Our Seniors Deserve Better
HOME ALONE The COVID-19 pandemic has laid bare the failings of Canada's long-term care sector, and the problems with for-profit care.
Seniors Advocate Review Slams For-Profit Nursing Homes
One month before an elderly resident of North Vancouver's Lynn Valley Care Centre became Canada's first recorded COVID-19 fatality, BC Seniors Advocate Isobel Mackenzie released a highly critical review of this province's $1.3 billion contracted long-term care sector.
Currently, 38 percent of BC's 27,000 funded long-term care beds are owned and operated by regional health authorities, 34 percent by for-profit companies, and 28 percent by not-for-profit societies.
The report, A Billion Reasons to Care: A Funding Review of Contracted Long-Term Care in BC, reveals for-profit homes are failing to deliver the level of direct patient care they're funded by taxpayers to provide, while at the same time underpaying and overworking staff.
For example, compared to non-profit facilities, for-profits spent $10,000 less (a whopping 24 percent) on care for each resident. They also failed to provide 207,000 funded direct care hours to their vulnerable residents. In contrast, not-for-profits delivered 80,000 hours of unfunded direct care in 2017.
Those numbers don't surprise BCNU members working in understaffed and underfunded long-term care facilities.
"When we were forced to work short, residents wouldn't get baths."
"I've worked in both types of homes on Vancouver Island," says veteran LPN Flo (Update is using a pseudonym to protect her identity). "And the differences are disturbing.
"When I worked at a large for-profit home on central Vancouver Island, the whole facility smelled of feces and urine. It was really gross. The stench hit you as soon as you walked in the door."
She says the overpowering odour came from the soiled cloths they used to wipe their residents. "They had to be washed and reused. We couldn't throw them away or management would get angry."
Unfortunately, it would appear that the multitude of other problems at for-profit long-term care homes across BC can be traced back to management's relentless drive to slash expenses and increase profits. This is too often achieved by reducing patient services and staff wages.
"I earned $2 to $3 an hour less there than at the not-for profit I was also working for at the same time," says Flo. "And when we were forced to work short, residents wouldn't get baths. I always provided the best care I could. But it's so hard when you're understaffed. That's just a fact."
Flo says that when she was injured while working at the for-profit facility, management blamed her, and then denied she had even been hurt while working at their facility.
"They were a mean, mean management team," says Flo. "They didn't care how staff members felt. And, in my opinion, they didn't care about residents."
She observed that the situation for nurses and residents was much different when she began working at a nearby non-profit, where she is now employed full time.
"For one, it is much cleaner, and there is no smell," she reports. "Management is very supportive. We're paid more and it feels like we're part of a team. Good care staff needs a good management team."
Before publishing A Billion Reasons to Care, Mackenzie and her staff conducted a systemic review of 174 contracted long-term care homes in BC. They examined industry contracts, audited financial statements, and expense reports for the years 2016/17 and 2017/18.
"Contracted long-term care homes cost taxpayers almost $1.3 billion a year," says Mackenzie, "so it's important to examine the levels of accountability, monitoring, and financial oversight. . . . The public needs to know whether [they] are meeting the needs of both residents and taxpayers."
However Mackenzie's research also exposed "a funding and monitoring system that lacks the type of accountability, openness, and transparency that both BC seniors and BC taxpayers deserve."
In addition, the Seniors Advocate revealed that for-profits pay an average of 17 percent less per hour for staff wages, and as much as 28 percent lower than the industry standard for care aides. Instead of paying their staff a liveable wage to care for their residents, these profit-obsessed businesses turn that money into profits.
Building costs, particularly capital building costs, is one area where private industry easily outspends the non-profits. Mackenzie points out that non-profits spend about nine percent of revenue on construction, compared to about 20 percent by the for-profits.
The report makes a range of recommendations to government. These include:
- Ensuring that funding for direct care be spent on direct care
- Monitoring for compliance with funded care hours that is more accurate
- Creating a clear definition of what constitutes profit in the industry
- Standardizing reporting for all care homes in BC
- Ensuring that revenues and expenditures for publicly funded care homes are available to the public.
BCNU President Christine Sorensen says the Seniors Advocate report, and the deadly coronavirus pandemic that has swept through nursing homes across Canada (accounting for more than 80 percent of Canadian COVID-19 deaths), confirm what frustrated members have been telling her for years.
"Our seniors, and the overworked staff who care for them, deserve so much more."
"It's outrageous," she says, "that for-profit homes failed to provide 207,000 hours of direct care that was funded by BC taxpayers in 2017." (see sidebar)
Sorensen says it's clear that for-profit facilities aren't delivering a safe level of care to their vulnerable residents. "The wage gap alone has led to a retention and recruitment crisis in many long-term care facilities," she notes. "Our seniors, and the overworked staff who care for them, deserve so much more. "
One of those seasoned long-term care nurses is Violet (not her real name). After emigrating from the Philippines, she worked as a care aide, licensed graduate nurse and RN at several Vancouver-area long-term care homes.
"Workload was always an issue at the for-profit facilities I nursed at," says Violet. "It became 'quantity' not 'quality' of care. And because we were always trying our best to finish our workloads, no matter what, we often could hardly get a break.
"It was always difficult to get all of our benefits, or to know what they were," she adds. "We sometimes had to beg for our benefits, like paid vacations.
"And it was hard to get paid overtime when we punched out 10 to 15 minutes late to finish our duties. But if we punched in late, even by one to five minutes, they deducted the time automatically.
"I was surprised to learn from the Seniors Advocate report that for-profits spend $10,000 less per patient annually than non-profits. I want the government to fix the problem and ensure they spend it on residents and staff instead of giving it to shareholders.
"It really bothered me to learn that for-profit homes are spending about $10,000 less per patient for direct care each year," agrees Flo. "I was shocked. That's a lot of money that should be going towards the residents' care and increasing staff pay.
"These companies are taking advantage of elderly, vulnerable people. It's stealing. It's elder abuse."
"And it's time for the government to force them to provide more transparency on how taxpayers' money is being spent at these homes.
"These companies are taking advantage of elderly, vulnerable people. It's stealing. It's elder abuse."
After working in both sectors, Flo and Violet agree that non-profits provide higher pay, additional benefits, and a much more positive environment for health-care workers and their vulnerable residents.
"If a new nurse asked me where to work," says Violet, "I would surely advise her or him to choose a not-for-profit facility, because they are focussed more on residents' and employees' well-being than they are on their profits.
Sorensen says the time for meaningful reform is long overdue. "The provincial government needs to act on the Seniors Advocate's recommendations. At the very least our contracted long-term care providers, who receive $1.3 billion from BC taxpayers annually, must deliver improved monitoring of care hours, tougher financial oversight, and more transparency. It's time to take the profit out of long-term care." •
Illustration by Caitlin Das
UPDATE (Summer 2020)