Page - 452 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE452 In BC, between 2001 and 2016, the number of beds in for-profit homes increased by 2,621, while those in non-profit homes declined by 2,082.10 Currently, 58% of Ontario homes are for-profit, compared with 24% non-profit and 16% publicly owned by municipalities.11 For-profit ownership is further complicated by the contracting out of services within non-profit and government-owned homes, blur- ring the lines among the various forms of ownership.12 The outsourc- ing may involve hiring individuals, often through agencies that take a proportion of the pay. Instead of hiring their own therapists and other professionals or expanding their nursing staff, homes contract for indi- viduals to provide these services through private agencies. Similarly, homes fill gaps in their nursing and other staff by using temporary help agencies. This form of contracting out may be based on the argu- ment that the home does not need these individuals full-time and thus paying by day or by service is a more efficient way of hiring. Another growing form of contracting involves handing over entire services to a for-profit company. This has become common for cleaning, dietary, laundry, and security services, most often provided by international corporations that also deliver services to other orga- nizations, such as hotels and universities. This kind of contracting is based on the argument that these are ancillary services rather than health care services, and that they are more efficiently and effectively undertaken by corporations with experience to achieve economies of scale. But research demonstrates that these services are critical to care.13 Perhaps the most surprising kind of contracting out involves management services. As Daly14 shows, a growing number of non- profit and publicly owned homes contract out their management to 10. Andrew Longhurst, “Privatization & Declining Access to BC Seniors’ Care” (2017) at 14, online (pdf): Canadian  Centre  for  Policy  Alternatives <https://www.pol- icyalternatives.ca/sites/default/files/uploads/publications/BC%20Office/2017/03/ access_to_seniors_care_report_170327%20FINAL.pdf>. 11. Ontario Long-Term Care Association, “This Is Long-Term Care 2019” (2019) at 13, online (pdf): Ontario  Long-Term  Care  Association <https://www.oltca.com/ OLTCA/Documents/Reports/TILTC2019web.pdf>, citing Ontario Ministry of Health and Long-Term Care, Long-Term  Care  Homes  System  Report 2018 (Ottawa: Ontario Ministry of Health and Long-Term Care, 2018). 12. Pat Armstrong & Hugh Armstrong, “Contracting Out Care” in Fran Collyer & Karen Willis, eds, Navigating  Private  and  Public  Healthcare:  Experiences  of  Patients,  Doctors  and  Policy-Makers (London: Palgrave Macmillan, 2020) 87. 13. Pat Armstrong, Hugh Armstrong & Krista Scott-Dixon, Critical to Care: The Invisible  Women  in  Health  Services (Toronto: University of Toronto Press, 2008). 14. Tamara Daly, “Dancing The Two-Step in Ontario’s Long-Term Care Sector: Deterrence Regulation = Consolidation” (2015) 95:1 Studies in Political Economy 29.