In the past, the majority of Ontario's nursing homes were operated by not-for-profit owners such as hospitals, charities and churches. But since the Ontario government invited bids for 20,000 new nursing-home bed licences nearly a decade ago, the balance has shifted as private companies able to arrange financing to construct new nursing homes were awarded two-thirds of the licences doled out.
Now, of the 621 government-funded nursing homes in Ontario, 353 facilities – 57 per cent – are owned by for-profit companies.
Ontario is the only province where for-profit companies hold the majority of licences. Outside the province, the proportion of for-profit ownership in long-term care ranges from zero in New Brunswick to about 35 per cent in Alberta.
But the move by the Ontario government to award more and more licences to private companies, usually big nursing-home chains, runs counter to a small but growing stack of research finding that not-for-profit nursing homes provide a higher level of staffing than their profit-driven counterparts with the same government funding.
A study of B.C. nursing homes published two years ago in the Canadian Medical Association Journal found that staff levels were higher in not-for-profit facilities and concluded that “public money used to provide care to frail elderly people purchases significantly fewer direct-care and support staff hours per resident day” in for-profit nursing homes.
Another B.C. study, published last year, discovered that not-for-profit nursing homes run by hospitals, local health authorities or in chains reported lower rates of acute-care hospital admissions for problems like bed sores and dehydration generally considered to reflect poorer quality of care than for-profit or smaller, stand-alone, not-for-profit homes.
An earlier study in Manitoba also found lower hospital admissions among residents of not-for-profit facilities than those residing in for-profit homes.
“If we know public money buys less through a for-profit system of nursing home care, that should give us some pause before proceeding down that line to a great extent,” suggests Kim McGrail, a researcher at the University of British Columbia's Centre for Health Services and Policy Research and an author of the B.C. studies.
