While there is some discussion of LTC homes in our health policy analysis, we thought it was valuable to offer a deeper look at this important topic.
COVID-19 awoke the general public to the dire state of Ontario’s long-term care (LTC) homes, but the problems had been present for much longer. Natalie Mehra, executive director of the Ontario Health Coalition gave a statement to Global News in 2020 that her organization had been working to raise awareness and combat the horrific conditions since well before the pandemic.
Before COVID, several Auditor General reports (2014, 2016) highlighted issues of neglect. These were most egregiously occurring at for-profit long-term care homes.
When the pandemic hit in 2020, the already awful state of these homes was brought into public awareness.
The Canadian Armed Forces was deployed to the province’s worst-hit LTC homes. They described the conditions using phrases like “blatant disregard [for infection control measures]” and “borderline abusive, if not abusive.” As a society, we were failing some of the most vulnerable members of our society—elderly and disabled people.
THE PROBLEM WITH FOR-PROFIT LONG-TERM CARE HOMES
In the first wave of COVID alone, over 2,000 people died in Ontario long-term care homes. The majority of these deaths occurred in for-profit homes owned by Sienna Senior Living and Revera Inc..
Advocates have argued since well before the pandemic that the greatest problem with private, for-profit care homes is that there is insufficient oversight to protect residents and staff. In these institutions, workers are often paid barely more than minimum wage and offered only part-time employment.
These institutions are severely understaffed, with one nurse responsible for 30-60 residents and often no on-site doctor. This shortage of staff means that these underpaid workers are saddled with far more than they can reasonably manage. As a result, residents receive the bare minimum of care and don’t get to experience the quality of care that they deserve.
Doctors as well as the unions representing these workers have called for more support and greater oversight of these institutions.
TIGHT QUARTERS
This shortage of staff mean that in order to survive, workers often take jobs in several long-term care homes simultaneously. During the pandemic, this made it much easier for coronavirus outbreaks to spread between homes.
This again was a greater danger in for-profit homes. In municipal or public homes, workers tend to earn more and are more likely to have full-time hours. This benefits both the workers and the people they care for.
An additional problem is the number of residents sharing a room. In many rooms, there will be 3-4 beds. In the pandemic, this has made social distancing nearly impossible and has enabled more rapid spread of the virus within a home.
Even in non-COVID times, these tight co-living conditions pose a threat to residents with vulnerable immune systems. Even the common cold can be extremely dangerous and spread quickly in these circumstances.
The 2021 Auditor General’s report found that 35,980 beds in LTC are in these “dorm-style” rooms. Most of them are in for-profit homes. In these residences, private rooms, which are safer, cost way more. People are forced to choose between financial stress and their own (or a loved one’s) health and safety.
POLITICAL ENTANGLEMENTS
Ontario has the highest percentage of private vs. public LTC homes in the country. While many activists speak out against private homes, Doug Ford has worked to protect them.
In early 2020, before the pandemic, Ford enacted legislation (Bill 124) that capped the wages of the personal support workers in homes, many of whom do not make enough to survive.
Later that same year, after the effects of the pandemic on these homes became clear, he introduced legislation that protected these businesses from lawsuits.
Sharleen Stewart, president of SEIU Healthcare (a union that represents front-line healthcare workers) lamented that they fought the provincial government “every step of the way” to protect the staff and residents in private homes. It’s little wonder that these corporations hold so much sway over the government. These companies have donated over $300,000 to the PC and Liberal parties. A number of conservative MPs are shareholders and directly benefit when these private homes experience record profits. Former PC Premier Mike Harris is the chair of the Chartwell’s board of directors.
The quality of life in LTC homes (especially in those that are for-profit) is so dire that CARP (Canada’s largest advocacy association for older Canadians ) has called for the firing of the Minister of Long-Term Care, something the organization has never before done.
POSSIBLE SOLUTIONS
As our country’s population ages, the need for elder care will continue to grow. By 2035, Canada will need an additional 199,000 long-term care beds—twice what we currently have.
Many advocates call for the eradication of private care homes and greater support of at-home care, so that elders can stay with their families and in their own homes.
CARP calls for government funding to be “tied to the adoption of provincial standards of care that are evidence-based, monitored, and evaluated.” They also call for the implementation of mandatory staffing levels.
What are the parties saying about Long-Term Care?
- Introduction of a new tax credit to provide support for medical expenses
- $1 billion investment in home care over the next 3 years with most funding going to for-profit homes.
- Promise to build 30,000 long-term care beds by 2028 through $6.4 billion in targeted funding since 2019
Unfortunately, the PCs have not released a platform but you can learn more by reading reporting on their most recent budget or the budget itself.
- Stop renewing and issuing new for-profit licenses for long-term care and start transferring care to public and not-for-profit organizations
- Invest at least $1 billion over four years in home care
- Build 50,000 new beds including small, modern “family-like” homes
- Clear the wait list of the current 38,000 people waiting
- Expand home care and provide financial support to people caring for their own family members
- Establish provincial standards for home and community care
- Ensure caregivers have full-time opportunities and higher pay
More here: https://www.ontariondp.ca/longtermcare
- Stop renewing licenses for for-profit long-term care homes starting next year15,000 more assisted-living homes over the next decade
- Start negotiating and financing the transfer of existing homes to not-for-profit entities and municipalities
- a home-care guarantee that would ensure 400,000 more seniors have access to home care in the next four years
- boost total base funding for the home-care system by $2 billion by 2026 through 10 percent annual increases
- Increase base pay for long-term care workers from $16.50 to $25/hour
Read more here: https://ontarioliberal.ca/ontario-liberals-release-emergency-long-term-care-plan/
- Phase out for-profit long-term care and stop licensing new for-profit homes.
- Build 55,000 long-term care beds by 2033 and at least 96,000 by 2041
- Create more Indigenous-led long-term care homes
- Increase base funding for long-term care by 10%
- Repeal Bill 218, which shields long-term care owners and operators from liability for negligence.
- Reinstate annual comprehensive inspections of long-term care homes without advance notice, and ensure homes with infractions face the legislated consequences.
- Transfer regulatory oversight of retirement homes to the Ministry of Long-Term Care.
- Create a system of formal oversight for long-term care Medical Directors working with the Ontario College of Physicians and Surgeons and the Ontario Medical Association.
- Mandate a minimum of 4 hours of nursing and personal care per resident per day, including a minimum of 48 minutes of care provided by a registered nurse and 60 minutes provided by a registered practical nurse.
- Increase long-term care resident access to allied health professionals, such as dieticians, physiotherapists, occupational therapists, and social workers, to a minimum of one hour per day.
- Increase funding to home care services by 20% so that people can safely stay in their homes longer
- Pilot a support program as part of a basic income phase-in for those doing unpaid caregiving in families and communities.
- Mandate that personal support workers are paid a minimum of $25 an hour and for their travel time between visits.
TO LEARN MORE: https://gpo.ca/platform/caring-society/#care-for-elders
Recommendation
While there are a number of policy differences between the Greens, NDP and Liberals, in this election the two possible outcomes are a Conservative majority and a minority government that will likely result in a coalition of the Liberals, the NDP and potentially the Greens. For this reason, if you like the policies presented by any of those three parties and would like to see for-profit long-term care phased out, you should vote for whichever party is likely to beat the Conservatives in your riding.
Resources and Groups and Individuals to Follow:
Canadian Association of Retired People
Ontario Voters Coalition 