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Doug Ford is spending billions to expand nursing home chains with some of the worst COVID-19 death rates

Posted: May 29, 2022

(May 27, 2022)  

By: Marco Chown Oved, Kenyon Wallace & Ed Tubb,Toronto Star

Nursing home chains with some of the highest COVID-19 death rates are set to reap big financial rewards under the Ford government’s $6.4-billion expansion of the province’s long-term-care system.

According to records obtained by the Star, more than half of the approximately 60,000 new and redeveloped beds in the government’s plan are set to go to private, for-profit companies — many of which had far higher death rates than non-profit and city-run chains.

Non-profit nursing homes are set to receive just over 30 per cent of the total beds. Municipal chains, which reported by far the lowest death rates during the pandemic, will receive just six per cent.

The end result is billions of dollars in taxpayer money going to the very model of elderly care that failed during the pandemic — resulting in nearly 4,400 resident deaths — locking it in for decades.

“We’ve just been through the worst mass tragedy in long-term care in a generation and those operators who were the worst, who were responsible for the most deaths, they’re now getting the most funding. I’m outraged,” said Natalie Mehra, executive director of the Ontario Health Coalition, which represents more than 400 seniors’ groups, patient organizations and unions across the province.

“We have this opportunity to do something different. Instead, we’re setting up a long-term-care system to be chain-owned by the same companies that failed their residents, left them in squalor, abandoned them to die. How could this be?”

Accountability for the deaths in long-term care has emerged as a wedge issue in the provincial election campaign. Both the provincial Liberals and the New Democratic Party are vowing to end for-profit long-term care if elected on June 2. The Progressive Conservatives, in contrast, are moving to entrench it. 

A spokesperson for the Ontario Progressive Conservative party said the plan “will help reduce the wait-list and provide seniors with the quality of care they need and deserve, now and in the future.”

The spokesperson said the province is investing $72 million over three years to double the number of inspectors across the province and is doubling fines for individuals and corporations in long-term care that violate care standards.

To date, no fines have been issued by the province to any long-term-care home for pandemic failures.

The province’s plan will expand Ontario’s long-term-care capacity by more than 40 per cent, from about 77,000 beds to about 110,000. With that expansion comes billions in public money to help operators buy land, construct new homes and redevelop existing facilities.

In total, the plan calls for 31,000 new long-term-care beds by 2028, with funding to replace another 28,000 beds built to out-of-date standards.

Revera, the for-profit chain operating the most long-term-care homes in Ontario, has been awarded the most new and redeveloped beds: 5,248. Next is Extendicare, another for-profit giant, with 4,248 total beds. Third is Schlegel, a for-profit chain that will see its operations nearly double in size, with 3,152 total beds. 

These companies all had far worse resident death rates than non-profit and municipal operators. 

“We take great issue with the … assertion that Extendicare or any other health-care provider contending with the devastation and unprecedented challenge of a global pandemic was ‘responsible for’ loss of life,” said an Extendicare spokesperson in response to questions from the Star.

The list of top recipients also includes some of Ontario’s worst-performing LTC chains when ranked by pandemic death rate.

The highest death rate of any large LTC chain was reported by Rykka Care Centres, with 11.1 resident deaths per 100 beds. It’s getting 1,728 total beds — the seventh-most. Rykka, a subsidiary of Markham-based Responsive Group, operates Anson Place in Hagersville, which reported 23 resident deaths in a facility of just 61 beds.

The second-highest death rate among large chains belongs to Southbridge Care Homes, which reported 9.1 resident deaths per 100 beds. It is getting 2,816 total beds, the fourth-highest total. Southbridge’s facilities include Pickering’s Orchard Villa, one of five Ontario homes that were taken over by the Canadian Forces amid deadly outbreaks. Seventy Orchard Villa residents died of COVID.

Nicola Major, a spokesperson for Responsive Group, told the Star that new and modern long-term-care homes are “long overdue” in Ontario.

“With a rapidly aging population, the demands for long-term-care spaces will increase significantly in the years to come,” she said. 

“The long-term-care homes that were hit early in the pandemic were hit the hardest regardless of ownership. Very critical lessons have been learned about managing COVID-19 in the interest of public health and safety, which are reflected today.”

Southbridge spokesperson Beryl Collingwood said non-profits, municipalities and the private sector need to be at the table if Ontario is going to have systems in place to meet the future needs of seniors. 

“This is a critical moment. The population over 80 years of age is increasing every year and will double in just 13 years,” she said. “We need to focus our efforts on delivering quality care, supporting residents’ quality of life, and ensuring seniors are safe and feel valued.”

Presented with the list of recipients, Mario Possamai, who led the provincial government’s investigation into health-care worker safety after the 2003 SARS outbreak, said he was “shocked.”

“If there’s one theme emerging from the pandemic, it’s a real indictment of the private-sector model for long-term care,” he said. “If this goes ahead, we’ll be stuck in a very bad position for many, many years.”

Long-term care was ground zero for the COVID-19 pandemic. The deaths of nearly 2,000 residents in Ontario’s first wave pushed Premier Doug Ford to declare an “iron ring” around the long-term-care sector. Then came a second wave that produced a similar toll.

Through those first two waves, multiple Star analyses have shown, Ontario’s for-profit homes reported far higher resident death rates; through to this week, for-profit operators have reported an average of 7.4 COVID-19 deaths for every 100 beds they operate; non-profit and municipally run homes have together averaged 3.3.

The for-profit industry disputes this, and many operators continue to tell the Star death rates have nothing to do with ownership type. Instead, Ontario’s for-profit operators and industry representatives argue their worse outcomes reflect other factors — most notably the fact that for-profits operate many more older homes that were built to standards grandfathered in that allowed for shared bedrooms.

“A long-term-care home’s age, size and proximity to community spread are the causative predictors of a severe outbreak, not the ownership model of the home,” an Extendicare spokesperson said. “Extendicare is delighted Ontario’s government has approved our proposals to replace all our older homes, build to modern standards for safety and resident quality of life.”

Revera spokesperson Larry Roberts said: “The vast majority of older long- term-care homes in need of redevelopment are owned by private operators. Revera is receiving the most beds because we have the largest number of older homes in need of redevelopment.”

A Star analysis published last year found for-profits reported higher death rates in both older homes and in newer homes, in communities with rampant virus spread, and in those without. 

Last year, the Ontario government began trickling out funding announcements for new and refurbished beds, part of a “commitment to modernize the long-term-care sector” that would “ensure our most vulnerable residents enjoy the level of care, comfort and safety they deserve,” then Long-Term Care Minister Merrilee Fullerton said at the time.

The once-in-a-generation renewal of the nursing home sector involves selling surplus public land, financing the construction of new homes and paying to tear down and replace older homes, built when standards allowed up to four residents to share a room — an infection-control weakness that significantly contributed to increased spread of COVID-19.

Ford’s long-term-care expansion plan mirrors that of the Conservatives under Mike Harris back in 1998 when the province put out 20,000 long-term-care beds for tender. To encourage construction, the government offered to subsidize construction costs with public money over 20 years. In the end, operators — for-profit, non-profit and municipal — would own and operate homes and beds partially paid for by Ontario taxpayers.

The plan worked. Dozens of operators took the government up on its offer. About 60 per cent of beds at that time went to for-profit operators, with the most going to Extendicare, Leisureworld (later to become Sienna) and CPL REIT (later to become Revera).

The Ford government’s plan is essentially the same, but this time around operators will be paid back over 25 years.

“I have déjà vu of 1998,” said Tamara J. Daly, professor of health policy and equity at York University who has been studying long-term care for 20 years. “It’s essentially more of the same. The reason it’s shocking is because we know so much more, or we at least have more evidence to show that it’s a failed model.”

The Ontario Health Coalition’s Mehra notes that the government does not have to go down this route. Licences for some 30,000 outdated beds, mostly in for-profit facilities, end in July 2025. 

There is precedent for ending for-profit long-term care elsewhere. For example, while Ontario is going in for the long haul with Extendicare, Saskatchewan, where Extendicare facilities also saw poor outcomes, is severing ties with the corporation. Saskatchewan’s Health Authority took over all of Extendicare’s five long-term-care homes in the province last year after 39 residents died of COVID at just one home.

“Why would we not pay for homes that are owned and operated in the public interest rather than to take as much profit out as possible from the care of the elderly and the frail?” Mehra said. “The public is paying for this, regardless of who owns them, so why wouldn’t we make them public and not-for-profit?”

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