![\"For-profit](\"https:\/\/dynamicmedia.zuza.com\/zz\/m\/original_\/0\/0\/00d30549-28d4-4c74-b092-e63307921c21\/Thestar_b076d90e_fa5f_4b40_ab80_fa29a0752cde_Image1_Super_Portrait.jpg\")
<\/p>\n(May 8, 2020)<\/p>\n
By:\u00a0Marco Chown Oved, Brendan Kennedy, Kenyon Wallace, Ed Tubb and Andrew Bailey,\u00a0DurhamRegion.com (Metroland Media Group)<\/p>\n
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Overall, for-profit homes make up less than 60 per cent of long-term care homes in the province, but they account for 16 of the 20 worst outbreaks. – Richard Lautens \/ Toronto Star<\/em><\/p>\n Residents of for-profit nursing homes in Ontario are far more likely to be infected with COVID-19 and die than those who live in non-profit and municipally-run homes, the Star has found.<\/p>\n A Star analysis of public data on long-term-care homes shows the facilities have been hit by outbreaks at approximately the same rate, regardless of ownership. But once COVID-19<\/a><\/span> makes it into a nursing home, the outcomes have been far worse for residents of for-profit homes.<\/p>\n In homes with an outbreak, residents in for-profit facilities are about twice as likely to catch COVID-19 and die than residents in non-profits, and about four times as likely to become infected and die from the virus as those in a municipal home.<\/p>\n \u201cI\u2019m not one bit surprised,\u201d said Sharleen Stewart, president of the SEIU Healthcare union, which represents personal support workers and other front-line staff in both for-profit and non-profit nursing homes.<\/p>\n Stewart said that based on the experiences of the union\u2019s members, for-profit nursing homes use more part-time and casual staff and have lower staffing levels overall compared to non-profit homes. She said non-profit homes have better infection controls and for-profit homes are less prepared to handle outbreaks. \u201cThis is old news for us.\u201d<\/p>\n Judy Irwin, a spokesperson for the Ontario Long Term Care Association (OLTCA), which represents about 70 per cent of Ontario\u2019s long-term-care homes of all ownership types, questioned the Star\u2019s analysis, saying \u201cthere will need to be much more rigour in both the data accuracy and the analysis before any conclusions can be drawn. To proceed down a path of loose interpretation of incomplete data at this point would not be responsible.\u201d<\/p>\n Long-term care is the front line of Canada\u2019s battle with COVID-19, accounting for as many as four out of every five deaths<\/a><\/span>. In an international study released earlier this week, Canada had the highest proportion of long-term care deaths<\/a><\/span> from COVID-19 among 14 countries. Those deaths are occurring at a disproportionate rate in for-profit homes.<\/p>\n The Star\u2019s analysis is based on a home-by-home database of every COVID-19 outbreak in Ontario<\/a><\/span> as of Friday morning. Using it, we took the total number of beds in long-term-care homes as reported to the province and sorted them according to the ownership: for-profit, non-profit and municipal. Then, using the number of cases and deaths reported in each home, we calculated the rate of infection and mortality per 100 beds for each type of ownership.<\/p>\n The results were stark.<\/p>\n A resident in a for-profit home has been about 60 per cent more likely to catch COVID-19 and 45 per cent more likely to die than a resident in a non-profit home. A for-profit resident has also been about four times more likely to catch COVID-19 and four times more likely to die than a resident in a municipally run home.<\/p>\n Non-profit and municipal homes have also suffered severe outbreaks, including the city-run Seven Oaks in Scarborough<\/a><\/span>, which has 108 cases, including 40 deaths among its 249 beds, and the Salvation Army\u2019s Isabel and Arthur Meighen Manor, where there have been 103 cases, including 42 deaths for 168 beds.<\/p>\n Overall, however, there are higher rates of infection and death in for-profit homes.<\/p>\n The province has recorded outbreaks \u2014 at least one lab-confirmed case of COVID-19 in a resident or staff member \u2014 in about a third of its 651 long-term-care homes, and for-profit, non-profit and municipal homes have been hit at about the same rate.<\/p>\n But where COVID-19 is present, the for-profit homes have fared worse in controlling the outbreak and preventing deaths: For-profit facilities with outbreaks had 16 cases per 100 beds, compared to eight in non-profits and four in municipal facilities. Likewise, there have been four deaths per 100 for-profit beds, compared to two per 100 beds in non-profits and one in municipal facilities.<\/p>\n Overall, for-profit homes make up less than 60 per cent of long-term-care homes in the province, but they account for 16 of the 20 worst outbreaks.<\/p>\n The Star\u2019s data uses the cumulative totals of cases and deaths in each outbreak since the beginning of the pandemic. This approach differs from the counts published daily by the Ministry of Long-Term Care<\/a><\/span>. The ministry says its counts refer to \u201cactive\u201d cases and therefore exclude both deaths and resolved illnesses from each home\u2019s current case count. The ministry says its data is meant as a snapshot in time, not as a record of total infections over the entire course of an outbreak.<\/p>\n Irwin, with the OLTCA, said the \u201ctype of home ownership is not relevant to the COVID-19 pandemic in long-term care.\u201d<\/p>\n All types of homes have been affected by COVID-19 \u201cand each has had a different experience with the disease based on a range of factors. These include factors such as whether the home has an aging infrastructure and shared washrooms and\/or 4-bed rooms, the staffing situation both pre-outbreak and during, and how rapidly homes have been able to access PPE and staffing support when they need assistance,\u201d she said.<\/p>\n Staffing levels in long-term-care homes are not publicly reported and the Star was not able to verify whether staffing levels are typically lower in for-profit homes. The claim has also been made in court filings, labour board applications and in academic research.<\/p>\n More than 190 residents at the 233-bed Orchard Villa long-term-care home in Pickering have been infected with COVID-19, giving the privately run home one of the highest rates of infection in Ontario. To date, 66 residents have died of the virus \u2014 the highest death total at a long-term-care home in the province.<\/p>\n A Star investigation published last week found that the home has a lengthy history of citations<\/a><\/span> for failing to comply with provincial regulations.<\/p>\n Orchard Villa is owned by Southbridge Care Homes, which operates 37 long-term-care and retirement homes in Ontario. Orchard Villa\u2019s executive director Jason Gay did not directly address the Star\u2019s findings, but in an emailed response to questions said that COVID-19 is \u201can aggressive virus, especially among seniors who are immune compromised or have pre-existing conditions.\u201d<\/p>\n \u201cThe impact across the long-term care community, in our home and to our residents, our families and our staff, is challenging and tragic,\u201d he said. \u201cOur singular focus at this time is on the safety and well-being of our residents and staff.\u201d<\/p>\n The highest total number of resident infections \u2014 209 \u2014 has been reported at the for-profit 240-bed Forest Heights Revera in Kitchener. There have been 45 deaths at the facility \u2014 the fourth-highest total as of Friday.<\/p>\n The home is owned by Revera Long Term Care Inc., a big player in the industry that runs more than 500 nursing and retirement homes across Canada, the U.S. and the U.K. Revera is owned by PSP Investments, the pension fund manager for the federal Public Service, the Canadian Forces and the Royal Canadian Mounted Police.<\/p>\n Asked to respond to the Star\u2019s findings, Revera issued a press release criticizing \u201cmedia stories attempting to draw a link between the ownership model for long-term care and the passing of residents from COVID-19.\u201d<\/p>\n \u201cThis focus on an issue that is not core to the challenges facing the system is becoming a distraction from discussions about the real reform needed,\u201d said Revera spokesperson Larry Roberts. \u201cLong-term care has not been, until recently, a high priority, and our most vulnerable citizens have paid a heavy price.\u201d<\/p>\n \u201cWe need to close the prioritization gap between acute care (e.g. hospitals) and chronic care (long-term),\u201d he said in the release, by prioritizing PPE and increasing funding so that pay and staffing levels in long-term care are equal to those in hospitals.<\/p>\n The Camilla Care Community in Mississauga and the Altamont Care Community in Scarborough have among the highest infection rates in the province, with both homes at about 80 per cent. They also have the second (48) and third (47) highest number of deaths, respectively. Both facilities are owned by Sienna Senior Living Inc., a publicly traded company which runs 70 retirement and long-term-care homes in Ontario and B.C. and last year reported a net income of $7.5 million. In its latest report to shareholders, the company said it has generated a total shareholder return of more than 250 per cent since it went public in 2010.<\/p>\n \u201cWe have adhered to provincial directives and protocols prior to and during this pandemic,\u201d wrote Sienna spokesperson Natalie Gokchenian in an email.<\/p>\n Gokchenian called into question the Star\u2019s methodology, saying that deaths should not be included in the total of confirmed cases and suggesting that it would be more appropriate to use the metric of active cases, which exclude both people who have died of COVID-19 and those who have recovered.<\/p>\n \u201cThe data you have provided is not correct,\u201d she wrote. \u201cIt is premature to draw conclusions on industry wide outcomes. Statistics are being collected in different ways and not all of them are up to date.\u201d<\/p>\n Gokchenian said Sienna plans to hire independent experts to conduct an internal review of the company\u2019s practices and protocols during the crisis. The company also suggests the provincial government should undertake a review of the entire sector.<\/p>\n Earlier this week, the Ontario Health Coalition did its own analysis<\/a><\/span> of the outbreaks and deaths in long-term-care homes and came to a conclusion that corroborates the Star\u2019s findings: for-profit homes are faring far worse than non-profits and municipally run centres.<\/p>\n \u201cWe can\u2019t say definitively what the causal relation is for the higher death rates in the for-profit homes, but the key element is staffing,\u201d said executive director Natalie Mehra. \u201c(For-profit homes) have lower staffing levels, they have lower wages and worse working conditions. While there was a critical staffing crisis across all types of homes before COVID-19, now it\u2019s beyond words.\u201d<\/p>\n The provincial decision to limit staff to working in a single home has exacerbated problems at the for-profits, she said.<\/p>\n \u201cGiven that the staff have to choose one home to work in, very likely they\u2019ve chosen a home where they have better wages and working conditions. And that\u2019s having an impact on the homes with the most precarious, most fragile staffing, which are really in very serious trouble now.\u201d<\/p>\n All types of long-term-care homes in the province have similar budget restraints: they receive funding from the province according to the same formula and their fees are capped at the same level, Mehra said. But the for-profit homes generally extract profits from their budgets, while the non-profits and municipally run homes often supplement their budgets with fundraising and local taxes.<\/p>\n \u201cThe differences are profound,\u201d she said. In non-profit settings, \u201cthere are more staff and they can provide more hours of care for each resident.\u201d<\/p>\n Staff working in for-profit homes have also been hit disproportionately hard by the coronavirus: For-profit home staff currently make up nearly 70 per cent of all front-line health-care worker infections.<\/p>\n Eatonville Care Centre in Etobicoke has to date recorded 104 cases of COVID-19 among its staff, the most in the province. The for-profit home also has one of the highest rates of infection among residents with 182 cases reported in the 247-bed facility. Hawthorne Place Care Centre in North York has the second-most staff cases with 83.<\/p>\n Both homes are owned and operated by Rykka Care Centres, a subsidiary of Markham-based Responsive Group Inc. The company also operates Anson Place Care Centre in Hagersville, where 27 deaths from COVID-19 have been recorded. That home also has one of the highest rates of infection in Ontario.<\/p>\n Linda Calabrese, vice-president of operations for Responsive Management Inc. and spokesperson for Responsive Group, said all long-term-care homes receive funding from the government in \u201cenvelopes\u201d that are \u201ccomplex, highly prescriptive and tightly regulated and monitored.\u201d<\/p>\n \u201cEvery dollar for nursing and personal care, programs, and food is spent and if not spent, is returned to the province,\u201d she said.<\/p>\n Calabrese added that many of the company\u2019s homes where outbreaks have occurred are \u201cturning the corner\u201d and many staff members have been cleared to come back to work. She said the company is seeing \u201cresidents recover fully\u201d and is hopeful the outbreaks at Anson Place and Eatonville can be declared over soon.<\/p>\n Responsive Group was named in a proposed class-action lawsuit<\/a><\/span> filed in Ontario Superior Court two weeks ago alleging the company failed to \u201cproperly and adequately plan for and respond to the COVID-19 pandemic\u201d and as a result, \u201cthe virus has run rampant through many of their homes,\u201d the claim alleges.<\/p>\n Among the allegations in the statement of claim: that residents who had tested positive for the virus were being kept in the same spaces as healthy individuals, that the homes had inadequate staff, had failed to provide sufficient personal protective equipment and conduct proper screening.<\/p>\n The lawsuit has not yet been certified by a judge.<\/p>\n In a statement to the Star\u2019s Betsy Powell, the company said it \u201crecognizes the rights of individuals to advance their concerns through litigation.\u201d<\/p>\n \u201cIt is equally important that all parties in such matters have the opportunity to present information to the court and for it to be reviewed and thoughtfully considered. The court will then have to determine whether a concern merits certification,\u201d the company said.<\/p>\n Pat Armstrong, a sociology professor at York University who has researched long-term care in Canada for more than 20 years, said she was unsurprised by the Star\u2019s findings.<\/p>\n The main reason, she said, is the incentive of for-profit companies to reduce labour costs. Her research has found that for-profit homes tend to have lower staffing levels, lower wages and a greater reliance on part-time and casual staff, she said.<\/p>\n \u201cManagerial practices taken from the business sector are designed for just enough labour and for making a profit, rather than for providing good care,\u201d Armstrong and her co-authors wrote in a report published last month<\/a><\/span> by the Canadian Centre for Policy Alternatives. \u201cThese include paying the lowest wages possible, and hiring part-time, casual and those defined as self employed in order to avoid paying benefits or providing other protections.\u201d<\/p>\n Armstrong said the expansion of privatized long-term care can be traced back to former Progressive Conservative Premier Mike Harris\u2019s time in government when he removed minimum staffing levels and set up a competitive bidding process for government contracts.<\/p>\n