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“We need to act now and bring long-term care under the Canada Health Act or we will continue to fail our seniors and see more of them die preventable deaths.” — Larry Brown, NUPGE President
Ottawa (27 May 2020) — British Columbia and Ontario have both passed emergency orders that grant the provinces the power to temporarily takeover management at long-term care facilities. BC began centralizing staffing in the Lower Mainland in early April. Ontario issued a press release on May 20, indicating the emergency order will, “support the use of rapid, immediate and effective management alternatives to protect residents and staff within a home,” though it’s unclear if or when the government plans to act on the order. Alberta has also taken over day-to-day operations of 1 long-term care facility, though no emergency order like the one in British Columbia or Ontario exists as of yet in Alberta.
These orders should be made permanent, and other provinces should follow this lead. And we need to move Long Term Care under the Canada Health Act.
There is currently no national standard that governs how long-term care is delivered across the country. While much of the coverage has focused on seniors, it's important to note that many residents of long-term care homes are young and living with disabilities.
Ontario launches independent commission
The Ontario provincial government has also announced plans to launch an independent commission into the province’s long-term care homes to understand how more than 1,300 residents and counting have died of COVID-19. The Ontario New Democratic Party (NDP) is instead pushing for a public commission.
The 3 largest for-profit long-term care facilities – Extendicare, Revera, and Chartwell - have registered at least 4 present or former Conservative party staffers to lobby the provincial government on their behalf. It’s also worth noting that Michael Harris, formerly the Premier of Ontario from 1995 to 2002, is the Chair of the Board for Chartwell Retirement Residences.
"We support a long overdue, public commission that examines the state of long-term care in Ontario," said Larry Brown, President of the National Union of Public and General Employees. "But we're still living through the pandemic and a commission won't stop more preventable COVID-19 deaths. The government needs to take action now and recognize that long-term care is part of our health care system, and should therefore be extended the same protections afforded under the Canada Health Act."
Problems in long-term care well documented
NUPGE has been following the COVID-19 outbreaks at long-term care residences since beginning of the pandemic. In a previous story, NUPGE reported findings from The Star that 82 per cent of all COVID-19 deaths in Canada occurred at long-term care facilities. The story also contained findings from the Ontario Health Coalition that 700 deaths occurred in (privately owned) for-profit homes, 275 occurred in non-profit homes, and 82 occurred in publicly owned homes.
In their publication Re-imagining Long-term Residential Care in the COVID-19 Crisis, the Canadian Centre for Policy Alternatives states, "homes run on a for-profit basis tend to have lower staffing levels, more verified complaints, and more transfers to hospitals, as well as higher rates for both ulcers and morbidity. Moreover, managerial practices taken from the business sector are designed for just enough labour and for making a profit, rather than for providing good care." Under the current system, there are no safeguards in place to make sure private facilities are providing adequate care. In 2019, only 9 out of 626 long-term care homes in Ontario received resident quality inspections. At that rate, it would take 70 years to complete an inspection of every facility.
Staffing levels have been a major problem in long-term care for many years pre-COVID-19 and the pandemic has made it much worse. Indeed, the situation in Quebec grew so dire that the armed forces were deployed to cover the shifts of thousands of workers who had contracted COVID-19.
In her opinion piece in Policy Options, Dr. Margaret McGregor points to research that demonstrates that on average, for-profit facilities hire fewer workers than publicly owned and non-profit facilities. Fewer workers per shift translates to worse quality of care for the residents; no matter how hard a worker tries, they can’t complete the workload intended for 2 employees. Dr. McGregor also cites research that finds facilities with low staffing levels have higher staff turnover rates. All of this adds up to publicly owned long-term care facilities being a better place to work which in turn means residents receive a higher level of care.
Bringing long-term care under the Canada Health Act would protect workers and residents
It has been widely reported that most provinces have limited staff to working at one long-term care facility during the pandemic. What hasn’t been reported as much is the reason why staff are currently working at 2 or more facilities: because they can’t earn a living wage working at a single facility. For-profit long-term care homes prefer to hire part-time workers because it means they can get away with not giving them benefits like pharmacare or paid sick leave.
It’s well documented that inequality breeds more inequality. For many long-term care workers—many of whom are racialized and women—the consequences of missing a few days of work are dire. The annual BDO Canada Affordability Index found that, in 2019, over half (53%) of Canadians are living paycheque to paycheque, and 27% do not have enough for their daily needs. For many long-term care workers, a few days off work could mean not having enough money for groceries or rent. The for-profit system is what puts the burden on these workers to continue working while sick.
Emergency orders should be made permanent
The Montreal Gazette reported that Quebec Premier François Legault is considering nationalizing private long-term care centres. British Columbia and Ontario should extend their emergency orders and take over the running of long-term care homes permanently, with the other provinces and territories following suit. When British Columbia restricted long-term care workers to working in one facility, they began paying all workers the same wage as the public sector workers. This meant thousands of workers received significant raises, some seeing nearly $7 an hour more than their current rate.
Premier Ford has been quoted as saying, “I was the first premier in this entire country, and the first leader that I’ve seen right across North America, including the United States, to come out with my hand up saying, “I want a commission and I’m not going to wait two-and-a-half years like the Wettlaufer or SARS, that took three-and-a-half years to get answers, while people are dying.”
The Premier is absolutely right. We don’t need to wait for a commission—independent or public—to tell us that COVID-19 decimated long-term care facilities because for-profit employers too often neglected to properly staff facilities or pay workers a living wage. We can take action now by bringing long-term care under the Canada Health Act. Government subsidies to for-profit homes are propping up a system that negatively impacts workers’ physical and mental health and endangers the lives of everyone in the facilities.
“It shouldn’t take a pandemic to make the problem this obvious. These are the chronic failures of the system that workers and unions have been speaking out against for years,” said Brown. “We need to act now and bring long-term care under the Canada Health Act or we will continue to fail our seniors and see more of them die preventable deaths.”