This is the third article in a five-part series on media coverage of long-term care homes in Ontario. Read parts one and two.
In the recent book, The Privatization of Care: The Case of Nursing Homes, a collection of academic articles edited by Pat and Hugh Armstrong about long-term residential care in multiple countries, the authors speak about “privatization by stealth.”
This process of privatization has been wholly absent from recent mainstream discourse – before and during the pandemic. Although it intersects with for-profit ownership, it speaks to the broader trends in the political economy.
In neoliberal Ontario, healthcare costs have been reduced by shifting services away from hospitals to long-term care and home care, which are funded at significantly lower levels. Patients that were previously taken care of in chronic care hospitals are now offloaded to nursing homes.
But while hospitals provide universal access through public insurance and provide not-for-profit services, long-term care and home care in Ontario are predominantly for-profit. Although no one in Ontario can be denied long-term care access, residents who don’t qualify for government subsidy pay a portion of the costs ranging from $1,890 to $2,700 per month.
Publicly-funded home care (mostly for-profit) is rationed, which means an increasing reliance on unpaid family caregivers, private insurance plans and/or private sector service providers, which are again predominantly for-profit.
Waitlist based on ability to pay
In Ontario, the waitlist for long-term care homes has risen by 78 per cent since 2011-12, to over 35,000 people. The provincial waitlist and the construction of new beds was covered periodically in the mainstream media between 2017-2019, often in response to government announcements.
But the coverage was largely superficial. Not only did the media completely ignore the role of privatization, the matter of privileged access was neglected.
Long-term care waitlists are much longer for low-income seniors and for the few homes catering specifically to Indigenous peoples and other racialized communities, and LGBTQ+ people. Not surprisingly, homes for equity-seeking groups are only owned by not-for-profit organizations or municipalities (although recently, a major for-profit firm unsuccessfully sought to buy a home catering to the Korean community).
There was very little reporting on the access to culturally-appropriate homes during the 2017-19 period in the six mainstream outlets that were assessed in this case study. But there was virtually none on access by socio-economic status.
According to the Ontario Health Coalition’s 2019 report, Situation Critical, there is an eight-month gap between people waiting for basic beds versus those who can afford to pay an additional $300 to $800 a month for “preferred accommodation.”
The significant gap in access is directly tied to the profit motive. Until the late 1990s, 40 per cent of long-term care beds were classified as preferred accommodation before the Mike Harris government increased the allocation to 60 per cent. This was yet another way in which the private nursing home lobby found a way to maintain profits in a period of austerity.
Private caregivers and unpaid care
Successive governments in Ontario, obsessed with restraining costs, have not increased staffing to safe levels. Although the media talks about understaffing, what goes unreported is that this is another form of privatization, as wealthier individuals hire paid caregivers in publicly-funded care homes.
Media reports also do not speak of the considerable amount of time family members spend providing essential care to residents. It’s not unheard of for some family members to spend over 40 hours a week doing tasks that are the responsibility of staff. In effect, this trend represents another shift of costs from the public sector to the private sphere, in confluence with the logic of personal responsibility.
This is an unfortunate reality for those residents who don’t have the means to hire their own staff, and those who are not visited by family. There is also a gendered component here as the unpaid caregiving burden tends to fall on women (again, this isn’t part of the mainstream discourse).
Although the Toronto Star has previously reported on the increasing reliance on paid caregiving in nursing homes, this process of creeping privatization was completely absent from mainstream discourse between 2017 and 2019.
Ironically, much of what I have written thus far was covered in the Ontario Health Coalition’s Situation Critical report. But the (relatively short) articles written about the report largely focused on the violence in homes and understaffing (important issues on their own).
“Much of that [information on discriminatory access] did not make it into any kind of reporting,” says Natalie Mehra, the executive director of the advocacy group. “There was a little bit of coverage [overall], but nothing sort of commensurate to the gravity of the issues and number of people affected.”
Mehra questions the Queen’s Park media bureaus’ lack of attention to the report, considering the provincial jurisdiction of long-term care.
Who will build the beds?
The previous Progressive Conservative government (1995-2003) made the last major investment in building new long-term care homes, but it awarded two-thirds of 20,000 beds to for-profit companies. Since then, insufficient development of new homes and rationing of public home care has led to long waiting lists.
Since 2017, long-term care waiting lists have been a recurrent theme in the media. However, even as there were 54 stories about development of beds, long wait-lists and access issues between 2017 and 2019, ownership was ignored.
There were some incidental allusions to private sector interests, as when a “company spokesperson” was quoted when announcing new buildings, but there was no debate about why these beds were going to for-profit homes.
The OHC, other advocacy groups like CareWatch and the Ontario New Democratic Party have long advocated for new long-term care beds to only be awarded to municipalities or non-profit organizations. But this isn’t a talking point in the media.
For instance, in the run-up to the 2018 Ontario elections, corporate media did not distinguish between the election promises in regard to building new homes. If one relied on CBC and the Toronto Star, one would get the impression that there was no significant difference between the three major parties’ promises on this front.
However, while the Liberals and Progressive Conservatives have a demonstrated record of awarding beds to for-profit companies, the NDP platform explicitly spoke out against for-profit delivery:
“We will build and fund 15,000 more long-term care beds over the next five years — rising to 40,000 new beds by 2028. Our investment will focus on expanding the not-for-profit and municipal sector, where funding goes to patient care instead of profit” (emphasis mine).
Even after the exposition of the horrors of private nursing homes during the pandemic, there has been little questioning or reportage on ownership in respect to new developments of long-term care homes.
Decline in public investment facilitates privatization
In all the reporting on long waitlists, the media has not bothered to ask a critical question: why has there been so little investment? And whom does it benefit?
In their book, the Armstrongs explain that “lack of public spaces in publicly subsidized homes push people into alternatives where they are responsible for the entire cost.”
In Ontario, long-term care costs $180 per day, with the government covering about $123. Alternative options for seniors (and younger people with disabilities) are assisted living facilities or retirement homes, with monthly fees for the latter ranging from $2,000 to $7,000.
The retirement home sector, predominantly for-profit, is dominated by the many of the REITs (Real Estate Income Trusts) that own and/or manage long-term care, providing yet another avenue for wealth accumulation, at the expense of residents and workers. Unlike long-term care, the retirement home sector is self-regulated.
But when it comes to mainstream discourse on waiting lists, these forms of privatization are ignored. Instead, vested sources are often the go-to sources.
Privatization of control
In October 2017, CBC, Global News and CTV reported that several long-term care homes in Toronto were considering relocating, and thereby potentially displacing 1,800 residents.
Based on the reporting, both nursing home associations (those representing for-profits and non-profits) said that the government subsidy for redeveloping beds was not enough in a city like Toronto. The for-profit homes were thereby considering moving their operations elsewhere.
‘Redevelopment’ here refers to the fact that nursing homes constructed based on 1972 guidelines have outdated designs and need to be rebuilt based on current guidelines.
In the case of non-profits, many of whom are charitable or religious organizations, fundraising is indeed challenging, even with the government subsidizing 60 to 80 per cent of the costs (the subsidy is only provided piecemeal after the construction is completed, requiring upfront capital investment).
In the case of for-profit homes, their properties also serve as an investment, which can be sold off when their contracts are over, or when they choose to relocate elsewhere.
This was not mentioned in any media report save a quote by a spokesperson for an advocacy group who pointed to the profit motive in CBC’s “exclusive” feature on October 24. Although this excerpt was under the subheader ‘Holding the government hostage,’ it wasn’t clearly explained, or elaborated upon.
Ultimately, that one critical paragraph was sandwiched between statements of the OLTCA spokesperson, who was far more prominently featured. The story did correctly identify the association as representing mainly for-profit homes.
However, curiously, the same CBC journalist, Mike Crawley, published another news report the following day, which essentially comprised talking points of the OLTCA (with no mention of the profit motive).
If CBC’s reporting had some redeeming quality, Global News’ headline, “It’s impossible to keep up: Toronto nursing homes unable to keep up with development costs,” would have made the OLTCA’s public relations’ rep blush.
CTV’s article, although more measured in tone, was also favourable to the nursing home lobby, using OLTCA and Toronto mayor John Tory as sources. Tory, former leader of the Ontario Progressive Conservatives, backed the demand for higher subsidies for for-profit homes.
The story was thus dominated by the OLTCA’s concerns, when it could so easily have been framed around questioning the logic of public subsidies for private assets, and about democratic community control of services versus the risk of displacement at the whims of private investors.
Individualizing solutions
Mehra, from the OHC, says that the media coverage was far more critical in the late 1990s and early 2000s when the Progressive Conservative was slashing public spending and privatizing services.
“When the Harris government brought in cuts, and [implemented] a really radical fiscal policy, there was widespread reporting on it,” she says. “It was an issue. It was a debate.”
She says that our expectations around collective solutions have since eroded, in conjunction with the neoliberalization of the state, represented by lower taxes on the wealthy and corporations
This cultural shift is reflected (and perpetuated by) occasional media reporting that normalizes growing income inequality, and advocates for individualized solutions, such as buying long-term care insurance. In this particular Globe and Mail piece, the sources are insurance companies themselves, who get a boost from free advertising.
Even when the problems are encapsulated relatively clearly, like in this Global News piece, the solutions are geared towards individual actions: buy long-term care insurance, set aside savings or “tap into home equity.”
Mehra says the problems are a clear reflection of wealth and income inequality, but advocates who present collective solutions are viewed skeptically by the media – who she says don’t bother investigating claims themselves.
“The media is skeptical about whether or not we can afford [better care] without even looking at fiscal policy,” she says. “Of course, we can afford it. We have cut taxes repeatedly for people who don’t need tax cuts.”
Zaid Noorsumar, Journalist 
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