Commission probing long-term care says for-profit companies should no longer be in charge of care

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The independent commission that examined the devastating impact of the coronavirus on Ontario’s nursing homes says for-profit companies that build the facilities should no longer be in the business of providing care for residents.

A new model is needed, the commission says, one that would both attract much-needed investment from the private sector to develop new homes while restoring the public’s faith in the province’s stewardship of the elderly in long-term care.

For-profit companies own two-thirds of the province’s 626 long-term care homes. They make their profits on the “hotelling” of residents – providing accommodation, room and board.

Care should be the sole focus of the entities responsible for operating the homes, the commission says in its 322-page report released on Friday evening. “It is difficult to see how one can build a culture of excellence in care when care is only a means to profit on the infrastructure and hotelling.”

Long-Term Care Minister Merrilee Fullerton pledged on Monday to adopt many of the report’s recommendations, including urging every long-term care home operator to provide counselling services for residents and staff traumatized by the pandemic.

She said her ministry also plans to: improve its inspection process (the government stopped doing annual inspections of every home in 2018); address a chronic staff shortage by hiring more personal support workers; and build new homes to replace crowded, older ones with multibed wards.

“We are fixing a broken system,” Ms. Fullerton told reporters. “We will continue to modernize the long-term care sector that was neglected for so many years.”

The report says the government did not have a pandemic plan in place before the coronavirus made its way into nursing homes in March, 2020, and it failed to heed lessons learned during the first wave, resulting in a more punishing second wave. To date, 3,760 residents have succumbed to the virus.

Ms. Fullerton expressed interest in pursuing the commission’s call to separate real estate development from the care of residents.

“There are many positives with very few negatives,” she said.

The three-member commission, led by retired associate chief justice Frank Marrocco, was set up last July to investigate the spread of COVID-19 in long-term care homes, including the impact on residents, their families and staff.

The pandemic has undermined the reputation of for-profit homes, which experienced some of the biggest outbreaks and deaths, the report says. The commissioners interviewed more than 700 individuals and “repeatedly heard about the distrust of the private sector when it comes to providing care.”

The government should adopt the same model used to build hospitals, courthouses and other public-sector projects, the report says. Infrastructure Ontario, the province’s procurement agency, awards contracts to private-sector developers to construct the buildings. But the building and land is owned by the province.

Expanding such an approach to nursing homes would allow residents to receive care from a provider whose focus is “care, not profits,” the commission says in its report. It would also recognize that those skilled at raising capital for construction projects might not be the best ones to operate a home.

The commissioners were, however, careful not to paint all for-profit long-term care operators with the same brush. They make a distinction between “mission-focused” owners and those who are “profit-focused” – including real estate investment trusts, or REITs, and other entities listed on a public stock exchange.

“I thought the recommendation was quite clever,” said Samir Sinha, director of geriatrics at the University Health Network and Sinai Health System. “It might be a path forward so that we actually get better quality care when we don’t force for-profit providers to do what they don’t want to do and, frankly, what some of them can’t do very well.”

Donna Duncan, chief executive officer of the Ontario Long Term Care Association, which represents the for-profit sector, said her members look forward to the commission’s “private/public proposal” with the government.

“It will take all of us, working together, to rebuild older homes and build new capacity quickly to meet the needs of our aging population,” she said in a statement.

Lisa Levin, CEO of AdvantAge Ontario, a group that represents municipal and not-for-profit homes, is urging the government to adopt other approaches that can achieve the same goal, including making it easier for her members to raise construction financing to build more homes.

While the number of COVID-19 infections has dropped dramatically in nursing homes now that the vast majority of residents are vaccinated, they continue to struggle with the aftermath of the pandemic.

Many residents experienced what is known as “confinement syndrome,” as a result of being restricted to their rooms for extended periods without access to recreational programs or visits from family, the report says.

Ms. Fullerton hinted that some of those restrictions are about to end. “Changes are coming later this week that will improve residents’ quality of life and address their emotional well-being,” she said, without elaborating.

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