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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>.
VULNERABLE
The Law, Policy and Ethics of COVID-19
- Titel
- VULNERABLE
- Untertitel
- The Law, Policy and Ethics of COVID-19
- Autoren
- Vanessa MacDonnell
- Jane Philpott
- Sophie Thériault
- Sridhar Venkatapuram
- Verlag
- Ottawa Press
- Datum
- 2020
- Sprache
- englisch
- Lizenz
- CC BY-NC-ND 4.0
- ISBN
- 9780776636429
- Abmessungen
- 15.2 x 22.8 cm
- Seiten
- 648
- Kategorien
- Coronavirus
- International