Should Canada Eliminate For-Profit Long-Term Care?

On March 22, the federal NDP tabled a motion to eliminate for-profit long-term care facilities in Canada by 2030. The party pledged to work with provincial and territorial governments to set up new licensing frameworks, according to CityNews, and to collaborate with experts and LTC workers to create new national care standards. It also promised $5 billion in total funding.

“Let’s be clear, nobody should be profiting off the neglect of our loved ones,” said NDP leader Jagmeet Singh.

The motion came as the country – and Ontario, in particular – came to terms with a series of devastating, deadly COVID-19 outbreaks in long-term care facilities, particularly for-profit homes. But while many advocates, doctors’ organizations, and nursing home negligence lawyers support moving away from the for-profit long-term care system, it’s important to ask how, or even if, this transition can reasonably be accomplished.

What Prompted the NDP Motion?

More than 80 per cent of COVID-19 deaths during the first wave in Canada occurred in long-term care facilities. According to Ontario’s COVID-19 Advisory Table, 78 per cent more deaths occurred in for-profit homes that experienced outbreaks than at not-for-profit homes that experienced outbreaks.

Issues relating to sub-standard care in for-profit facilities predate the pandemic, however. According to a 2015 study conducted by the Ottawa Hospital Research Institute, residents of for-profit homes had a 10 per cent higher risk of dying and 25 per cent higher risk of hospitalization than residents of not-for-profit homes between January 1, 2010 and March 1, 2012. The study also found that for-profit homes were twice as likely to be in the lowest performing 20 per cent of facilities, overall. Not-for-profit facilities also reported lower use of antipsychotics, lower use of restraints, and fewer ER transfers.

In other words, for-profit long-term care facilities have a reputation for providing worse care than their not-for-profit counterparts, a fact that can easily be interpreted as putting profits over patient health.

“If you own something, you want a return on investment,” University of Ottawa professor Michael Wolfson told the Ottawa Citizen in March. “There’s no question there’s a profit wedge that detracts from the capacity to provide the best-quality care.”

“When you think about for-profit homes, they’re by design created to have one thing in mind and that’s profits for shareholders,” Dr. Naheed Dosani told CBC Radio’s Metro Morning in January. “It’s not care for our seniors. This is a humanitarian crisis.”

Arguments Against Transitioning Away from For-Profit Homes

First, it’s important to remember that for-profit nursing homes were not the only long-term care facilities that failed to adequately protect patients during the pandemic. Our nursing home negligence lawyers have launched several class action lawsuits against long-term care operators, including some not-for-profit facilities. A full list of lawsuits is available here.

Even if every long-term care death in Ontario had occurred in for-profit facilities, switching those facilities to the not-for-profit system may not have been a silver bullet against COVID. As Ontario Long-Term Care Minister Merrillee Fullerton told iPolitics last month, issues like the age of a facility or the size of its resident rooms may have been as much of a factor as its ownership model.

Another issue to consider is Ontario’s significant reliance on for-profit homes. Today, 58 per cent of the province’s 626 licensed LTC facilities are privately owned, 24 per cent are operated by non-profit or charitable organizations, and 16 per cent are run by municipalities. There’s no easy way to move tens of thousands of long-term care residents into not-for-profit units. The owners of for-profit homes aren’t obligated to hand over their facilities or the land on which those facilities are built. Replacing those facilities, while simultaneously building tens of thousands of additional beds to accommodate a rapidly aging population, would likely cost far more than the $5 billion pledged in the NDP’s proposal.

Are There Alternatives to Eliminating For-Profit Care?

There may be ways to improve the quality of long-term care without immediately eliminating for-profit homes. The provincial government has already pledged to increase the amount of direct care nursing home residents receive, from two hours and 45 minutes to four hour per day.

More substantial changes might include improving transparency around the performance of for-profit homes, or paying families to take care of aging parents rather than moving them into long-term care.

One thing is clear: Ontario’s for-profit long-term care system does not provide an acceptable level of care, and its not-for-profit system doesn’t have the capacity to handle a massive influx of aging and sick residents. The COVID-19 pandemic exposed the system’s flaws; it’s now up to the province’s decision makers to ensure aging Ontarians don’t experience similar catastrophes in the future.

Contact Will Davidson LLP

The nursing home negligence lawyers at Will Davidson LLP have been representing vulnerable Ontarians for years, since long before the pandemic. If a member of your family has been affected by COVID-19 in long-term care, contact us today to learn how we can help.

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