Seite - 459 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

459Privatization and COVID-19: A Deadly Combination for Nursing Homes intensified before the pandemic, but deteriorated dramatically when the disease began to hit home after home. The extent to which this deterioration can be directly linked to privatization is difficult to deter- mine, but there are clear indications that privatization set the stage. Adequate staffing levels are a necessary condition for quality care or even minimal care. As the recent Gillese inquiry in Ontario made clear, the “vulnerability of residents in LTC homes is not only a function of their physical and mental states. It also stems from the shortage of staff—particularly nurses—in the home.”34 While most Canadian jurisdictions require an RN on site at all times, only a few set out minimum staffing levels, and none are set at the 4.1 hours of direct nursing hours per resident per day that research indicated was necessary35 before their needs spiked with the pandemic. According to AdvantAge Ontario calculations, Ontario residents receive 3.45 hours of care per resident per day.36 This calculation may be generous, because the data are based on staffing on the books rather than who is actually present for care. Many staff are regularly off work due to illness, injury, or other leaves, and the data often include those not involved in providing direct care. Indeed, our research indicates that staff regularly work short.37 The low staffing levels can be linked to privatization, both in the sense that for-profit homes have lower staff- ing levels than do the others, and that public funding has not kept up with need as governments have promoted for-profit managerial strat- egies for the non-profit homes that remain. Profits must come from somewhere and, in a labour-intensive sector, that is typically from labour costs. These trends existed before the pandemic, and now the workload and stress have grown significantly. So has the need for more staff, with the care required per resident doubling. Putting on and taking 34. The Honourable Eileen E Gillese, Public  Inquiry  into  the  Safety  and  Security  of  Residents  in  the  Long-Term  Care  Homes  System,  (Toronto: Ministry of the Attorney General, 2019) at 87, online (pdf): Ministry  of  the  Attorney  General  <https://www. attorneygeneral.jus.gov.on.ca/english/about/pubs/ltc-review/>. 35. Charlene Harrington et al, “The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes” (2016) 9 Health Services Insights 13. 36. AdvantAge Ontario, “The Way Forward: Next Steps to Meet the Needs of Ontario’s Seniors” (2020), online (pdf): AdvantAge  Ontario  <http://www.advan- tageontario.ca/AAO/Content/Resources/Advantage_Ontario/2020-Pre-Budget. aspx>. 37. Pat Armstrong et al, “Long-Term Care Home Wait Times in Ontario” (2009), online: Health  Quality  Ontario <https://www.hqontario.ca/System-Performance/ Long-Term-Care-Home-Performance/Wait-Times>.