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453Privatization
and COVID-19: A Deadly Combination for Nursing Homes
for-profit chains, further blurring the lines between for-profit and
non-profit homes.
While there are for-profit facilities that provide quality care,
there are clear patterns of lower staffing contributing to lower quality
care in for-profit homes.15 For-profit staffing strategies are not only
about fewer staff but also about a different mix of staff, with more
having fewer formal qualifications, who in turn are paid less. There is
evidence that this kind of staff mix also has an impact on the quality
of care, demonstrating the importance of a mix that includes staff with
more formal qualifications. For-profit strategies also encourage more
precarity: hiring more casual and part-time staff and failing to replace
staff absent for leaves or other reasons in order to reduce costs related
to benefits, such as sick leave and pensions, union pay rates, and other
job protections related to unionization.16 These strategies reduce hours
to the absolute minimum. Precarity not only leaves workers without
any form of security, it makes it more difficult to have continuity in
care and the development of relationship-based care with residents,
essential for good quality.
Other indications that quality tends to be lower in for-profit
homes include higher morbidity and hospitalization rates in for-
profit chains.17 Hospitalization suggests that problems with the care
received in the nursing home may put residents at risk.18 Verified
complaints are also higher.19 That the public also judge non-profit
and public homes as having higher quality is indicated by their rela-
tive preference: in Ontario, 67% of the first choices for nursing home
admission in 2010 were to non-profit and public homes although
they accounted for only 46% of the province’s beds.20 This is the case
15. Charlene Harrington, Allyson M Pollock & Shailen Sutaria, “Privatization of
Nursing Homes in the United Kingdom and the United States” in Pat Armstrong
& Hugh Armstrong, eds, The Privatization of Care: The Case of Nursing Homes
(New York: Routledge, 2020) 51.
16. David Harvey, A Brief History of Neoliberalism (Oxford: Oxford University Press,
2005) at 167.
17. Peter Tanuseputro et al, “Hospitalization and Mortality Rates in Long-Term Care
Facilities: Does For-Profit Status Matter?” (2015) 16:10 Journal of the American
Medical Directors Association 874.
18. Gudmund Ågotnes et al, “A Critical Review of Research on Hospitalization from
Nursing Homes; What is Missing?” (2016) 41:1 Ageing International 3.
19. Margaret J McGregor et al, “Complaints in For-Profit, Non-Profit and Public
Nursing Homes in Two Canadian Provinces” (2011) 5:4 Open Medicine 183.
20. Dan Buchanan, “The Not-For-Profit Contribution and Issues from the Provider
Perspective” (Presentation delivered at Reimagining Long-Term Residential
Care Annual Meeting, Toronto, 2011) [unpublished].
VULNERABLE
The Law, Policy and Ethics of COVID-19
- Title
- VULNERABLE
- Subtitle
- The Law, Policy and Ethics of COVID-19
- Authors
- Vanessa MacDonnell
- Jane Philpott
- Sophie Thériault
- Sridhar Venkatapuram
- Publisher
- Ottawa Press
- Date
- 2020
- Language
- English
- License
- CC BY-NC-ND 4.0
- ISBN
- 9780776636429
- Size
- 15.2 x 22.8 cm
- Pages
- 648
- Categories
- Coronavirus
- International