39 more. On Thursday, 34. And on Friday, another 29.
The numbers keep coming, each of them a mother, father, sister or grandparent. By Friday, the number had reached 3,491. That’s just shy of 60 per cent of all those claimed by the pandemic in Ontario.
It’s a collective tragedy and a collective failure, so it’s no surprise there’s a hunt on for someone or something to blame. And for many advocates, the villain in this deadly drama are the private, for-profit companies that operate most care homes in the province.
The NDP, for one, is pushing at both the provincial and federal levels to get for-profit companies out of long-term care entirely. And a group of some 300 doctors this week put ending for-profit homes at the top of their list of things that must be done to provide decent conditions for residents and stop the spread of COVID-19.
If only it were that simple. If only there really was a big pot of money that could be funnelled back into long-term care, enough to make sure the people there enjoy the kind of lives they deserve. Enough to make sure we never again read stories about neglected seniors reduced to banging on walls, pleading for food and water, as we did just weeks ago at the Tendercare Living Centre in Scarborough.
The truth is there’s no easy solution, and focusing now on who owns and runs care homes isn’t necessarily going to get us any closer to it. Doing away with for-profit homes entirely could have many unintended consequences. And by itself it doesn’t address the most basic issue: the COVID crisis has shown that we’re going to have to spend a lot more tax dollars on long-term care.
We’re going to have to do that regardless of who owns care homes: government, municipalities, non-profit organizations like charities and community groups, or private for-profit companies.
Certainly, COVID has strengthened the arguments of those who have argued for years that profit shouldn’t be a part of long-term care, both on principle and because for-profit homes produce worse outcomes for the people who live there.
During the pandemic, residents of homes run by for-profit companies have been more likely to get sick, and more likely to die, than those in public and non-profit homes.
The reasons aren’t entirely clear. Private companies say the most important factor is that they run most of the older homes where residents are crowded as much as four to a room, all breathing the same air and making it easier for infections to spread. Their critics charge that they skimp on care and pile up profits at the expense of residents.
Whatever the cause it’s an ugly picture that demands a full explanation. The independent commission set up by the Ford government to look into the care home tragedy should do its best to come up with an answer. The government has been throwing roadblocks in its way by, for example, failing to turn over necessary documents. But the commission is in the best position to point a way forward when it reports on April 30.
In the meantime, though, it’s worth pondering some of the realities that make abolishing for-profit ownership in long-term care more problematic than it may seem at first glance.
This is, to start with, a highly regulated sector. Government sets an amount for each resident’s care needs, and establishes how much daily care they will get. Care homes, as explained in detail this past week by the Star’s Richard Warnica, must spend all the money they get for medical care, personal support services, “raw food” and programming on exactly those things. If there’s anything left over, it goes back to the government.
They can make profit in some areas, like maintenance, laundry and kitchen staff and management fees. But it’s far from the free-for-all that some advocates portray.
Nor is the accusation that for-profit companies have creamed off millions by paying dividends to shareholders so straightforward. The companies operate other lines of business — such as retirement homes — and dividends come from their overall operations. The idea that they represent a big pot of cash extracted from long-term care at the expense of residents doesn’t hold up.
It’s also not clear who or what would step in if for-profit companies were eliminated from the sector. Many, many billions will be needed to build a decent long-term care system and it’s a stretch to think that non-profits or municipalities will take on that kind of debt (in fact, companies might well be glad to get out of the sector and develop their land for more profitable purposes). It’s a challenge for government, as well, at a time when there are so many other demands on it.
It comes back to the fact that governments (representing us, the taxpayers) simply haven’t been putting enough into long-term care. Collectively, through our taxes, we’re going to have to commit a lot more to ensure seniors can live in acceptable conditions. And we’re going to have to spend more on inspections to make sure homes live up to those standards — regardless who owns or runs them.
In other words, there aren’t any shortcuts to the kind of long-term care that we can be proud of.
https://www.thestar.com/opinion/editorials/2021/01/29/for-profit-or-not-there-arent-any-shortcuts-to-decent-long-term-care.html
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