NO The private model is misunderstood

Our failure to protect residents and staff of long term care homes in Ontario from COVID-19 is a disaster. Recent media articles and political arguments conclude that private ownership is the problem, due to higher mortality rates at for-profit facilities in Ontario.

Some advocates propose eliminating private care in the province. Here are two reasons that proposal is wrong — and an agenda for what we need to do instead.

First, concluding that private ownership causes higher mortality than municipal or non-profit ownership violates the first rule of statistics: “correlation is not causation.”

For historical reasons, privately owned facilities in Ontario tend to be substantially older than municipal or non-profit homes, often located in urban neighbourhoods.

Because of limited funding and slow approvals in the province for upgrades, rebuilding has been slow.

Older facilities are more likely to spread infections through multi-bed wards, shared washrooms, limited ventilation, and crowded staff space. Studies in the Canadian Medical Association Journal and elsewhere show that COVID-19 infection in Ontario does not arise from type of ownership, but rather reflects spread of the disease from local neighbourhoods and, strikingly, increases with facility age.

Second, private long term care facilities are essential for meeting the needs of Canada’s dispersed and aging population. Currently, Ontario has almost 80,000 beds in long-term care homes, with more than half in private facilities. And we will soon need far more care: by 2036, Ontario’s population of people over 80 years will nearly double, likely costing tens of billions of dollars to develop and operate new care capacity.

While municipal and non-profit facilities, as well as increased opportunities for at-home support, are key parts of the long-term care ecosystem, they simply do not have the scale or financial strength to meet all our current needs, let alone drive expansion over the next 15 years. We lack public tax dollars to fully fund construction and operations of a massive expansion. We require private investment as part of the growth solution.

Let’s be clear — private long-term care facilities need a return on investment. But they earn no more than a fair profit in Canada. Audited financial statements of three major publicly traded chains in Ontario – Chartwell Retirement Residences, Extendicare, and Sienna Senior Living – report at best moderate earnings ratios over the past decade (2010-2019), with 10-year median return on assets ranging from a high of 2.7 per cent to a low of 0.3 per cent per company.

The limited profit levels, which are below most other industries, are not a surprise: Ontario facilities depend on constrained public funding for much of their resident care and must either provide mandated services or return funds to the ministry.

So, rather than eliminate private care, what do we need to do — both to mitigate the current COVID-19 disaster and to protect staff, residents, and our communities from future pandemics?

Here are eight actions that are critical for all types of ownership:

> Rebuild older homes to meet current standards, using both private and public investment.

> Provide funding for improved wages, job conditions, and training for front line staff, as well as more hours of care for residents.

> Improve facilities for staff members to take breaks and avoid infecting each other.

> Invest in digital support to complement hands on care.

> Increase inspections. á Mandate public reporting of key metrics, including resident demographics, staffing levels, care quality, and inspection reports.

> Ramp up pandemic readiness, including testing, contact tracing, stocks of personal protective equipment, and vaccination and treatment planning.

> Integrate long-term care facilities within an ecosystem of at-home and hospital-based care, rather than operating in the current poorly co-ordinated silos.

Staff and leaders of private long-term care homes care as deeply as people working in other facilities about protecting their co-workers and residents. Rather than argue about the best type of ownership, let’s work together to provide the best combination of public and private support for outstanding care.