Defend Public Healthcare

The number of full time equivalent staff in Ontario long term care (LTC) facilities increased from 51,898 to 62,739 between  2003/4  and to  2009/10 .  That's an increase of 10,841 staff, or 20.9%. That is significantly more rapid than the growth in the number of approved beds (which increased by 8.8% over the same period, as discussed earlier this week).  This may reflect the growing age and infirmity of residents in LTC homes. Still staffing falls far short of need. Will the staffing increase continue? It's hard to see other alternatives in the longer term.  But right now there is a decided lack of enthusiasm for long term care from the Minister of Health and LTC and problems in the industry are bubbling down south, thanks to government austerity. Kaiser   reports that the stocks of US nursing-home operators — and the landlords that rent to them — have tanked since late July, when the federal US government announced an 11.1 percent cut in Medicare reimbursements (thanks

Stats Canada research shows that between 2003/4 and 2009/10 the total number of residents in "homes for the aged" (a phrase  used by Stats Can to mean a range of LTC facilities)  increased from 76,866 to 84,873  in Ontario.  That is an increase of 8,007 residents, or 10.4%.   The number of people aged 85 or over in these homes increased quite a bit more rapidly,  growing by 18.8%. The 85 and over age group are now a majority in the homes. The number of 'approved' beds is increasing more slowly, growing by 7,186 beds, going from 81,849  beds to 89,035 .  That is an 8.8% increase. In fact, the nursing home beds are not keeping up with the explosion in the number of people 85 and over, the main age group in the homes.   As reported a few days ago, the population 85 and over is growing very rapidly -- roughly four times more rapidly than the number of  LTC beds . Contrary to what the Health Minister has suggested , these new nursing home beds do not make up for th

A new Statistics Canada report on residential care facilities indicates that expenditures per resident per day in "homes for the aged" (the phrase used by Stats Can to mean a range of LTC facilities) are considerably less in Ontario than in Canada as a whole. Quite a bit less, in fact: $28 per  resident per day. Operating facilities Expenditures per resident-day Number Approved beds   dollars Canada 2,136 215,313 183.6 Ontario 738 89,035 155.3 All other provinces, except for PEI and New Brunswick, have higher expenditures.  Some provinces are considerably higher (Quebec $254.30, Saskatchewan $216.70, Alberta $201.80). At the same time, income from residents for accommodation makes up a much larger portion of total income in Ontario homes for the aged than in homes for the aged in Canada as a whole. Homes for the Aged

Southern Cross, the giant, for-profit British nursing home chain that failed in July, has now begun to transfer its homes to other operators as it winds up its own operations. It announced in late September that the first 250 of its 752 homes were being transferred to new operators and that it hoped to transfer more in October and November. It claims that it has entered unconditional business purchase agreements for 70% of its homes, with the remaining 30% still in progress. But another for-profit corporation, Four Seasons, which hopes to take over 140 of the 752 homes, is now itself having to refinance its operations. It's currently in discussions to refinance hundreds of millions of pounds in debt. The union, GMB, has called on the Care Quality Council to investigate, arguing tha t "Four Seasons Healthcare is saddled with debts of £790m and has no other income except money to care for residents to pay them." The Independent reports Justin Bowden, natio

A December 2010 Statistics Canada study on B.C.  long term care facilities confirms that not-for-profit care provides more care: Total nursing hours per resident day have increased over the past decade (1996-2006) for all facility ownership groups in British Columbia. The rate of increase in not-for-profit facilities owned by a health region was significantly greater compared with for-profit facilities. Total nursing hours per resident day were also significantly lower in for-profit facilities, compared with not-for-profit facilities. Total nursing and personal care time per day ranged from 2.13 hour per day in for-profit facilities to 3.30 hours per day in not-for-profit facilities operated by regional health authorities. American studies have found that not-for-profit ownership of nursing homes is associated with higher staffing levels, lower staff turnover, and better outcomes on a range of measures, compared with for-profit ownership. The study adds that regardless of

The London Evening Standard reports that the 75,000 residents and staff of the for-profit nursing home chain Southern Cross still remain in the dark about their future, over a month after the business announced it was going kaput.  Britain's biggest nursing home business missed a deadline to announce the future operator of each home. The plan was to "sell" each home's operation back to the landlords by 1 August.   Now , Southern Cross claims it will make an announcement within two weeks, according to the Press Association . Nationwide the firm has 752 care homes and some 80 different landlords. The Standard reports that analysts expected that between 25 and 35 different operators would take over the homes. "The ongoing delay is highly frustrating for residents and staff," said Justin Bowden, national officer of the GMB union. "Southern Cross is at the mercy of its landlords." Public sector spending cuts, declining bed occupancy, and t

As noted earlier , Britain's largest nursing home chain, Southern Cross is going kaput, and despite all the chatter from government proponents and business about how such public private partnerships (P3s) transfer risk from the public to the private, it is the most vulnerable members of the public who are taking it on the chin.     Some useful comments from Max Pemberton of Britain's leading (and normally conservative) newspaper  The Telegraph on how this privatization deal transferred the risk to the elderly and most vulnerable:  While the Government insists that no residents will end up homeless as a result of Southern Cross’s collapse, ministers have been unable to give assurances that residents will not have to be placed elsewhere. There is a wealth of research to show that moving individuals who are settled in nursing homes has a severe impact on their well-being. There is a clear correlation between such upheaval and an increase in morbidity and mortality. There i

The Sudbury Star reports that Community Care Access Centre clients on crisis lists are given first shot at any long-term care bed that becomes available in their community.  But if they refuse that first bed, they face having home care reduced as the refusal indicates they are not in crisis. MPP France Gelinas, the NDP Health and Long-Term Care critic, says the policy causes untold hardship for people in Ontario. The Star adds that this "policy, or at least the result of it, has devastated the family of Alphonse Savoie, of Hanmer.   The 81-year-old's six children fought to keep Alphonse and his wife, Alice, together as long as they could.   After exhausting the family's financial and emotional resources, and failing to find long-term care together for their parents, the family finally agreed to place Alphonse alone at Extendicare York." Update: The Star reports today that Health Minister Matthews and the Ministry are following up with the North Eas

Britain's biggest for-profit long term care (LTC) operator, with 752 homes and 31,000 residents, is teetering on the brink of financial collapse as it struggles to pay an annual rent bill of £230m, the Guardian reports . Southern Cross lost more than £300m in the six months to the end of last March.  Over the coming months, many of Southern Cross's homes will be taken over by other operators, as landlords seek tenants who are on a sounder financial footing. Around 3,000 Southern Cross employees are losing their jobs as part of a cost-cutting exercise by the firm, a move the GMB union says will affect the quality of care for residents. Southern Cross staff are also being asked to agree to harsh new working conditions which one care worker described as "the modern-day equivalent of slavery". Many of Southern Cross staff are already paid little more than the minimum wage of £5.90 an hour (about $9.43) Age UK said it was alarmed the Southern Cross "situat

A Windsor developer met the requirements set by the Ministry of Health and LTC to proceed with turning the former Grace Hospital site into a long-term care facility, the Windsor Star reports. That was the last day this public private partnership (P3) had to meet the Ministry's deadline, so the developer just made it.   As reported earlie r, the 256 LTC bed P3 project has been stalled for years while the city has been desperately short of long term care beds, causing the local hospital to fall into a bed crisis.  The new LTC facility was supposed to be completed in March of 2010.     Health Minister  Deb Matthews  said Friday, "We will be watching these developments very closely, given the challenges this project has experienced. As I understand it, workers were on site today to begin preparations for demolition. We know it's in everyone's best interest, especially patients and future residents, to get this project done as quickly as possible. I know how importan

Two recent comments, one from Ontario's not-for-profit long term care organization, the other from the for-profit long term care organization. [1] "A recent analysis conducted by the Association of the Ministry of Health and Long-Term Care’s wait list data revealed that two of every three seniors on the provincial list identified not-for-profit homes as their number one choice. This is despite the fact that not-for-profit homes account for just over 40% of all homes in the province."  [ 2 ] "...a recent survey by the sector found that, despite the demand for long term care spaces across Ontario, some 67 homes report having hundreds of empty beds." I'm betting you can guess who said what.  

The Canadian Press reports that of the 40,000 new or renovated Long Term Care (LTC) beds the Progressive Conservatives (PCs) are promising, only 5,000 are going to be new beds - the other 35,000 are simply renovations of existing beds (over ten years). I'm underwhelmed.  We have a province which has a couple of thousand patients in acute or medical care beds waiting for a LTC bed and which has experienced a  tripling of wait times for an LTC bed since 2005. And with an aging population, things are not going to get magically easier any time soon. The PCs policy sounds pretty much like a continuation of the existing policy to slow the growth of LTC beds.

On Tuesday, as part of their health care funding announcement, the Ontario Progressive Conservatives promised  40,000 new and renovated long-term care beds Increasing investments in home care, and giving families more control over services There are exactly zero  promises regarding hospitals.  Given that the PC funding promise is more like a promise to cut services (see yesterday's note),  the emphasis on long term care and home care will likely mean an especially hard time for hospitals.   That is completely consistent with the initial approach of the Mike Harris PC government in the 1990s.  The Harris PCs actually cut hospital funding (not just by letting inflation erode the value of their funding, but by actually reducing the number of dollars provided).   And they did this under a fog of rhetoric about better long term care and better home care.  Eventually, rising public anger forced them to reverse direction and increase hospital funding (quite significantl

The influential Organization for Economic Cooperation and Development (OECD) has released a new report ( Help Wanted? Providing and paying for long-term care  ) that concludes that      aging populations in developed countries will cause spending on long term care to double or triple by 2050.  Spending  on long-term care currently accounts for 1.5% of the economy in developed countries. The growth in demand for long term care leads the OECD to  conclude  that pay and working conditions in long term care (including home care) must improve: "Major reforms to attract more care workers and retain them in the sector should be put in place quickly. Most long-term care careers are dead-end jobs with a high turnover and low pay and benefits....Upgrading the status of the long-term care workforce by improving pay and working conditions is key." These conclusions are particularly striking as the OECD is tightly tied to ruling elites, and is generally known for being boss-friendly

Alex Munter the newly minted CEO of the Champlain LHIN   makes it a bit more clear than is usually the case, that the focus on squeezing hospital beds has now spread to squeezing long term care beds.  Hospitals have lost thousands of beds over the last twenty years, while LTC beds have increased.  But the focus on diverting patients from hospital beds to home is broadening to include diverting patients from  LTC beds. It certainly is a very worthwhile goal for elders to stay in their homes rather than move to a long term care facility.  Where it can be done, it should be done. But is this new focus just a cover for a reduction in public care?  The wait lists for a long term care bed have exploded in the last few years as government has squeezed hospital funding and slowed the creation of new LTC beds.  Moreover, the large majority of patients in hospitals designated "alternate level of care" (ALC) are waiting for a long term care bed or for a different sort of hospita

The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) says the provincial Budget will fund 1,100 new personal support workers (PSWs) in long-term care homes. With 700 homes in the province, that is about 1.5 PSWs per home.   "Residents will see a direct benefit from this investment through enhanced levels of care and services" claims OANHSS.   OANHSS also claims the Budget will provide funding to help the homes deal with the increasingly complex ALC patients they are getting from hospitals.   The 1,100 PSWs  are suppose to  complete a promise in the 2008 Budget for 2,500 more PSWs.   LTC union representatives remain skeptical, having heard promises in the past.  This writer, at least, has not been able to find the specific PSW promise in the 2011 Budget. On a different tack,  for-profit long term care facilities (represented by OLTCA) are meeting with the Ministry of Health and LTC this week to discuss the Budget and encourage them to allow  the

For-profit health care corporations continue to lead the drive for more private payment for health care services.  This time, it's the CEO and president of Chartwell that "foresees long-term care offering a private-pay option in order to meet the demands of a changing demographic." Seniors “won’t settle for anything less and they will put all of the pressure on the government to allow them to buy what they want,” Brent Binions told  the organization representing Ontario for-profit LTC providers. “I strongly believe that if it’s a little more competitive, there’s a little more return for your innovation, for what you do, people will be more innovative." Nevertheless, Binions adds: "“We’re not saying we want to make more money so let’s have private pay, that’s not the goal." Of course. dallan@cupe.ca

Yesterday, the Institute for  Clinical Evaluative Sciences (ICES -- funded by the Ontario Ministry of Health and LTC) released a detailed study on seniors health care entitled  Aging in Ontario .  The study reports a number of interesting results: The number of Ontario seniors aged 85 and older increased by 36% over six years (2002-3 through 2008-9), This is more than any other age group in the adult population.  There was also a 13.7% increase in seniors 65 and over. The number of acute care hospital beds per 100,000 Ontario seniors decreased (Quite significantly: from close to 1,000 beds to, perhaps, 850 beds -- D.A.). The number of "ALC patients" (i.e. patients in acute care beds who no longer need acute care services) waiting for a bed at an LTC home (i.e. a nursing home)  almost doubled between 2005/06 and 2008/09. Patients in hospitals waited 55 days in the last quarter of 2008/09 for admittance to an LTC home. Those admitted from the community waited 153 days, w

The CBC reports an alarming increase in the number of hospital patients waiting for long-term care, noting that the Ottawa Hospital says the problem has increased by 30 per cent in the past five years. Cameron Love, vice-president of the  Ottawa Hospital, pretty much captures the government's current approach:  hospitals need to assess whether patients can go home, instead of moving them towards long-term care.  Indeed, the government  is reluctant to fund new long term care beds and its strategy is officially called "Aging at Home". Not everyone thinks the strategy has been a success:  "Clearly the LHINs have bungled the Aging at Home program," said Ontario Conservative leader Tim Hudak in August .  "Despite putting a quarter of a billion dollars into the strategy, we've actually gone backwards with wait lists for long-term care homes increasing by over 4,000 people and waits for emergency rooms well in excess of provincial standards." And

In response to a Toronto Star investigative report that pulled back the veil on appaling conditions for residents in for-profit retirement homes, Health minister Deb Matthews says caring for the elderly in a rapidly aging society is the one issue "that keeps me up at night. I am consumed by this." My question: when will the government end its policy of caring for hospital patients in for-profit retirement homes?     dallan@cupe.ca