Change and Continuity by Mark P. Thomas

Author:Mark P. Thomas
Language: eng
Format: epub
Publisher: MQUP

MARKETS IN CARE

Historically, hospitals in Canada have been owned by non-profit and charitable organizations or by municipalities. Before neoliberal restructuring, however, there were a significant number of privately owned nursing homes. These were frequently converted houses and mainly owned by individuals or families. “Few homes provided much more than room and board ‘with practically no nursing care of a skilled type’” (Struthers 1997, 176). As neoliberal hospital reforms and an aging population increased demands for residential care, governments in many jurisdictions developed affirmative action plans to promote corporate ownership of both homes and of services within non-profit homes. The result was a transformed landscape and renewed questions about the quality of care.

Ontario and BC have taken the lead in promoting for-profit ownership of facilities but the Atlantic Provinces have been close behind (Berta et al. 2006). When the Ontario Conservative Government decided to license 20,000 new nursing home beds and retrofit another 16,000 to meet safety, fire, and privacy standards, it introduced a competitive bidding process that favoured large corporations (McKay 2003). To make the investment attractive, the government offered to pay $10.35 per day for the next twenty years, at a total of $75,555 per bed in capital subsidies and additional operating costs as well as per diems for every resident to cover food, nursing care, supplies, and programs (McKay 2003). At the same time, it removed the regulations requiring at least one registered nurse on every shift and a minimum of 2.5 hours of nursing care per resident per day. It also allowed owners to increase the proportion of beds that could be charged extra fees. The requirement to have enough capital to enter a formal bidding process based on considerable expertise in markets and to meet new standards for physical structures all made it difficult for charitable or non-profit homes to compete even for the retrofit money. As a result, two-thirds of the 20,000 new nursing home beds were awarded to for-profit nursing home chains. The top five municipal and charity-based nursing home operators were awarded 2,049 new beds while the top five for-profit corporations such as Leisureworld (now called Sienna) and Extendicare were allocated 6,573 new beds (McKay 2003). Today the majority of beds in Ontario are owned by for-profits (CIHI 2015, Table 1.1), virtually all of them corporations.

There are similar patterns in BC. With the contracting conditions favouring large ownership, the number of corporate-controlled beds for all types of residential care facilities in BC increased between 1990 and 2004 by 599 per cent, or from 552 to 3,856 (Cohen et al. 2005, Table 8). Not all provinces have followed this pattern but the latest data from CIHI (2015, Table 1.1) indicate that the largest share of facilities is owned by for-profit facilities and those facilities tend to have the highest number of beds.

Even these data hide the extent to which corporations operate within non-profit, government, and charitable homes. Some governments such as in BC have actively pressured homes to contract out services, while others have done so indirectly by failing to provide sufficient funding.

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