It’s time to make long-term care part of the public hospital system
Posted: April 27, 2020
(April 26, 2020)
By: Geoffrey Stevens, The Hamilton Spectator
“In Canada, we shouldn’t have soldiers taking care of seniors. In the weeks and months to come, we will all have to ask tough questions about how it came to this.” — Prime Minister Justin Trudeau, April 23, 2020.
Questions are good. Answers would be better.
A few hours after the prime minister spoke last Thursday, his government announced the day’s grim statistics — 42,110 confirmed cases of COVID-19 in Canada; 2,147 deaths. Of those 2,147 victims, more than 50 per cent were residents of long-term care homes. This percentage soared to 72 in Ontario; it spiked at 80 per cent in Quebec.
Ottawa can be accused, fairly, of dropping the ball when it was slow to recognize the approaching pandemic. But how did the federal and provincial governments alike manage, in football parlance, to fumble the ball in their own end zone when it came to the danger to vulnerable Canadians housed — some might say warehoused — in nursing homes and seniors’ residences?
I suspect most people, unless they have a friend or relative in one of these places, don’t give much thought to the long-care dimension of the public health system. Yet it is a huge industry. Ontario alone has 626 long-term care homes with roughly 78,000 beds for seniors who require long-stay care. That may sound like a lot, but among the provinces Ontario has the second fewest long-term beds per 1,000 population. Only Newfoundland has fewer.
It’s an expensive business. As of 2018, the province was spending $149.95 per day for each nursing home patient. That works out to $54,730 a year. And that’s not all. The province only covers the basics; nursing and personal care (including help with bathing, eating and toileting), various therapies and the cost of ingredients for meals.
Patients are charged a co-payment for “room and board” to cover the cost of the bed they lie in and the conversion of those ingredients into the meals they are served. Room and board can run to $2,700 a month, bringing the annual shared tab to a bit over $87,000 per patient.
Fifty-eight per cent of the long-term care homes in Ontario are privately owned. Some of them are highly profitable. Others are not. Some are adequately staffed. Others are not. Some are genuinely concerned about the well-being of their patients. Others regard them as entries in the monthly ledger.
Some of the homes are well-maintained. Others are so worn and shabby that they should be torn down.
It’s crap shoot for families trying to find a safe, caring place for their elder members.
The Ontario Health Coalition reported in February last year that 30,000 of Ontario’s long-term care beds are in homes that have reached the end of their institutional life and need to be replaced or extensively renovated. The report was titled, “Situation Critical.”
Replacing worn-out facilities is part of an answer to the questions Trudeau was referring to. A larger part of the answer would require a hard look at the long-term care industry. While 58 per cent of Ontario’s 626 homes are private for-profit operations that make their money from room and board charges, 24 per cent are non-profits run by charities, and the remainder are owned by municipalities.
It is a complicated industry and the complications make it hard to regulate. Why, I wonder, are we saddled with a setup in which nursing homes and seniors’ residences are treated as operations separate and distinct from the rest of the health care system?
Why should a majority of long-term care facilities operate for profit, free to spend as much or as little as they choose on patient meals and comfort? Why should they not be held to the same high standard of patient care and safety as hospitals are? Why, for that matter, should they not be recognized for what they are — the natural extension of public hospitals — and be run by hospital professionals?
Inevitably, more questions than answers.