By Doug Nesbitt
As COVID-19 took hold through the spring of 2020, it ravaged the elderly, particularly those in congregate settings such as long-term care homes. By late spring, it was apparent that the infection and death rates in Ontario’s long-term care homes were among the worst in the world. Of all COVID-19 deaths in Ontario in 2020, 61 per cent were long-term care residents. By the end of April 2021, 11 staff and almost 4,000 residents in Ontario’s long-term care homes had died.
These words introduce the Executive Summary of the Ontario Long-Term Care COVID-19 Commission’s Final Report, published April 30, 2021. The Final Report documents the comprehensive failures and inferiority of for-profit long-term care in Ontario, but makes no recommendations in favour of a public LTC system. In fact, the Report rehabilitates for-profit long-term care operators and proposes a system where they can flourish.
This is a disappointing but unsurprising conclusion. Doug Ford’s government is not going to create a special investigation that fundamentally opposes their vision of a publicly-subsidized, privately-profitable LTC system.
But weaknesses in the long-term care system are all across Canada, not just Ontario. About 70 percent of all Canadian COVID-19 deaths are in long-term care. The failure of governments to reform LTC after the first wave has led to an even more devastating second wave. Only prioritized vaccinations have prevented the huge third wave from hitting long-term care homes like before.
The rot is deep, and the thousands of LTC deaths during this pandemic is all the reason we need to justify sweeping changes to the healthcare system and the expulsion of profiteers.
Long-term care has been subject to study for many decades, and the problems are well documented. However, there’s a coalition of for-profit healthcare corporations and establishment politicians preventing changes from happening.
Austerity and the profit motive
In the long-term care system there are two sources of rot, and they are related to each other. The first kind of rot is austerity. Government funding of long-term care has been insufficient since federal and provincial governments began introducing austerity budgets in the 1980s and 1990s. Care and labour standards have suffered immensely, especially as hospital beds were cut by the thousands and demand for long-term care grew.
The second source of rot is the profit motive. Just over a quarter of all long-term care homes in Canada are run for profit. It’s highest in Ontario where 57 percent are run for profit. The profit motive in long-term care is what drives ownership to lower the quality of food, cleaning, equipment, and building design. The profit motive is what compels ownership to keep labour costs down and fight unions.
The solution to the austerity rot is obvious: more government funding. Even the long-term care profiteers and their business associations are calling for more government funding. The profiteers collect substantial public subsidies to deliver long-term care.
The solution to the profit rot is getting rid of the profit motive in long-term care. This is where Canada’s corporate political parties won’t go.
Profits and power
The Ontario LTC Commission’s report is only the latest institution calling for change but refusing to kick out the profiteers. Profiteers, we are told, are more efficient. This is a dishonest view because every healthcare dollar going to executive bonuses, company profits, and shareholder dividends is a dollar less going to frontline workers, patient services, and building maintenance.
But the profiteer problem is even deeper. It’s a problem of power. The private healthcare profiteers have organized themselves into a powerful political force. In Ontario, where their power is strongest, they’re organized into the Ontario Long-Term Care Association which represents mainly for-profit corporations.
The OLTCA has a long, consistent record of demanding more government funding for both capital and labour costs. They are happy to make this known. However, they are publicly silent around their other demands, such as greater managerial powers over healthcare workers, and special protections against lawsuits. For years they’ve consistently resisted minimum care standards and routinely conduct union-busting campaigns against workers.
As Rankandfile.ca correspondent Zaid Noorsumar has carefully documented, OLTCA lobbyists and senior industry officials have served as powerful party staff and government advisors to both the Ontario PC Party and the Ontario Liberals. This extends to politicians themselves, with former Ontario Premiers Mike Harris and Bill Davis profiting handsomely as they sit on the boards of large long-term care profiteers.
What is “regulatory capture”?
This revolving door of corruption leads to what’s called regulatory capture. As Bruce Campbell writes in his book on the Lac-Mégantic rail disaster,
Regulatory capture embodies a fundamental conflict between the primary obligation of government to protect the health and safety of its citizens and the interest of corporations to maximize shareholder value. If a regulator is captured – Canada’s National Energy Board is a notorious example – industry removes or dilutes existing regulations it deems too expensive, shapes new regulations to suit its interests and blocks the prospect of more aggressive interventions.
This is exactly what has played out during the pandemic in Ontario. Instead of having their operating licenses pulled, the OLTCA has achieved two major goals since the pandemic started.
First, a directive by Premier Doug Ford in the first weeks of the pandemic gave LTC management new sweeping powers over staffing, training and reporting requirements. OLTCA has been demanding these powers for years now, but they’ve been resisted by unions.
Second, Doug Ford passed Bill 218 in November 2020, creating greater COVID-specific protections for Ontario long-term care operators against residents and their families.
But wait! Didn’t Ford also introduce minimum care standards in late 2020? In the face of public outrage and union pressure, Doug Ford committed to minimum care standards – but the commitment isn’t until 2024-25! It’s a sick joke.
Expanding corporate empires
The power of the for-profits extends further with their role in managing long-term care centres which they don’t own. For example, the profiteer Extendicare owns 34 LTC facilities in Ontario, and is contracted to manage another 19. Eight of these are private non-profit LTCs, and two of them are municipally-owned public LTCs. As a result, Extendicare is managing 1 in every 10 of Ontario’s long-term care beds.
The for-profit LTC operators extend their reach into retirement homes and home care. Both these sectors are dominated by for-profit companies. Extendicare, for example, owns Paramed, one of the largest home care agencies. Paramed lives off public contracts. Chartwell, Sienna Senior Living, Revera, Southbridge, Schlegel, and other large for-profits LTC corporations also operate large numbers of retirement homes, too.
This isn’t just an Ontario problem. These companies are based in most provinces, operating retirement homes, home care agencies, and long-term care facilities. Ontario is where the profiteers have made the greatest advances, and they are working hard to replicate their achievements in other provinces.
Federal and provincial routes to public LTC
The political power of the for-profit LTC operators has proven a disaster and is far too dangerous to allow. Public ownership is the alternative. There are two legislative routes towards achieving this.
First, the federal Canada Health Act can be amended by Parliament in Ottawa to mandate public ownership of long-term care. The Canada Health Act already does this for hospitals, but does not do this for long-term care (or home care).
Second, the provinces can enact legislation to bring for-profit LTC facilities under public ownership. This can be done independently of the federal government. Provincial governments do not have to wait for the federal government to act.
Both routes are of course immensely difficult, but if the achievement of medicare is any guide, the provincial route will be the most fruitful. A breakthrough in one province can build pressure on other provincial governments and the federal government.
There is also the potential of bringing Revera, the second-largest long-term care profiteer in Canada, under public ownership. The corporation is owned entirely by the federal crown corporation, the Public Sector Pension Investment Board. A petition is circulating to make this happen, and many union and healthcare activists have spoken about the case of Revera, such as CUPE pensions researcher Kevin Skerrett.
Is there a party who can do this? The federal NDP and the Ontario NDP have both called for an end to for-profit long-term care. However, the timelines from both parties are so long, they’re hard to take seriously.
The Ontario NDP plan would take 8 years. This timeline is based on not renewing the operating licenses of for-profit operators. Eight years would require back-to-back NDP majority governments. How realistic is this?
Given the political power of these companies and their integration into the Ontario Liberals and PCs, a credible plan would bring LTC under public ownership in a single four-year term. The awful pandemic performance and the corrosive political power of the profiteers is the justification for such speed. Their political and economic power must be removed as soon as possible. Public ownership must be entrenched quickly and deeply so it is extremely difficult to reverse.
The federal NDP has a public LTC plan that would take 10 years. This would require electing the NDP three times in a row! This has only happened twice since World War Two! The federal NDP says they would implement a task force to study the problem, amend the Canada Health Act and carry out the transition, which they believe would take a decade.
The Campaign for Public LTC Ownership
Millions of people are sick and tired and ready for change. Millions of us want the profiteers out of healthcare. However, the understanding of how the LTC system works, and how the profiteers wield power, is not well known. There is much we have to learn ourselves, and models of healthcare around the world that we can study. We can’t fight them without major education efforts, and the patient construction of organizations in every community capable of educating, organizing and focusing our power.
Rather than contracting out the question of political power to the NDP, fighters for public healthcare have an opportunity to build the organizations required to do this work, including our health coalitions across the country. But what we are talking about is a long-term campaign which will take many years, perhaps decades of work.
It is sobering to consider how long it took for farmers and workers to win the great healthcare victories of the 1960s. Nor can it be forgotten that the achievement of medicare in Saskatchewan in 1962 came eighteen years after Tommy Douglas and the CCF (precursor to the NDP) were elected to office in 1944.
In the same era that medicare was achieved in Canada, Martin Luther King Jr. observed,
Change does not roll in on the wheels of inevitability, but comes through continuous struggle.
About the author
Doug Nesbitt is co-founder and editor of Rankandfile.ca and a former union organizer. He most recently was involved in home care organizing in eastern Ontario, and is currently writing a book on the Mike Harris years in Ontario.
Long term care in Ontario has been a rolling train wreck ever since Premier Harris sold the care responsibility to the for-profit care industry. At the time private sector care was a business, often family owned, relatively small scale but the takeover by the hedge funds and asset strippers turned the sector into high powered, high profit, high turnover operations, vertically organized so that the top level ownership and management acquired /made investments in the manufacturers, suppliers of food, equipment and consumable supplies – buying from their own companies, and doing the usual self dealing scam of inflated prices, skimming profits from every aspect of the corporate enterprise. Lobbying governments for ever more generous grants, supposedly to improve facilities, improve staffing – none of which happened.
The litany of their fraud, sins of omission, scams, bad faith management, is a dismal tale repeatedly exposed but nothing was ever done to correct it. Successive governments appear to have been held to ransom by the industry – all of which resulted in abuse, premature death and needless suffering, as well as financial abuse of residents and their families.
The mess this misbegotten system has created seems intractable and probably will not be improved anytime soon because there is no political will to do so. The reasons are simple: the residents are too often cognitively impaired and cannot effectively advocate for themselves. The majority of the residents are females and the corporate world is well acquainted with the tactics to exploit, abuse and defraud females. The families are intimidated by the problems of caring for mentally impaired, frail elderly women and the care and advocacy for those elderly women overwhelmingly falls on the shoulders of their female children. Not that the profiteers are any more tender in their treatment of the few hapless males charged with the responsibility of care.
The recent scandals of the COVID deaths in LTC facilities, throughout North America is an outrageous tragedy that – based on the report of the Ontario Commission – will not be seriously reformed or repaired. The Industry Lobby has no doubt done more excellent self-serving work in skewing this report – like so many others before it. The train wreck will continue, Medical Assistance in Dying will be the more popular choice in years to come for aging people faced with the prospect of incarceration in LTC institutions.
There are viable alternatives to this system – however the chaos in the health care system for the elderly is so extreme that implementing these alternatives – even if we could persuade government to do so, will be a massively messy business with all the vested interests, for profit, not for profit, medical establishment, etc scrambling to protect their own interests without regard to the welfare of the aging. All of this dysfunction has gone on too long and involves too many agencies, companies, organizations, even unions who are now entrenched in their own concerns and none of them are willing to do what seniors themselves want to do.