LONG-TERM CARE: IT’S NOT LIKE WE DIDN’T KNOW TRAGEDY WAS COMING
It was a disaster even before COVID -19 came along and blew open a window into Canada’s failing long-term care system, revealing to all what too many residents, families and experts have warned of for years.
The neglect and conditions at some are so horrific that one person I’ve talked to described it as reminiscent of Romanian orphanages in the 1980s and 1990s under Communist dictator Nicolae Ceausescu.
A week ago, the military was again sent into an Ontario care home owned by Sienna Senior Living, one of the largest private providers of publicly funded care in Canada. A few days earlier, the province had replaced the administrators after 22 residents died from COVID-19, and 102 residents and 40 staff tested positive.
This followed last month’s deployment of Canadian Armed Forces to more than two dozen care homes in Ontario and Quebec to provide “humanitarian relief and medical support” for residents.
Some had been left for days in soiled diapers, according to Brig.-Gen. C.J.J. Mialkowski’s report on what was witnessed in five Ontario homes.
Others had bleeding fungal infections.
Staff were aggressive and abusive.
Residents were sedated “when they are likely just sad or depressed.” There were insect infestations, rotting food.
The list goes on and on, and prompted Ontario’s ombudsman to launch an investigation into whether the province’s oversight is “adequate to ensure the safety of residents and staff.”
Nothing quite like that has happened in B.C. since the pandemic was declared. At least, not yet.
It doesn’t mean it won’t happen, although it’s fair to say that B.C.’s reckoning began long before COVID-19. In 2014, it was the first province to appoint a seniors advocate, and she has been warning of problems ever since.
In 2017, in the largest Canadian survey of residents and families, Isobel Mackenzie found nearly two-thirds didn’t get showers or baths as often as they would like. One in four residents said they never, rarely or only sometimes got help going to the toilet when they need it.
They were likely downplaying the problem because 82 per cent of family members complained about their loved ones’ inability to have baths and showers when needed.
Staff shortages are at the root of the problem. So too are the lack of government oversight, enforcement and penalties for failure to meet standards.
Experts suggest a minimum of 4.1 hours of care per resident each day is needed. In B.C., care homes have struggled to meet a target of 3.36 hours, while other provinces such as Saskatchewan have no targets.
While targets don’t guarantee good care, staff shortages inevitably hurt vulnerable residents who either can’t complain or won’t because they are afraid of reprisal.
The epicentre of B.C.’s pandemic was the Lynn Valley Care Centre, where the two-month outbreak began March 7. Twenty residents died, 52 were infected and survived, along with 26 staff.
Twelve days earlier, Interior Health Authority appointed an administrator after Retirement Concepts’ home to 112 residents in Summerland didn’t meet the minimum provincial standards.
Last fall, three other Retirement Concepts residences in Comox, Nanaimo and Victoria were taken over by Vancouver Island Health Authority after complaints about “significant” staff shortages and their inability to meet minimum standards. Their administrators remain in place.
Retirement Concepts is B.C.’s largest contracted provider of long-term care with 1,641 beds, a third of those now being run by appointed administrators.
Operated by West Coast Seniors Housing under the name of Pacific Reach Seniors Housing Management, Retirement Concepts itself is a subsidiary of Anbang Insurance Group, a company owned by the Chinese government. Anbang’s purchase of the Vancouver-based Retirement Concepts was approved by the federal Liberal government in February 2017. A year later, the Chinese government took control of Anbang after its chairman Wu Xiaohui had been arrested and accused of fraud.
Staff shortages have been described as epidemic at care homes because of a complicated stew of factors: Ever-increasing demand as the Canadian population ages, increased complexity of care, low wages, and the fact that many workers are hired only part time and have no sick benefits.
To pay the rent, that means that many workers have jobs at multiple sites and, often enough, don’t stay home unless they are really sick.
That is what helped the coronavirus spread so quickly. And it’s why on April 1 with COVID outbreaks at 19 B.C. care homes — it would eventually spread to 37, with four outbreaks still active — B.C.’s provincial health officer issued a six-month order. The nearly 9,000 workers with jobs at multiple sites had to choose a single site where the government would top up their salaries equal to the collective agreements of publicly run facilities.
How this happened dates back to 2002 when then-premier Gordon Campbell’s B.C. Liberal government removed “successorship rights” from the Labour Code. It meant that when companies were sold, the union agreements weren’t part of the deal.
That opened the way for a slew of companies taking advantage of the government’s willingness to privatize long-term care to fire and re-hire employees. In some cases, workers’ pay was cut to $11 an hour from $18, and sick leave gutted to three days a year from 15.
The NDP government repealed the changes, but has kept in place Campbell’s other legislation that allows jobs to be contracted out.
The B.C. Care Providers Association — the industry’s lobby group — disputes the notion that wages are the problem. It filed a formal complaint with the government last year, blaming regulations for creating critical staff shortages.
Last fall, it contended that B.C.’s standards for care aides are too high, and that 99 per cent of candidates from outside the province are screened out after completing an $800 competency assessment.
According to the association, almost half are told to do a 12-week refresher course or a seven-month, health-care aide training program that costs up to $4,500. The rest, it said, are directed to targeted modules and short courses to address specific shortcomings.
The Health Ministry disputes that. It says 30 per cent are registered without further training.
But given that the quality of care provided has been so starkly put on view because of COVID-19, it’s likely that most people would agree with Health Minister Adrian Dix.
“I don’t think the solution is to lower those standards,” he said at the time. “The challenge ... is to train more care aides.”
Regardless, the fact is that residents have not been getting the care they need or want.
Just weeks before that first Lynn Valley outbreak, Seniors Advocate Isobel Mackenzie released an audit of care homes’ 2016-2018 financial statements.
More than 70 per cent of the $1.4-billion annual cost of B.C.’s taxpayer-funded, long-term care goes to corporations, and Mackenzie found the government has essentially been handing care providers blank cheques.
For-profits generated revenue 12 times that of the non-profit providers. Not only that, for-profit homes had stiffed the government. They had delivered 207,000 fewer hours of care than they were paid for.
But they got to keep that money and more because regulations are vague, non-existent or aren’t applied uniformly across the six health authorities.
Mackenzie’s report, A Billion Reasons to Care, points out that not only did companies not deliver what they were paid for, they are allowed to claim building expenses at 20 per cent of their revenues compared to the not-for-profits’ nine per cent.
They deducted mortgage interest rates considerably higher than market rates, claimed double the depreciation rates as well as unexplained lump sum payments to contractors working for affiliated companies, and had unspecified management fees on top of administrative expenses higher than non-profits.
Given a long stream of critical reports, it’s not surprising that the industry lobby group has called for Mackenzie’s resignation, describing her as too “cosy” with the Hospital Employees’ Union.
But it doesn’t change the facts highlighted by COVID-19, which has killed far too many seniors in Canada. The system is a mess. Care is inadequate and it’s no longer a question of whether something needs to be done.
It must be done. Rebuilding it from the ashes of COVID-19 needs careful thought, but the solutions have already been proposed. And it needs quick action because Canada’s seniors haven’t got time to wait.
Staff shortages are at the root of the problem. So too are the lack of government oversight, enforcement and penalties ...