Daphne Bramham: It's finally time to build a decent long-term care system
Daphne Bramham
2 hrs ago
© Veronica Henri
A woman visits with her mother through the window of a care
facility in Ontario.
It
was a disaster even before COVID-19 came along and blew open a
window into Canada’s failing long-term care system, revealing to
all what too many residents, families and experts have warned of
for years.
The
neglect and conditions at some are so horrific that one person I’ve
talked to described it as reminiscent of Romanian orphanages in the
1980s and 1990s under Communist dictator Nicolae Ceaușescu.
A
week ago, the military was again sent into an Ontario care home
owned by Sienna Senior Living, one of the largest private providers
of publicly funded care in Canada.
A
few days earlier, the province had replaced the administrators
after 22 residents died from COVID-19, and 102 residents and 40
staff tested positive.
This
followed last month’s deployment of Canadian Armed Forces to more
than two dozen care homes in Ontario and Quebec to provide
“humanitarian relief and medical support” for residents.
Some
had been left for days in soiled diapers, according to Brig.-Gen.
C.J.J. Mialkowski’s report on what was witnessed in five Ontario
homes.
Others
had bleeding fungal infections. Staff were aggressive and abusive.
Residents were sedated “when they are likely just sad or
depressed.” There were insect infestations, rotting food.
The
list goes on and on and prompted Ontario’s ombudsman to launch an
investigation into whether the province’s oversight is “adequate
to ensure the safety of residents and staff.”
Nothing
quite like that has happened in B.C. since the pandemic was
declared … at least, not yet.
It
doesn’t mean it won’t happen, although it’s fair to say that
B.C.’s reckoning began long before COVID. In 2014, it was the
first province to appoint a seniors advocate, and she has been
warning of problems ever since.
In
2017, in the largest Canadian survey of residents and families,
Isobel Mackenzie found nearly two-thirds didn’t get showers or
baths as often as they would like. One in four residents said they
never, rarely or only sometimes got help going to the toilet when
they need it.
They
were likely downplaying the problem because 82 per cent of family
members complained about their loved ones’ inability to have
baths and showers when needed.
Staff
shortages are at the root of the problem. So too are the lack of
government oversight, enforcement and penalties for failure to meet
standards.
Experts
suggest a minimum of 4.1 hours of care per resident each day is
needed. In B.C., care homes have struggled to meet a target of 3.36
hours, while other provinces such as Saskatchewan have no targets.
While
targets don’t guarantee good care, staff shortages inevitably
hurt vulnerable residents who either can’t complain or won’t
because they are afraid of reprisal.
The
epicentre of B.C.’s pandemic was the Lynn Valley Care Centre,
where the two-month outbreak began March 7. Twenty residents died,
52 were infected and survived, along with 26 staff.
Twelve
days earlier, Interior Health Authority appointed an administrator
after Retirement Concepts’ home to 112 residents in Summerland
didn’t meet the minimum provincial standards.
Last
fall, three other Retirement Concepts residences in Comox, Nanaimo
and Victoria were taken over by Vancouver Island Health Authority
after complaints about “significant” staff shortages and their
inability to meet minimum standards. Their administrators remain in
place.
Retirement
Concepts is B.C.’s largest contracted provider of long-term care
with 1,641 beds, a third of those now being run by appointed
administrators.
Operated
by West Coast Seniors Housing under the name of Pacific Reach
Seniors Housing Management, Retirement Concepts itself is a
subsidiary of Anbang Insurance Group, a company owned by the
Chinese government. Anbang’s purchase of the Vancouver-based
Retirement Concepts was approved by the federal Liberal government
in February 2017. A year later, the Chinese government took control
of Anbang after its chairman Wu Xiaohui had been arrested and
accused of fraud.
Staff
shortages have been described as epidemic at care homes because of
a complicated stew of factors: Ever-increasing demand as the
Canadian population ages, increased complexity of care, low wages,
and the fact that many workers are hired only part-time and have no
sick benefits.
To
pay the rent, that means that many worker have jobs at multiple
sites and, often enough, don’t stay home unless they are really
sick.
That
is what helped the coronavirus spread so quickly. And it’s why on
April 1 with COVID outbreaks at 19 B.C. care homes — it would
eventually spread to 37, with four outbreaks still active —
B.C.’s provincial health officer issued a six-month order. The
nearly 9,000 workers with jobs at multiple sites had to choose a
single site where the government would top up their salaries equal
to the collective agreements of publicly run facilities.
How
this happened dates back to 2002 when then-Premier Gordon
Campbell’s B.C. Liberal government removed “successorship
rights” from the Labour Code. It meant that when companies were
sold, the union agreements weren’t part of the deal.
That
opened the way for a slew of companies taking advantage of the
government’s willingness to privatize long-term care to fire and
re-hire employees. In some cases, workers’ pay was cut to $11 an
hour from $18, and sick leave gutted to three days a year from 15.
The
NDP government repealed the changes, but has kept in place
Campbell’s other legislation that allows jobs to be contracted
out.
The
B.C. Care Providers Association — the industry’s lobby group —
disputes the notion that wages are the problem. It filed a formal
complaint with the government last year, blaming regulations for
creating critical staff shortages.
Last
fall, it contended that B.C.’s standards for care aides are too
high and that 99 per cent of candidates from outside the province
are screened out after completing an $800 competency assessment.
According
to the association, almost half are told to do a 12-week refresher
course or a seven-month, health-care aide training program that
costs up to $4,500. The rest, it said, are directed to targeted
modules and short courses to address specific shortcomings.
The
Health Ministry disputes that. It says 30 per cent are registered
without further training.
But
given that the quality of care provided has been so starkly put on
view because of COVID, it’s likely that most people would agree
with Health Minister Adrian Dix.
“I
don’t think the solution is to lower those standards,” he said
at the time. “The challenge … is to train more care aides.”
Regardless,
the fact is that residents have not been getting the care they need
or want.
Just
weeks before that first Lynn Valley outbreak, Seniors Advocate
Isobel Mackenzie’s released an audit of care homes’ 2016-2018
financial statements.
More
than 70 per cent of the $1.4-billion annual cost of B.C.’s
taxpayer-funded, long-term care goes to corporations and Mackenzie
found the government has essentially been handing care providers
blank cheques.
For-profits
generated revenue 12 times that of the non-profit providers. Not
only that, for-profit homes had stiffed the government. They had
delivered 207,000 fewer hours of care than they were paid for.
But
they got to keep that money and more because regulations are vague,
non-existent or aren’t applied uniformly across the six health
authorities.
Mackenzie’s
report, A
Billion Reasons to Care
, points out that not only did companies not deliver what they were
paid for, they are allowed to claim building expenses at 20 per
cent of their revenues compared to the not-for-profits’ nine per
cent.
They
deducted mortgage interest rates considerably higher than market
rates, claimed double the depreciation rates as well as unexplained
lump sum payments to contractors working for affiliated companies,
and had unspecified management fees on top of administrative
expenses higher than non-profits.
Given
a long stream of critical reports, it’s not surprising that the
industry lobby group has called for Mackenzie’s resignation,
describing her as too “cosy” with the Hospital Employees Union.
But
it doesn’t change the facts highlighted by COVID, which has
killed far too many seniors in Canada. The system is a mess. Care
is inadequate and it’s no longer a question of whether something
needs to be done.
It
must be done. Rebuilding it from the ashes of COVID needs careful
thought, but the solutions have already been proposed. And it needs
quick action because Canada’s seniors haven’t got time to wait.
Twitter:
@bramham_daphne
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