{"id":77087,"date":"2021-06-08T13:31:57","date_gmt":"2021-06-08T17:31:57","guid":{"rendered":"https:\/\/newsroom.carleton.ca\/?post_type=cu_story&p=77087"},"modified":"2025-08-19T09:37:13","modified_gmt":"2025-08-19T13:37:13","slug":"long-term-care-homes-covid-19","status":"publish","type":"cu_story","link":"https:\/\/carleton.ca\/news\/story\/long-term-care-homes-covid-19\/","title":{"rendered":"Non-profit long-term care homes have lost too many residents to COVID-19"},"content":{"rendered":"\n
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\n Non-profit long-term care homes have lost too many residents to COVID-19\n <\/h1>\n \n <\/header>\n <\/div>\n\n \n <\/path>\n <\/path>\n <\/svg>\n <\/div>\n\n \n\n <\/div>\n<\/section>\n\n

The COVID-19 pandemic has been a humanitarian catastrophe for long-term care facilities. A series of policy failures, combined with existing systemic weaknesses<\/a>, have left Canadians in long-term care extremely vulnerable to COVID-19.<\/p>\n\n\n\n

It\u2019s difficult to overstate the scale of this crisis. Almost 4,000<\/a> long-term care residents in Ontario have died from COVID-19, a 28 per cent increase<\/a> in excess deaths in 2020.<\/p>\n\n\n\n

With the vaccination of residents and staff now well under way, it\u2019s time to consider how to reform long-term care to ensure this situation never repeats itself. Many are calling for an end to for-profit care. But non-profits, which make up 28 per cent of long-term care homes<\/a>, have largely been absent from the discussion. <\/p>\n\n\n\n

Governments outperform non-profits, too<\/h2>\n\n\n\n

We set out to understand whether the type of long-term care home \u2014 government, for-profit or non-profit \u2014 made a difference in COVID-19 outcomes. Our recently published paper, \u201cDoes the Profit Motive Matter? COVID-19 Prevention and Management in Ontario Long-term Care Homes<\/a>,\u201d finds that government long-term care homes did a better job than both for-profits and non-profits at preventing COVID-19 deaths.<\/p>\n\n\n\n

Our modelling predicts that if all long-term care homes had been government-run, 1,348 residents would have died during the pandemic \u2014 less than half of the 3,790 long-term care deaths actually experienced. That same modelling predicts 4,977 deaths if all long-term care was for-profit, and 2,822 if all homes were non-profit. So even though the predicted deaths are highest in for-profit long-term care facilities, non-profits also fare badly compared to government. <\/p>\n\n\n\n

These findings suggest a need to consider replacing all contracted long-term care with direct government provision \u2014 going further than the Ontario Long-Term Care Commission\u2019s recommendation<\/a> to eliminate commercial long-term care operators. <\/p>\n\n\n\n

Abolish non-profit and for-profit homes?<\/h2>\n\n\n\n

The Long-Term Care Commission released its final report<\/a> in April. Among other things, the commission recommends preserving a role for commercial for-profits in construction, while suggesting that only \u201cmission-driven\u201d non-profit and for-profit organizations should be allowed to operate long-term care facilities. <\/p>\n\n\n\n

We have two concerns with this recommendation. <\/p>\n\n\n\n

First, we find the distinction between \u201cmission-driven\u201d and \u201ccommercial\u201d for-profit organizations a bit perplexing. It\u2019s difficult to see how one would reliably ascertain whether a for-profit is \u201cmission-seeking\u201d and will remain so in the future. By definition, a for-profit organizational model is geared toward profit-seeking.<\/p>\n\n\n\n

But more fundamentally, this recommendation fails to address the reality that government-run long-term care homes have done a better job of preserving life than both for-profits and non-profits. Our paper clearly finds that governments were the safest during the pandemic. That means we should consider the possibility that all long-term care should be replaced with government facilities.<\/p>\n\n\n\n

Why have non-profits performed so badly?<\/h2>\n\n\n\n

Whether we should keep non-profit long-term care facilities depends on why non-profits under-perform government homes in infection management and possibly other measures of service quality. This is an important question to which we lack satisfying answers.<\/p>\n\n\n\n

The association between for-profit provision and lower care quality is obvious and well-understood: there is also a large body of long-term care research demonstrating that for-profits under-perform government providers<\/a> on a range of quality indicators<\/a>.<\/p>\n\n\n\n

\"Funeral
\n Workers of a funeral home remove a body from a for-profit long-term care home in Laval, Que., during the COVID-19 pandemic.<\/span>
\n THE CANADIAN PRESS\/Ryan Remiorz<\/span><\/span>
\n <\/figcaption><\/figure>\n\n\n\n

But there has been very little study of non-profit service quality, in the pandemic or otherwise. We clearly cannot rely on a common bogeyman \u2014 the profit motive \u2014 to explain non-profits\u2019 poor performance relative to government. So what explains the middling performance of non-profits? <\/p>\n\n\n\n

In our paper<\/a> we introduce two possible explanations.<\/p>\n\n\n\n

The structure of non-profits gives them some disadvantages in terms of investing in the future and being financially prepared for crises. For example, it\u2019s difficult for non-profits to borrow money. The poor performance of non-profits may reflect a struggle to react to the pandemic in light of these structural disadvantages. <\/p>\n\n\n\n

If that\u2019s why non-profits under-perform governments, reforms should either address these disadvantages or, if this is not possible, end non-profit provision of long-term care.<\/p>\n\n\n\n

Access to resources<\/h2>\n\n\n\n

Another possible explanation we present in the paper is cross-subsidization<\/a>.<\/p>\n\n\n\n

Both non-profits and government-run facilities have access to resources that enable them to provide a better quality of service. Governments can use tax revenue, while non-profits can cross-subsidize with philanthropic donations. But even though non-profits can cross-subsidize, perhaps they can\u2019t do so as effectively as government-run homes, which would explain their lacklustre performance in preventing COVID-19 outbreaks.<\/p>\n\n\n\n

If this is why non-profits are under-performing government facilities, that\u2019s a clear indicator that public funding is insufficient to cover the real cost of long-term care. <\/p>\n\n\n\n

We need to develop a clear understanding of why non-profit long-term care providers lost so many residents to COVID-19, and whether they under-perform government on other indicators. Maybe all non-profit homes should be taken over by government, or maybe more incremental changes would rectify the gap. <\/p>\n\n\n\n

Understanding why non-profits were unable to manage outbreaks as well as government homes is the first step toward deciding what to do about it.<\/p>\n\n\n\n

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This article is republished from The Conversation<\/a> under a Creative Commons license. Carleton University is a member of this unique digital journalism platform that launched in June 2017 to boost visibility of Canada\u2019s academic faculty and researchers. Interested in writing a piece? Please contact Steven Reid<\/a> or sign up to become an author<\/a>.<\/p>\n\n\n\n

All photos provided by The Conversation from various sources.<\/em><\/p>\n\n\n\n

—
\nCarleton Newsroom<\/a><\/p>\n\n\n\n

\"The<\/figure>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

The COVID-19 pandemic has been a humanitarian catastrophe for long-term care facilities. A series of policy failures, combined with existing systemic weaknesses, have left Canadians in long-term care extremely vulnerable to COVID-19. It\u2019s difficult to overstate the scale of this crisis. Almost 4,000 long-term care residents in Ontario have died from COVID-19, a 28 per […]<\/p>\n","protected":false},"author":410,"featured_media":77089,"template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"cu_story_type":[1623],"cu_story_tag":[],"class_list":["post-77087","cu_story","type-cu_story","status-publish","has-post-thumbnail","hentry","cu_story_type-expert-perspectives"],"acf":{"cu_post_thumbnail":false},"_links":{"self":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story\/77087","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story"}],"about":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/types\/cu_story"}],"author":[{"embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/users\/410"}],"version-history":[{"count":2,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story\/77087\/revisions"}],"predecessor-version":[{"id":77090,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story\/77087\/revisions\/77090"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/media\/77089"}],"wp:attachment":[{"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/media?parent=77087"}],"wp:term":[{"taxonomy":"cu_story_type","embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story_type?post=77087"},{"taxonomy":"cu_story_tag","embeddable":true,"href":"https:\/\/carleton.ca\/news\/wp-json\/wp\/v2\/cu_story_tag?post=77087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}