Ontario’s fiscal policies have wrecked long-term care

A one per cent budget increase could pay for appropriate staffing in long-term care homes

By Zaid Noorsumar

A new report by the Canadian Centre for Policy Alternatives demonstrates how the fiscal policies of successive Ontario governments have led to immense pain and hardship for long-term care residents, their families and the workforce.

For decades, the province has failed to raise staffing levels to the required standard even as dozens of reports and studies have highlighted its importance. Short-staffing has led to unsustainable workloads, high levels of injury among workers, shameful neglect of residents, shocking levels of violence and even homicides. 

According to the Ontario Health Coalition, staffing is worse than ever during the pandemic, as COVID-19 has claimed more than 1,800 lives in the province’s nursing homes.

Small investment, massive changes

The CCPA’s report says Ontario needs to invest $1.6 billion to raise staffing levels in long-term care to the widely-recognized minimum standard of 4.1 hours of direct daily care. 

An additional $285 million would fund wage enhancements to bring non-unionized workers up to the standards of unionized employees. 

Although the required investment would boost long-term care spending by 40 per cent, it would only be a 1.2 per cent increase in the entire Ontario budget. 

In other words, a relatively small amount of money has been required to improve working and living conditions in nursing homes.

So what has prevented successive Ontario governments from taking action even as lack of staffing has known to be a major barrier in providing care? 

Austerity in Ontario

Sheila Block, co-author of the CCPA report, points to Ontario’s decades of fiscal restraint. Ontario’s per capita public spending is the lowest across Canada – and has been the case for long before Doug Ford got elected.

She contextualizes the problem within the logic of neoliberalism, whereby governments have reduced public spending to pay for tax cuts (generally for the wealthier segments of the population) while increasing privatization. 

“I think this neglect has to do with austerity, and it has to do with a neoliberal agenda,” she says. “And this is just one of the many examples where public services are dangerously underfunded.”

According to the Financial Accountability Office, based on 2017 figures, Ontario’s budget would be $29 billion more if it spent at the same level as the average spending of other provinces. 

In other words, there have been viable ways to pay for proper staffing all along. But successive governments have chosen to limit the spending capacity of the state. 

Last year, Block co-wrote a report presenting an alternative 2019 budget for Ontario that would increase revenue by $8.3 billion. Among the suggestions included reversing the Ford government’s tax cuts of $3.3 billion and increasing the corporate income tax rate by merely two percentage points to generate additional revenue of $2.4 billion.

The current corporate tax rate in Ontario is 11.5 per cent, which the Liberal government gradually decreased from 14 per cent in 2010. Block says that personal income taxes in Ontario have also been relatively low ever since the 30 percent reduction during the Mike Harris years (over half the Harris tax cut wealth went to the top 10 percent income earners).

“This is the cost”

Natalie Mehra, the executive director of the Ontario Health Coalition, says that the present state of affairs is unacceptable.

“We’ve had years of fiscal restraint that has been borne largely by the elderly, in terms of access to care for long-term care and [health care in general],” she says.

“Ontario has pursued a much more aggressive tax cutting regime that has benefited the wealthy and corporations more than anywhere else in the country and this is the cost. I think that it goes against the fundamental values of the vast majority of Ontarians.” 

Block cautioned against using the options presented in the CCPA’s 2019 alternative budget due to the economic reconfiguration during the pandemic. However, she said the money required for long-term care was a relatively small amount that the government should spend immediately and recoup it in the medium-term by increasing revenues.

Staffing regulations opposed by for-profits

Ontario has not had a staffing standard since Premier Mike Harris and the Ontario PCs removed it in 1996. 

Former Liberal Premier Dalton McGuinty – whose health minister publicly cried in response to a 2003 Toronto Star investigation of long-term care horror stories – promised to reinstate a minimum care standard but failed to do so.

Ontario Health Coalition’s Natalie Mehra says that there has been total consensus on the necessity of legislated staffing standards among advocates, including family and resident councils as well as unions.

The only opposition to these standards is the Ontario Long-Term Care Association (OLTCA), which mainly represents for-profit nursing homes. In Ontario, 58 per cent of homes are for-profit but many non-profit homes are also managed by corporate entities like Extendicare.

A whole range of academic studies show that staffing levels are lower in for-profit homes, which also have significantly higher levels of mortality and hospitalization compared to not-for-profit homes.

Mehra says aside from a brief interlude, the for-profits have opposed a care standard as it would potentially hurt their revenues. She says they have also opposed other regulations including unannounced inspections and having a registered nurse on duty at all times.

Although the OLTCA acknowledges understaffing as a critical issue, it doesn’t want a legislated minimum standard. In fact, it has called for “flexible staffing.”

“OLTCA is saying they need more staff, but they’re also asking to substitute lower trained staff for higher trained staff,” said Pat Armstrong in a 2019 interview with Rankandfile.ca. 

A Distinguished Research Professor of Sociology at York University, Armstrong is one of the leading researchers on long-term care in Canada. 

“I think that it’s pretty clear that in addition to more staff, we need staff with the right kinds of training, we don’t need less training,” she said. 

As Rankandfile.ca previously reported, the OLTCA (and its affiliated corporations) has made significant political donations and used lobbyists with close ties to the respective leaderships of the Liberals and Progressive Conservatives, depending on the party in power at the time. 

Donna Duncan, the current CEO of OLTCA, was formerly a policy advisor in 2006-07 for John Tory when he was the leader of the Ontario PCs.

Jim Brophy, professor at University of Windsor, perhaps summed it up best when he told Rankandfile.ca in 2019, that the residents and workers have no political voice compared to the corporations that run long-term care. 

Next in the series:
Staffing in long-term care homes has worsened during the pandemic