People are dying in Ontario's for-profit long-term care homes at a "significantly higher" rate than those that are run as non-profits, a health advocacy group has found. A review of provincial statistics by QP Briefing found the same. The results mirror several international studies that find poorer health outcomes, on average, in for-profit facilities in Ontario and around the world.
In an analysis of 93 long-term care homes with COVID-19 outbreaks that have resulted in death, the Ontario Health Coalition (OHC) found fatality rates of 9 per cent in for-profit homes, 5.3 per cent in non-profits, and 3.6 per cent in municipally owned facilities.
— Jane Philpott (@janephilpott) May 7, 2020
The four homes with the most resident deaths during the pandemic — Orchard Villa, Altamont Care Community, Camilla Care Community and Forest Heights — are all for-profit, with 195 resident deaths among them, according to provincial numbers released Thursday. However, non-profit and municipal homes have experienced catastrophic outbreaks as well, with 42 deaths at the Salvation Army's Isabel and Arthur Meighen Manor and 38 deaths at the City of Toronto's Seven Oaks home.
The OHC's report is not surprising to Hugh Armstrong, a professor emeritus of social work at Carleton University, who has been studying long-term care systems in Canada, the United States, the United Kingdom, Germany, Norway and Sweden for more than a decade.
"It certainly is consistent with what I’ve been finding," said Armstrong, who has joined the OHC's board since retiring from Carleton. "The main difference is that the for-profits have to siphon off some of what they get in revenue to become profit. So in effect they are operating with less money in terms of care."
As of February 2019, 58 per cent of Ontario's long-term care homes were privately owned, 24 per cent were non-profit or charitable, and 16 per cent were municipally owned, according to the Ontario Long-Term Care Association. The province subsidizes things like nursing and support services at each facility, no matter the ownership, while residents pay for room and board. But unlike other facilities, for-profit homes must maximize profits for shareholders, which experts say often leads them to hire fewer care staff and contract out services like cleaning and food preparation.
"They try to economize — be efficient, as they put it — by cutting back on things as much as they can get away with," Armstrong said.
A recent report co-authored by Armstrong calls for the end of for-profit long-term care and finds "managerial practices taken from the business sector are designed for just enough labour and for making a profit, rather than for providing good care."
Several academic studies in Ontario and around the world have found that for-profit long-term care homes generally provide inferior care compared to publicly run facilities.
- A 2015 study of 640 long-term care homes in Ontario found that "for-profit facilities have significantly higher rates of both mortality and hospital admissions" than non-profits.
- A 2016 study of international care homes found "considerable evidence" that "public funding of care delivered in for-profit facilities is inferior to care delivered in public or nonprofit facilities."
- A 2009 meta-analysis of long-term care studies found that "on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes."
- British Columbia's seniors advocate found in February that for-profit operations spend 24 per cent less on direct care for residents than non-profits, while underpaying staff and failing to deliver on their contracted standards of care.
“This is a result that’s been shown fairly consistently," said Dr. Peter Tanuseputro, a University of Ottawa professor and seniors' care expert who co-authored the 2015 study on Ontario homes.
His team found a 15-per-cent higher death rate in for-profit facilities, compared to non-profits. But he cautioned against linking higher death rates during the pandemic to for-profit homes just yet. The data "does tend to show that there may be more deaths in the for-profit homes. But mind you, when we did our study, we adjusted for a whole host of factors," including facility size, and age and sickness of residents, he said.
Tanuseputro agreed that lower staff levels in for-profit homes is "one of the strongest theories" about why they perform worse than non-profits in general.
Deaths in long-term care account for over 75 per cent of all of Ontario's COVID-19 fatalities — 1,111 of 1,477 — according to numbers from the ministry of long-term care. The OHC counted 1,057 deaths in their analysis.
The Ontario Long-Term Care Association, which represents both for-profit and non-profit facilities, did not respond to a request for comment by deadline.
Two class action suits have been launched recently in Ontario, arguing that care providers Revera and Responsive Group have mismanaged their homes during the COVID-19 pandemic, and residents have suffered as a result. Similar suits had been filed before the pandemic. Many care home operators in the United States, where almost 70 per cent of facilities are for-profit, have gone so far as to ask for temporary immunity from lawsuits.
Service Employees International Union Healthcare has called for criminal investigations into "negligent operators" after three of their members died after contracting COVID-19. Two of those members worked at for-profit homes, and the other was scheduled to work in multiple facilities.
Neither Premier Doug Ford or Health Minister Christine Elliott voice a pro- or anti-for-profit opinion when asked about long-term care ownership on Wednesday.
“The system is absolutely broken. We are going to fix it,” Ford said.
Long-term Care Minister Merrilee Fullerton promised a review of the province's long-term care system Thursday morning.
My heart breaks for the lives lost as a result of this pandemic. Our gov has been clear: the system is broken. Long-term care has endured years of neglect. Once we emerge from this pandemic, we will get to the bottom of this. Yes, there will be a review.
— Merrilee Fullerton, MPP (@DrFullertonMPP) May 7, 2020
Green Leader Mike Schreiner said Fullerton should promise a "complete overhaul" of the system, not just a review.
"For years, elders have been neglected and workers have been undervalued by a system that puts savings over safety. The promise of a ‘review’ is cold comfort to the families whose loved ones have died alone or to the residents who continue to live in fear," he said in a statement.
In response to a QP Briefing question about whether he believes for-profit facilities should exist in Ontario, he said: "Our top priority should be raising the standard of care, including higher staff ratios, additional registered nurses, living wages and more inspections. This pandemic raises questions about whether private facilities can meet these standards of care and this is something that needs to be looked at."
Most for-profit homes are on contracts that will expire in the next five or six years — the government should look into rolling those homes into the public health system when that happens, OHC Executive Director Natalie Mehra said. In the meantime, she called on the government to commit to building its promised 15,000 long-term care beds in non-profit settings.
Armstrong's report calls for a number of changes to Ontario's long-term care homes in the long- and short-term, such as limiting staff to one nursing home; raising staff wages; and bringing facilities under a universal public system.