When it comes to long-term care, what matters more than ownership is accountability and responsibility

Posted on May 12, 2020 in Child & Family Policy Context

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We’ve long known that nursing homes are incubators for infection in this pandemic.

We now know that not all incubators have the same outcomes.

The results from a Toronto Star investigation published Saturday are profoundly disturbing — for residents trapped in those homes, people with parents in long-term care, any voter who may one day end up in a home, and politicians responsible for the system. Regardless of ownership model, the facilities have been hit with outbreaks of COVID-19 at roughly the same rate, but once affected, the infection outcomes are dramatically different.

Residents in profit-seeking homes 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 as those in municipally-run homes, the Star found. We won’t know where the final numbers end up until further down the road of this pandemic, but it is impossible to ignore the early data.

Today there are calls to make all nursing homes publicly-owned, binding them not only to government regulations but nationwide standards. We have closed our eyes for decades to the inequities and in-built distortions of a system that relies on profit-seeking over caregiving, but are we truly ready to ban for-profit care?

If so, do we grandfather or nationalize decades-old homes? In reality, politically and economically, it is not so simple to dismantle and rebuild a hybrid public-private system built up over decades of deregulation and inattention.

It is tempting to blame Mike Harris for foisting this mess upon us, for he furthered the for-profit sector when he presided over deregulation as premier in the mid-1990s, undoing the staffing ratios of the previous NDP government. He profits from it today from his perch as chair of Chartwell Retirement Residences, one of Canada’s biggest private operators.

But just as it is pointless to personalize this problem, it is also fruitless to politicize it. Beware of intellectual and ideological shortcuts in analyzing the daunting challenge of long-term care.

The profit motive works in our market system. But what works for Walmart — relentless cost-cutting pressure on suppliers and minimal staffing ratios for low wage part-timers — is hardly an optimal model for nursing homes where part-time, underpaid caregivers are responsible for safeguarding people, not products.

The data may change over time, but we need to look at ownership with open minds and open eyes, recognizing that there is no panacea. As the Star’s research makes clear, there is no immunity from infection in not-for-profit nursing homes — the Salvation Army’s Meighen Manor in Toronto has reported dozens of confirmed cases and more than 34 deaths in a 168-bed facility.

We dare not demonize the ownership, for sometimes it is us: Revera Long Term Care Inc., an industry giant, is owned by the pension fund manager for federal public servants, soldiers and police. Which means that a fearful Revera resident might be a civil service pensioner whose monthly retirement income depends on the profits earned by the owner of that very home.

There will always be statistical variations and deviations — good for-profit operators, bad municipal homes — but the private sector lobby distorts the entire system by wielding disproportionate cost-cutting influence. Their profit-seeking race to the bottom — the worst wages, lowest staffing ratios and weakest standards — have an undeniable and ideological domino effect, dragging down all other players toward the lowest common denominator.

Either way, what matters more than ownership is accountability and responsibility. Harris answered to us as premier, but apparently owes us no explanations as chair of Chartwell (when I asked for comment last week, after Premier Doug Ford confirmed their phone conversation to me, Harris declined an interview). Public servants are accountable to us for their policy decisions, but not as retirees when their pension fund calls the shots in long-term-care homes.

That’s why every operator, no matter their ownership model, must be scrutinized. The Ford government decided last year to end comprehensive annual inspections, opting instead for a complaint-based model — as if seniors suffering from dementia, or without extended families, can truly benefit from the premier’s fetish for snitch lines or online web forms.

There is no excuse for not regulating and inspecting comprehensively, annually and aggressively. Surely that is the primary role and responsibility of government — not always ownership, but oversight at all times.

Martin Regg Cohn is a Toronto-based columnist covering Ontario politics for the Star. 

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