It is not acceptable at any time that the province simply hands over the funds and refuses to take any responsibility for what the operators do with it. The COVID-19 pandemic and its impact on seniors makes this situation an emergency.
By BARBARA BILEY
The neo-liberal anti-social measures that have been implemented by successive governments over the last several decades have resulted in a crisis in seniors’ care in many parts of the country. The proliferation of private seniors’ homes, many replacing what were public homes, has created a perfect storm, which has been activated in all its fury with the current COVID-19 pandemic.
A report issued on February 4 by the Office of the Seniors Advocate, entitled “A Billion Reasons to Care,” proved, through analysis of the revenue and expenses of these homes, that a significant portion of the public funding that is given to private-for-profit operators specifically for care instead becomes part of the profit taken by the owners. This profit is generated by denying care to the seniors as well as overworking and underpaying the workers. Funding from the province accounts for $1.3 billion of the $1.4 billion in revenue the contracted homes generate annually. The balance of the funding comes from seniors in care, who pay 80 per cent of their after-tax income to a maximum of $3,278.80 per month, as well as from fund-raising and payment for outpatient services such as Adult Day Care programs, bathing for people from the community, etc. The report analyzed only privately owned and operated homes, both those operated by not-for-profit societies and those operated by private for-profit operators. The report did not analyze the homes operated by the Province through the regional Health Authorities.
Among the findings were that “the not-for-profit sector spends 59 per cent of its revenue on direct care compared with 49 per cent in the for-profit sector,” that “the for-profit sector failed to deliver 207,000 hours of funded care and the not-for-profit sector provided 80,000 more hours of direct care than they were funded to deliver,” and that “the for-profit sector spends an average of 17 per cent less per worked hour, and wages paid to care aide staff in the for-profit sector can be as much as 28 per cent below the industry standard.”
Over the last decades of the 20th century, a concerted and successful effort was made by health care unions to ensure that all workers were compensated at the same level, whether they worked in hospitals or seniors homes, both private and public. Prior to 2002 the vast majority of workers in hospitals and almost all seniors’ homes – whether owned and operated by the province, non-profits, including churches and community based societies, or a small number of private homes operated for profit – received the same wages and benefits and were covered by one master collective agreement. Legislation passed in 2002 allowing the contracting out of health care services in hospitals and seniors’ residences to private operators opened the health care sector to multinational corporations like Compass, Aramark, Sodexho and Acciona, which now provide food and housekeeping services in most hospitals. Subsequent legislation opened the door for the awarding of contracts for seniors’ care homes to private operators, who themselves typically subcontract to other companies. The profits that are generated come directly from public funds provided by the government through suppression of wages and substandard services provided to seniors.
In many communities in British Columbia, there are significant problems with staffing levels and quality of care, cleaning and food in the corporate-owned homes. The largest operator is Retirement Concepts, a company which is owned by a multinational investment firm based in China. The purchase of the homes was approved by the federal government in 2017 and the previous owners now manage and operate the homes through West Coast Senior Housing Management. Since September of 2019, four of these homes have been put under administration by Health Authorities, three by Island Health – in the Comox Valley, Nanaimo and Victoria – and one by Interior Health, in Summerland.
Families of residents in care have spoken out in every community in the province, informing the Health Authorities and the Ministry of Health of the extent of the problems, including lack of care due to inadequate staff, facilities that are not cleaned properly, poor food and lack of stimulation and recreation activities. As an example, it took months of complaints from families and investigations by Licensing before the local Medical Health Officer ordered Island Health to put Comox Valley Seniors Village under administration. The Medical Health Officers in Nanaimo and Victoria subsequently issued similar orders and Nanaimo Seniors Village and Selkirk Seniors Village in Victoria were also put under administration. On February 24, it was reported that a fourth Retirement Concepts facility, Summerland Seniors Village, has been put under administration by the Interior Health Authority.
On a daily basis many of the private for-profit homes operate without sufficient staff to provide the level of care that is required by their contracts with the province, as confirmed by the report of the Office of the Seniors Advocate. On their part, the for-profit operators, through their organization, the BC Care Providers Association, have blamed the problem on difficulty in recruiting staff and lack of funding from the provincial government.
The COVID-19 pandemic has turned an unacceptable situation into a crisis. On identification of the pandemic, immediate measures needed to be taken to increase staffing in order to provide increased and more rigorous cleaning, and to support seniors who are being required to stay in their rooms and avoid communal areas like dining rooms and lounges, exercise programs and outings. Instead what has happened is that the number of workers has decreased, not increased. Some workers who are casual have chosen not to accept shifts. Employers are also requiring that workers not work in more than one home and many who have the choice between working for lower wages and poorer conditions in a private home or working for industry standard wages in a Health Authority home are choosing the Health Authority home. As the needs of seniors increase due to the measures required to flatten the curve of the epidemic and treat those who become ill, the number of workers is decreasing.
The tragic consequences of this situation are seen in the COVID-19 outbreak at the Lynn Valley Care Centre in North Vancouver, a private facility where subcontracting has resulted in three different employers operating in the home. Several residents have died, other residents and staff have been infected, and family members report an increasingly severe shortage of staff resulting in terrible living conditions for the residents and increasing danger for residents, staff and family members.
It’s time for the province to listen to what communities and families have been telling them – that it is the responsibility of the province to ensure that seniors in care receive necessary and dignified care and that the workers who provide that care receive industry standard wages, with adequate staff and appropriate training and supplies. It is not acceptable at any time that the province simply hands over the funds and refuses to take any responsibility for what the operators do with it. The COVID-19 pandemic and its impact on seniors makes this situation an emergency. The province should use its emergency powers to put all seniors’ homes that do not meet the standards of care under administration, which would permit Health Authority employees, workers from other sectors and new hires to be deployed where needed.
For Your Information
“A Billion Reasons to Care” – Report of the Office of the Seniors Advocate
On February 4, the Office of the Seniors Advocate for BC issued a 51-page report entitled “A Billion Reasons to Care: A Funding Review of Contracted Long-Term Care in BC.” The report provides very important factual information about what happens to the public funds that are provided by the province to contracted care providers, both those which are not-for-profit societies and those that are private corporations whose aim is profit, most of which are part of a chain like Revera, Park Place or Retirement Concepts, each of which operate several homes in British Columbia.
The provincial government, through the five regional health authorities, owns and operates 33 per cent of the residential care beds in the province. It contracts with private operators in 174 long-term-care homes for the other 18,000 beds. Homes operated by for-profit companies make up 35 per cent and not-for-profit societies 32 per cent. The province provides funding for all long-term care facilities, a total of about $2 billion per year or which $1.3 billion goes to contracted operators.
The executive summary of the report notes the following “very significant differences in several expenditures” (between the not-for-profit and for-profit homes):
– The not-for-profit sector spends 59 per cent of its revenue on direct care compared with 49 per cent in the for-profit sector. This equals almost $10,000 or 24 per cent more per resident, per year spent on care in the not-for-profit sector.
– The for-profit sector failed to deliver 207,000 hours of funded care and the not-for-profit sector provided 80,000 more hours of direct care than they were funded to deliver.
– The for-profit sector generated 12 times the amount of profit/surplus generated by the not-for-profit sector ($34.4 million versus $2.8 million).
– The for-profit sector had high building expenses at 20 per cent of revenues compared to the not-for-profit sector at 9 per cent.
– There were 18 care homes with an annual profit in excess of $1 million and all but one was in the for-profit sector. These 18 care homes also expensed $23 million in capital building costs.
– The not-for-profit sector may not be receiving adequate compensation for its building capital given its low rate of both capital building costs and profit/surplus.
– The for-profit sector spends an average of 17 per cent less per worked hour, and wages paid to care aide staff in the for-profit sector can be as much as 28 per cent below the industry standard.
The report details some of the myriad ways in which private operators are able to use public funds to increase their profits while failing to meet even their contractual obligations to provide an agreed upon number of hours of care per resident. The report cites various ways in which the public authorities have failed to regulate and monitor private for-profit operators and ways in which the private operators have failed to meet the needs of the seniors in their care and placed impossible workload burdens on too few workers.
The conclusions reached by the Office of the Seniors Advocate in the report are basically that there are “financial incentives” in the current practices for funding in long-term care that “may be producing some unintended consequences” and that funding and financial reporting is “disjointed, unfair to the not-for-profit sector, and unaccountable to the public.” The report recommends that five steps should be taken:
1) Funding for direct care must be spent on direct care. Remove the financial incentive for operations to do anything other than provide as many care hours as possible with the public money they receive to deliver direct care. If an operator can find staff who will work for lower wages than their funded rate, they should use their surplus funds to provide more hours of care or return the funding. Anything short of this will not provide operators with the incentives we need in today’s labour market to ensure residents have consistent and sufficient care staff to meet their needs.
2) Monitoring for compliance with funded care hours must be more accurate. We need tighter standardized reporting for direct care hours. All beds need to be counted at 100 per cent occupancy and we need to verify self-reported working hours. Consideration needs to be given to regulation changes that will empower licensing to monitor staffing levels similar to the current regulatory and licensing practices in licensed day care.
3) Define profit. There are a number of reported expenses that may or may not be fair and appropriate. There needs to be a decision about how to treat building capital along with management feeds, head office allocations, administrative expenses, and subcontracts with related parties. The decisions made need to be uniformly applied to all care homes in the province and to transparently demonstrate value for money to the taxpayer.
4) Standardize reporting for all care homes throughout BC. We need to be collecting the same information, using the same calculations and the same measurements, for all care homes regardless of health authority and we should report this at the provincial level.
5) Revenues and expenditures for publicly funded care homes should be available to the public. The public is entitled to know how their money is spent, in detail, and residents and families are entitled to know how many care hours are delivered by their care home.
These articles were published in
Volume 50 Number 9 – March 21, 2020