In long-term care facilities — also referred to as nursing homes — experts recommend a minimum care standard of 4.1 hours. The number refers to the direct interaction between caregivers and residents per day.
“I think [the 4.1 hour care standard] is very important. It’s been proven by several studies that it’s really the minimum that people should be receiving per day,” says Melanie Benard, a director at the advocacy group Canadian Health Coalition.
According to the CHC, no province has an established guideline that meets that minimum standard. Jurisdictions such as Ontario — where the quality of care is marked with high levels of violence — do not have a standard at all.
Other provincial guidelines fall below that standard. For instance, CHC points out that Manitoba’s 3.6 hours of minimum care includes time spent on non-care related tasks such as staff meetings, training and administrative tasks.
“We specify direct care because sometimes the calculations are based on any type of interaction for the residents, including things like doing laundry,” Benard says. “And that is not direct care.”
Navigating provincial autonomy
While health care is a provincial matter, Benard says the federal government can provide leadership through adequate funding for Canada Health Transfers and setting national standards.
The NDP is the only party to call for a national care standard, but it hasn’t committed to specifics.
Malcolm Allen, former NDP MP and current candidate for the Niagara Centre riding says that a federal NDP government would have to establish a national standard in concert with the provinces.
“We want to make sure that when we sit down [to negotiate] and we have that standard written, everybody’s on board across the country saying, ‘Yes, we’re going to do it,'” he says.
Care standards and the profit motive
Any improvement in the direct care provided to long-term care residents hinges upon the level of staffing. However, staffing is also contingent on the ownership of homes.
Currently, 44 per cent of long-term care homes in Canada are owned by for-profit operators. In provinces like Ontario, where 58 per cent of facilities are for-profit, the government subsidizes all homes.
The CHC’s report on seniors’ care cites research from several provinces that indicates that government-owned and non-profit homes provide better care as they can afford to hire more staff. Conversely, for-profit providers tend to cut costs by hiring less staff.
The overburdening of staff creates poorer outcomes not just for seniors but also for a largely woman-dominated, immigrant workforce that faces burnout, high levels of injury, and unsafe working conditions.
Allen affirms the NDP’s stance that health care should be delivered without the need to make a profit.
“It’s pretty simple arithmetic. [Having for-profit operators] simply costs additional funds because somebody has to drag a profit out of that,” he says.
“And if they don’t drag it out by [the government] giving them more money, then they’ll find ways to cut things around the edges so that they can do their business.”
According to Statistics Canada, for-profit companies in the residential and long-term care sector had a nine per cent operating profit margin in 2015.
Rising costs
The case for public ownership is made stronger by the cost projections of last week’s National Institute of Ageing report, which estimates long-term care (including home care) costs would more than triple by 2050 to $71 billion annually from the current $22 billion.
Benard says public ownership is one way of addressing costs and delivering care more efficiently, while also emphasizing better allocation of resources.
“The focus is always on how much things will cost but we also have to look at how much we’d be saving as well,” Benard says.
“For example, we’re already spending inordinate amounts of money by keeping people in hospital when they are ready to be transferred to long term care facilities or sent back home, but they can’t access the home care they need [because of lack of funding]. So they’re sent back to hospitals [which is more costly].”
A holistic approach
The CHC has called for a national care strategy for seniors that is based on a holistic approach. Targeted spending on seniors alone is not sufficient, it says, if the overall health care system is not well funded.
Its recommendations include better federal funding, a national pharmacare plan, affordable housing for seniors and extending the principles of the Canada Health Act to long-term care and home care.
The CHA makes federal funding for provinces contingent on public administration, accessibility, comprehensiveness, universality and portability.
“We’re calling for the criteria from the Canada Health Act to be applied to seniors care as well,” Benard says.
When asked if an NDP government would consider amending the CHA to ban for-profit delivery of long-term and home care, Allen said the party would seriously need to consider the idea.
“We need to take a good hard look at that and see what are the tools we can use to get ourselves and get the provinces to build the public option over time,” he said.
One of those tools would be educating the public. In his experience, people are generally not aware of profit-making in long-term care.
In Ontario, Allen says, people go through the local health unit to access care and don’t interact directly with private companies.
“We have to help folks understand the difference,” he says. “Because when they know that, they’ll go, ‘Woah! Why are they making money off the backs of my mom and dad who need to live in a long term care facility?'”
Zaid Noorsumar is rabble’s labour beat reporter for 2019, and is a journalist who has previously contributed to CBC, The Canadian Press, the Toronto Star and Rankandfile.ca. To contact Zaid with story leads, email zaid[at]rabble.ca.
Image: beejees/Pixabay
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