Power, profit and politics in Ontario's home-care sector

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Ontario Deputy Premier and Minister of Health Christine Elliot announcing new legislation for home and community care on February 25, 2020. Image: Government of Ontario/Flickr

Does it seem contradictory that a company that frequently emails its employees to boast about organizing charitable trips to third-world "countries in need of medical care" also refuses to pay those employees decent wages?  

CarePartners, the for-profit company contracted by the Ontario government to provide home care services to the elderly and people with disabilities, is a poverty-wage employer that has recently engaged in union-busting.

In January, the company reached a deal with 3,000 of its home-care workers represented by Service International Employees Union (SEIU). But the settlement came  only after a year of bargaining with the employer, who wielded the threat of a lockout and temporarily imposed a concessionary contract on the workers.

The finalized collective agreement isn't spectacular. Personal support workers (PSWs) previously earning $16.50 and $19 per hour have received minor pay bumps plus a meagre increase in mileage compensation to 38 cents per kilometre from 37 cents. The union had been hoping for 42 cents. 

According to the new deal, the health-care workers will continue to work without a single paid sick day.

But such is the greed of health-care employers who make their profits at the expense of their workers. 

Who is CarePartners?

Like most of the major for-profit home-care providers in Ontario, CarePartners is privately incorporated, meaning that unlike publicly traded corporations, it is not required to publicly disclose its financial information. 

According to SEIU, the company told the union that it receives over $140 million annually from the province. 

A share of that is naturally allocated for profits, as CarePartners, like other businesses, views Ontario's aging demographic as an investment opportunity.  

Linda Knight, the CEO and owner of the firm, is a former vice president of the mutual funds division at the Bank of Montreal and a former winner of BMO's entrepreneurial award for women for her role at CarePartners. 

While her predominantly female workers struggle to escape poverty and face numerous health risks at work, Knight is also a recipient of BMO's Celebrating Women Award for "providing healthcare to third world countries."

While her workers go without a pension plan at work, Knight -- as quoted in BMO's 2008 annual report -- says she "values a clear plan for retirement."

Perhaps the most significant of Knight's roles is her chairing of Home Care Ontario -- the association that mainly represents for-profit providers. 

CarePartners did not return phone calls or emails requesting comment. Home Care Ontario also did not respond to requests for comment.

What does Home Care Ontario stand for?

In 2017, Home Care Ontario lobbied against certain pro-labour provisions of the impending Bill 148, Fair Workplaces, Better Jobs Act, the landmark labour rights bill eventually legislated by the Liberal government (after 14 years in power and in response to sustained pressure from activists). 

The association attributed the low unionization rate in the sector to "lack of precarious employment." However, as rabble.ca has documented, Ontario's home-care sector is plagued by poor working conditions and insecurity

Besides, the low rate of unionization in the home-care sector -- 31.8 per cent according to 2018 Statistics Canada data -- is in part due to the absence of successor rights during the late 1990s, when employers competed for government home-care contracts. 

Successor rights enable workers to retain unions when their employer loses a contract to another provider. But as home-care providers competed for contracts, the for-profit firms were often able to outbid unionized non-profits by lowering the cost of labour. 

When the contracts changed hands, the workers were left without a union and poor compensation. That led to the precarious employment conditions across the sector that prevail today, as evidenced by the ubiquity of part-time work, long work days and stagnant wages.

Home Care Ontario has also attacked card check certification and claimed organizing workers benefits unions but "not Ontarians." Card check makes unionization easier in contrast to the current system of voting to join a union, which can be manipulated by employers

The association welcomed the Conservative government's Bill 47, Making Ontario Open for Business Act, in November 2018, which rolled back many of the progressive legislative changes the Liberals had enacted a year earlier.

Of course -- Home Care Ontario's support for Doug Ford's anti-labour legislation isn't surprising. 

Health care is a business. 

Contradictions of the marketplace

Although home-care firms profited off the reforms of the Ontario government's restructuring in the 1990s, the contradictions of the marketplace play out in ways not always to the liking of its beneficiaries. 

Letting the private sector take over home care was a way for the government to reduce health-care spending. For-profit providers obliged by undercutting non-profits and lowering wages. 

But even as home-care budgets have increased to compensate for budget cuts in the costlier hospital sector, it has in some ways backfired for the sector. 

Home care is plagued by shortages of personal support workers (PSWs), due to lower wages compared to long-term care and hospitals. But even long-term care is facing a PSW shortage due to similar reasons, which goes to show how poorly home-care workers are paid. 

Home Care Ontario in turn has argued for more funding ($600 million in additional spending in 2020), ostensibly to improve compensation for workers and to serve more people. 

While funding increases are most certainly required, the organization's track record belies its stated intentions. In ideology and practice, Home Care Ontario's purpose is to maximize profits for its members -- on the back of workers and regardless of whether it's at the expense of care recipients.

After all, health care is a business.

And as far as government-funded businesses go, there isn't enough of a supply of cash for profits. But when the government's ability to generate revenue is hampered due to decades of tax cuts, it doesn't have the ability to raise spending to match the desires of home-care corporations.

That is itself a bit ironic considering that corporations at large lobby for and benefit from lower taxes

However, inadequate government funding can also be monetized by some home-care firms. When care recipients don't receive adequate care from the public purse, they are forced to purchase services from the private market.

According to the 2015-16 Canadian Community Health Survey, only 62 per cent of professional home-care and related services in Ontario were paid for by the government. The remainder were purchased privately through various means including out-of-pocket and insurance.

The private market includes many of the same providers who receive funds from the government, such as CarePartners. But it also includes home-care businesses who don't have government contracts (or not many of them), for whom insufficient public health-care funding creates opportunities. 

But care comes at a steep cost for workers, patients and caregivers. 

For publicly funded home care, the government-mandated minimum wage is $16.50. But that wage floor doesn't apply to privately purchased services, where providers can get away with paying the provincial minimum wage of $14 per hour. 

For patients, home care can be purchased for around $30 per hour. The prohibitive costs mean that it's unpaid caregivers among family and friends who pick up the slack. 

However, full-time caregiving for people with disabilities (including the elderly) is an arduous responsibility that extracts physical, mental and emotional labour while draining financial resources, as caring takes time away from paid work. 

No wonder then that 26.5 per cent of primary caregivers have suffered distress, anger or depression, as reported by Health Quality Ontario. 

But this number rises to 40 per cent among caregivers for "long-stay clients" -- people who receive home care for more than 60 days. 

Home care is big business 

As the global population ages, and seniors experience increasingly complex conditions as they live longer than ever before, the home-care sector is projected to expand rapidly. 

The U.S. market is expected to grow at a rate of seven per cent annually to US$173 billion by 2026, from $103 billion in 2018. 

The much smaller Canadian market was worth $5.4 billion in 2017, with 62 per cent of revenues generated by for-profit enterprises. 

In Ontario, as the government underfunds the hospital sector and discharges patients into the community "quicker and sicker," profit-seekers trot through the trail of opportunities. 

An aging population provides businesses with a consumer base, while a workforce of precariously employed women -- often racialized and new immigrants -- makes for easy prey.  

The business even has a franchise model, as companies such as Nurse Next Door offer their brand to entrepreneurs. 

In 2012, former Conservative premier Mike Harris, whose policies helped expand the market share of for-profit companies, bought a Nurse Next Door franchise to take advantage of "Toronto's favourable demographics," neatly encapsulating the mutually beneficial relationship between government and industry. 

Unfortunately, the political orthodoxy of private ownership remains strong. Even the federal government encourages entrepreneurship in the seniors care industry. 

Last week in Ontario, Conservative Health Minister Christine Elliott announced new home-care legislative reforms that, according to Ontario Health Coalition, will favour for-profit firms.

Doug Ford's health-care council includes Connie Clerici, the founder and executive chair of the for-profit firm Closing the Gap (represented by Home Care Ontario). 

The council also includes Shirlee Sharkey, CEO of the non-profit St. Elizabeth Home Health, which has been heavily criticized by CUPE for poor labour practices. 

Stuart Cotrelle, CEO of the for-profit firm Bayshore, is leading one of the Ontario Health Teams -- which will soon be running health care in the province.

Reversing privatization

France Gélinas, NDP health critic and MPP from Nickel Belt, says reversing the last 25 years of privatization would not be an easy endeavour. 

But a government dedicated to the task could take measures such as capping profits at a certain percentage and mandating higher minimum wages, she says. 

"The government has many resources at its disposal to influence the sector," Gélinas says.  

"You can make the sector attractive to not-for-profit providers. There are many things a government can do and put the focus on quality of care and satisfaction of patients."

However, profit-taking is one part of the problem. The other is underfunding. 

The Ontario Community Support Association, which represents many of the non-profit organizations in the sector, had called for additional annual funding of $489 million (2019 home care spending was $3.1 billion). 

The OCSA says the enhanced funding would enable providers to close the wage gap between the home-care sector and hospitals, serve more people and provide better services. 

Of course, this government's aversion to investment in public services doesn't provide cause for optimism for workers, patients or caregivers. But the problem goes deeper than Doug Ford.

Over the past few decades, provincial and federal governments of all stripes have adopted austerity policies: lowering taxes on corporations and wealthy citizens, and reducing services for ordinary people. 

As PressProgress reports, the effective combined federal-provincial tax rate for Canadian corporations dropped to 18.8 per cent in 2018 from 40 per cent about two decades ago. 

In Ontario, the current tax rate of 11.5 per cent is the second-lowest in Canada after Alberta's recent corporate tax cuts. The reduction from 14 per cent in 2010 was courtesy of the Liberals (the NDP pledged to increase it to 13 per cent in its 2018 platform). 

As corporations have been hoarding cash and feting their executives with lavish salaries and bonuses, Canadians are told to expect less services because of high government debt. 

Essentially, addressing problems in seniors' care is part of a larger problem. 

Albert Banerjee, research chair in community health and aging at St. Thomas University, told rabble.ca that most of "most of what goes on in [long-term care] homes is determined outside. It's where our tax money goes and how unequal our society is."

The same is true for home care.

Zaid Noorsumar is a journalist who has written for the CBC, The Canadian Press, the Toronto Star, VICE and Rankandfile.ca. He was rabble's labour beat reporter for 2019.

Image: Government of Ontario/Flickr​

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