Ongoing long-term-care crisis is being overlooked in COVID-19’s second wave
Four months ago, on Sept. 23, when Parliament resumed following its summer hiatus, Prime Minister Justin Trudeau went on television and made a promise to the nation: “We will start working as of today with the provinces and territories in order to establish new national standards for long-term care.”
A second wave of the COVID-19 virus was looming then, and political leaders at both levels were determined to do everything within their power to prevent the pandemic from cutting a swath through the country’s nursing homes and seniors’ residences, as it had in the first wave. Yet, today — with the nation locked in a deadly battle with the second wave — the situation in the long-term-care (LTC) sector is as desperate as it was before.
Canada had the worst record among the world’s wealthy nations in protecting residents of LTC facilities in the first wave — 80 per cent of the deaths occurred in those homes — and the percentage looks as though it will be about the same in the second wave. Every province has taken steps of one sort or another to reduce the toll, but they have all been too little too late.
As for a national strategy or Trudeau’s “new national standards” for LTC — nada!
The inaction is partly, but only partly, the product of constitutional protectivism — the provinces will take Ottawa’s money, but will not surrender a centimetre of control or authority. The reality is that all governments have been overwhelmed by their daily struggle to protect the entire community, not LTC residents alone. They are not able to look beyond today and tomorrow — to the challenges of getting people to stay at home, to get everyone to wear masks, to vaccinate millions of people as the supply of vaccines becomes unreliable.
Putting the LTC crisis on the back burner means only one thing: it will get worse. Two steps need to be taken on a priority basis. One will be politically difficult, the other hugely expensive.
The first, politically difficult, one is to get rid of for-profit LTC homes. Twenty-eight per cent of Canada’s 2,039 LTC facilities are operated for profit — for Ontario, it’s 57 per cent — yet that 28 per cent have had twice as many residents infected with COVID-19 as non-profit homes and 78 per cent more resident deaths.
A Toronto Star investigation of private for-profit homes in Ontario revealed that they employ 17 per cent fewer staff than non-profit and publicly owned homes. In the first three quarters of 2020, these companies took in at least $138.5 million in government COVID relief money while paying out $171 million in dividends to shareholders.
Conclusion: for-profit LTC operators take in public funds, cut costs to the bone, record an unconscionably high rate of deaths and pump out dividends to their owners. Where is the sense — or justice — in that?
The second, and expensive, step would be to radically reform the long-term-care system by replacing nursing homes — to the fullest extent possible — with an expanded, muscular system of home care. On the face of it, this reform looks economically attractive.
According to the Canadian Institute for Health Information, it costs $730 a day for hospital care for a patient in Ontario, $201 a day in an LTC home and just $103 a day to provide home care and community services.
This last figure is based on the current — woefully inadequate — level of available home care. A proper system that would enable frail, elderly citizens to be cared for 24-7 in their own homes, close to their family and friends, would clearly be hugely expensive, and it would not eliminate the need for institutional care for patients with dementia and other debilitating illnesses.
Still, most seniors who do not need to be institutionalized would be happier, more comfortable, better cared for and safer in their own home than in the warehouse of an LTC facility.
Surely comfort and safety for vulnerable Canadians is worth whatever the price.
Cambridge resident Geoffrey Stevens, an author and former Ottawa columnist and managing editor of the Globe and Mail, recently retired from teaching political science at the University of Guelph. His column appears Mondays. He welcomes comments at geoffstevens40@gmail.com.
For-profit LTC operators take in public funds, cut costs to the bone, record an unconscionably high rate of deaths and pump out dividends to their owners