Calls for fundamental reform to subsidized long-term care beds in British Columbia are drawing a range of responses after the provincial seniors advocate criticized the current model.
“We are rewarding, if you view profit as your reward, not spending on the care,” Isobel Mackenzie said Monday, when she presented her new report titled Billions More Reasons to Care: Contracted Long-Term Care-Funding Review Update at the provincial legislature.
Provincial health authorities spent about $2.87 million on just under 28,000 long-term care beds in 2021/22 — 35 per cent more than in 2017/18. Of this amount, $1.9 billion, some 65 per cent of all spending for long-term care went to private operators, for-profit or not-for-profit. They managed just under 19,000 beds with 52 per cent under private ownership.
But not-for-profit operators spent 25 per cent more on direct care than for-profit operators and delivered 93,000 hours more care relative to their funding, while for-profit operators delivered 500,000 less hours. At the same time, their profits rose 113 per cent during the period.
“(These) issues are going to grow without fundamental reform,” she said, noting that B.C. will need more beds with costs and care demands only going up.
“So it’s really important to get this fund system aligned to the incentives and it is critical when we do that, to recognize that for profit-facilities perform differently than not-for-profit facilities, all things being equal,” she said.
(That’s) not a bad thing. We just need a funding formula that recognizes, that harnesses what is going about the for-profit sector and turns it to incentivize it to provide the care that we need, and then to be fair to the not-for-profit sector.”
Mackenzie’s review examined 181 contracted facilities representing 93 per cent of all contracted sites for 2021/22, building on a 2020 report that looked at subsidized long-term care in 2017/18.
“There hasn’t really been much change over the last five year,” Mackenzie said.
While the government has made such changes to financial reporting and is working on revising the funding formula, it is not clear when those changes will come into effect, she said.
“The current system is not maximizing resident care,” she said. “It’s not equitable to operators, so it is not fair to the people who are living there…and it is not fair to the (not-for-profits).”
The report makes four recommendations, including incentives ensuring money received for direct care goes toward direct care, improved monitoring of what constitutes direct care, and a better definition of what constitutes profit.
More broadly, Mackenzie called for more government intervention in the industry.
“We are not partners in the delivery of this care,” she said. “It’s not an equal relationship. Government is the regulator and the funder. We have a responsibility to the people who live there and we have a responsibility to the taxpayers…we need to understand that in order to make this equitable, a group of people are going to make a lot less money than they have been making.”
Health Minister Adrian Dix said the provincial government is currently working on a new funding formula.
“We are working with the sector on it and it should be relatively soon,” he said.
Dix added government is working on the four recommendations.
“Had it not been for the pandemic, they would have been in place already,” he said. “I think people know how significant long-term care was during the pandemic. The work is ongoing and they should expect it soon.”
When asked about Mackenzie’s criticism, Dix said the public expects government to work with all different players.
“One of the ways you are successful, is to engage with people and that is what I will continue to do,” he said. “When you are asking people to deliver the care, you gotta work with them. “
But Dix also pointed out that government has not been neutral on these questions.
“We raised wages, we got rid of Bill 29, we increased care standards,” he said. We very significantly supported the sector and increased support for the sector during COVID-19 because costs went up for the sector and we implemented the best human resources program that I have seen maybe in decades in government. You don’t succeed in that by just ordering people. You succeed by working with people.”
Mackenzie’s report acknowledges several areas of improvement in the sector.
“It’s breath-taking the progress that we have made over the last number of years and what Isobel Mackenzie wants for us to do, is even better,” Dix said.
Terry Lake, chief executive officer for BC Care Providers Association, said his organization echoes Mackenzie’s call for a better funding formula.
“We have been in deep discussions with the Ministry of Health and Health Authorities on a new formula based on equity, transparency and importantly, sustainability,” Lake said, in a statement. He added that report points to a 13 per cent decrease in long-term care beds versus the demand and a 149 per cent increase in wait lists, “which clearly is not sustainable.”
But if Lake praises aspects of the report, he is critical of others, noting that the data dates back to the COVID-19 pandemic.
“To say this time was chaotic is an understatement,” he said, adding providers across the sector were focused on keeping residents and staff safe by pouring money into overtime and infection prevention and control supplies.
Lake added that the costs from 2021-22 have yet to be finalized.
“It is difficult to have confidence in the current data, as reconciliation for COVID-related spending is still underway and it is irresponsible to draw conclusions for a COVID impacted year,” he said.
Operators also dealt with staff shortages, Lake said. While health authorities reviewing and approving staffing plans acknowledged staffing challenges, incentives were not available, he added.