About three months ago I asked if we wanted long term care for all of our elderly or just long term long term storage for those not really closely related to us. The continual shocking news from long term care homes here in Ontario and elsewhere suggests that, years ago, I suppose, we opted for long term storage.
The obvious reason why is cost. High quality long term care is expensive ~ but, it isn’t that nicely decorated rooms cost a lot; they don’t. Nor is it that good food and nice dining facilities are prohibitively expensive; they’re not. It is possible to provide a quite “nice” environment at a modest, affordable cost. Facility costs are not the problem.
Nor is profit. It is true that most long term care facilities, including, I suspect, both the best and the worst, are operated on a for profit basis. I spent 35+ years in government, first in the Army, including several years as a senior officer where I saw organizational, management and financial issues close up, and then a decade managing an agency that worked hand-in-glove with government. I have no hesitation in saying that that removing the profit motive does NOT lower costs. In my nearly half a century of work experience I leaned that public services are always at least as expensive (and usually more expensive) than private services. One of the reasons that both the (Liberal) Chrétien and (Conservative) Harper governments were so keen on contracting out (alternate service delivery they called it) was because everyone inside government knew that the private sector could do many things as well as but cheaper than the government could. Of course, there are exceptions, but they just prove the rule.
When a private corporation provides a service it must do so at, at the very least, on a “break even” level or else it must go out of business. Even charities like the Salvation Army must, at least, break even in the long term. Governments are not charities. Every government agency has a fixed budget and the agencies where the budget keeps place with ever rising costs are few and far between, and social service agencies are not amongst them. When a private sector manager cannot meet budget (s)he cuts costs ~ staff, facilities, other “input” costs ~ until (s)he can. That includes cutting wages. When a government agency that provides a public service cannot meet budget it is almost never allowed to cut “output” until the very end. First it cuts staff, because the government workforce is unionized government managers are never allowed to cut individual wages, and the remaining staff are told to “do more with less.” Only when that has gone past its logical extreme is “output” cut ~ in healthcare, for example, that means closing hospital (or long term care) beds. Put simply: public (government) services are neither cheaper nor better than private services.
What is the biggest “input cost” in long term care? People ~ the wages for nurses and cooks and cleaners and administrative staff and drivers and …
… above, all the personal support workers. They are, mostly, already low paid workers ~ unionized or not. I believe that the biggest single problem that the Canadian Forces found when they went to help in long term care homes in Ontario was inadequate staffing: too few cleaners, above all, and too few personal support workers, too.
OK, so the solution is simple, right? Pay them more …
If only it was that simple. Many of the jobs in long term care are hard, dirty, low-skill and, in economic terms “low values” jobs. They are “low value” because they add little to the service being sold. But, because they are “low value” jobs they are also low paying ~ minimum wage ~ jobs and some people can live “better” on social assistance than they can in the work-force if they must e.g. pay for transportation and child care on a single, minimum. wage, salary. Some years ago, during the Harper years, actually, the government closed off the best source of long-term care workers when, in an effort to appease one political faction, it closed off that part of the temporary (foreign) worker programme which saw tens of thousands of (mostly) women who wee also ‘people of colour,’ mostly from the Philippines but many from the Caribbean and Fiji and South Asia, who were willing to do that hard, dirty low-paid work because: a) it gave them an entrée to Canada (in some cases they could apply for permanent resident status after two years of “service”); and b) the low pay was still enough, after taxes, for a frugal person to send a few hundred dollars a month home ~ often supporting both parents and children.
I do not have a solution for what I agree is a crisis in long term care for Canadians, especially for those, the majority, who cannot afford first-class care. I do not believe that making long-term-care a public service is either: a) cost effective or affordable; or b) going to make it qualitatively better than the long term storage of our elderly and mentally disabled that we have now.