Some modes of elder care delivery are more equal than others

This op-ed by Parkland Institute research manager Rebecca Graff-McRae appeared in the February 10, 2018 edition of the Calgary Herald.

Elder care should not be an industry. Decisions about caring for our aging population should be made based on best practice and the highest achievable standards of care, not on “business sense” that prioritizes cost-cutting, understaffing and profit-making while treating our elders as consumers.

Tammy Leach of the Alberta Continuing Care Association (an industry association), tries to make the case that “a swelling senior population with increasingly complex needs” requires a “diverse continuing care industry.”

However, the selective statistics – and indeed, the very language she deploys – paint only a partial picture of what it means to “put our seniors first” in Alberta.

The various delivery models for elder care are not equal. Research for the Parkland Institute by Dave Campanella, comparing the Alberta elder care landscape to national and international studies, confirmed that publicly run facilities provide more hours of care to residents than those operated by private or non-profit organizations.

Of the three categories, only publicly run facilities came close to the best-practice benchmark of 4.1 direct care hours per resident day – providing on average a full hour of care more than their non-profit and private counterparts.

Public facilities provided residents with the highest level of staff time from registered nurses and health care aides, while non-profit facilities provided residents significantly more time with licensed practical nurses. Private facilities provided residents below-average levels of care from each type of staff.

According to Statistics Canada’s long-term care facilities survey, between 2011 and 2013, only public facilities spent most of their revenue on nursing staff (RNs, LPNs and aides) – 59 per cent of their total revenue. In comparison, private facilities spent 48 per cent of their revenue on nursing staff over that same period, and non-profit facilities just 44 per cent.

In numerous studies, staffing levels are directly correlated to patient care.

The facilities lauded by Leach for budget-friendly buildings are mainly comprised of supportive living units, not the more complex types of long-term care or dementia care units, which require increasingly specialized equipment and security features. It is these elders with complex and diverse needs to whom Leach alludes to in the headline, but the majority of beds added since 2015 have been designated for much lower levels of care.

Even the small percentage of dementia and long-tern care beds created via Affordable Supportive Living Initiative funding had to be fiercely negotiated by the current government for inclusion.

While Leach observes, correctly, that “All continuing care providers, regardless of ownership type, are held to the same government-set standards and accountabilities,” these are minimum standards. On the whole, private facilities do not offer the same levels of direct, skilled, or complex care as public.

Designated supportive living facilities also operate under much looser standards than those providing long-term care, with no requirement for minimum staffing levels.

Privately run facilities also allocate significantly higher resources to administration than public facilities – a finding backed up by the Canadian Institute for Health Information. Every dollar spent on administration is money not spent on front-line care.

Why then, is Leach “concerned” about “recent investments announced … by government to open new public continuing care spaces,” when those public spaces have been consistently shown by peer-reviewed research to provide better quality of care?

Her bottom line argument simply doesn’t stand up: how is it more cost effective to use public funds to subsidize private organizations?

If we truly hope to “put our seniors first” as a province, we must consider how publicly funded and delivered elder care can work alongside our health-care system to provide services that keep them at home longer, keep them out of hospital longer, and preserve their quality of life. That is the best investment we can make.