It’s time to remove profit from long-term care



I’ve been thinking a lot about my grandmother lately, perhaps because it was a year and a few weeks ago since she died.

She died quite naturally, nothing to do with living in a for-profit retirement home, though she did live in one.  That the end of her life came before the pandemic is, almost certainly, a blessing.  One morning she woke up, went to the washroom to put her teeth in and the aneurism that had been growing for some years in her aorta let go, just a couple months out from her 95th birthday.  She never did get her teeth in.  We should all be so lucky to meet our end so swiftly.

But before she’d died, she’d had to move from her lovely little apartment on the top floor, down to a nursing floor, with a stop on the memory care floor — where people with dementia, Alzheimer’s and other similar illnesses lived — while waiting for a general nursing bed.  She’d had to be moved to a higher level of care after beating pneumonia — at 94! — but all the same slowing down just a little more.

It was during these stays on the care floors that I began to question the whole system of retirement homes.  They weren’t bad, by any stretch of things.  There was no abuse.  Everyone was given attention and cared for, but it always felt a bit lacking.  I was always left with the thought, “This is it?  This is the best this place offers?’  The home was not a cheap one, and while nothing approached neglect, it never felt entirely adequate. 

The shabby floors on the memory care floor said something, how it compared unfavourably to the rest of the building.  When people were at their most vulnerable, when there was nowhere else to go, they were kept in the worst conditions in the home.  The more independent you were, the better the options.

Worst of all was the knowledge, or at least the assumption, that however lacking the place seemed, it was going to be miles better than other homes.

This is all a long wind up to saying that profit has no place in our long-term care system.

From the start of the pandemic the broken parts in our society, the things that have always been there, have been exposed in brutal and horrifying ways.  No more has that been more clear, brutal, and horrifying than in long-term care.

In Ontario, nearly 6,000 people have died of COVID, more than two-thirds of those people — 4,100 or so — have died in long term care.  And of the people who have died in long-term care, the vast majority, 69 percent, have died in for-profit LTCs.  Most of the province’s LTCs are privately owned, for-profit operations, but even though they only account for 57 percent of the LTCs in the province, they still account for 69 percent of the deaths.  Only eight percent of deaths have happened in public homes, which make up 16 percent of the total homes.

(The numbers for deaths in types of homes comes courtesy of the incredible work freelance journalist Nora Loreto is doing compiling it all, with an assist from the visualization of Andrew Lam.  The Canadian Institute for Health Information is the source of the ownership percentage numbers.  I’ve kept the numbers round as they’ll have changed slightly between when I’m writing this and when this is published.)

Okay, you may be saying, have you any other examples?  Why yes, I just so happen to right here. 

Quebec has a much different mix of private and public homes. In this province, 86 percent of the homes are publicly run. It’s a province that has been hammered by COVID, where deaths in long-term care make up just shy of 40 percent of the country’s whole death toll, at about 7,500. It’s horrific. Even still, for-profit private homes still make up a full one-quarter (25 percent) of the LTC deaths in the province, despite making up less than 14 percent of the total homes. Deaths in publicly owned homes make up only 45 percent of the total.  For-profit homes in the province don’t even make up the full slice of privately owned homes in the province — CIHI doesn’t have information on how many private LTCs in Quebec are for-profit, and how many are not-for-profit — and yet they still make up more than the share of private vs. public LTCs.

The numbers in the other provinces are harder to draw too many conclusions from, given how many fewer people have died in LTC outside of Ontario and Quebec.  As well the percentage of LTC deaths where the type of home is unknown is many times higher in provinces outside those provinces where a significant number of people have died in LTC.

But where there is an obvious trend, the implication is a clear one: where homes are run to make a profit, more people are dying.

And there’s no reason that this trend will reverse.  The outbreak in Barrie, Ont. currently ravaging a home there is largely being blamed on the new strain of COVID going around, but what may actually be in play is neglectful policies that ignored COVID best practices and instead did things like put people who were negative for the virus in the same room as people who were positive.  Would you believe the Roberta Place LTC is privately run for profit?  Of course it is.

An excellent feature in the Toronto Star makes clear many things, and is worth your time, but the bottom line is this: over decades the evidence is clear, for-profit homes have worse health outcomes for residents, pandemic or no pandemic.

My grandmother was lucky, in the sense she didn’t have to live through this pandemic.  If she had lived, and her aneurism had not burst, and the loneliness of lockdown had not had her fade out of life, what would have happened?  I don’t know.  But three people at her former home died after a COVID outbreak there.  What are the odds a 95-year-old who had beaten pneumonia would have been able to beat COVID, too?

Now is the time to ask ourselves why it is people are making money off the care of society’s most vulnerable.  They aren’t doing the job well, more people are suffering and dying because of the for-profit model.  We should not allow it any longer.  Profit has no place in the care of people.

Photo Credit:  CBC News

More from Robert Hiltz.     @robert_hiltz

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