For decades, long-term care homes have been operated by non-profits, municipalities, or for-profit companies. It was the Chair of Chartwell Retirement Residences, and former Premier, Mike Harris, that started the for-profit boom in Ontario.
With Harris’ introduction of a competitive bidding process for home care services what was a minority of homes being run for-profit became a majority by the end of the Harris government tenure in 2002.
“When Harris was in power and he decided to go to the competitive bidding process that’s when we first saw the major move towards for-profit chains,” researcher Pat Armstrong, an authority on long-term care, explained to The Post Millennial. “The competitive bidding process really favors the for-profits, the big companies.”
Ever since, major lawsuits and government reports have exposed the conditions in many privately run homes.
In 2014, a Health Ministry report accused Chartwell, one of Canada's largest companies providing for-profit care, of “neglect” and “inaction” in the handling of an elderly woman. Her bedsores revealed “a rotting ulcer [that] ate deep into her leg, exposing her shinbone through blackened flesh.”
In 2018, Sienna, Revera and Extendicare, three industry giants, were involved in an unprecedented lawsuit brought by 200 families. One plaintiff’s mother lived in an Extendicare home where a cockroach was discovered in her bed. The concerned daughter told the media “[my mother] was in diapers. She was always wet and dirty.”
Another plaintiff accused Sienna of allowing his father to develop bedsores. The ulcers were so severe that an Ontario hospital assessed them as being stage four sores, “with bone being visible.”
“Many for-profits are not providing appropriate care. We’ve looked at scandals that have been made in the media. Almost all are in for-profit homes,” recalled Armstrong of an earlier study.
Last fall, Inspectors sent to an Extendicare facility found that residents were “not always getting bathed on a regular basis,” pointing to a “pattern” of understaffing. Meanwhile, Sienna and Revera are among companies currently facing a $100-million class-action lawsuit started by those whose loved ones died during the recent epidemic.
These results anticipated a scathing military report which found several Ontario homes to be host to poor sanitary conditions and degenerating care for residents. The military observed cockroaches and flies, residents being allowed to soil their beds, and food being left in residents’ mouths while they slept.
All five of the homes that had soldiers turn whistleblower were owned by for-profit companies.
The formal academic research has been equally damning. Two studies in 2011 found lower staffing levels and higher rates of resident complaints in for-profit homes. A 2015 study found residents in Ontario for-profits at a 10 per cent higher risk of mortality and at a 25 per cent higher risk of hospitalization.
During the epidemic, according to research released early May, the death rate in private, for-profit homes has been more than double that of Ontario’s many municipal, publicly owned facilities.
"Undervalued and underpaid"
According to Sarah, a personal support worker (commonly referred to by the acronym, PSW) who has worked through the COVID-19 epidemic, things were already bad in her home.
“There’s been problems for years. But they just kind of turned a blind eye to it. Because they knew the job would get done,” said Sarah, whose for-profit home struggles with low staffing levels. “So who’s going to leave someone in a soiled mess and just go home. The job would get done. But you would have to cut corners somewhere.”
Pay is also low at Sarah’s home. The building is run by one of Canada’s wealthiest long-term care operators. Yet, at the end of the month, almost all of the staff’s salary is spent on rent.
“A lot of PSWs work two or three jobs. We have a lot of part time people who probably work three jobs. I only work one. I can’t handle two.” said Sarah chuckling with her last comment. “Even some of our full time people are working another job.”
“This is a for-profit home. Honestly, it’s money, money, money. Only so much money is allocated for each area. Years ago funding was so short so that had to go dip into their fund for overtime… Then we were really working short.”
With the Pandemic, Sarah has had to help bag some of the dozens of residents that have died from COVID-19. This work used to be done by funeral homes who are no longer allowed to enter the building. Many of these residents she has considered family.
Morgane, a PSW in non-profit, described the experience of working in a home hit by the epidemic.
“These people become part of your family circle. You don’t mean for it to happen. But, when you take care of someone day in and day out, and you know their family, and their family knows you by name. To watch them go through the end of life alone—scared—surrounded by strangers… it breaks you as a person” Morgane said.
“Because we are strangers even though we’re still family. We’re not daughters, we’re not sons, we’re not grandkids, we’re not husbands... They talk to the family over FaceTime. They say goodbye to the family over FaceTime...”
For the surviving residents, says Morgane, things are equally grim. Many have gone into a depression after being forced to spend long-periods alone in their rooms.
“Some of them are able to pick up the phones and make calls to their loved ones. But there are some with limited mobility who can’t. So now they’re stuck in their rooms sitting in front of the TV or the window and they’re lost. They’re just lost and broken.”
Despite how bad things have become in her home, Morgane, who did a placement in Revera, is still glad she does not work in a for-profit. The crisis, according to her, has exposed the real difference between the profit and the not-for-profit industry.
“The people that do the most work are the most undervalued and underpaid. I have always said this. I will always say this,” she concluded. “The crisis in long term care was really bad before the pandemic and then the pandemic happened and then it just absolutely destroyed all hopes of ever having any normalcy again. Which is why we need help.”
A “revolving door”
Groups like the Ontario Health Coalition (OHC), which represents half a million people with 400 member organizations, have tried to shine the spotlight on long-standing issues in long-term care.
Yet, despite these groups widespread membership and wealth of research, they have had a difficult time getting their concerns through to the Ford government.
“Normally, we’ve met with every health minister and every premier.” Natalie Mehra, Executive Director of the OHC told The Post Millennial. “We have not been allowed to meet with Doug Ford or Christine Elliot. We talk with MNA’s when we run into them. Formal meetings, however, generally, they’ve just ignored our correspondence or are just not responding.”
On the other hand, numerous lobbyists are hired by these for-profit companies and by the Ontario Long-Term Care Association (OLTCA) which represents their interests. These lobbyists target offices like that of the Minister of Health, the Premier, his Cabinet, and the Attorney General, with phone calls, meetings, and presentations.
Frequently hired through a public affairs agency, these consultants are often connected to the Conservative party. Andrew Brander who has lobbied for the OLTCA, was the director of communications of Ford’s current Minister of Finance and is described by his agency as being “[f]resh off role in Ford Government.” Christopher Chapin, who’s done lobbying for a large Ontario for-profit, was the Deputy Digital Director for the 2018 Conservative election campaign.
Other lobbyists have been senior advisers, heads of strategic communications, and campaign directors for the Ontario PCs.
For Mehra, this is evidence of a different story going on behind closed doors: “For family members, and for organizations like ours, trying to get in the door is very difficult. Obviously people who have close relationships—who have closely worked with politicians, or have been at the head of political parties, or at the head of governments—have the ability to get into the door instantly, and have the ability to get listened to by the government.”
Indeed, the OLTCA publicly publishes its demands to the government. In 2019, the organization was asking that owners receive increased “flexibility” with staffing. Specifically, they wanted the removal of the requirement for an on-site registered nurse 24/7.
Moreover, because these facilities, which can sometimes face serious lawsuits or damning reports, “feel over-scrutinized by the public, the media and by Ministry inspectors” the OLTCA is pushing for an end to “punitive approaches to compliance”: namely, fines for repeated statutory non-compliance. They also ask that the government “revise” its decision to hire 100 inspectors who inspect homes annually.
“All of these things are not in the public interest,” says Mehra. “It is absolutely not in the public interest to not even have one RN on staff in the homes. It is not in the public interest to cancel annual, unannounced inspections. It’s not in the public interest to not have an effective enforcement regime. But that’s what they have been lobbying for.”
When the Ford government came to power they eliminated annual unannounced inspections. Despite the protests of groups like the OHC and Ontario unions, Ford is yet to put in place minimum care standards for residents. Funding increases for long-term care were also placed below inflation.
Mehra described what she called the “revolving door” that has developed between for-profit long-term care and Conservative politics. Conservative politicians and insiders routinely turn from the party and government payroll to for-profit companies. Mike Harris is not the only premier to have gone on to sit on the boards of these large companies. Conservative premiers Ernie Eves and Bill Davis have gone on to sit on the boards of major for-profits.
Others, like Shelly Jamieson and Donna Duncan worked in Conservative politics before they started earning a salary from Extendicare and the OLTCA respectively.
For-profit Corporations and their lobby have also made good on paying the Ontario PCs at least $340,477 in political donations since 2007.
According to Unifor, which has almost 15,000 members in long-term care, the major concerns that ought to be dealt with relate to low wages and better working conditions. The OLTCA’s members, who negotiate collectively with Unifor, have apparently been less charming in these matters.
“Arbitrated settlements have not been good to Personal Support Workers (PSWs) over the last decade and, in fact, included a two-year wage freeze if you can believe it,” explained Katha Fortier, Unifor’s Ontario Regional Director. “So they’ve fallen below inflation.”
“Before ten years ago we were bargaining wage increases like %2.6, %2.75. Not that things were perfect but people were staying. It was a decent job and now, relatively speaking, it’s not.”
At one facility with degenerating staffing levels, one employee Fortier cited as an example, left for better pay at a Booster Juice for $16.50 an hour. When Unifor took its staffing concerns to the Minister of long-term care they received the following response:
“Minister Fullerton told us that she was aware of the issues around personal support workers... The response was essentially to tell us that she would be creating an advisory group which of course, our union or any other union is not a member of. In fact, there’s not a single PSW on the advisory group to talk about a staffing plan.”
Unifor later learned that the staffing advisory group did include industry leaders like James Schlegel. The Schlegel family has donated at least $70,000 to the Ontario PCs. They were recently in a bargaining dispute over short-staffing levels. Moreover, their homes have collectively had one of the highest death tolls among major Ontario chains since the COVID-19 epidemic started.
Getting out “smelling like roses”
To date, across Ontario, at least 261 people have died in Revera homes. 79 elderly Ontarians have died in Schlegel Villages facilities. At Extendicare homes and subsidiaries, 66 passed. At Sienna, two workers, one in their fifties, another, a Hatian man in their 60s, have also died, along with 43 residents.
With the high death tolls, there have been calls from unions and civil society groups for the government to take over for-profit homes as they have done in BC and elsewhere. There have also been demands for a public inquiry into the crisis in long-term care. A public inquiry would allow for warrants and the summoning of witnesses to investigate the long-term care industry.
COVID-19 has otherwise been accompanied by a spurt in lobbying. A study conducted by The Post Millennial of Ontario’s lobbying registries over the past two months shows at least 17 different representatives or consultants have registered as active lobbyists for for-profit long-term care companies or for the OLTCA.
Of those newly registered lobbyists at least five have previously worked for the Ontario Progressive Conservatives.
Lauren McDonald registered May 7 to represent Revera. Revera’s Ontario homes have seen the most deaths among for-profit Ontario chains. McDonald worked in the Office of Premier Ford and was the premier’s director of marketing in the opening months of his administration.
Michael Wilson is another recent lobbyist for Revera. He was Conservative Ontario Attorney General Doug Downey’s “go to” (as Downey called him) when he was being paid to be Downey’s chief of staff.
There is also Leslie Noble, registered for Chartwell, a for-profit whose revenues neared one billion in 2019. Noble is described by her government relations firm as being “well-known in Conservative circles” after serving as strategic advisor on numerous political campaigns. She frequently comments in national outlets on industry and Conservative politics.
In the same boat as Noble, Carly Luis is earning money through Chartwell and previously served as director of strategic communications for the Ontario PCs. She has worked in the office as an adviser to the leader of the PC’s when Patrick Brown was holding the reins.
Melissa Lantsman registered April 27 for Extendicare. Lantsman’s bio describes her as the “war room director and chief spokesperson in Premier Doug Ford’s successful 2018 election campaign” and as having held “senior roles” in the war rooms of the federal Conservative Party through 2008-2015.
From out of province Conservative politics, Chad Rogers has been lobbying for the OLTCA since April 20. Rogers was Senior Advisor to Nova Scotia’s Conservative Premier John Hamm and has worked on numerous other provincial and federal campaigns.
Other consultants registered prior to this two month period. Among them is Patrick Tuns who lobbies for Caressant care, a large for-profit that owns fifteen long-term care homes across Ontario. Tuns was deputy campaign manager for Doug Ford and the Ontario PC’s in the 2018 election campaign.
“The Long Term Care Association wants to get out of this smelling like roses,” suspects Unifor’s Katha Fortier.
The Post Millennial reached out to several lobbyists asking for comment on for-profit long-term care. None accepted the request.
Note: The front-line workers interviewed for this piece have had their names changed in order to maintain their confidentiality. The conditions they reported in their homes have not be altered in any way.