For-profit long-term care isn't the issue, government neglect is

The COVID-19 pandemic has made it apparent that Ontario's long-term care sector has significant problems. That's progress, because the plight of Ontario's frailest elderly people has been ignored by government and the public for 20 years.

What's disturbing is that so many of those just discovering this long-standing issue are barking up the wrong tree, and quite loudly. Ontario long-term care homes' poor performance during the pandemic has almost nothing to do with public vs. private ownership and a great deal to do with years of government neglect and underspending. Most of the province's care homes were not built to withstand a pandemic.

The failure to modernize the sector is the fault of government. The last significant wave of new long-term care construction was in 2000, when 2,000 beds were built. These mostly replaced existing municipal and non-profit homes, which were the oldest at the time. Much of Ontario's remaining stock of buildings only meets 1972 standards.

An analysis in the Canadian Medical Association Journal determined that 53.6 per cent of private-sector care homes have older design standards, while only 18.5 per cent of non-profit homes and 11.9 per cent of municipal homes do.

These outmoded private homes with their three- and four-bed units have proven to be a problem in the pandemic. In the first wave, 13 of the 15 homes with the highest infection rates were older private sector homes, the type that feature overcrowding, shared washrooms and lack of ventilation.

The CMAJ study concluded that “the risk of an outbreak of COVID-19 at an LTC home was related to the COVID-19 incidence rate in the public health unit region surrounding the home, its total number of beds and older design standards, rather than for-profit status.”

One might reasonably ask why these shabby older buildings have not been replaced. Building new homes is not economically feasible without government offering a partial subsidy, and that subsidy was either inadequate or non-existent until the Ford government's new $1.75-billion renovation plan.

When it comes to operating costs, all long-term care homes, whether they are owned by corporations, community groups or municipalities, are funded under the same detailed template created by government. All nursing and personal care costs, social programs, support services and food are paid for with tax dollars.

Privately run long-term care homes don't make a profit from this operating funding and they don't gain anything by skimping on it. If they don't spend the money, they have to give it back.

Residents pay a monthly fee that covers things such as utilities, mortgages, maintenance and repairs. The government sets the amount. Homes can make a profit here, but they still have to meet government standards. Government rules prevent them from using that profit to offer enhanced care or better food.

Some of the standards government sets are inadequate. Only last month, Premier Doug Ford announced that the number of hours of direct personal care per day would be raised from

2.75 to four hours. That was long overdue, but again, government determines care levels, not the individual homes. A government takeover of private sector long-term care would cripple the sector's overdue expansion. Without private sector capital, that expansion wouldn't be affordable for government. Without profit, the private sector would have no motivation to build and operate homes. There certainly isn't a long line of municipalities or non-profits offering to build needed homes.

That leaves direct government control of long-term care as the only other option. Not only would that create a situation where the regulator is also the operator, but it would mean that government would have to spend billions of dollars to buy out the existing homes. After all of that expense, Ontarians would not have a single additional bed to show for it. Driving the private sector out of long-term care is an idea not even worth contemplating, much less doing.

Instead, let's focus our attention on the real problems of bed supply, staffing and quality control. That's where real gains can be made.