For rebuilding, the report recommends private-public partnerships (P3s) because these are commonplace rather than because they are good value. Given the considerable evidence of much higher cost and poorer outcomes in these projects over public alternatives, the commission seems uninformed on this issue.
In discussing nursing home operation, the report suggests that good “mission-driven” for-profits should be distinguished from bad “solely commercial enterprises” but does not say how this distinction can be made, how these organizations can be held accountable, or how levels of profit and mission can be regulated or monitored. No doubt on the weekend, for-profit long-term-care companies were running to publish statements about a mission-driven approach on their websites!
Further, the report fails to grapple with issues related to significant sub-contracting to for-profit companies across the nursing home sector, for food service, cleaning, laundry, management services and more. This sub-contracting exists in many for-profit, public and non-profit nursing homes in Ontario. Research has shown that sub-contracts, while initially attractive, over time tend to produce lower quality and higher costs than in-house services.
In Canada and other countries, there are many workable public and non-profit alternatives to for-profit rebuilding and operations. Indeed, some publicly funded services that were previously contracted out to for-profit operators are being returned to direct government operation, due to persistent cost hikes, poor accountability and abysmal service quality. While successive provincial governments have ignored this evidence, it is there for the asking.
That said, Ontarians should be grateful to the commissioners for producing a useful, comprehensive report that lays out many urgently needed actions to strengthen, support and improve long-term care. For the Ford government, redemption is impossible. To restore public trust, even in part, it must take immediate action on the majority of the commission’s recommendations and make long-term care a top priority.
Susan Braedley is an Associate Professor at Carleton University whose research program focuses on identifying promising practices in long-term care.
This content was originally published here.