On long-term care reform, Ontario could take a page from B.C.’s playbook

Last week, Ontario’s Progressive Conservative government gave itself the power to take over temporary management of long-term care homes that are unable to cope with the COVID-19 pandemic.

One might ask why Ontario waited so long. British Columbia, which has been more successful in holding off the coronavirus, made the same move six weeks earlier.

A comparison of the two large provinces is worth noting. Ontario, with three times the population of B.C., has reported 10 times as many COVID-19 cases and 13 times as many deaths (1,798 compared to B.C.’s 135, as of last Thursday).

British Columbia also appears to be well ahead of Ontario in recognizing the particular problem posed by for-profit operators in the acute-care sector.

The state of the B.C.’s long-term care system is reviewed regularly by the Office of the Seniors Advocate — essentially an ombudsman for B.C. senior citizens. On Feb. 4, just before the pandemic arrived, the Seniors Advocate published a report, A Billion Reasons to Care, on the funding of longterm care.

The report, which covers the 2017-2018 fiscal year, asks whether the province is getting value for the $1.4 billion a year it spends to subsidize LTC care homes when large chunks end up in the profit columns of some operators.

About 27,000 B.C. seniors live in 293 publicly funded long-term care homes. Of these, 38 per cent are owned and operated by regional health authorities, 28 per cent by non-profit societies, and 34 per cent by for-profit companies.

Although the non-profits and forprofits receive virtually the same per-patient subsidy (about $212 a day) from the province, the nonprofits spend more of it (59 per cent) on direct patient care than the for-profits do (49 per cent). The discrepancy is significant. Over a year, it means non-profit homes spend $10,000 more on care for each patient than the profitbased homes do.

The Seniors Advocate has another way to measure the difference: “The for-profit sector failed to deliver 207,000 hours of funded care and the not-for-profit sector provided 80,000 more hours of direct care than they were funded to deliver.”

Seventeen of B.C.’s for-profit homes registered annual profits in excess of $1 million. Some of that came from steep management fees that the operators paid themselves out of the provincial subsidy. More came from paying low wages.

The report found that the forprofit sector paid its employees an average of 17 per cent less than the non-profit sector. For personal support workers, the wage rate could be as much as 28 per cent below the industry standard. That gap, as the Seniors Advocate noted, led to rapid staff turnover and difficulty in recruiting replacements.

“It could be argued that for-profit care operators are doing exactly what they are expected to do — look for areas where they can be efficient and achieve cost savings,” the report observed. But it emphasized that savings should not be achieved at the expense of patient care.

All provinces are different in the way they regulate long-term care. But they all have three common needs.

They need to find a way to prevent their LTC homes from becoming epicentres of the next pandemic.

They need to make sure that nurses, personal support workers and other front-line workers receive wages commensurate with the responsibility they accept and the risks they run.

And, if the anachronism of profitmaking enterprise is to continue in the chronic care field, the provinces need to ensure — as the B.C. report recommended — that every dollar of public money earmarked for patient care is, in fact, spent for that purpose.

British Columbia’s Seniors Advocate made another recommendation that should be adopted in Ontario, too. “Revenues and expenditures for publicly funded care homes should be available to the public,” it said. “The public is entitled to know how their money is spent, in detail, and residents and families are entitled to know how many care hours are delivered by their care home.”

Amen.

Cambridge resident Geoffrey Stevens, an author and former Ottawa columnist and managing editor of the Globe and Mail, teaches political science at the University of Guelph. His column appears Mondays. He welcomes comments at geoffstevens40@gmail.com.

British Columbia appears to be well ahead of Ontario in recognizing the particular problem posed by for-profit operators in the acute-care sector.