Defend Public Healthcare

The Ontario government’s 26 page Action Plan for Seniors  came out yesterday.  There’s not much to it.  About half of the report simply rehashes what is already in place. To the good, they at least formally recognize that the elderly population is expanding rapidly and that this is going to require an   “overarching plan” that  (absent their reforms) is going to cost a lot of cash. (For more information on the tsunami we are facing in long-term care, and how far short we are falling, click here , here , and here .) To the bad, their reforms are pipsqueak-sized compared to the problem at hand. Perhaps the biggest proposal here is their plan to designate 250 beds in long-term care as ‘assess and restore’ beds.   Essentially this means opening hospital beds in long term care facilities.  Instead of using long-term care to provide long-term residential care, they want to use long-term care to provide short- term care (providing curative treatment, as in the hospitals).   

Photo:  LOLren As with hospital beds, the government and other proponents of  the near freeze in new long-term care beds suggest that home care can take up the slack. Does this stand up?  Well, let's take even a very aggressive version of this theory.  Say that 25% of all people in LTC could be dealt with through home care.   (Currently, that would mean evicting 19,250 LTC residents, which is hardly realistic!) As noted in the previous post , the demographics of the province are rapidly changing, with huge growth in the elderly population, now and into the years ahead. A 2011 study the Conference Board concludes "based on Statistics Canada‘s reported utilization rate by age and the Government of Ontario‘s population projection, it is estimated that by 2035—when boomers are 71 to 89 years old— 238,000 Ontarians will be in need of long-term care."  That is 161,000 more than the 77,000 LTC beds existing now.   If we somehow can subtract 25% from 238,000 we still

The Auditor General reports that the stock of long-term care beds in Ontario has grown only 3% since 2004-5.  Over seven years (until 2011-12) that means an annual average growth rate of  0.42% (or about 319 beds per year). Photo: Derek Tyson That falls well short of population growth.  But much more important, it falls far short of the growth of the relevant population - the elderly.  Or as the Auditor General demurely states:   " An increase in the number of LTC home beds of 3% during that period has not kept pace with the rising demand from an aging population." Ontario Ministry of Finance figures  indicate  that in the five years between 2006 and 2011 the number of people 85 and over increased 34%.  By 2016 the plus 85 set will have increased by 67% over 2006 -- and the ratio of those 90 and over compared to those between 85 and 90 will have increased from about 50% to 70%. With a 1.5% annual increase in the number of LTC beds, the Conference Board estimates

Jane Meadus of the Advocacy Centre for the Elderly says that some seniors are being pushed out of hospital too soon under the province's Home First policy, the Ottawa Citizen reports. "Patient safety is at high risk...While many patients will do well at home with extra home-care services, there are many who are too sick to be cared for at home." Some elderly patients are being "forced" to go home to recuperate without being given the option to apply for long-term care and waiting for a bed while in hospital. And that might violate their legal rights.  In other cases, people are being pressured to enter private retirement homes, which can cost $5,000 a month and might not be able to provide the care needed, Meadus told the  Citizen . "There have already been cases where people have died due to being forced into them while really requiring long-term care." ACE has received about 250 complaints from across Ontario in the past year. "Disc

Today, in the Ottawa Citizen , the Queensway Carleton Hospital reports a big decline in the number of  "ALC" patients, down  from 50 patients a day to 20 or 25.  That is a  50% to 60% decline. Queensway Carleton Hospital The story highlights the home first program (where seniors get intensive home care for up to two months) and a decision not to discuss LTC options with patients, or fill in LTC applications.    It sounds like a more important explanation of the ALC decline was the creation of 24 "restorative" beds at the hospital.    The patients in those beds are the same sort of patients who were formerly ALC (i.e. not requiring acute care but still not ready to go home).   With the creation of the restorative beds program t here are now  special programs  to help these patients become fit and active while they fully recover in hospital. With this program, these patients are no longer in acute care beds and are no longer waiting for another form or

No surprise here -- but the bosses of the for-profit corporations that provide long term care and home care services funded by the public sector are excluded from the Protecting Public Services  legislation proposed today by the Liberal government (as set out in schedule 1 of the Public Sector Compensation Restraint Act, 2012 ) . Also no surprise -- the unionized employees who work  for those bosses at for-profit long-term care and home care businesses don't get any such exclusion (as set out in schedule 1 of the  Respecting Collective Bargaining Act [Public Sector], 2012 ) . They, like other publicly funded workers, are free only to agree to terms and conditions pre-determined by government.

As part of its turn from care in facilities, the Ontario government has let the wait lists for long-term care facilities explode.  This problem has been around for several years now, and there is little sign the government intends to remedy the problem.   Instead they simply talk about keeping people in their homes.  It sounds great -- until you need long-term care.   With a tsunami of aging coming, this problem is set to get worse.   Fitting nicely with this plan, the for-profit long-term care industry has commissioned a report that actually calls for less  publicly funded long-term care: instead, the publicly funded long-term care sector would expand into hospital services and provide short-term care.    As noted a few days ago , the private insurance corporations have seized on the government's turn away from publicly funded long-term care and called for an expansion of private insurance for long-term care needs  --  along with private delivery and no price caps to pr

Giant insurance corporations are pushing into long-term care. As part of its austerity song book, the Ontario government has pretended that there is no need to expand long-term care, complex continuing care, rehabilitative care, and other forms of care.  If any needs aren't met, it can all be solved , this fairy tale goes, by home care -- even while there isn't much of that going around.   In that, there is opportunity for corporations.  If government won't insure it, they will - and make a nifty profit doing it.  As noted in an earlier  post , demographic change will drive the growth of long term care for the next several decades.  A recent  insurance industry  report estimates that "the cost in current dollars, of providing long-term care over this timeframe (the aging of baby-boomers) is almost $1.2 trillion. Current levels of government program and funding support will cover about $595 billion of this total cost. As a result, Canadians currently ha

A 2011  Conference Board of Canada  report done for the for-profit long-term care (LTC) facilities in Ontario estimates (based on population projections and utilization by age) that 238,000 Ontarians will be in need of long-term care by 2035.  This compares with about 98,000 today. So we are looking at a need to increase long-term care 143%.   With a 1.5% annual increase in the number of LTC beds, the Conference Board estimates Ontario would be 127,000 beds short of need, with the gap gradually increasing year by year until 2035.  That's an increase of 103,000 from the current wait list of 24,000. The report notes that government policies could affect utilization. Certainly, this is what the government appears to be hoping to achieve. But even moderating the  huge growth in need would require some big leaps in policy handiwork. A more likely scenario may just be to provide less care to those in need. Compounding the problem,  the Liberal government may not choose to in

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 fo

Four months into the fiscal year, and we now know that long term care funding per bed is going up 1.47% in Ontario. The LTC funding envelope that will get the biggest increase will be "Raw Food", which will see a 3% increase effective July 1. (The 3% is not counting a commitment by the government to continue extra raw food funding of 1.8% that was supposed to expire June 30). Other funding envelopes that are connected to wages for long term care workers (raw food is not connected) will see a much more modest increase effective April 1: just slightly less than 1% for the "Nursing and Personal Care" and "Program and Support Services" envelops. While raw food costs are not affected by LTC wages, these two areas most definitely are.  In other words, long term care workers are being asked to bear the main role in containing costs. Accommodation funding (the one envelope where owners can rake off a profit) will get a 2.1% increase effective July 1 (agai

A Windsor hospital has been officially blocked from setting up hospital beds in a for-profit retirement home.  As noted in June , the Hotel Dieu Hospital was trying to create 18 "assess and restore" hospital beds in a for-profit retirement home in Amhertsburg.   The hitch for the Ministry of Health and LTC wasn't the for-profit nature of the home, it was that the home  didn't meet the building and fire code for hospital services.  This despite $300,000 in renovations by the retirement home and nine months of planning.    For the hospital project, the retirement home installed wheelchair-accessible bathrooms, the flooring was changed from carpet to vinyl, and a nursing station, common room and dining room were built. Apparently , the relatively new retirement home was built to a different building code than that required for hospitals and so cannot house hospital patients. The Ontario government has practically made moving work out of hospitals a new re

Pre-cooked food will no longer be trucked in to Alberta's smaller long term care homes.   Alberta Health Services shut down the kitchens in LTC homes with fewer than 125 beds two years ago to cut costs, the  Calgary Herald   reports. Meals were instead prepared off-site (sometimes outside the province) often using "flash freezing" techniques. But complaints about  the taste and nutritional value of the food have spurred the Health Minister to order the  Alberta Heath Services to serve home-cooked menu items in all of its 73 long-term care facilities by the end of this year to improve the taste, appearance and variety of food. The Health Minister said r esidents and seniors advocacy groups have "told us clearly that preparing food off-site and reheating it does not meet expectations . . . and we are taking actions to change that".   Alberta Health Services plans to have a strategy by October  for all facilities. The problems are much the same in Ontario

The Ontario Auditor General did a follow up to his 2009 report on health care acquired infections (HAIs) in long term care homes.  The good news is that all three of the homes he examined are now doing the twice daily cleanings of rooms for residents with C. Difficile infections. The bad news is that there is little movement on public reporting of HAIs in LTC. (OCHU helped win this in the hospital sector several years ago.)  Here is the AG's comment: The Ministry indicated that it had examined whether long-term-care homes should be required to publicly report patient-safety indicators such as HAI rates, as hospitals do. The Ministry noted that it had consulted with the long-term-care homes and other stakeholders and that there was a high level of satisfaction with the current extent of voluntary public reporting through Health Quality Ontario. Although Health Quality Ontario  does not provide public information on cases of C. difficile or hand-hygiene compliance among reside

The Canadian study on long term care facilities discussed yesterday noted  that US studies have indicated that for-profit long term care homes were inferior to for-profit homes.   In a 5-year examination of complaints in all US states, Stevenson 12   found that for-profit facilities had an almost two-fold greater chance of receiving a complaint compared with non-profit facilities and that chains had a significantly higher rate of complaints compared with non-chain facilities. Harrington and colleagues 5   also found that for-profit investor ownership predicted 0.679 additional “deficiencies” (a US regulatory measure similar to unmet standards), and chain ownership an additional 0.633 deficiencies per facility compared with non-profit facilities. On another issue, the Canadian study notes " that non-profit, single-site facilities demonstrate higher complaint rates in comparison with public and charitable facilities. This diversity of performance between public and non-profit gr

A new Canadian academic study has examined  publicly available data on complaints about long term care homes for the elderly, comparing for-profit homes with not-for profit homes.   Complaints are one way to measure the quality of  the different types of homes.   The report notes that while "studies conducted in the United States have demonstrated an association between for-profit ownership and inferior quality, relatively few Canadian studies have made performance comparisons with reference to type of ownership."  The study concludes:  Compared with for-profit chain facilities, non-profit, charitable and public facilities had significantly lower rates of complaints in Ontario. Likewise, in British Columbia’s Fraser Health region, non-profit owned facilities had significantly lower rates of complaints compared with for-profit owned facilities. Most complaints were related to resident care. Complaints were more frequent in facilities with more citations, i.e.

For-profit long term care (LTC) beds for the elderly increased by over 2,100 in Ontario between 2003/4 and 2009/10 according to new Statistics Canada data.   The number of for-profit facilities increased by 70, taking a large majority in the growth in facilities, gaining 70 out of the total of 94 new LTC facilities. However, with slightly stronger growth in the number of beds operated by not-for-profit operators, not-for-profit operators actually increased their share of the total number of LTC beds by a couple of percent.  Nevertheless, 60% of  all LTC beds are still operated by for-profit corporations.   As well, 65% of the facilities are operated by for-profit corporations. The biggest increase in beds over the six years was in not-for-profit facilities operated by lay organizations.  These lay facilities saw their number of beds increase from 9,600 beds to 13,200 beds.  Municipal homes also increased their share of total beds.  The Stats Canada reports are linked below.