“If private ownership of LTC were associated with higher mortality, we would advocate stopping private ownership. However, this simple analysis shows that it was not ownership that caused COVID deaths — it was the multiple residents sharing the same room and the same air,” write Bob Bell and Walter Wodchis.
Long-term care deaths related to residents per room
If private ownership of LTC were associated with higher mortality, we would advocate stopping private ownership. However, this simple analysis shows that it was not ownership that caused COVID deaths — it was the multiple residents sharing the same room and the same air.
“If private ownership of LTC were associated with higher mortality, we would advocate stopping private ownership. However, this simple analysis shows that it was not ownership that caused COVID deaths — it was the multiple residents sharing the same room and the same air,” write Bob Bell and Walter Wodchis.
The most important lesson learned from the COVID-19 pandemic is that Ontario must improve the long-term care (LTC) system that houses our most vulnerable seniors. About 55 per cent of Ontario deaths from COVID-19 have occurred in nursing homes and countless families have tragically lost loved ones.
In order to improve LTC we need to understand what problems exist today. In analyzing mortality in LTC, the Toronto Star suggests that for-profit ownership of homes is associated with higher mortality. Our analysis presented below contradicts that conclusion.
Appropriate statistical comparison for-profit (FP) and not-for-profit (NFP) homes shows that the factor associated with mortality is whether the home houses three or four people in the same room — not who owns the home.
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To evaluate what factor is primarily associated with COVID-19 mortality, we determined whether each FP and NFP home in the province housed three or more residents in a room. Complete information was available for 510 homes. We excluded municipally owned homes which (unlike FP and NFP homes) receive extra funding from municipal taxes.
We documented how many residents died due to COVID-19 in each home to March 1, 2021. Thankfully, vaccination has dramatically reduced COVID deaths following this date. The number of COVID deaths was divided by the number of residents to determine a mortality ratio for each home.
A standard statistical test called “multiple regression” was done to figure out whether the ownership model (FP versus NFP) or the presence of three or more people in a room was associated with a higher mortality ratio.
The answer is clear. FP ownership was not linked to higher mortality (for statisticians, this factor had a p-value of 0.43). However, the presence of three or four people in a room was strongly associated with higher mortality (p=0.002). This routine statistical analysis showed that the Star conclusion about for-profit care increasing mortality was wrong.
This conclusion is consistent with the Canadian Institute for Health Information’s presentation to the Marrocco Commission, which found no association between the ownership model and higher mortality. Other investigators developed a “crowding index” to test the impact of multi-resident rooms on mortality with more detailed statistics and had findings similar to what we are reporting.
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The Star is correct that mortality in FP homes averaged 1.7 per cent higher than NFP homes. However, 55 per cent of FP homes offer older, three to four person bedrooms versus only 17 per cent of NFP homes which are generally newer facilities. Mortality with either FP or NFP ownership is 3 per cent higher on average in homes with three- to four-person bedrooms.
Improving Ontario LTC requires that we know what needs to change. If private ownership of LTC were associated with higher mortality, we would advocate stopping private ownership. However, this simple analysis shows that it was not ownership that caused COVID deaths — it was the multiple residents sharing the same room and the same air.
We need to urgently replace the 31,000 Ontario LTC beds located in homes with three- to four-person bedrooms. Replacing those older homes will cost about $10 billion. Raising money and rebuilding those homes will be faster with everyone engaged — both NFP organizations and FP companies.
We also know this is about more than buildings. We need to continually monitor quality in LTC and ensure more hours of care from full-time staff, who are better trained and better paid and supported by effective management and leadership. Assuring sufficient resources to protect and care for LTC residents represents our society’s value for life when we are old and infirm and when the preferred option of home care is not safe or appropriate.
We agree with The Star that no one should profit by skimping on care to vulnerable seniors. But that is NOT how companies providing LTC care create profit. Every dollar provided for care is reviewed by government to ensure it goes to providing care — these dollars cannot be diverted to profit. Companies achieve profit from co-payments that residents provide for room and board.
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The Star is wrong in suggesting that for profit LTC ownership is associated with higher COVID-19 mortality in nursing homes. Standard statistics show mortality is related to three or more people sharing air in the same room. This risk must be eliminated as quickly as possible.
Editor’s note — Mar. 23, 2021: The headline on this column was edited.
Dr. Bob Bell is a former Ontario deputy minister of health and long-term care. In 2020, Bell chaired a panel that examined Revera’s response to the virus. He was not reimbursed for that work. Dr. Walter Wodchis is a professor at the Dalla Lana School of Public Health, the University of Toronto. Neither contributor has received any compensation from any long-term care company at any time.
