Connect  |  Newsletter  |  Donate

Seniors Calling. Public or Private Pursuit in Long-Term Care

Posted: April 28, 2017

(October 25, 2016)

By: Lynne Brown

A research paper published earlier this year in the journal PLOS Medicine, found that, ‘For-profit nursing homes provide “inferior” care to seniors, and though the evidence isn’t perfect it’s strong enough to suggest that policy makers should pay attention.’ The authors draw on years of research, in the U.S., Canada and elsewhere, comparing for-profit long-term residential care facilities to ones run by public bodies, or non-profit groups.

The research study titled: ‘Observational Evidence of For-Profit Delivery and Inferior Nursing Home Care: When Is There Enough Evidence for Policy Change?’ states ‘Nursing home residents are a highly vulnerable population, and nursing home care quality has been a persistent focus of public concern.’

According to the report, evidence has piled up showing that for-profit delivery does not save money. Nor does it improve choice, quality or access. Indeed, it often does the reverse. And it reduces opportunities for public, democratic influence on health care. Nursing homes that are owned by for-profit companies tend to have lower staffing levels, even though low staffing levels have been widely linked to lower quality of care. The evidence indicates that for-profit homes are more likely to transfer their residents to hospitals, and their residents are more likely to die within a year of nursing home admission. For-profit homes have more verified complaints filed against them, and often have higher administrative costs.

There is considerable evidence from observational studies that public funding of care delivered in for-profit facilities is inferior to care delivered in public or non-profit facilities.

For-profit organizations operate on the principle that profits or net income (revenue in excess of expenses) is directed to the owners, investors, or shareholders. In non-profit organizations and publicly owned facilities, net income is used to benefit clients. (

Dr. Pat Armstrong — Distinguished Research Professor of Sociology, York University and Principal Investigator, “Reimagining Long-Term Residential Care: An International Study of Promising Practices.” and contributing author of aforementioned study, Dr. Hugh Armstrong — Distinguished Research Professor Emeritus of Social Work & Political Economy, Carleton University will be speaking at an upcoming Ontario Health Coalition Conference. ‘Reforming Long-Term Care Homes in the Public Interest’ Conference gets underway in Toronto Friday, October 28th, 2016.

The Ontario Health Coalition is hosting this pan-Canadian conference on reforming long-term care in the public interest, co-sponsored by the Canadian Health Coalition and Health Coalitions from across the country. (ontariohealthcoalition)

In a 2003 document published in ‘Journal of the American Public Health Association’ researchers describe the trade-off between profit and quality: “If increasing quality raises costs more quickly than it does revenues, profits must fall as quality improves”. In order to generate profits, for-profit homes tend to have lower costs and lower staff-to-patient ratios than non-profit facilities. Money diverted to shareholders and investors leaves less money to pay for staff, and in turn, having fewer or untrained staff is associated with lower quality. (O’Neill C, Harrington C, Kitchener M, Saliba D. Quality of care in nursing homes: an analysis of relationships among profit, quality, and ownership. Medical Care 2003)

In November, 2015, The Conference Board of Canada stated: ‘The rising number of Canadian seniors who will need continuing care supports over the next few decades, has pressing implications for public spending, the labour market, and housing and institutional infrastructure.’

In a report titled, ‘Future Care for Canadian Seniors: A Status Quo Forecast’, the authors state that by 2026, over 2.4 million Canadians age 65+ will require paid and unpaid continuing care supports—up 71 per cent from 2011. By 2046, this number will reach nearly 3.3 million.

Spending on continuing care for seniors will increase from $29.3 billion in 2011 to $184.2 billion in 2046. With nearly two-thirds of this spending provided by governments, spending growth will significantly outpace revenue growth for most provinces.

Labour demand growth for the continuing care sector will also far exceed general labour force growth.

The reliance on unpaid caregivers and volunteers to provide continuing care supports will grow dramatically and could compound the perceived level of unmet or under-met needs of seniors.

The Conference Board of Canada report concludes by stating ‘Responding to these needs in an efficient and sustainable manner will require collaboration among the diverse mix of public and private stakeholders that make up the continuing care sector.’ (

Click here for original article