Residents of for-profit nursing homes in Ontario are much more likely to be infected with COVID-19 and die than those living in non-profit, publicly-operated homes, according to The Star.
A Star analysis of public data on long-term care homes shows that facilities have been affected by epidemics at about the same rate, regardless of ownership. But once COVID-19 became a nursing home, the results were much worse for residents of for-profit homes.
In homes where an epidemic has occurred, residents of for-profit establishments are approximately twice as likely to catch COVID-19 and die than residents of non-profit organizations, and approximately four times more likely to be infected and die from the virus than those in a municipal house.
“I’m not at all surprised,” said Sharleen Stewart, president of the SEIU Healthcare union, which represents personal support workers and other front-line workers in for-profit and not-for-profit care homes.
Stewart said that based on the experience of union members, for-profit nursing homes use more part-time and casual staff and have lower overall staffing levels than non-profit houses. She said that non-profit homes have better infection control and that for-profit homes are less prepared to handle epidemics. “This is old news for us. “
Judy Irwin, spokesperson for the Ontario Long Term Care Association (OLTCA), which represents about 70% of Ontario long-term care homes of all property types, questioned Star’s analysis, stating that “it will take much more rigor in both the accuracy of the data and the analysis before we can draw conclusions. It would not be responsible for embarking on a vague interpretation of incomplete data at this stage. “
Long-term care is Canada’s first line of battle against COVID-19, accounting for up to four in five deaths. In an international study released earlier this week, Canada had the highest proportion of long-term care deaths from COVID-19 among 14 countries. These deaths occur at a disproportionate rate in for-profit homes.
The Star’s analysis is based on a house-by-house database of each COVID-19 outbreak in Ontario on Friday morning. Using it, we took the total number of beds in long-term care homes as reported to the province and sorted them by property: for-profit, not-for-profit and municipal. Then, using the number of cases and deaths reported in each household, we calculated the infection and mortality rate per 100 beds for each type of owner.
The results have been striking.
A resident in a for-profit home was approximately 60% more likely to get COVID-19 and 45% more likely to die than a resident in a non-profit home. A for-profit resident is also about four years old. are more likely to get COVID-19 and four times more likely to die than a resident of a municipal house.
Nonprofit and municipal homes have also suffered serious epidemics, including Seven Oaks, a facility managed by the city of Scarborough, which has 108 cases, including 40 deaths among its 249 beds, and Isabel and Arthur Meighen manor house. the Salvation Army, where there have been 103 cases, including 42 deaths for 168 beds.
Overall, however, infection and death rates are higher in for-profit homes.
The province has recorded outbreaks – at least one laboratory-confirmed case of COVID-19 in a resident or staff member – in about one-third of its 651 long-term care homes, and for-profit, not-for-profit homes profit and municipal governments were affected at approximately the same rate.
But where COVID-19 is present, for-profit homes have performed better in fighting the epidemic and preventing death: for-profit establishments with epidemics have recorded 16 cases per 100 beds, compared to eight in non-profit organizations and four in municipal establishments. Also, there were four deaths per 100 for-profit beds, compared to two per 100 beds in non-profit organizations and one in municipal establishments.
Global, for-profit homes account for less than 60% of long-term care homes in the province, but are responsible for 16 of the 20 worst epidemics.
Star data uses the cumulative total of cases and deaths in each epidemic since the start of the pandemic. This approach differs from the figures released daily by the Ministry of Long-Term Care. The ministry says its counts refer to “active” cases and therefore excludes both resolved deaths and illnesses from the current count for each household. The ministry says its data is intended to be a snapshot of time, not a record of the total number of infections for the duration of an epidemic.
Irwin, with the OLTCA, said that “the type of home ownership is irrelevant to the COVID-19 pandemic in long-term care.”
All types of homes have been affected by COVID-19 “and each has had a different experience of the disease depending on a variety of factors. These include factors such as the fact that the home has aging infrastructure and shared toilets and / or rooms with 4 beds, the situation of staff before and during the outbreak and the speed with which households have was able to access PPE and staff support when they need help. , ” she said.
Staffing levels in long-term care homes are not being made public and the Star has not been able to verify whether staffing levels are generally lower in for-profit homes. The claim has also been presented in court records, applications for labor relations boards and academic research.
More than 190 residents of the 233-bed Orchard Villa long-term care home in Pickering have been infected with COVID-19, making the private home one of the highest infection rates in Ontario. To date, 66 residents have died from the virus – the highest number of deaths in a long-term care home in the province.
A Star investigation released last week revealed that the house has a long history of citations for failing to comply with provincial regulations.
Orchard Villa is owned by Southbridge Care Homes, which operates 37 long-term care homes and retirement homes in Ontario. Orchard Villa executive director Jason Gay did not directly address the Star’s findings, but in an email response to questions, COVID-19 is “an aggressive virus, particularly in the elderly who are immunocompromised or having preexisting conditions. “
“The impact on the entire long-term care community, in our home and for our residents, families and staff, is difficult and tragic,” he said. “Right now, we are focused on the safety and well-being of our residents and staff.”
The highest total number of resident infections – 209 – was reported at Forest Heights Revera, a 240-bed for-profit facility in Kitchener. There were 45 deaths at the facility – the fourth highest total on Friday.
The home is owned by Revera Long Term Care Inc., a large industry player that manages more than 500 nursing and retirement homes in Canada, the United States and the United Kingdom. Revera is owned by PSP Investments, the federal government’s pension fund manager. Service, the Canadian Forces and the Royal Canadian Mounted Police.
Invited to respond to the Star’s findings, Revera issued a press release criticizing “media reports attempting to link the long-term care ownership model to the deaths of COVID-19 residents.”
“This focus on an issue that is not at the heart of the challenges facing the system becomes a distraction from discussions on the real reform needed,” said Larry Roberts, spokesperson for Revera. “Until recently, long-term care has not been a high priority, and our most vulnerable citizens have paid a heavy price.”
“We must close the priority gap between acute care (eg hospitals) and chronic care (long term),” he said in the statement, prioritizing PPE and increasing the funding to ensure that the levels of compensation and staffing in long-term care are equal. to those in hospitals.
The Camilla community of care in Mississauga and the Altamont community of care in Scarborough have some of the highest infection rates in the province, with both homes reaching around 80%. They also have the second (48) and third (47) highest number of deaths, respectively. Both facilities are owned by Sienna Senior Living Inc., a publicly traded company that manages 70 retirement and long-term care homes in Ontario and British Columbia. and last year reported net earnings of $ 7.5 million. In its latest report to shareholders, the company said it has generated total returns to shareholders of more than 250% since its IPO in 2010.
“We followed provincial guidelines and protocols before and during this pandemic,” Siena spokeswoman Natalie Gokchenian wrote in an email.
Gokchenian questioned the methodology of Star, saying that deaths should not be included in the total of confirmed cases and suggesting that it would be more appropriate to use the active case metric, which excludes both deceased persons. COVID-19 and those that have recovered.
“The data you have provided is not correct,” she wrote. “It is premature to draw conclusions about industry-wide results. Statistics are collected in different ways and not all of them are up to date. “
Gokchenian said Sienna plans to hire independent experts to conduct an internal review of the company’s practices and protocols during the crisis. The company also suggests that the provincial government should undertake a sector-wide review.
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Earlier this week, the Ontario Health Coalition did its own analysis of outbreaks and deaths in long-term care homes and came to a conclusion that supports the Star’s findings: for-profit homes are far worse than non-profit organizations and managed by the municipality centers.
“We cannot say for sure what the causal link is with higher mortality rates in for-profit homes, but the key is staffing,” said executive director Natalie Mehra. “(For-profit houses) have lower numbers, their wages and working conditions are worse. Although there was a critical staffing crisis in all types of homes before COVID-19, now that is beyond words. “
The provincial decision to limit staff to working in one house has exacerbated the problems of for-profit organizations, she said.
“Since staff have to choose a house to work, it is very likely that they have chosen a house where they have better wages and better working conditions. And this has an impact on homes with the most precarious and fragile staff, who are really in very serious trouble now. ”
All types of long-term care homes in the province have similar budgetary constraints: they receive funding from the province under the same formula and their costs are capped at the same level, said Mehra. But for-profit homes usually extract profits from their budgets, while non-profit and municipal-run homes often supplement their budgets with fundraising and local taxes.
“The differences are profound,” she said. In non-profit settings, “there are more staff and they can provide more hours of care to each resident.”
Staff working in for-profit homes have also been disproportionately affected by coronavirus: home-based for-profit staff currently account for almost 70% of all infections in front-line healthcare workers.
To date, the Eatonville Etobicoke Health Center has recorded 104 cases of COVID-19 among its staff, the most in the province. The for-profit home also has one of the highest infection rates among residents with 182 cases reported in the 247-bed facility. The Hawthorne Place health center in North York has the second highest number of staff cases with 83.
Both houses are owned and managed by Rykka Care Centers, a Markham-based subsidiary of Responsive Group Inc. The company also operates Anson Place Care Center in Hagersville, where 27 deaths from COVID-19 have been recorded. This home also has one of the highest infection rates in Ontario.
Linda Calabrese, Vice President of Operations for Responsive Management Inc. and spokesperson for Responsive Group, said that all long-term care homes receive government funding in “envelopes” that are “complex, highly prescriptive and strictly regulated and supervised ”.
“Every dollar spent on nursing and personal care, programs and food is spent and, if it is not spent, is returned to the province,” she said.
Calabrese added that many of the company’s homes where outbreaks have occurred “go around the corner” and many staff have been allowed to return to work. She said the company is seeing “residents fully recover” and hopes the outbreaks at Anson Place and Eatonville can be declared soon.
The reactive group was named in a proposed class action filed in Ontario Superior Court two weeks ago, alleging that the company had not “properly and adequately planned and responded to the COVID-19 pandemic” and, therefore, “the virus has spread to many of their homes,” says the claim.
Among the allegations in the statement, residents who tested positive for the virus were kept in the same spaces as healthy individuals, houses were understaffed, had not provided enough personal protective equipment and performed appropriate screening.
The trial has not yet been certified by a judge.
In a statement to The Star’s Betsy Powell, the company said it “recognizes the right of individuals to voice their concerns through litigation.”
“It is equally important that all parties to these matters have the opportunity to present information to the court and that it be thoroughly investigated and considered. The court will then have to determine whether a concern deserves to be certified, “the company said.
Pat Armstrong, a professor of sociology at York University who has been researching long-term care in Canada for more than 20 years, said she was not surprised by the Star’s results.
The main reason, she said, is the incentive for for-profit companies to cut labor costs. Her research found that for-profit homes tend to have lower numbers, lower wages, and greater dependence on part-time and casual workers, she said.
“Managerial practices from the corporate sector are designed to provide just enough labor and profit, rather than to provide good care,” wrote Armstrong and co-authors in a report released last month. last by the Canadian Center for Policy Alternatives. “These include paying the lowest possible salary, and hiring part-time, casual and those defined as self-employed to avoid paying benefits or providing other protections.”
Armstrong said that the expansion of privatized long-term care dates back to the days of former Progressive Conservative Prime Minister Mike Harris in government when he cut minimum staffing levels and put in place an appeal process competitive tenders for public procurement.
Harris is currently chairman of the board of directors for Chartwell, one of the largest private owners of retirement and long-term care homes in the province.
Laura Tamblyn Watts, President of CanAge, an seniors’ organization, said government needs to understand the reasons for the disparity in COVID-19 infection rates and deaths between for-profit and not-for-profit homes .
“Are these staffing levels? Is it staff training? Is it the availability of PPE? Is it something else? It’s not just about whether they are making money or not, but what is going on in every household that seems to be having these results and we need to learn what it is quickly. “
The main problem, she said, is the lack of national standards.
“If we had national standards for quality of care, funding for care, funding for staff, then ultimately whether or not it is provided by a for-profit or not-for-profit organization is not as important, “she said. “What is important is that everyone who provides care meets the standards.”