People protest outside the Tendercare Living Centre LTC facility on Dec. 29, 2020. “The reason that COVID deaths are sadly greater in private LTCs is because almost all of Ontario’s older nursing homes are privately owned,” Bob Bell writes.
Ending private long-term care would be an expensive mistake
Deaths are greater in private LTCs because almost all of Ontario’s older nursing homes are privately owned. These old homes have multi-resident rooms where four seniors could transmit the virus through the air they were sharing. We should be investing funds in the urgent redevelopment of these homes.
People protest outside the Tendercare Living Centre LTC facility on Dec. 29, 2020. “The reason that COVID deaths are sadly greater in private LTCs is because almost all of Ontario’s older nursing homes are privately owned,” Bob Bell writes.
The fact that pandemic deaths have been tragically commonplace in long-term-care (LTC) homes is a source of grief and understandable anger for Ontario families. They trusted their loved ones would be safe in government-regulated residences. Recognition that resident mortality has been more common in privately owned homes has resulted in an outcry that private ownership should be abolished.
The reason that COVID deaths are sadly greater in private LTCs is because almost all of Ontario’s older nursing homes are privately owned. These old homes have multi-resident rooms where four seniors could transmit the virus through the air they were sharing.
In fairness, most of the private LTC companies have applied to the government to redevelop these homes. Unfortunately, until very recently, few of these applications for rebuilding have been approved. It is disingenuous to blame the private ownership model for patients dying in multi-resident rooms when successive governments failed to support redevelopment of these old homes.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
In expanding their arguments against private ownership of LTCs, advocates have created a false narrative that needs to be countered.
The first myth is that private employers keep workers’ wages low and reduce hours of care in order to increase profits.
Employers do not arbitrarily set wages. Nearly all workers in Ontario LTCs are unionized and have access to binding arbitration. If the union and employer cannot reach agreement on compensation, arbitrators decide on a wage settlement.
Nor are the hours of care residents receive determined by employers. The government funds a fixed monetary sum for patients’ daily care needs. The ministry has established rules on how that money is spent and monitors expenditure annually. If the employer fails to spend all these “care” dollars on wages for providers, the money is clawed back by the ministry. Private companies cannot create profit by taking money away from deserving workers or by reducing hours of care.
Private LTC employers are also accused of hiring more part-time workers to increase profit margins. However, there is no profit achieved through part-time workers. Part-time workers are members of the same unions as full-time workers and receive proportionate benefits (or pay in lieu of benefits) appropriate for hours worked. We could achieve the laudable goal of increasing full-time work in LTC, but this will require more ministry funding.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
I have no affinity for private ownership of LTC homes. However, I do believe that the current advocacy for changing the ownership model in Ontario ignores facts and detracts attention from fixing the real problems facing LTC in Ontario.
The first practical issue is finding another model to substitute for private ownership. Municipalities are mandated to operate a small number of municipal “homes for the aged” — about 18 per cent of Ontario’s LTC beds. But municipal leaders feel strongly that LTC is a provincial responsibility. They will not increase their ownership of LTC homes, since this represents provincial government downloading of costs.
Another alternative to private LTCs is for more homes to be owned and operated by not-for-profit (NFP) charitable community, cultural or religious groups. About 25 per cent of Ontario LTCs are currently owned by NFP groups. However, Ontario needs to rebuild old homes with 32,000 beds and expand bed capacity for the 38,000 people currently on our waiting lists. Expecting community volunteers to take on the multimillion mortgages needed to build homes in response to this urgent need is unrealistic.
Why shouldn’t the government just finance redevelopment and build new homes through provincial debt rather than relying on private or NFP owners to take on mortgages? Recent estimates of costs suggest that redeveloping and building 70,000 beds would cost at least $20 billion. Given current demographic trends of an aging population, this cost would likely double in five to ten years. That is a big increase in the provincial debt load for our grandchildren to manage.
If current licences were taken away from private landlords, there would probably be further costs in restitution to these privately owned companies that possess valid 25-year licences. If licences are revoked, the private operator will likely keep the land and buildings they have title to. This land would probably be deployed more profitably for retirement homes or condominiums.
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
Rather than wasting money in buying back licences, we should be investing those funds in urgently redeveloping older homes, increasing home inspections, providing higher wages for more full-time providers and increasing hours of care. We should also be investing in home-care that keeps seniors independent rather than requiring admission to LTC.
All LTC homes need much better inspection. Old homes need redevelopment. Workers in those homes require better training, job conditions, pay and respect. Spending money to eliminate private ownership when that money could enhance quality of care for all LTC residents would be a public policy disaster that would not honour the lives that have been tragically lost.
Bob Bell worked in Ontario health care for more than 40 years as a GP, surgeon, hospital CEO and deputy minister of health. Follow him on Twitter: @drbobbell. In 2020, Bell chaired a panel that examined Revera’s response to the virus. He was not reimbursed for that work.
