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Keeping seniors safe
We will look at everything differently. COVID-19 will, for many folks, and for a long time, frame the way we live and interact with other humans. When it is over—perhaps before then—we will insist upon the reform of institutions that we hadn’t given much thought to before.
Near the top of the list will be a vow that we will never again allow our senior population to be so exposed to a deadly wave of disease. According to data compiled by journalist Nora Loreto, it appears that over 80 per cent of those who have succumbed to COVID-19 in Canada were living in long-term care or retirement homes.
Already some are proposing to eliminate private long-term care and retirement residences— that the fate of our vulnerable elders ought not to be put in the hands of organizations driven by profit. That corporations are the enemy of compassion. It is a seductive argument. It was even floated by Ontario Premier Doug Ford on Monday and then dismissed as unaffordable. Yet it is likely to get plenty of traction among a frightened public. But it would be a dreadful mistake. Let us begin with the evidence.
According to Loreto’s compilation, 12 of the seniors’ residences that have experienced the most deaths due to COVID-19 in Canada are public (10) or not-for-profit (2). Indeed public (i.e. government-operated) residences rank as the top three places enduring the most deaths due to the disease so far.
It turns out that that knowing whether a long-term care residence or nursing home is operated by a corporation, a municipality or a not-for-profit community group tells us little about the safety of the facility or the resident’s susceptibility to COVID-19.
This won’t change the fact that we will rightly demand to know what happened. What could we have done to protect them better? We will commission studies. Assemble expert panels.
But who will preside over these reforms? Upon whose wisdom will we rely?
Healthcare planners? The folks who toil inside ministry hallways, who steer regional healthcare resource distribution and guide hospital corporations? Unsullied by competing ideas or challenging philosophies?
For a generation, these folks have promoted and created centralized factory hospitals with the express aim of moving patients in and out quickly. They did this, they explained, to manage escalating healthcare costs. In the process, they greatly diminished the capacity of community hospitals like Prince Edward County Memorial and Trenton Memorial. Home care buttressed this approach. But older folks with a complex array of health challenges posed a problem: How to move them out of the hospital quickly while minimizing the risk of these folks returning even sicker? The answer was to put more and more folks into assisted living or long-term care homes. Then, as the velocity of patients through the hospital system increased, a shortage of long-term care beds created a cohort of patients with nowhere to go.
Healthcare planners created a name for this problem: Alternative Level of Care, or ALC patients. Folks who were taking up the hospital beds but unwell enough to go home. In response, planners lobbied for more longterm care beds. Bigger, denser, centralized, efficient, synergistic residences.
Are these folks responsible for the tragedy of COVID-19 among our elderly? Of course not, but it is undeniable that collective groupthink— unchallenged by competing notions— helped to inform a system that propelled more folks into long-term care beds.
But it gets more complicated than this.
While one group of healthcare planners were creating more demand, another group was working to squeeze out small, family-operated retirement homes. Here in Prince Edward County, we have over the last decade witnessed the unrelenting demise of family-operated retirement homes collapsing under the weight of ever-expanding reporting, documenting, and infrastructure demands from the healthcare bureaucracy.
Healthcare planners are fond of systems. And they have a penchant for bigness. For density. As we’ve seen elsewhere, their incentive structures prize centralization and homogeneity as a means to efficiency and efficacy. In this model, large corporate chains are favoured over small independent homes. It has led them to lose sight of the humans for whom they are responsible.
Are we really considering handing the operation of all long-term care and retirement homes to these folks? We know that left to healthcare planners, in time, cost efficiency would dictate that we live out our final years in the same massive gulag parked beside a freeway for ease of access. Would you allow the government to design and operate your home?
On the other hand, might we be better served by a mix of competing facilities—big and small—public and private—that will continue to attract folks based upon a rich variety of settings, services, and amenities?
So where should we start when it comes to keeping these folks safe? It begins and ends with better, more inspired regulation and compliance. And better oversight in which residents, their families, and their caregivers participate directly. It is no more complicated than that. Let us get out of the way of small, family-operated retirement homes. Let’s encourage diversity of living arrangements. Let us expand community hospitals to accommodate those who need a few extra days to recover before going home.
None this is new. We understood this a generation ago. Yet the brave new cohort of healthcare planners currently at the helm would propel us toward the dense, homogenous government big box human warehouses that put our elderly at risk. Is that really the direction we wish to head?
Readers should not be mislead. Turns out It does make a difference – a significant difference – to your safety and susceptibility to disease whether the long term or retirement home you choose is operated privately for-profit or not. Let us begin again with the evidence.
Contrary to what this article has told us. The three top places enduring the most deaths due to disease so far are all private for-profit businesses. News writer Nora Loreto, has said as much in her article, Covid-19 Has Exposed the Horror of Long Term Care Facilities, which can be read online @ rabble.ca. In this article she recounted what health professionals described as concentration camp-like conditions at Herron Seniors residence in Dorval Quebec where as of April 12th, 31 seniors had died. Loreto also listed 2 more long term homes having the highest number of deaths. Pinecrest Nursing Home in Bobcaygeon Ontario was listed as having 29 seniors who died as of April 16th and Eatonville Etobicoke where 36 residence died as of April 20th. (Note Eatonville Centre is one of three facilities operated by same owner, Rykka Care centres, which include Anson Place in Hagersville where 29 folks died, and Hawthorne Place where 8 died. That is a total of 75 folks who died in Rykka Care Centres.)
“Together, these three private, for profit facilities have had at least 93 deaths thus far.”Loreto pointed out adding, “ While there have been more deaths in private care homes than public ones, public facilities have also been the sites of outbreaks, especially in Quebec.” wrote Loreto.
Indeed there has been an alarming number of more deaths in for-profit care facilities than public. As of April 26th, 79 residents of private for-profit Orchard Villa, died of Covid-19. “It leads the country as well as the province in the number of deaths by covid,” Pickering Mayor Kevin Ashe told the T.O Star.
T.O. Star May 8th reported “for-profit retirement and nursing homes have 4 times as many covid deaths as city run homes.”
Ontario Health Coalition has been tracking the number of deaths by covid in for-profit, non- profit and public municipal retirement/nsg care homes. The proportion of deaths out of the total number of beds are as follows; for-profit was 9%, non-profit was 5.25%, public municipal was 3.6%.
T.O. Star May 16th reported “for-profit retirement/nsg homes have had far worse outcomes than public facilities” and “3 of the largest paid $1.5 billion to shareholders not including $138 million paid to its executives.
In Globe & Mail Feb 4th B.C.s senior advocate Isobel MacKenzie’s latest report revealed “non-profit care homes spent 10% more of their revenues on direct client care compared with for-profit care homes.” It found for the same level of public funding the for-profit care operators failed to deliver 207,000 hours of funded care while the not-for-profit delivered 80,000 more care hours than they were funded for.”
This report listed further troubling findings. “Wages paid to care aid staff were as much as 28% or $6.35 less than industry standard.”
Another study, reported in the Vancouver Sun 2016 entitled, For-profit Care of Seniors Proven to Be Inferior, pointed out that the “decision to go with private for-profit beds contradicts scientific evidence about ownership and residential care quality.” Statistics showed for example, “for-profit have fewer nurses which results in at least 60 mins less direct care per resident everyday, an increase in bedsores, and higher rates of hospital admissions.”
There are many studies/research going back years that point to the inferior quality of care in private for-profit homes – too many to all go into here – all providing strong evidence that the retirement care home industry cannot be trusted to provide safe let alone compassionate care. And it would be a dreadful mistake to continue to misuse public funds for private profits.
Given all these findings, is it any wonder that a lack of trust in the for-profit retirement/nsg home industry to provide decent care has gained traction in the public eye? This is not so much due to being frightened by Covid-19 as it is to the spotlight Covid-19 has shone on the dismal reality of life for our vulnerable elderly in long term care facilities and the ill-use of care-givers most particularly private for-profit operated homes.