June 16, 2020 - No. 41

The Need to End Private-Profit Arrangements in Long-Term Care

Governments Must Be Held to Account!

• Profit Motive and Unaccountability -- Culprits for Deficiencies in
Long-Term Care
  - Diane Johnston

National Union Calls on Public Service Pension Investment Board to Pull Out of the Business of Long-Term Care 

Alberta Government's Subsidies to Private Seniors' Care
Operators
- Peggy Morton
Alberta Federation of Labour Statement
Ontario Registered Nurses Association Sets Minimum Standards for Long-Term Care
Rally to Support Extendicare Guildwood Residents in Scarborough, Ontario
Quebec Government's Callous Disregard for Life, Health and
Dignity
- Pierre Soublière


Profit Motive and Unaccountability -- Culprits
for Deficiencies in Long-Term Care

Long-term care is not available to Canadians on a universal basis. They are largely left to fend for themselves with regard to ensuring that their long-term care needs, and the costs associated with them, are met.

In reference to the glaring deficiencies in long-term care, in a recent interview on CTV's Question Period, Sharleen Stewart, the President of the Services Employees International Union (SEIU) Healthcare, a union representing over 60,000 frontline workers in Canada,[1] said: "We've been [tolling] on the alarm bells for decades on this and just recently over the past couple of months with the pandemic, constantly we've been asking, announcing, and reporting what we were hearing in real time off the front lines that our members were reporting to us."

"There has to be accountability to any money transferred from anybody's hands, whether it be federal money to the provinces or provinces to those homes," she noted.

Stewart also said that Canada must put an end to privately-owned facilities, "who[se] priorities are based more on paying out shareholders rather than making sure that the proper and adequate care is given."

On June 2, Stewart wrote a letter to Ontario Premier Doug Ford, regarding his announcement of pandemic pay for eligible frontline health care workers, effective for 16 weeks from April 24 until August 13.

In her letter, she points to the fact that "tens of thousands of frontline health care workers were wrongfully excluded, which showed your government's clear lack of understanding of the critical roles so many are playing during these unprecedented times."

"Along with over 8,000 of our union members who have signed our petition demanding the expansion of pandemic pay," she writes, "I am calling on you to immediately ensure that pandemic pay is applied to ALL non-management frontline health care workers. We are also asking you to make Pandemic Pay retroactive to the start of this pandemic, instead of the April 24 date that was arbitrarily chosen."

Concluded the SEIU Healthcare President, "It is long overdue that all frontline health care workers, who are risking their lives each and every day during this pandemic, are properly supported and respected."

The pandemic has made it glaringly clear that a new direction is needed in the care of seniors and the health care sector generally. In order for that to happen, the most urgent need is for a credible public authority.


SIEU continues to hold rallies at Ontario seniors' care homes, thanking the healthcare workers. This one, at Westgate Lodge in Belleville, honours those who have died of COVID-19.

For such an authority to be credible, legitimate and accountable, it must have a direct connection with the working class with regard to determining the direction of the economy, as it is the working class that creates all the value produced in the society. That value must be placed towards responding to the needs and well-being of the society in general.[2]

Notes

1. SEIU Healthcare members include clerical support, developmental support workers, dietary aides, housekeepers, lab technicians, maintenance workers, paramedics, registered nurses, personal support workers, registered practical nurses and social workers

2. "The Necessity for a Credible Public Authority," TML Weekly Supplement, May 30, 2020.

(With files from TML Weekly, CTV News, SEIU Healthcare. Photos: SEIU Healthcare)

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National Union Calls on Public Service
Pension Investment Board to Pull Out of
the Business of Long-Term Care

A May 26 press release from the Public Service Alliance of Canada (PSAC) informs that National President Chris Aylward has called on the Public Sector Pension Investment Board (PSP Investments) "to end its investment" in the long-term care provider Revera and instead "put the second largest Canadian network of for-profit long-term facilities under public ownership and control."

Revera is a wholly-owned subsidiary of PSP Investments, a federal Crown corporation[1] which PSAC points out, "manages the investments of the pension plans of the federal public service, the Canadian Armed Forces, the Royal Canadian Mounted Police and the Reserve Force. As the bargaining agent for members of the federal public service and federal agencies, PSAC represents a large proportion of the contributors and beneficiaries of federal public service plan."

PSAC notes that it made the call for a change in ownership of Revera as a result of "mounting evidence that the incidence of deaths and illnesses attributable to COVID-19 is disproportionately large in private, for-profit long term care facilities. Also, a class action lawsuit by family members of deceased former residents of Revera Inc., has exposed the risk that comes with owning the long-term care chain."

In a letter sent on May 11 to the pension fund's president and CEO Neil Cunningham, PSAC President Chris Aylward wrote: "Regrettably, in the midst of this unprecedented global pandemic, we find ourselves having to write to you again on behalf of the approximately 140,000 members of the Public Service Alliance of Canada (PSAC) who currently contribute to [the] Federal Public Service Pension Fund pursuant to the provisions of the Public Service Superannuation Act (PSSA). As we have advised previously, the objectives of our organization include a commitment to ensure that quality services are provided to the Canadian public and that the compensation and working conditions of employees are conducive to fulfilling this responsibility."

Aylward then highlights the issue of "the mounting and overwhelming evidence of an extremely disproportionate incidence of COVID-19 related deaths and illnesses amongst residents and employees of Long-Term Care (LTC) facilities," which he notes, "raises a number of troubling concerns. In this regard, and as you are aware, Revera Inc., as a wholly owned subsidiary of PSP Investments, operates the second largest network of for-profit LTCs in Canada."

"Our organization has previously had to intervene with both yourself and your predecessors regarding the operations and conduct of Revera Inc. towards both residents and staff. The responses provided by PSP Investments have, quite frankly, been inadequate and dismissive." With regard to media reports about a class action lawsuit initiated in Ontario by family members of deceased former residents of Revera facilities which cite the lack of proper sanitation protocols and testing procedures in the face of the pandemic, Aylward notes that PSAC "suspects the foregoing is the first of many forthcoming on the horizon."

Stressing that PSAC has long warned PSP Investments "that the continuation of business practices without addressing the concerns of our organization would not only be detrimental to the residents and employees" of Revera, he adds that such practices "could also pose long-term consequences for the contributors and beneficiaries of the Federal Public Service Pension Plan."

"As a consequence of all of the foregoing, and in the interests of the residents, employees and stakeholders in Revera," Aylward concludes, "the PSAC membership is requesting that your office initiate immediate and formal comprehensive consultations with federal and provincial governments for the transition of the management and control" of Revera's operations, "to the corresponding provincial health authorities" in jurisdictions where Revera operates.

A copy of that letter was sent to Treasury Board of Canada President Jean-Yves Duclos, to whom PSP Investments reports.

Note

1. "Taking Advantage of the Most Vulnerable and Then Passing the Buck," Diane Johnston, TML Weekly, May 30, 2020 

(With files from PSAC and TML Weekly)

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Alberta Government's Subsidies to
Private Seniors' Care Operators

The Alberta government announced on May 20 that it would provide $170 million to private operators of long-term care facilities, designated supportive living facilities and seniors' homes across Alberta. The government stated that the funding was "to help support vulnerable seniors in Alberta amid the COVID-19 pandemic" and would go towards enhancing staffing, providing more cleaning supplies, and addressing lost accommodation revenue.

The funding is retroactive to March 15 and is only available to "contracted operators," not to publicly-owned facilities or those managed by Covenant Health (Catholic hospitals and continuing care facilities). United Nurses of Alberta, the Alberta Union of Provincial Employees, the Canadian Union of Public Employees, the Alberta Federation of Labour, and Friends of Medicare all denounced the decision to guarantee the profits of the private operators, while refusing to recognize the contribution of all staff working in seniors' care.

The Alberta Union of Provincial Employees (AUPE) called for a suspension of profits and executive bonuses at continuing care facilities, saying that "profitable corporations should not be rewarded for their pandemic failures."

"During the announcement, Health Minister Tyler Shandro acknowledged more than 70 per cent of Alberta's COVID-19 deaths have been in continuing care," says Kevin Barry, Vice-President of AUPE. "What he left out was that a disproportionate majority of those deaths and outbreaks have occurred in for-profit centres.[1] Providing this money while still allowing multi-million dollar corporations like Revera and Chartwell to run a profit is rewarding them for their failures..."

"Residents and staff have had to sacrifice their safety during the pandemic, and to do right by those residents and staff, for-profit providers should have profits suspended and to dip into their revenues to manage this crisis instead of expecting a publicly funded bailout," says Barry.

United Nurses of Alberta (UNA) said the announcement showed the failure of seniors' care operated for private profit, which the United Conservative Party (UCP) government has announced it will expand. "While the money is necessary as an emergency measure to protect vulnerable residents of private long-term care facilities that have been hit hard by COVID-19, it amounts in many cases to a bailout for businesses with a conspicuously bad record of protecting the people trusted to their care," UNA President Heather Smith said. "In essence the government is rewarding private operators who have diverted public funding to profits instead of paying fair wages and ensuring adequate staffing."

Speaking to the fact that the majority of deaths in seniors' homes across Canada are linked to privately owned facilities, Smith stated, "In most cases, these were needless, preventable deaths. The current system is broken and the Alberta government's priority should be to fix it by returning it to the public sector, not by shoring up for-profit private operators with public funds for ideological reasons."

The Alberta government has promised funding for a $2 an hour raise only for personal support workers or nursing aides in private and not-for-private-profit facilities. All other staff, including licensed practical nurses, housekeepers, food services workers, maintenance, and clerical workers will receive nothing, and even the aides in public facilities and those managed by Covenant Care have been excluded. The fact that they all have risked their lives to provide care and services to patients is not recognized, the unions point out, nor the fact that staff who do not normally provide direct patient care have been doing so during the pandemic.

Several private operators have withheld funds, including Chartwell and Rosedale Development, claiming that they are only required to pay for hours worked in publicly funded beds. "This is utter nonsense, of course," says AUPE Vice-President Susan Slade. "All these residents live side by side in the same units. The work these HCAs do, and the risks they are taking, are exactly the same. The pay they get should be the same."

One particularly obscene aspect of the announcement was that operators who have empty beds in their facilities as a result of patient deaths would be compensated for the loss of revenue from "accommodation fees." When private operators' negligence, greed and indifference to the seniors under their care is rewarded by government, it shows there is no governing authority fit to rule. Money given retroactively to facilities for extra cleaning due to the pandemic, all goes into the hands of the private operators, not housekeeping staff and others who have risked their lives to keep the seniors' care homes clean.

While Albertans, together with all of Canada and Quebec are calling for increased funding for social programs and an end to privatization, the Alberta Health Minister's obsession is to guarantee the profits of the wealthy owners and shareholders. It is, as the workers and their organizations point out, one more compelling reason why the Minister should resign, and why the UCP government has shown itself unfit to govern.

Note

1. Of the 102 deaths identified by Alberta's Medical Officer of Health in long-term care and seniors' residences, the facilities are not identified in five deaths. Seventy-one of the remaining 97 were in for-private-profit facilities.

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Alberta Federation of Labour Statement

On April 20, Health Minister Tyler Shandro publicly promised a $2 per hour wage top-up for Health Care Aides working in private continuing care facilities. Shortly after the government also announced a new provincial order of a one-site policy, which would restrict some care workers from working at multiple long-term care facilities. Both of these policies left non-profit community care agencies and group homes in the lurch.

"Many care workers are forced to work multiple jobs just to make ends meet. This often means a worker in a private continuing care facility will also work in home care, a group home or elsewhere to make a living," said Alberta Federation of Labour President Gil McGowan. "By restricting the provincial policies to only certain continuing care facilities the UCP government is now causing staffing concerns for the other community agencies and workplaces where these workers also work."

Non-profit agencies providing care for society's most vulnerable are receiving no extra PDD [persons with developmental disabilities] funding or support for staffing from the provincial government. With many workers restricted to one workplace, and receiving higher wages if they choose to work at other facilities, these agencies are left without the support required to compete for, or retain staffing.

"The federal government announced support for provinces to boost care worker wages, but the UCP have chosen not to expand their wage top-ups to help support these crucial non-profit agencies caring for some of our society's most vulnerable," said McGowan. "This exclusion is leaving many group homes in a constant struggle to provide adequate staffing levels or support for their residents."

"The COVID-19 pandemic has highlighted that care workers are crucial all of the time and have always deserved to get paid more than the lowest legally allowed wages," said McGowan. "Unions representing care workers have repeatedly requested to be at the table for these discussions to help this government implement better policy decisions during this pandemic. So far the Kenney government has shown no interest in involving workers in decisions and as such they are missing the mark for ensuring society's most vulnerable are protected and cared for during this pandemic."

The Alberta Federation of Labour has joined with LIUNA 3000 to co-sponsor a petition calling on the UCP government to act on these issues. The petition can be found here.

(June 1, 2020)

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Ontario Registered Nurses Association Sets Minimum Standards for Long-Term Care


Memorial established by families of residents who had died of COVID-19 at the Camilla Care Community, a long-term care home in Mississauga. 

On June 5, the Registered Nurses Association of Ontario (RNAO) threw down the gauntlet to the government of Ontario, setting out standards of care that the RNAO deems necessary for residents of long-term care facilities. RNAO also declared there is no need to look any further into what is needed than the dozens of reports that have already been written over the past 20 years. The RNAO statement is posted below.

If the Ontario government is serious about fixing the long-term care (LTC) system, it must adopt evidenced-based solutions documented in numerous reports that have examined the sector's failings.

RNAO today released a list detailing dozens and dozens of recommendations in the areas of staffing and funding made in 35 reports as well as a public inquiry and a coroner's inquest looking into the problems in LTC over the past 20 years. The recommendations in these reports call for more staffing in LTC homes, the proper skill mix of regulated and unregulated staff to meet the increasing acuteness, and a funding model that responds to growing needs.

RNAO compiled Long-Term Care Systemic Failings: Two Decades of Staffing and Funding Recommendations[1] because we are among those who have examined this issue for years. "We implore the Ministry of Long-Term Care, the Ministry of Health and the premier to act NOW. It is disheartening, exhausting and expensive to continue to study problems that are known and understood and where the missing factor is the political will to act decisively rather than, once again, kick the can down the road with more commissions and more reports," says Dr. Doris Grinspun, RNAO's CEO. "Enough of over-studying and under-acting in this sector -- we know and the government knows what needs to be done to improve and save the lives of LTC residents."

"Premier Ford has vowed to fix the system. He says there will be accountability. However, as much as I want to believe him, I have heard heartfelt words from political leaders before. Accountability begins at the top and must be delivered with swift actions. Residents living in long-term care, along with their families, and staff can't wait any longer for change. No study and no words will deliver better care for residents, only better funding and better staffing will," Grinspun insists.

RNAO has proposed a staffing formula that builds on earlier reports and studies and addresses those needs. It wants each LTC home resident to receive at least four hours of direct nursing and personal care per day, based on a skill mix of regulated and unregulated care providers. Of those four hours, 0.8 hours (48 minutes per day) should be provided by a registered nurse (RN), 1 hour (60 minutes per day) by a registered practical nurse (RPN), and 2.2 hours (132 minutes per day) by an unregulated personal support worker (PSW). In addition, each home should have one nurse practitioner (NP) for every 120 residents as well as a nurse specializing in infection prevention and control.

RNAO explains such a formula is necessary because about 55 per cent of LTC residents are 85 years or older and 90 per cent of all residents have some form of cognitive impairment, including dementia. The majority of residents in LTC also have complex health needs including chronic conditions such as heart disease, diabetes or arthritis -- needs that require the expert care and skill mix NPs, RNs, RPNs and PSWs provide.

RNAO's President Dr. Angela Cooper Brathwaite says a critical deadline is looming. "July 31, 2020 is an important date on the government's calendar. It's the deadline Justice Eileen Gillese gave the government to table in the legislature a detailed report on the adequacy of regulated staffing in LTC. It was a key recommendation in her report The Long-Term Care Homes Public Inquiry (2019)."

"The July 31 government report gives the opportunity to Premier Ford to demonstrate he means action. We need to address staffing and funding issues in LTC immediately. We don't need more studies, as the list released by RNAO today demonstrates. Let us get on with improving the lives of people, in real ways. We owe residents in LTC a debt of gratitude for the contributions they have made during their lives. They should be able to live with dignity, comfort and love, and they and their staff should be better equipped and protected, especially when the second wave of the pandemic hits," adds Dr. Cooper Brathwaite.

The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario.

Note

1. To view the full report, click here.

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Rally to Support Extendicare Guildwood Residents in Scarborough, Ontario


Rally at Guildwood Extendicare, June 12, 2020.

Friends and family members of residents at Extendicare Guildwood long-term care home in Scarborough are calling on the Ontario government to step in and take control of that facility. On Friday, June 12, they held a protest rally in front of the home. They have also started a Facebook page and issued a statement on the appalling conditions at the facility.

The Guildwood Extendicare Family Support Group came out in full support of the Service Employees International Union's (SEIU) call for government to take over long-term care services in Ontario. In fact, the SEIU, citing a more than $10 million dividend that Extendicare recently voted to pay its shareholders, issued a demand that dividend payments to long-term care operators should come to an end given the state of affairs in long-term care facilities across the country. SEIU Healthcare President Sharleen Stewart said at the time: "What I heard today from Extendicare was both alarming and an affirmation of a truly ugly long-term care system. Residents are getting sick and dying. Workers are getting sick and dying. Enough is enough. Corporate dividends from companies like Extendicare, Chartwell, and Sienna, can no longer be a part of the delivery of health care equation."

The conditions at Extendicare Guildwood in Scarborough are completely opposite to the way the Ford government characterizes the situation in long-term care. Premier Ford announced on June 11 that because "progress" has been made containing COVID-19 outbreaks in long-term care facilities, families would soon be able to visit their loved ones, with strict distancing requirements in place. There is absolutely no sense of shame or accountability for what has happened to seniors in long-term care.

The Guildwood Extendicare Family Support Group paints a very different picture, one so dire that it is enough to make one weep. Their statement reads:

"As of June 10, there have been at least 54 deaths at the facility since the outbreak began there in April. There were 159 residents before the outbreak began which means a third of all residents have died while 86 per cent of residents have tested positive for COVID-19. Forty-two staff members have also been diagnosed. By any objective measure, Extendicare Guildwood is in crisis.


Family of seniors in Guildwood held an earlier picket May 26, 2020.

"Attempts to contain the virus to a single wing of the facility failed. Uninfected residents are still living in close quarters with those infected as the virus continues to infect all those within the building. Families are terrified for their loved ones. Both the Administrator and Director of Care of Guildwood Extendicare contracted the virus in the early days of the outbreak and have not yet returned to work. At this time, it is unclear who is in charge at Extendicare Guildwood. Management have turned away an offer of assistance from the Red Cross. Enhanced protective measures have not been adopted. The lockdown has failed.

"'We don't understand why Extendicare continues to stonewall our efforts to stabilize the outbreak,' said Wendy Cooper-Parkinson, whose mother remains under lockdown at the Extendicare Guildwood.

"'We have borne witness to the devastation caused by the cost cutting measures employed by these facilities, especially during the current COVID-19 outbreak. For 14 weeks, surviving residents have been deprived of their loved ones' care, love, intervention and advocacy,' she added.

"Extendicare Guildwood has been in lockdown for over 14 weeks with only essential staff and visitors permitted inside. On May 4, when window visits were allowed, families were appalled at the diminished state of their loved ones. Without the assistance of families and friends, residents are not receiving adequate care in this facility. Additionally, the absence of family love and contact has taken a devastating toll on both the mental and physical health of the residents, leaving those uninfected even more vulnerable to the virus should they contract it.

"'One family member recently witnessed his brother calling out for water, while he watched through a window from outside, unable to help. That resident has since died. Having this happen even once is horrific. It keeps on happening here, over and over again and families are demanding to know why, and what the Government plans to do,' said Cooper-Parkinson. Despite having one of the highest rates of infection and fatalities in Ontario, Extendicare Guildwood has slipped under the radar and has not received the help from the government so desperately needed to ensure the safety of staff and residents.

"'The government needs to act now to save them,' said Cooper-Parkinson."

Their statement concludes:

"COVID-19 has shed light on numerous problems with Ontario's care facilities for the vulnerable. Changes to these facilities are critical to all Canadians, as many face the reality of placing beloved family members in long-term care or entering such a residence themselves. Please help us save our loved ones!

"We stand together to support one another and our loved ones who depend on us to be their voices."

(Photos: Guildwood Ext Family Support Group, SIEU)

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Quebec Government's Callous Disregard
for Life, Health and Dignity

The Integrated Centre for Health and Social Services for the Outaouais region (CISSSO) recently revealed that in one long-term care centre (CHSLD), Lionel-Émond, a public institution, there had been 30 infections and six deaths among the residents and 21 cases among the health care workers. On the other hand, in a private CHSLD, Champlain de Gatineau, belonging to the Toronto company All Seniors Care Living Centres, there are active cases but, in spite of that, the CISSSO recently told a local newspaper that it had decided not to divulge the number of cases "out of respect for the owners." In Quebec's daily count, how many such cases are not being made public?

In some cases, people are presently resorting to legal action. For example, on April 17, a class action suit was launched against the Herron CHSLD in Dorval where 31 people lost their lives. The litigants are seeking punitive damages for the inhuman and degrading treatment of the seniors who live there. The action is being taken for the 130 residents because of everything they have been through. The Kasata Group, the owners of Herron, are being held responsible for not having given their health care workers the proper personal protective equipment, nor ensuring that the surroundings were safe and had adequate sanitary conditions. They are also held responsible for having abandoned their residents with the most callous disregard for their life, their health and their dignity by treating them in an inhuman and degrading way. On one specific day, the claimants point out, there was one nurse and two aides for the 130 residents.

Long before the pandemic, the situation was such in the seniors' homes that in July 2018, the Conseil pour la protection des malades took up a similar class action in which it gave many examples of degrading living conditions. It denounced the systemic negligence and ill treatment of patients in the CHSLDs. The class action involved no less than 34,000 people who had experienced such conditions since July 2015. It raised the lack of personnel and work overload for health care workers as being a part of the problem. The government at the time tried to quash the lawsuit, under the pretext that a "living environment" as raised by the claimants was "difficult to define." The judge upheld the class action in 2019 on the basis that matters of living conditions and those of adequate quality of health were identical, rejecting the government's argument. This is just one of many instances where governments, which are supposed to defend the public good, instead, acting on behalf of private interests, attempt to quash collective legal efforts to defend the rights of workers and Indigenous peoples.

Now, on May 26, in the midst of the pandemic, the Quebec government made a "global offer" to various health care workers' unions in negotiations for new contracts that embodies this callous disregard for the life, health and dignity of the workers and people. None of the workers' demands for working conditions that ensure their health and safety, and the well-being of their patients, are addressed. Consequently, the offer was rejected with contempt. Not only do such offers refuse to meet the needs of public service workers, they pointed out, but the hardships the workers and people are going through at this time are precisely a result of this refusal.

(Photos: FIQ)

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