Seite - 450 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE450 secrecy on the grounds that a competitive environment protects corpo- rate rights to trade secrecy, including over exactly how profits are made. All these forms are evident in nursing homes, residential facili- ties that receive considerable public funding to provide 24-hour nurs- ing care. Nursing Home Privatization Labelled by several different names, what are most commonly called nursing homes are primarily a provincial/territorial responsibility. They are not explicitly named under the Canada Health Act, the legis- lation that establishes principles for federal funding. As a result, there is considerable variation among jurisdictions in relation to funding, regulation, and policy. Nevertheless, as McDonald4 explains, there are five common funding patterns across jurisdictions: • health care costs are publicly covered; • residents bear some responsibility for accommodation costs; • public subsidies of accommodation costs are targeted based on residents’ ability to pay; • residents’ payments should not take all of their income; • residents’ payments should take into account the needs of other family members. Another commonality has been the closure of chronic care and psychiatric hospitals, a narrowing of the definition of acute care, and the dramatic shortening of hospital stays in the name of health care reform. Policy increasingly emphasizes aging  in  place, which primarily means looking after yourself (i.e., responsibiliza- tion) or having—usually female—relatives look after you, with some support from government-funded home care. Homecare pro- vides some services previously available in hospitals and nursing homes, but many do not have private homes, or homes organized in a way that can safely accommodate their needs, or relatives with the time, skill, or other capacities to provide the required care. The complexity of the care and equipment required means that much 4. Martha MacDonald, “Regulating Individual Charges for Long-Term Residential Care In Canada” (2015) 95:1 Studies in Political Economy 83 at 89.