Skip to main content

Long-term care industry plans reinvention during austerity

Not all beds in "long-term care" facilities provide long-term care.

"Convalescent care" beds are a form of "short-stay" beds in long-term care (LTC) facilities.  Convalescent beds receive an extra $70.94 more per day than standard long-term care beds.  That's 45.7% more funding than the $155.18 for a standard bed.  


Started in 2005, the LTC "convalescent care" program is now a “Home First Program” that is designed, in part, to reduce hospital Alternate Level of Care (ALC) days.  “As not all patients are ready to return home immediately from the hospital, convalescent care is proving to be a solution suitable for patients that no longer need hospitalization but are still too frail to go home.”   


The LTC convalescent care focus is supposed to be on rehabilitation, daily living activities, restorative care, physiotherapy for strengthening, and “specific client goals that will support their transition back home”.   Patients can stay for up to 90 days, but often stay for shorter periods. 


The for-profit section of the long-term care industry sees convalescent care as a growth part of the LTC industry.   Currently, 76,073 beds in LTC facilities are standard, ‘long-term care’ beds according to the March 2012 “Expert Panel” report sponsored by the OLTCA (the for-profit LTC employer association).   That's 97.7% of the total of 77,863 beds in LTC facilities.

In contrast only 438 beds are convalescent care beds.  There are also a couple of other forms of short-stay beds in LTC facilities:  404 beds are respite/end of life beds and 948 are interim beds. 

The OLTCA Panel suggests rebalancing LTC beds so that the number of ‘long term’ LTC beds would fall  to 70,007 and there would be a significant increase in the ‘short stay’ beds: convalescent care would grow to 3,115 LTC beds, as would the number of interim LTC beds, while respite/end of life beds would grow to 1,557.   

This would increase the number of short stay beds in long-term care facilities by 5,997 to 7,787.  The number of short stay beds would increase 435%.   Not surprisingly, the OLTCA report recommends that they re-consider the use of 'long-term' care to describe the sector.

The OLTCA report proposal would significantly shrink the average length of stay as the length of stay for the short-stay long term care beds varies from 25 to 65 days, while the ‘long term’ LTC beds have an average stay of 3.1 years.   

This would fit well with an austerity government bent on containing the growth of long-term care.   But it would also reduce opportunities for people who need long term care -- and the waits for long term care have already exploded in recent years.

Probably not coincidentally, reducing the length of stay in this manner would also help the for-profit LTC industry maintain their revenue flow (indeed given the extra funding for convalescent care, it would increase funding).  But the industry would also be taking work from the traditional short term stay provider – the hospitals.  There appears to be significant overlap between LTC 'convalescent care' beds and hospital 'assess and restore' beds.  

The OLTCA panel report wants to grow the LTC industry into what have been hospital services.  The report flags three areas of “emerging LTC areas of expertise”: chronic disease management,  "assess and restore" services, and geriatric mental health.  They also wish to radically reduce the number of residents who are moved from LTC to hospitals to get palliative care and suggest that hospital provision of interim LTC beds be "re-examined"

In effect, LTC "residents" would become "patients" as the sector moved into hospital services and the focus of the industry moves from daily care to treatment.  

The OLTCA panel markets LTC as a “mix of public, non-profit and private ownership” with a “healthy balance of collaboration and competition”.  The industry can provide ”services at a guaranteed price” and can “maximize limited resources”.   Flagging the dominance of the for-profit chains, they note that in LTC “there is a limited number of provider organizations enabling economies of scale and capacity to rapidly duplicate and replicate programs and practices across the sector.”

A problem -- and an opportunity -- for the reinvention for the LTC industry is that 35,000 LTC beds must be redeveloped over the “next few years” according to the OLTCA panel.  That’s about half the LTC bed stock. 

Comments

  1. Great post. This is a low wage and union busting strategy, in addition to a strategy to shift money and power to the private sector. Many groups, across the political spectrum, argue for continuing care (home/community and residential) as substitution for hospitals without acknowledging that the costs are lower because compensation is lower and workers have less power, either unorganized or in decentralized unions. Hospitals are being redefined, with extended care, rehab beds and psych beds moved to LTC and "community", or just plain cut. Thanks for the post!

    ReplyDelete

Post a Comment

Popular posts from this blog

Health care funding falls, again

Real provincial government health care funding per-person has fallen again this year in Ontario, the third year in a row.  Since 2009 real funding per-person has fallen 2.6% -- $63 per person. 

Across Canada real per person funding is in its fourth consecutive year of increase. Since 2009, real provincial funding across Canada is up $89 -- 3.6%.
In fact the funding gap between Ontario and Canada as a whole has gown consistently for years (as set out below in current dollars).

Ontario funds health care less than any other province -- indeed, the province that funds health care the second least (B.C.) provides $185 more per person per year, 4.7% more.  
Provincial health care spending in the rest of Canada (excluding Ontario) is now  $574 higher per person annually than in Ontario. 

 Ontario has not always provided lower than average health care funding increases-- but that has been the general pattern since 2005.
Private expenditures on health care have exceeded Ontario government increases …

Ontario long-term care staffing falls far short of other provinces

CUPE and others are campaigning for a legislated minimum average of four worked hours of nursing and personal care per resident per day in long-term care (LTC) facilities.  New research indicates that not only is LTC underfunded in Ontario, it is also understaffed compared to the other provinces. 
LTC staffing falls short:  The latest data published by the Canadian Institute for Health Information (and based on a mandatory survey undertaken by Statistics Canada) indicates that staffing at long-term care (LTC) facilities falls far short of other provinces. 
Part of this is driven by a low level of provincial funding for LTC.





Ontario has 0.575 health care full-time equivalent employees (FTEs) per bed staffed and in operation.[1]  The rest of Canada reports 0.665 health care FTEs.[2] The rest of Canada has 15.7% more health care staff per bed staffed and in operation than Ontario.[3] 


No other province reports fewer LTC health care staff per resident (or per bed) than Ontario.[4]

Occupancy r…

Six more problems with Public Private Partnerships (P3s)

The Auditor General (AG) has again identified issues in her annual reportwhich reflect problems with Ontario health care capacity and privatization.   First, here are six key problems with the maintenance of the 16 privatized P3 ("public private partnership") hospitals in Ontario:
There are long-term ongoing disputes with privatized P3 contractors over the P3 agreements, including about what is covered by the P3  (or “AFP” as the government likes to call them) contract.The hospitals are required to pay higher than reasonable rates tothe P3 contractor for  maintenance work the contractor has deemed to be outside of the P3 contract. Hospitals are almost forced to use P3 contractors to do maintenance work the contractors deem outside of the P3 contract or face the prospect of transferring the risk associated with maintaining the related hospital assets from the private-sector company back to the hospitalP3 companies with poor perf…