Profit motive blamed in long-term care crisis

  • June 4, 2020

The 88-year-old godmother of palliative care in Ontario knows exactly what’s wrong with long-term care in the province. Much of it is motivated by profit.

“The profit motive is — what do I want to call it? — something that sets fire to the concept of care,” said Jean Echlin.

“It’s just — ohhh!” said a frustrated Echlin.

On June 1, Ontario Ombudsman Paul Dubé, acting on his own authority to investigate, assembled a “special ombudsman response team” to examine the entire sector. His investigation came one week after the Canadian Armed Forces, called in to help at five long-term care facilities facing crisis due to COVID-19, issued a damning report that found unsanitary conditions and an absence of basic care in all five for-profit homes.

“Palliative first” should be the guiding principle in any home that cares for the frail elderly, Echlin said, but that’s not what she sees in an industry dominated by big corporations.

Echlin taught palliative care in the University of Windsor’s faculty of nursing for 40 years and founded Ontario’s first modern hospice in Windsor. Since 2014 the deVeber Institute for Bioethics and Social Research has been handing out the annual Jean Echlin Award for Ethics in Palliative Care. 

“I’m very fortunate right now that I have two of my children who take turns with my care in day time and night time. I just consider myself blessed not to be in a long-term care home right now,” she said.

Echlin’s instincts about the profit motive are supported by an investigation by Rabbi Shalom Schachter into COVID-19 death rates in Ontario’s long-term care homes. In a May report for the Interfaith Social Assistance Reform Coalition and the Ontario Health Coalition, Schacter found death rates were substantially higher in for-profit homes compared to non-profit and municipal homes.

Just shy of 2,000 Ontario seniors live in Catholic-sponsored, non-profit long-term care homes.

The Ontario Long Term Care Clinicians have issued a call for a palliative first model of care that would deliver real powers to the medical directors of the homes.

“What is called for in long-term care, throughout our health care system, is a palliative approach to care, the essence of which is wholistic care, addressing all parts of an individual human being. It is truly compassionate care,” said OLTCC board member Dr. Janice Legere in a release.

Staffing shortages, gaps in training and funding and an industry driven to produce returns for investors has resulted in a system that is failing both patients and workers, said Ontario Health Coalition executive director Natalie Mehra.

“Care is about relationships…. The continuity of that care and that relationship (between patient and caregiver) is fundamental,” Mehra said. “And that is broken. That is completely broken.”

Twenty years of Ontario Health Coalition studies of long-term care show that “the profit motive contorts all of the approaches to care and it absolutely corrupts the care relationships,” Mehra said.

To the extent that care can be measured, the numbers speak against for-profit care.

“Overwhelmingly, the studies show that the for-profits are much worse,” said Mehra.

The problems in Ontario are not isolated, said Catholic Health Alliance of Canada president and CEO Michael Shea.

“Recently we had a call involving a variety of people connected with Catholic health services across North America (and) with officials at the Vatican,” Shea wrote in an e-mail. “The discussion brought into focus that this world-wide crisis (COVID-19) is highlighting the marginalization of the elderly in many countries. This is definitely a concern for Catholic health care.”

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