B.C. Seniors Advocate Isobel Mackenzie is calling for “fundamental reform” in the funding of long-term care homes.
In a report issued last week, Mackenzie points out that on average, publicly-subsidized for-profit facilities provide far less care than they are paid to deliver. Specifically, between 2021 and 2022, they delivered 500,000 fewer hours of care than the government paid them to provide.
By comparison, over the same period not-for-profit facilities actually delivered 93,000 more care hours than they were paid for.
How could this happen?
Across the province there are close to 300 publicly-subsidized long-term care facilities. Around a third are government owned and operated, a third are not-for-profit homes run by groups like charities, and a third are privately owned, for-profit facilities.
All three groups are paid using the same formula. They receive a set amount for each 3.36 hours of care they provide per resident per day.
That formula was introduced because of concerns that some facilities were delivering inadequate care.
The intent, then, was to ensure that all three types of facility would provide the same defined amount of care per resident.
Yet Mackenzie’s report shows conclusively that many for-profit homes are failing to meet that standard.
There are several possible explanations. It may be that some private homes offer higher wage rates to their staff, and thus can’t afford the amount of care they are paid to provide.
It’s also possible that staffing shortages cause some private facilities to come up short.
These are certainly difficulties, yet they are beside the point. Each long-term care facility operates on the basis of a contract which sets out the care standard that must be met.
A facility that fails to meet that standard is in breach of its contract, plain and simple.
There is a further consideration. Mackenzie found that between 2017 and 2022, long-term care profits rose 113 per cent. But this was more than twice the increase in staffing and supply costs.
Evidently then, those care homes that fail to meet their contract obligations are in no position to plead poverty.
Mackenzie recommends that contracts be rewritten to spell out, in plain language, that funding for care must be spent on care.
She also notes that the definition of “profit” needs greater clarity. Some facilities may be fudging their records to mask the full extent of their takings.
The health ministry has said it is aware of these issues. Work is underway on a new contract model that will demand greater financial transparency, and establish standard accounting procedures.
Yet does that go far enough?
If Mackenzie’s report is accurate, and it appears well researched, there are real concerns about the adequacy of care being provided by numerous for-profit facilities.
The residents of these homes average 83 years of age, and many are in poor health.
That makes them amongst the most vulnerable members of our society, and often the least able to speak out for themselves.
At present, medical health officers are empowered to investigate complaints of poor care.
Over the past several years those investigations led to four privately-owned facilities being taken over temporarily by the government after evidence was found of neglect, emotional abuse and staffing shortages.
Yet does that tell anything like the whole story? Half a million missing care hours points to more than a handful of non-compliant facilities.
What’s required is a full-scale inquiry into the management and performance of long-term care homes in our province.
And now, with a new variant of the COVID virus on the way, such an inquiry is all the more urgent.
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