- by David Clark

In a recent study, published in Canadian Public Policy (September 2021), the authors (from the universities of Saskatchewan, Toronto, and Carlton) tested the “association between [Long-Term-Care Homes (LTCHs)] provider type and outcomes in preventing and managing COVID-19 outbreaks”. The data they used was as of February 2021 for government run, non-profits, and for-profit homes. As the authors noted, as of July 2020 about 80% of COVID-19 deaths were “linked to long-term-care or retirement homes, andwhere in Ontario outbreaks occurred in “at least 491 LTCHs”.

LTCHs operate and are regulated under license and are required to meet the terms of their license. Funding is received from the province and can only be used for “eligible administrative, operational, and maintenance costs”. Additional funding may come from fundraising/donations for government and non-profits and borrowing by for-profits.

LTCH licenses are usually for a period of up to 30-years. The authors state there seems to be little competition for licenses and, based on policy discussions and how policy is applied in other social policy areas, the government leans to “supporting existing providers”. Ontario is the most privatized province at 55% privately owned, government operated at 16%, and non-profits at 28%.

This study used data from various government reports and websites for 608 homes for which data was available for the 630 LTCHs in Ontario. As of February 11th 2021 there were 491 homes with 491 outbreaks, active and inactive.

The full article, which includes statistical tests for significance and confidence levels and other analyses can be found in the journal Canadian Public Policy, doi:10.3138/cpp.2020-151.

So, here is the Coles’ Notes version of their findings.

For-profits had the worst record of COVID-19 deaths in homes with outbreaks, than not-for-profits, and government-run. The average percentage of deaths, as a percentage of beds, was for in for-profits was 6.54, followed by non-profits (4.47), and government-run (1.63).

Overall, including homes without outbreaks, the number of deaths as a percentage of beds was 1.30 (government-run), 3.40 (non-profits), and 5.62 (for-profits).

Based on previous research, the authors hypothesised that government-run homes would have a better record of preventing and managing outbreaks, non-profits would be less successful, and for-profits would be worst: “Although no type of home [for-profit, non-profit, government-run] was particularly effective at preventing outbreaks, government-run LTCHs were the most successful at limiting the number of deaths once an outbreak had occurred.”

This study was at the provincially aggregated level of analysis so it likely that there are exceptions to the above at the individual home level. In fact, there are only six health unit regions for which LTCHs reported no COVID-19-related resident deaths as of 14th December 2021. These are Grey-Bruce, Haldimand-Norfolk, Kingston-Frontenac-Lennox & Addington, North Bay-Parry Sound, Northwestern, and Timiskaming (covid-19.ontario.ca). These exceptions also reported no COVID-19-related worker deaths.

The authors suggest more research is required to understand the different outcomes by home type (private, non-profit, and charitable).

David Clark, BA(H), BES, MA is an Independent Researcher in Owen Sound