Page - 453 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

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].