In July 2020, 26 people died in a single for-profit long-term care home (LTC) in Ontario. These people did not die of COVID-19, but from dehydration and neglect. In fact, the COVID-19 pandemic has been devastating for LTC residents, whether they were sickened from the virus or suffered from the pre-existing conditions it exposed. Of the more than 27,000 people who have died of COVID-19 in Canada, 18,000 (or two-thirds of the total) died in LTC and retirement homes. Those who died were elders, from the generation that gave Canada its public health-care system, but many died in homes run for profit.

Three in five Canadians believe for-profit care for our elders should be reduced or phased out entirely. During this federal election, most political parties have raised the urgency of improving eldercare, and rightfully so. But the importance of phasing out profit-driven seniors’ care has not received the attention it deserves.

Canadians want care to be the sole focus of LTC. But the reality is different. In British Columbia, 37 per cent of LTCs are for-profit, and that share is rising. Ontario has the highest percentage in the country at 57 per cent.

There is strong evidence that for-profit homes, on average, provide inferior care, not to mention poor working conditions. In Ontario, for-profit LTC homes have higher death rates compared with non-profit homes; those owned by corporate chains performed the worst. Across the country and in multiple provinces, for-profit homes were over-represented among homes that had COVID outbreaks and also experienced higher death rates from the virus.

While people were dying, for-profit corporate chains Extendicare, Sienna Senior Living and Chartwell Retirement Residences collectively distributed nearly $171 million to their shareholders. Meanwhile, they received $138.5 million in pandemic-related subsidies from the federal government. This form of ownership – in which long-term care is treated not only as a business, but also as a real estate investment for shareholders – is unacceptable. How can we permit extracting profits when that contributes to unsafe and inadequate staffing levels, and ultimately the suffering and death of our elders?

Not all for-profit LTC homes are the same. Corporate chains own and operate multiple facilities. “Mom-and-pop” companies operate single facilities, but they are less and less common. Investor-owned chains may be publicly traded on the stock market or privately held by private equity firms or real estate investment trusts. Corporate chains may subcontract operations and front-line care to other firms, creating layers of privatization and undermining care quality.

More specifically, the risky financialized business model common to chains, whether publicly traded or not, puts profit extraction first. This high-risk practice came to a head when public health authorities had to take over operations of five LTC homes in B.C. and Alberta – owned by the troubled Beijing-based Anbang Insurance Group investment firm – as a result of severe staffing shortages and resident safety concerns. While the problems with chains predate COVID-19, the pandemic made them even more dangerous for seniors and health workers. In Manitoba, the Revera-owned Parkview Place had one of the province’s longest and deadliest outbreaks, leading to 30 deaths over four months.

From the perspective of the taxpayer, for-profit corporations get the same funding as non-profits, which devote all their resources to front-line care. B.C.’s Office of the Seniors Advocate found that while receiving on average the same funding from government, non-profit operators spend $10,000 or 24 per cent more per year on care for each resident compared to for-profit providers.

Some argue that for-profits fund the construction of new homes, but in fact taxpayers subsidize that, too. A growing body of evidence from provincial auditors general and researchers shows that the public pays more to finance health infrastructure through the for-profit sector. The corporations “end up owning the house after we pay the mortgage,” is how Dr. Pat Armstrong, one of the country’s leading LTC researchers, puts it.

So, how can we phase out for-profit LTC?

New federal seniors’ care funding should be restricted to non-profit provision, including LTC, through federal legislation. The federal government should require provinces to develop plans to phase out for-profit care. While some will say this is provincial jurisdiction, the federal government can set criteria that the provinces must meet. For example, the safe long-term care fund, a new funding envelope announced by the federal government in 2020, requires provinces to meet specific funding requirements.

At a minimum, provinces should not grant new licences to for-profit operators. In Ontario, for example, the licences for 185 homes containing more than 20,000 beds will expire in 2025. This is an opportunity for the federal government to work with Ontario to transition to non-profit operation.

You may be surprised to know that Revera, one of Canada’s largest corporate chains, is wholly owned by a federal Crown corporation operating the pension funds for public sector employees, who have been leading calls to make Revera public. Through federal leadership, Revera could be one of the first of Canada’s corporate chains to shift from for-profit to non-profit and municipal ownership, with the support of provincial and federal governments.

We also must ensure that governments of all levels work together to provide non-profits and health authorities with access to low-cost capital financing as well as the capital-planning expertise necessary for new construction and renovation. This will enable them to replicate the economies of scale available to for-profit chains, which often run many homes, while still maintaining personalized care and customized programming. A repurposed Canada Infrastructure Bank could help with this rather than embroiling Canada in more costly public-private partnerships.

Furthermore, federally legislated care and quality improvement standards for LTC are urgently required. Because it will necessarily put a squeeze on profit margins, it will likely mean many for-profit operators will exit the sector. Realistically, it is not possible to improve conditions for residents, upgrade facilities, increase staffing levels, provide a living wage and increase accountability while still squeezing out a big profit.

Let’s be frank. Taking profit out of the system alone will not be enough, and is therefore just an initial step. We will all have to contribute a little more to make the lives of elders – and eventually our own – a lot better. But this is not all about building more LTC homes.

Federal and provincial governments need to devote more resources to health promotion through primary care and home care. This will help seniors remain in their homes for as long as possible, and is also more cost-effective. For this to be a reality, a large number of low-income seniors need to have secure affordable housing. In fact, a whole suite of publicly funded services such as dental and vision care are required to meet the needs of our aging population. Improving seniors’ care cannot be addressed in isolation from these issues – and these issues should be at the forefront this election.

The tragedy of COVID-19 has also been a wake-up call for transforming Canada’s LTC system. As the Canadian population is aging faster than ever before, the demand for eldercare will only increase. So during this election, shouldn’t we hold all political parties accountable to creating an eldercare system that improves well-being through high-quality care, rather than making people rich?

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Jackie Brown
Jackie Brown is a researcher, writer and urban planner whose work has focused on economic justice and long-term care home ownership in Ontario. Follow her at @jackiebrownTO.
Amit Arya
Dr. Amit Arya is a co-founder of Doctors for Justice in LTC and a palliative care physician who works at long-term care homes in the Greater Toronto Area. He holds faculty appointments at the University of Toronto and McMaster University. Follow him at @AmitAryaMD.
Andrew Longhurst
Andrew Longhurst, MA, is a health policy researcher and PhD student in the department of geography at Simon Fraser University, and research associate with the Canadian Centre for Policy Alternatives. Follow him at @a_longhurst.

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