The global pandemic drew attention to decades-long problems in long-term residential care in Canada – resulting in tragic loss of life for thousands, and loss of quality of life for the many more who experienced isolation and inadequate care during pandemic lockdowns.
Research has demonstrated that COVID-19 related mortality and inadequate care during the pandemic was most pronounced within for-profit long-term care facilities.
Unsurprisingly, political organizations and advocates have called for the elimination of for-profit provision of residential care across the country. Many of the same critics have called on increased provision of homecare as a solution. But there has been relative silence about the for-profit model in homecare too.
Why is no one talking about for-profit homecare in Canada?
Given the rise in demand for homecare, the acceleration of private homecare services, and our rapidly aging population, the role of profit in homecare should also be front and centre in our public discourse.
In Canada, homecare involves a complex and often confusing mix of public, for-profit and not-for-profit organizations delivering services across the country, often, but not always using a kind of managed competition model. Although publicly funded to varying degrees by the provinces, many Canadians pay personally for services, either to top-up publicly funded services or replace them.
Poorly funded public services can mean wealthier families turn more frequently towards for-profit agencies. Although there is heavy reliance on not-for-profit care providers in this sector, some regions (particularly Ontario) have seen expansion of for-profit homecare delivery.
With colleagues, we conducted a review of mainstream media articles on homecare in Canada. We found that during the pandemic, articles addressing the issue of homecare emphasized the safety, desirability and comfort of homecare compared to residential care, but never questioned the profit-model in homecare the way they do in residential care. We also found overwhelmingly homecare agencies, often for-profit ones, were the ones interviewed and quoted in the articles. Frequently the articles were supplied by the for-profit agencies themselves.
Problematically, we also found that despite the considerable variability in homecare across Canada, media articles conveyed a sense of homecare as a singular entity.
The outlier was a newly released CBC Marketplace investigation which revealed disturbing concerns with homecare quality and accountability in Ontario (where for-profit companies play a significant role in delivery).
Media is not the only place where the discussion has been largely ignored. Analyses of for-profit homecare in Canada are also largely ignored in academic research.
In the 1990s, when Manitoba shifted a small portion of its homecare from public to for-profit delivery, it was found not only to be more expensive for government but had higher worker turnover. Yet despite these findings, little academic research has been done on the for-profit model in homecare across Canada.
There is also concern for potential conflicts of interest amidst the expansion of for-profit care delivery, especially given the lack of oversight of this sector.
We should not give this sector a free pass — from media scrutiny or academic research. It’s time the nation turned its eyes to for-profit homecare. Is this the path we want to traverse?
As homecare is more and more frequently turned to as the fix for long-term residential care woes, we need to more carefully assess the profit-model of homecare. It appears we are rapidly heading in this direction — so, it’s long past time for a public discussion.
Photo courtesy of DepositPhoto
