Even before COVID-19 struck, the rising costs of long-term care threatened to overwhelm governments, taxpayers and families. Now as deaths mount, voices on the left are demanding that Ottawa nationalize nursing homes. This would be a mistake.
Apart from being expensive and invasive, there is insufficient evidence to justify eliminating private-sector nursing homes. Long-term-care insurance may be the better way to go. But before any government acts, we need more data.
It’s horrific that people living in long-term care facilities account for eight in 10 novel coronavirus-related deaths in Canada. Many of the deaths occur in homes that are privately run.
“We know the system’s broken,” Ontario Premier Doug Ford acknowledged earlier this month. “We’re going to have a complete review.”
The Canadian Labour Congress doesn’t need to wait for any review. It wants long-term care to be brought under the Canada Health Act and for-profit care facilities banned.
“The tragedy we’re seeing is a direct result of the move to a for-profit model,” CLC president Hassan Yussuff stated. ”Long-term care must be offered as a public service.”
York University sociologist Pat Armstrong, who has studied long-term care for many years, agrees. “We have to ensure that our public money goes to care rather than to profit, and to democratic decision making rather than shareholder decision making.” she told the Commons health committee Wednesday.
But Michael Nicin, executive director of the National Institute on Ageing, says proof that one ownership model is better than another at keeping residents safe just isn’t there.
“At the moment, we’re seeing ideological fervour more than we are reasonable discussion on available data,” he said.
Do for-profits consistently underperform non-profits in protecting residents? Are chains better or worse than independent operators? How much does the composition of the board influence outcomes? What about the age and upkeep of the building? All of this requires study, not knee-jerk calls to nationalize.
Besides, “the key is not to change the ownership of nursing homes,” Mr. Nicin says. “The key is to reduce our reliance on nursing homes, or to have as few as possible, as Denmark and other countries have” by focusing on home care and other community supports.
There is also the question of the federal government intruding in an area of provincial responsibility. Quebec and other provinces would flatly reject any proposal to regulate long-term care under the Canada Health Act, as Prof. Armstrong and Mr. Yussuff advocate.
Those who study the long-term care system have been warning for years – decades, really – that Canada is ill-equipped to meet the growing needs of our aging population. The system would have collapsed long before now were it not that three-quarters of all long-term care is provided for free by family members, usually women.
For those who require nursing homes, costs are kept in line by paying personal support workers little more than minimum wage for the difficult, dangerous work they do. Almost all PSWs are women and many are immigrants. Because many are hired only part time, they often work in two or more homes, which may have contributed to the spread of COVID-19.
Long-term care costs in Canada are projected to more than triple from about $20-billion to $70-billion over the next 30 years, the equivalent of 20 per cent of personal income-tax revenues. Canada’s low fertility rate means that every year there are fewer young workers available to provide the taxes and free family care needed to sustain the older population. The coronavirus pandemic has revealed and accelerated an coming demographic tsunami.
Governments and institutions can study the nationalization of long-term care if they wish. But they would be better off examining an alternative that several countries, including Germany and Japan, have already adopted: long-term-care insurance, in which everyone pays into a fund that provides long-term-care services for those who need it.
In the meantime, we’re going to need to increase the pay of personal support workers in care homes who generally earn far less than PSWs in hospitals.
This pandemic has forced us all to face a harsh truth: We don’t think about, care about or spend as much money on the frail elderly as we should. But a rush to nationalize nursing homes isn’t likely to make anything better.
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