Senior care homes, the private sector ripoff, death, working and living conditions,

The Parlimentary Budget Officer (PBO) concludes that it would cost $13.7 billion, a doubling of current spending, to implement a series of major improvements to our long-term-care (LTC) facilities across the country to improve the terrible conditions in a broadscale manner from the terrible state that the Covid pandemic revealed that they were in. The Trudeau Liberal government is planning on spending a pittance of what is needed, $600 million a year over five years in new money. All the public health experts are warning us that even if we defeat Covid, it won't belong before we have another pandemic as humans move increasingly into places where they have not lived because of population growth and modern transportation can spread communicable diseases globally in less than a day. Furthermore, there is only one way that you don't need LTC at the end of your life. 

Governments would have to double their spending on long-term care to implement a range of improvements proposed over the course of the COVID-19 pandemic, a new report from the Parliamentary Budget Officer says. The report says that public spending on long-term care across federal, provincial and territorial governments would have to increase by $13.7 billion at first, and that costs would grow at 4.1 per cent per year thereafter because of an aging population. In 2019-20, governments in Canada spent $13.6 billion on facilities-based long-term care.

The report was prepared at the request of Green MP Paul Manly, whose Motion 77 (M-77)proposes a number of changes to long-term care services in Canada. They include providing long-term care to anyone who needs it, increasing pay and benefits for long-term care workers in the private and non-profit sector, mandating four hours minimum of direct care per resident per day and increasing spending on home care to 35 per cent of total public spending on long-term care. ...

"The number of residents in long-term care is expected to rise due to population growth, population aging and changing socioeconomic circumstances of the elderly," the PBO report says. That rise in demand is expected to increase the cost of the changes to $17.5 billion by 2025-26, according to the PBO report. ...

The report estimates that 205,000 people in Canada lived in long-term care in 2019-20, with 52,000 on waiting lists. The report says most of the burden of any increase in spending would fall on the provinces. Of the $13.6 billion spent on long-term care in 2019-20, $13.2 billion was direct spending by provinces, says the report. ...

About $43 billion in health care spending is covered by the federal government — an amount premiers have said they want to see increased. They've called on the federal government to increase transfers by $28 billion, which would increase the federal share of health care spending to 35 per cent of the total.

In a statement, New Democratic Party health critic Don Davies called on the federal government to increase funding for long-term care.

"The PBO report makes it clear that there must be serious investment from all levels of government in long-term care," he said. "The federal Liberal government should help fund these changes through the Canada Health Transfer immediately."

Earlier this year, the federal government announced that it would spend $3 billion over five years to establish new standards for improved long-term care in Canada.

https://www.cbc.ca/news/politics/pbo-long-term-care-report-1.6128955

The Ombudsman's report on the collapse of long term care homes inspections during Covid delivers another devastating attack on the Ford PC government with no inspections of the LTC homes during the first seven weeks as the death toll mounted contributing to the deaths of 4,355 resdients and LTC workers. 

Ontario's long-term care inspection system was totally overwhelmed during the first wave of the COVID-19 pandemic, and the ministry overseeing care homes was caught unprepared and unable to ensure the safety of residents and staff, the province's ombudsman says. In a new report issued Thursday, Ombudsman Paul Dubé revealed there were no inspections in the province's long-term care homes for seven weeks in the spring of 2020, and no inspection reports issued for two months. That left facilities without proper oversight in a time where hundreds died in a matter of weeks.

"To effectively oversee a system, you have to have inspections," Dubé said at a Thursday morning news conference. "It was already strained before the pandemic, and it was not ready.

"The system wasn't there to enable inspections to happen in a safe and effective manner."

The ministry's lack of planning and preparedness was "unreasonable, unjust and wrong," the ombudsman found. His office has made 76 recommendations to the government. You can read the full report at the bottom of this story.

"The people of Ontario should be able to count on their public services to learn lessons from our experience with COVID-19 and be adequately prepared for the next threat to our collective health," Dubé wrote.

In a statement sent to CBC News, Stan Cho — the province's newly appointed minister of long-term care — said the province has accepted all of the ombudsman's recommendations, and "made progress on over half. COVID-19 was an unprecedented global event with devastating impacts on long-term care homes around the world," Cho said. "The lessons learned from this have ensured we take action by creating a new investigations unit that can refer charges when necessary, and introducing new monetary penalties for bad actors."

From March 2020 to April 2022, 4,335 residents died in Ontario's long-term care homes, as well as 13 staff members. 

For a seven-week period from mid-March into May, inspections stopped in the province, the report states — with many senior government officials totally unaware that on-site investigations were not happening. There were 720 COVID-related deaths in long-term care during this period alone.

NDP MPP Wayne Gates, the Opposition's critic for long-term care, called the report "very disturbing" during a call with reporters Thursday, as well as an "absolute failure" by Premier Doug Ford's government. "It was unreasonable, unjust and wrong," Gates said. "There needs to be immediate consequences because our loved ones deserve so much more than this."

Cho said the province plans to use the report to "ensure safe, high-quality care is delivered to seniors in long-term care homes across the province." The ombudsman's new report is not the first to denounce the province's handling of COVID-19 in long-term care, following damning reports from the Canadian Armed Forces (CAF) in 2020, and Ontario's auditor general in 2021. Given those other investigations were also underway, Dubé says he focused specifically on inspection and enforcement activities for his report. Though he launched the investigation of his own accord after the CAF report landed, his office also received 269 complaints and inquiries from families of long-term care residents, as well as from employees and other stakeholders in the sector.

According to the report, one ministry employee reported a "complete system breakdown" in the early weeks of the pandemic, with inspections stopping because the province had no plan to ensure the safety of inspectors. At the time, inspectors had no personal protective equipment or training on infection control. ...

Instead, inspectors were deployed to call and "support" homes, Dubé wrote. When inspections began again, only workers who volunteered were sent into facilities experiencing outbreaks, and inspectors often gave homes reduced penalties for non-compliance, or let them have months to remedy issues that were causing residents' serious harm.  "We saw many examples where inspectors used their considerable discretion to lower the default enforcement action that would otherwise apply, even in very serious situations and with little to no explanation," Dubé said in the report — effectively making sure homes were "let off quite easily" and given time to fix things instead of facing tough sanctions for serious issues, he later told reporters.

One such example laid out in the report was at Pinecrest Nursing Home in Bobcaygeon, which was the first facility in the province to experience a large outbreak of the virus. By the time it was declared over, 28 of the home's 65 residents had died. An inspection found a litany of problems, like staff and residents sitting together and not wearing masks, staff not changing their gloves while moving throughout the home, not putting on or removing protective equipment properly, and a recently hospitalized resident returning to the home and being put in a room with another resident, even though there were other rooms available. In this situation, policy recommended the ministry revoke the home's licence and consider installing an interim manager while it shut down, the report says. Instead, inspectors gave the home three months to train staff and make sure issues were fixed.

https://www.msn.com/en-ca/news/canada/ontarios-ltc-inspection-system-fel...

On CBC Rundown on the CBC News Network, Professor Vivian Stamatopoulus, a long term care (LTC)home researcher and advocate, that she was not surprised by the Ombudsman's findings because she and many others "had been screaming from the rooftops about what was happening during the first two months of the LTC home Covid crisis about the collapse of LTC home inspections" and resulting thousands of deaths. She feels the report backs up what the problem is but does not go far enough because it does not tackle the elephant in the room, the failure of private LTC homes to protect their residents and workers. She notes that all evidence, whether provincial, national or international shows clearly that the for-profit model is problematic when it comes to care because these homes do not have enough workers, have more preventable injuries, greater hospilizations, and more deaths than non-profit homes. For example, "A CBC Marketplace data analysis found Southbridge and Rykka homes had higher death rates than other for-profit homes in Ontario. All of those companies had death rates higher than the non-profit and municipal categories. Non-profits had an average of 2.8 deaths per 100 beds while municipal homes averaged 1.4." (https://www.cbc.ca/news/canada/nursing-homes-covid-19-death-rates-ontari....)

Professor Stamatopoulus noted that the Ombudsman's report did not get into the issue of high private sector LTC deaths, but should have. She also pointed out despite all of the identified problems in private sector homes, the PC Ford government has rewarded these homes with extensions of their operations for another generation. 

The BC seniors advocate is calling for fundamental reform in the provinces long term care facilities where private sector companies increased profits by 101% since before Covid yet delivered 500,000 fewer care-hours than funded for, while non-profits delivered 93,000 more hours  than they were funded for. The private sector LTC homes also spent 42% on capital building costs At the same time, "the cost of a publicly subsidized long-term care bed through a private operator has jumped 35 per cent in the last five years", costing the taxpayer "$2 billion a year to private sector operators" that operate 65% of long term care facilities. She concluded "there needs to be more "extremely uncomfortable conversations" with care providers, given that the province and taxpayers are the ones paying the bills."  She noted that the "fragmented, lacking in transparency" system had been inherited from previous governments. This ripoff needs to end by converting the private sector homes to non-profit homes. This is especially true when combined with information from Ontario where death rates at private sector long term care homes is two to three times higher than in the non-profit sector,  the quality of care is much lower, the staffing and working conditions, as well as the living conditions for residents, are much worse (see last post  for details of Ontario long term care homes).

British Columbia's advocate for seniors is calling for "fundamental reform" in how the province funds contracted long-term care providers, after a study found for-profit facilities routinely under-delivered care for the funding they received.

Isobel Mackenzie said a review of financial records from 2021 and 2022 shows that long-term care facilities operated by for-profit companies delivered 500,000 fewer care-hours than they were funded for by the province.  In comparison, facilities run by non-profit societies delivered 93,000 more care hours than what they were funded to provide.

"The funding formula that's supplied is the same," Mackenzie said. "And this is the result from that funding formula, where we are rewarding — if you view profit as your reward — not spending on the care." The province transfers about $2 billion a year to contracted operators to provide long-term care beds, which Mackenzie says is one of the largest annual fund transfers on the provincial budget.

There are about 28,000 subsidized long-term care beds in B.C., 65 per cent of which are provided by contracting out to private operators who may be for-profit companies or non-profit societies. The latest report finds that the cost of a publicly subsidized long-term care bed through a private operator has jumped 35 per cent in the last five years, and the province needs to make sure that taxpayers' money isn't allowed to "drift" to paying for other costs beyond providing care. "That's why it's very important for us to ensure that … the money being spent in these facilities is being done in a way that provides the best possible care for the residents who live there and good value for the public who's paying for it," Mackenzie said.

A review of 181 facilities contracted to provide long-term care showed profit in 2022 increased 113 per cent over five years, while expenditures such as supply costs and staffing compensation rose 61 and 33 per cent respectively. Mackenzie said the "pronounced" pattern of under-delivery by for-profit companies in long-term care was even more concerning given that 80 per cent of the total profit made during the same period went to just 20 per cent of the facilities — almost all of them operated by for-profits.

She said there needs to be more "extremely uncomfortable conversations" with care providers, given that the province and taxpayers are the ones paying the bills. "We're not partners in the delivery of this care," she said. "This is not an equal relationship. Government is the regulator and the funder. We have a responsibility to the people who live there, and we have a responsibility to the taxpayers. Those are our primary responsibilities."  The advocate said in the report that while there have clearly been efforts to improve long-term care, the underlying issues have prevented the province's investment from making needed improvement.

In response to the report, the Hospital Employees' Union said in a statement that it agrees with Mackenzie's call for fundamental reforms. The union said such reforms should reintroduce standard wages, benefits and working conditions at long-term care facilities that were promised by the NDP in 2020.

"This government has inherited a long-term care system that is fragmented, lacking in transparency and failing to deliver on the common working and caring conditions that our seniors and our members deserve,” the union statement said. “But the solutions are also clear.

“Our seniors’ care system is pushed to the limit, and we have a responsibility to ensure public money goes to front line care," the statement said.  Mackenzie's review found not-for-profit facilities spent about 25 per cent more per resident on direct care when compared with for-profit care. For-profit facilities spent 42 per cent more per bed than their non-profit counterparts on capital building costs, the report said. "The public is entitled to know how their money is spent," Mackenzie concluded in the report. "Residents and their families are entitled to access information about revenues, expenditures and delivered care hours for their facility."

The report also made a number of recommendations, including on ways to ensure that funding for direct care goes only towards that purpose and cannot be shifted to fund other operational costs. It also suggested a more standardized definition of "what is counted as profit" be determined to clear up if costs such as mortgages, head office allocations, management fees and executive compensation provide for-profit long-term care facilities with additional revenue. "A greater understanding of the details of these expenses is required to begin to address the issue of what expenditures will be allowed, what are reasonable and equitable building costs and what is a reasonable profit," Mackenzie said in the report.  She also called for a more accurate tracking of care hours, since the current self-reporting system "is vulnerable to inaccuracies."

https://www.timescolonist.com/bc-news/report-from-seniors-advocate-blast...