More than 10,000 people in long-term care homes (LTC) have died in Canada due to COVID-19, according to one metric. That number represents 73 percent of all coronavirus-related deaths in the country.

The numbers are damning. As of May, among 14 high-income countries, Canada had the highest proportion of COVID-19 LTC deaths. And it was predictable — a symptom of a decades-long, creeping pandemic: austerity vis-à-vis capitalism.

About half of Canada’s long-term care homes are privately owned. Half of those are operated by for-profit corporations. In Ontario, that proportion rises to 57 per cent, with 16 per cent of the facilities publicly-owned.

In Ontario, more than 20,000 LTC staff and residents have become infected, and more than 3,000 have died. This is not surprising when we dive into Ontario’s rugged policy past. The province’s long-term crisis of austerity began when funding was shifted from welfare infrastructure (“poorhouses”) towards private nursing homes under commercial for-profit provisions between 1940 and 1966. Those years saw widespread abuse and poor conditions. As for-profit chains grew their ownership stake in facilities, Ontario bolstered a rise in public funding for private, for-profit delivery of service through the Extended Care Plan, 1972.

During a suite of policy changes in the late 1990s, the Mike Harris-led Progressive Conservative government began to fund commercial for-profit providers on par with municipal, publicly-owned homes. For-profit operators had access to debt servicing. A competitive bidding process of adding new beds gave for-profit firms a competitive advantage given their easier access to capital funds and bidding expertise. And two-thirds of new publicly-funded beds were allotted to for-profit operators.

At the behest of the for-profit lobby to reduce “red tape,” one of the most regressive actions of the Harris administration was its elimination of a minimum care standard (2.25 hours of direct care per resident per day) in 1996 that had been introduced by the NDP after advocacy by health unions. This is why, today, for-profit homes in Ontario have the lowest staffing levels (2.63 hours) compared to municipal homes (3.5 hours).

Paradoxically, “red tape” has been weaponized to serve the interests of for-profit companies. The regulatory and compliance requirements of the Long-Term Care Act, 2010, privileged larger corporations that were able to sustain large, fixed costs of regulation. Smaller not-for-profit and public homes could not keep up. From 1971 to 2011, the proportion of for-profit chain-owned LTC homes in the province increased eightfold, from seven percent to 56 percent of all operating facilities.

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The line between public and private was also strategically blurred. Large for-profit chains sell their management expertise to municipal and not-for-profit homes that need to follow the province’s reporting requirements. These chains advise them on how to cut costs under regulatory and fiscal pressures. As not-for-profit and publicly-owned homes are increasingly managed by corporations, services like cleaning, cooking, security and laundry are contracted out.

The delineation of public and private is further complicated by how public pension schemes are invested in for-profit LTC chains. Take Revera, one of the largest transnational for-profit LTC corporations, with 500 properties across Canada. The Crown corporation Public Sector Pension Investment Board, which manages the pensions of the Canadian Forces, the RCMP, and federal public service workers, bought what’s currently known as Revera for $2.8 billion in 2007.

Revera faces at least 85 lawsuits from Canadian families alleging neglect. And just as Mike Harris sits on the board of Chartwell — a for-profit chain — another former Ontario premier, William Davis, sits as a director of Revera.

Residents in Ontario’s financialized LTC homes (operated by investment trusts and private equity firms) have been five times more likely to die from COVID-19 than those in publicly-owned homes. For-profit ownership is linked to inferior care, higher risk of mortality, and precariously employed workers. But as Canada’s population ages and complex medical needs rise, we cannot keep playing ignorant.

Long-term care residents are only as safe and healthy as the people who take care of them. Yet the pandemic has seen LTC workers being laid off, burnt out, and worst of all, dead. Workers who provide direct care (nurses and personal support workers) are overworked, sustaining high injury and abuse rates, increasingly deregulated and non-unionized, and are paid a fraction of their labour value. These workers are overwhelmingly racialized, women, and migrants — typically all three.

As Canada’s population ages and complex medical needs rise, we cannot keep playing ignorant.

Long-term care also takes a village: nutritionists, physiotherapists, housekeeping, food service, laundry, recreation, clerical staff, volunteers, and families are all central to care. Yet the cost-cutting model of homes owned and operated by private firms tends towards part-time, temporary, and casual workers instead of full-time, unionized workers with benefits.

The solution to staffing shortages and poor quality of care has been in plain sight since the 1990s: hire more nurses and personal support workers, and legislate a mandated minimum of 4.1 hours of direct care per resident per day. This gold standard has been advocated for by the Ontario Health Coalition, Canadian Health Coalition, numerous health unions, and health experts.

Care for elderly and disabled people must be universal, free, and publicly owned and operated. This can only be done if long-term care and home care are brought into the Canada Health Act. Standards of care must be budgeted and tied to federal dollars, and provinces and territories need to be mandated to provide adequate pay, sick leave, and benefits to unionized LTC workers.

Anything less than a complete overhaul of the profit-driven long-term care system would be a slap in the face of the families whose loved ones have died — not due to COVID-19, but by the state cowering to capital.

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Simran Dhunna is a recent Master of Public Health Epidemiology graduate from the Dalla Lana School of Public Health, and a community organizer in Peel region in Ontario. She has written for Briarpatch Magazine, Spring Magazine, and The Toronto Star. 

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