FFor-profit nnursing homes fare wworse amid second wave

Residents more likely to catch virus during outbreaks, raising fears of new surge in deaths

RResidents of Ontario’s for-profit long- term-care homes are still experiencing significantly worse COVID-19 outcomes — both cases and deaths — than tthose living in municipal or non-profit f facilities, a Star analysis shows.

According to available data on Ontario’s second wave, the province’s longterm-care facilities are experiencing coronavirus outbreaks at about the same rate, regardless of whether or not the homes are run by for-profit corporations.

But once the virus arrives, for-profit facilities have fared far worse — much as they did during the first wave of COVID-19 infections that swept through Ontario nursing homes in the spring, killing more than 1,800k people aand prompting a provinciala commis- sion to examine the problem.

Among facilities with at least one confirmed COVID-19 infection since AAug. 1, theAStar’s analysis shows for- profit homes have struggled to stop the spread of the virus: Residents in forprofit long-term-care homes have been more than three times as likely to catch COVID-19 as those in a nonprofit facility, and for-profits have seen more than twice as many staff infections per bed. Resident deaths have been more common, too.

“It’s like a nightmare that we’re reliving now which we really shouldn’t have had to, given that we had months to prepare over the summer for a second wave,” said Dr. Amit Arya, a palliative care physician specializing in long-term care who witnessed the ravages of the first wave while working in GTA facilities.

“Now is the time for us as a society and for our governments to actually bring long-term care into the public system and hold the for-profit sector accountable.”

Ontario’s second wave has not yet crested, and although cases and deaths are rising fast, the totals in vulnerable long-term-care homes are to date significantly smaller than that which the province saw in its devastating spring.

But the early data on the second wave is stark: In homes experiencing an outbreak, for-profit homes have seen nearly 10 times the number of fatal cases per bed than non-profit homes, and nearly twice that of municipal homes, the analysis shows.

In the first wave, the province saw at least 1,394 deaths in for-profit homes — more than 70 per cent of all long-termcare home deaths in Ontario. At least another 126 residents of a for-profit long-term-care home have died since cases started rising again in August; 28 have died in municipally run facilities; and six in non-profit homes.

Krystle Caputo, press secretary for Minister of Long-Term Care Merrilee Fullerton, said in an email the government is “working hard to solve the longstanding and systemic challenges facing the long-term-care sector,” including investing “over half a billion dollars to protect residents, caregivers, and staff in long-term-care homes from the second wave of COVID-19.

“This will enable necessary renovations and measures to improve infection prevention and control, shore up personal protective equipment (PPE) stockpiles, create emergency bed capacity, and build a strong health-care workforce,” Caputo said.

Last month, the government’s commission on nursing homes released its interim report calling for swift action to hire additional staff and provide at least four hours of daily care per resident, a recommendation the government says it is acting on.

The Star’s analysis is based on the province’s open database of outbreaks in registered long-term-care homes. Using it, we took the total number of beds in each facility as reported to the province and sorted them according to the ownership: for-profit, non-profit and municipal. Then, using the number of cases and deaths reported in each home, we calculated the rate of infection and mortality per 100 beds for each type of ownership.

It’s the same method the Star used in May to first report that for-profit homes were experiencing disproportionately severe outcomes.

That investigation found that residents in for-profit facilities are about twice as likely to catch COVID-19 and die than residents in non-profits, and about four times as likely to become infected and die from the virus as those in a municipally owned home.

In a follow-up report, the Star found that, while all long-term-care facilities receive government funding using the same formula, over the last decade public and non-profit homes have topped up their government funding and for-profit homes paid out more than $1.5 billion to shareholders and executives.

Researchers at Sinai Health and the University Health Network confirmed the Star’s initial findings in a July study published in the Canadian Medical Association Journal that also found that, in general, homes more prone to outbreaks had older building design standards and the highest proportion of chain ownership.

Lead author Nathan Stall, a geriatrician at Mount Sinai Hospital, told the Star on Thursday that bigger and deadlier outbreaks in for-profit homes can largely be explained by the fact that forprofit operators have tended to buy up a lot of older nursing homes with older design standards. The Nursing Home Act was amended in 1972 to allow for four beds per room with just one sink and toilet — standards that were removed in 1998.

Stall said while he believes operators bought these homes with the intention to redevelop them, they largely did not.

“So there’s a higher concentration of the homes of older design standards within the for-profit sector and that’s one of the reasons we’re saying that the for-profit sector has had worse outcomes,” he said.

Other studies have shown that privately owned long-term-care homes have suffered from lower levels of staffing and lower wages. A Star analysis of union staffing data in June found that Ontario’s for-profit homes employ17 per cent fewer full-time and part-time workers, on average, than non-profit and municipal homes, based on pre-pandemic staffing levels. (This data largely excludes registered nurses and roughly 150 nonunionized long-term-care homes).

Data on salary and benefits provided earlier to the Star by two major unions representing workers in the GTHA showed municipal long-term-care workers were paid on average $3.18 to $4.65 more per hour than those at facilities with different ownership.

Donna Duncan, CEO of the Ontario Long Term Care Association, which represents about 70 per cent of the province’s homes, said in an emailed statement that the majority of major outbreaks “are in homes where there is a high rate of COVID-19 in the community and in older homes that have significant space constraints and outdated infrastructure.”

She said long-term-care homes urgently need dedicated on-site infection prevention and control specialists in every home and access to timely COVID-19 tests to inform measures to control any outbreaks quickly.

“We learned in the spring that the earlier a long-term-care home received critical supports, the more likely they could control an outbreak,” Duncan said.

She added that the last major rebuild of long-term-care homes took place in the late 1990s, when the government added 20,000 new beds and funded a program to rebuild older municipal homes that didn’t meet the 1972 design standards.

Nearly 60 per cent of Ontario’s 626 long-term-care homes are private and for-profit, while the remainder are operated by charities, non-profit organizations and municipalities.

According to the provincial data, the home with the highest number of resident infections since Aug. 1 is the 204bed Rockcliffe Care Community in Scarborough, with 111 to date, followed by Extendicare Starwood in Nepean, with 94, and Résidence Prescott et Russell, a municipal facility in Hawkesbury with 68. (The outbreaks at Extendicare Starwood and Résidence Prescott et Russell both peaked last month; the homes have significantly fewer active cases.)

The home with the most second-wave deaths is Scarborough’s Kennedy Lodge, owned by the Mississauga-based private company Revera. The operator announced Wednesday that 29 residents of the 289-bed facility have died of COVID-19 since an outbreak at the home began last month. As of Wednesday, there were 30 residents with active cases and 32 had recovered. The company also said 35 staff members had tested positive for the virus and 17 cases had been resolved.

Susan Schutta, a spokesperson for Revera, told the Star in an email that “there are many variables and factors that have played a part in why COVID-19 spread in some homes and not others … (and) ownership is not one of them.”

“The prevalence of the virus in the community around a home, and building design — older homes with shared bathrooms and ward-style rooms make it very difficult to stop the spread of COVID-19,” said Schutta, who said that a focus on the kind of ownership of the homes is a “distraction.”

“We are working with local health systems to reduce the use of ward-style rooms wherever it is safe to do so.”

Arya, the palliative care physician, said what has happened in long-term-care homes during COVID-19 and problems identified before the pandemic show the system in Ontario requires a fundamental change.

“It needs to be redesigned where it doesn’t prioritize the operator, but rather the people that it is serving and hopefully their family members and frontline health workers as well.”