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As doctors who work in long-term care homes and serve marginalized populations, we believe it’s well past time to end for-profit long-term care

Posted: December 30, 2020

(December 29, 2020)

By: Dr. Amit Arya, Dr. Naheed Dosani, Dr. Silvy Mathew and Dr. Andrew Boozary, Toronto Star

Dr. Amit Arya is a palliative care physician who works in long-term care facilities and is an Ontario Health Coalition board member

We’re almost a year into this pandemic and the inhumane horror in long-term care homes is repeating itself. It’s been nothing short of a nightmare. Vulnerable elders at a private for-profit Scarborough long-term care home, Tendercare, have died and will most likely continue to die from a virus that they were supposed to be protected from with an “iron ring”. It is unconscionable that this one home alone now has over 40 deaths. Adding further insult to this tragedy is a recent investigation showing for-profit long-term care companies paying out $170 million dollars to shareholders. And for what performance?

As physicians who work in long-term care homes and serve marginalized populations, we believe governments have been shirking crucial questions for far too long.

Why has COVID-19 been so much more deadly for frail seniors living in for-profit long-term care homes? Also, given that COVID-19 remains a crisis in long-term care homes today, what can be done to save lives?

For-profit homes are literally designed in a way that puts frail seniors at risk. With structural safety standards that were set in the 1970s, these homes are more likely to have three or four people living together in one room, which can accelerate the spread of the virus. Since for-profit long-term care companies have made billions of dollars in profits over the last few decades, and have been mandated since 1998 to perform structural upgrades, it is astonishing as to why so many homes have been waiting years to be renovated accordingly. They have more than enough money to fix this issue and wherever they can act quickly and safely, they should do so to save lives.

For-profit long-term care companies generate extra revenue by keeping their health workers -, mostly racialized women — poor. Ultimately, this means less full time staff and even worse staffing shortages. A greater reliance on agency staff, who are moving between multiple homes, also increases the risk of COVID-19. All of this has worsened a crisis where there is not enough support and monitoring for people who are sick with COVID-19. It has resulted in some of the most devastating situations, where vulnerable seniors died not just from the virus, but from dehydration, hunger, and loneliness. Protecting our elders in long-term care means protecting all staff through a decent living wage, paid sick leave and more full-time roles, so more staff are working at a single home.

Throughout the pandemic, we have seen a lack of transparency and accountability from for-profit long-term care companies enabled by a provincial government that is failing to take decisive action. For example, when inspectors identified major failures with infection control at Tendercare, why did it take a major media outcry, and a delay of a week, for the government to take action and assign a hospital to help?

The result is that the system is designed to protect corporations over human life. The calamity of placing profits over people needs to end.

We also need an inspection system which has the power to remove licenses and impose heavy fines directly, before lives are unnecessarily lost. If conditions in a daycare were so abhorrent that authorities had to step in to protect children, and take over management, it would be unthinkable for the license to be handed back to the same operator. So why then, does this same ethic not protect vulnerable seniors in private for-profit long-term care homes?

It should be clear that the immediate solutions suggested will not just improve care during the pandemic, but also well beyond. After all, improved staffing levels and care provided by skilled full-time workers will mean that seniors receive individualized care by people who know and understand them. Performing long overdue renovations will ensure we protect the privacy and autonomy of seniors in their last years of life.

If we ensure that improved care is provided in all long-term-care homes, including for-profit ones, the cost of care will increase. This will result in decreased revenue and dropping share prices, making the sector less profitable. In turn, for-profit corporations may well want to leave the ‘business’ of caring for seniors. But most pressingly, governments of all levels need to work together to bring all long-term care homes under public ownership much like other parts of our Medicare system, including hospitals and physician care.

With public support and political will, long-term care can be part of the universal health care system that we as Canadians are so proud of. With the immense grief and suffering continuing for people living in long-term care homes today, this must be a priority. It’s a matter of life and death.

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