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Ontario’s call to Ottawa for long-term care support doesn’t aim to reduce private ownership: Ford’s office

Posted: May 12, 2020

(May 11, 2020)

By: Victoria Gibson, IPolitics

Premier Doug Ford at his daily COVID-19 press conference, at Queen’s Park in Toronto. May 5, 2020. Steve Russell/Toronto Star

Internal talks between the Ford and Trudeau governments over supports for the long-term care sector have not included the aim of reducing for-profit facilities, the premier’s office says — as recent analyses have revealed higher death rates in for-profit homes.

Ontario Premier Doug Ford appeared to indicate interest in speaking with the feds about the proliferation of privately-owned long-term care homes last week. Asked by a reporter whether he would support, in some capacity, ending privatized care, Ford noted that Ontario couldn’t currently afford to do so on their own.

“We aren’t in the financial spot to be able to fund the whole system, but I’d love to sit down, and I’ve mentioned this to the Prime Minister and Deputy Prime Minister, we need their support,” Ford replied, during a May 6 press briefing. But on Monday, premier’s office spokesperson Ivana Yelich told iPolitics that Ontario’s discussions with the feds about aid hadn’t veered in that direction.

“It doesn’t necessarily have anything to do with the province going and looking at eliminating all private homes,” Yelich said of their talks. “It’s not really a conversation we’re having right now, at all.”

Yelich pointed out that for-profit and not-for-profit homes in Ontario have been hit by COVID-19 outbreaks at comparable rates — a statement that was bolstered by a recent breakdown of public long-term care data in the Toronto Star. But recent analyses by news outlets and health groups have shown a steeper death rate in for-profits with outbreaks than in not-for-profits or municipal homes.

An Ontario Health Coalition assessment of 93 homes with COVID-19 outbreaks recently found that for-profit homes had a 9-per-cent fatality rate, versus a death rate of 5.3 per cent in non-profits and 3.6 per cent in homes owned by Ontario’s municipalities.

The coalition’s published findings were bolstered by breakdowns from news outlets like QP Briefing and the Toronto Star, with the latter finding that during outbreaks, residents of for-profit homes were roughly twice as likely to catch the novel coronavirus and die than those in non-profits, and roughly four times as likely to die from the virus as residents in municipally owned homes. 

OHC also found that death rates had declined in municipal homes since April 28, but increased in both for-profits and not-for-profits — with for-profits’ death rates increasing faster out of the two.

Despite the recent analyses, the premier’s office says it will await a post-pandemic review to determine where key vulnerabilities lay.

“There are so many factors at play, and we have to figure out what exactly happened in some of these homes. Is it the staffing shortage issue? Is it the size of the home?” Yelich said. “I’m not saying there aren’t issues, but there’s likely issues for a number of reasons … and those are what we’ll really have to zero in on, when this is all done.”

Private ownership of nursing homes expanded in Ontario under the administration of former PC premier Mike Harris. In 2017, a team of researchers from academic institutions across the globe — including York University in Toronto — honed in on several policy changes made in Ontario during the mid-1990s, which they said favoured the growth of for-profit home chains in the province.

The changes they identified included accepting low bids for contracts, publicly financed capital funding, legislation eliminating minimum staffing standards, and a revised payment system that, per the team of researchers, allowed companies to maintain profits. 

Earlier still, a requirement for nursing homes to be licensed in the 60s and extension of hospital insurance to homes in the 70s, spurred reliance on for-profit homes and chains, the researchers found — due to restraints on government funding, and the government’s limited role in quality “regulation and enforcement.”

As of last year, the Ontario Long Term Care Association — which represents the full slate of provincial operators, including both private and public — said 58 per cent of Ontario’s homes were privately owned, 24 per cent non-profits or charities, and 16 per cent were owned by municipalities. Another 2 per cent of long-term care was via facilities like hospitals. “Many homes are part of multi-home organizations,” the association noted in a 2019 report.

The association’s report claimed there were no differences in quality, on average, between privately owned and not-for-profit homes — both of which they said scored higher for quality of care than municipal homes. On average, the group said smaller homes had “significantly” lower scores for care quality, and surmised that the cause could be connected to differences in staffing levels.

A study of 640 long-term care facilities in Ontario in the early 2010s, which was published in the Journal of the American Medical Directors Association in 2015, found that for-profit facilities had “significantly higher” rates of both mortality and hospital admissions than their counterparts. The lead author told the Star at the time that, while their work hadn’t addressed the cause for that discrepancy, other research had identified the staffing levels issue. 

Ontario NDP leader Andrea Horwath recently called for an examination of long-term care ownership and COVID-19 via a public inquiry. “I oppose profits being made by corporations in long-term care,” Horwath said in a statement, in which she vouched for a system of community-based not-profits and public care. 

Calls to take long-term care out of private hands have also echoed out at the national level in recent days. The Canadian Labour Congress was among them, per the Globe and Mail, and federal NDP leader Jagmeet Singh threw his weight behind the call to CTV.

“We absolutely need to look at developing a national standard, a care guarantee and then using the Canada Health Act to bring that into the public realm,” Singh said in the interview this weekend.

“The for-profit system has failed, and long-term care homes in general have failed seniors, and we need to do a lot better.”

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