The pandemic proved that privatization is a failed strategy for continuing care, but the government is still pushing ahead
Nearly 2,000 Albertans have died in continuing-care homes because of the COVID-19 pandemic, but the UCP government sees no reason to change how it cares for seniors and other vulnerable people. With the potential for more waves of the virus to come, it would make sense for the government to rethink things, to look at what happened and see what lessons can be learned. That, however, is not the UCP government way.
AUPE vice-president Mike Dempsey says we learned a lot from COVID-19. The pandemic exposed continuing care practices that work, but also those that failed. The results are clear: publicly-run care facilities are better than privately-run care facilities.
“I think the first and biggest lesson is that the profit-motive in long-term and continuing care created disastrous effects for seniors and staff in the private facilities,” he says. “The statistics that came out across the country revealed that.”
Studies have shown that private facilities provided fewer hours of care and had fewer staff than publicly-run facilities even before the pandemic. Private care companies do this all the time to earn higher profits; the fewer staff and services they have, the less money they spend. This meant that residents suffered and died at higher rates in private care homes when COVID-19 struck.
“The main point of the for-profit private facilities is to generate profit,” says Dempsey. “Anything that takes away from that, including care, reduces the profit. It’s as simple as that.”
When seniors and other Albertans in need of care were struck by the pandemic’s tidal waves of death and illness, private facilities were slower to react. AUPE had to fight with several private employers to ensure workers had access to appropriate Personal Protective Equipment (PPE).
It became clear that having staff working at multiple sites would result in the virus spreading even faster. The priority was keeping residents and staff safe, but AUPE members had to fight with private employers because they did not care if front-line care workers had their hours and pay cut because of the single-site order.
We also had to fight to get paid sick leave for front-line workers, especially in private care homes.
“Battling employers to meet basic needs should not be necessary,” says Dempsey. “It’s such a drain on resources to have to fight every single employer.”
New life-saving measures could have been taken faster if all continuing care was in the public system. Asked for the pandemic’s biggest lesson in continuing care, Pat Armstrong of the Canadian Centre for Policy Alternatives (CCPA) says: “Staffing, staffing, staffing.”
COVID-19 “really brought home” how staffing and working conditions are the most important parts of providing quality care, said Armstrong, who co-authored a CCPA report called Re-imagining Long-term Residential Care in the COVID-19 Crisis.
Armstrong is a distinguished research professor in sociology and has been writing about Canadian health care for more than 30 years. She knows what she’s talking about.
“The conditions of work are the conditions of care,” she says.
In other words, if bosses force staff to work in lousy conditions, it’s impossible for staff to provide proper care.
With the evidence showing that public care is the best option, Alberta could act now to brace for future waves of COVID-19 and other new viruses. Instead, Alberta is doubling down on its strategy of handing over more care to private, often for-profit, operators.
“Bill 11, the Continuing Care Act, is based on a government-commissioned report that recommended increased standards of care and more hours of care per resident, the government ignored that recommendation.”
Instead, the UCP government is sticking with the model that failed—one where working conditions for staff are worse and the resulting care for residents is worse. That’s the model where most staff don’t get full-time jobs; where they get fewer benefits; where care homes have higher staff turnover rates.
Armstrong says: “We have lots of evidence indicating that the for-profits have higher hospitalization rates, they have more bed ulcers, they have lower staffing levels, they have more part-time [staff] ... there’s a clear pattern that the government-owned ones are better, followed by the not-for-profits, and the worst are the for-profits on a whole range of indicators.”
The reason for-profit homes fare worse is because money that could go to care goes to profit instead. “The most common kind of for-profit now is the giant international chain,” says Armstrong. “Amika, Extendicare, and Chartwell are the big ones. They continued to make profit during all of the high death rates … which is a little depressing.”
Alberta could do better in building a continuing-care system that works for seniors and other vulnerable people, but it lacks the political will.
“It is possible because we know what’s been done in other countries, in Europe and so on,” says Dempsey. “But we have a far-right government – and it generally considers its donors and the party bank account before it considers the needs of Albertans.”
Unfortunately, the Alberta NDP proved equally disappointing on this file when Rachel Notley was premier, choosing to continue with privatization in continuing care instead of bringing care under the public umbrella. They even broke their promise to build 2,000 new public long-term care beds.
“One of the reasons I’m sure COVID-19 hit so hard was the fact that the NDP didn’t do anything to stop privatization of care facilities,” says Dempsey. “I’m very worried for our members, for families and their loved ones.”
He also says AUPE members in continuing care are demoralized, looking for new work, or to retire altogether. They are burned out after years of throwing their health and lives into the front-lines during a deadly pandemic.
“I think that we are really facing a crisis in the health-care labour force,” warns Armstrong.
The answer she sees coming from governments is the wrong one. “We can’t say, oh well, we’ll just import labour because they’ll put up with the crappy labour conditions, which is part of the solution we are seeing being offered here [in Ontario] and in Quebec.”
According to Dempsey: “We must not forget that most people working in long-term continuing care are women and people of colour. Employers and our society shamefully view them as disposable. I’ve seen elements of racism throughout the whole model.”