A new study of long-term care homes in Ontario shows that older facilities, with design standards dating back to the 1970s, were a significant factor in determining the likelihood of a COVID-19 outbreak.
The study also revealed that homes owned by for-profit corporate chains were most likely to have the dated design features, including shared bedrooms for up to four people and larger common areas where the virus could spread more easily among groups of people.
The study, which was published in the Canadian Medical Association Journal, used Ministry of Long-Term Care data from March 29 to May 20, 2020 in the province's 623 long-term care homes.
As reported by the CBC, "around 30 per cent of homes in the province experienced outbreaks during this peak period, with 110 occurring in for-profit homes, 55 in nonprofit homes, and 25 in municipal homes."
At for-profit homes, the report said, "the rate of cases was almost double compared to those with non-profit status. These homes also had a 178 per cent increase in the number of resident deaths."
"Of the 10 homes with the highest death rates in Ontario, seven were for-profit homes with older design standards and chain ownership," the CBC reports. "Of the 15 homes with the highest numbers of cases, 12 had older design standards and are owned by for-profit chains."
Nova Scotia also considering design flaws
Seniors care advocates are also raising the question of building design in Nova Scotia where 53 people died in Northwood Manor. Part of that complex has an older design that allows three people to share one room.
A CBC article tells the story of Gerald Jackson, who "spent his final days with COVID-19 lying just centimetres from another man's bed, separated by a curtain in an eighth-floor room. A third man lay about three metres away."
When one of Gerald's roommates tested positive for COVID-19, his family knew it was only a matter of time before he would too. They were told there was nowhere to relocate him.
He died from COVID-19 on April 28. His family blames his death on the layout of the 44-year-old building.
"This was like a hospital room," his daughter, Darlene Metzler, said in an interview with the CBC. "I challenge somebody to walk in that room and tell me that doesn't look like institutional living where seniors are being warehoused."
Family members, unions and local groups like Families for Quality Elder Care are calling for a full public inquiry into what went wrong at the home.
Need to limit infections
Medical research has shown that cramped homes where multiple people share rooms may make it easier to provide care but more difficult for controlling the spread of viruses. Newer designs allow for larger and more private rooms and less crowded, self-contained common space. This limits infection.
In Ontario, a CBC Marketplace investigation – like the recent CMAJ study – found that homes owned by for-profit corporations were most likely to have failed to upgrade to the newer building designs.
According to the CBC, Ontario changed its structural safety standards back in 1998 requiring, among other things, that rooms in long-term care homes should have no more than two residents in them.
Homes that didn't meet the new standard could keep running as-is, with an expectation they would upgrade in the future. "The vast majority of homes that haven't yet upgraded are run by for-profit companies," according to the CBC.
Mike Harris' Conservative government decided that the 1998 rules would only be applied to new long-term care homes being built. Standards were upgraded again in 2002, and again in 2015. None of these building changes were enforced on existing for-profit home owners. In 2010, the McGuinty government gave Ontario long-term care homes in Ontario 15-year licences based on the structural standards they had at the time. Home owners were not required to make clear commitments on when design upgrades would occur.
For-profit homes failed to upgrade
So why have so many for-profit long-term care homes failed to upgrade their facilities? Like many things, it comes down to a question of money – and who will pay.
Large corporations like Extendicare, Sienna Living, Revera and Chartwell – all bringing in millions in shareholder profits through their seniors' living businesses – expect Ontario taxpayers to foot the bill for needed changes. According to the Ontario Long-Term Care Association, these corporate chains have called on the Ontario government to give them the funding for the design changes.
Jane Meadus, an elder advocate and lawyer, told the CBC that the companies won't feel the pressure to change as long as the for-profit homes are full (which they are because there is a desperate need for seniors' care in Ontario as evidenced by the province's long waiting lists.)
"They would have to use some of their profits to rebuild," said Meadus. "They're able to keep their homes occupied at a high rate ... and so there isn't any particular impetus for them to build because they fill their beds anyway."
Having new design standards that improve the care, comfort and especially the safety of those who live in long-term care homes is great – but only when they are enforced. Allowing for-profit long-term care home owners to ignore these building standards has contributed to the deaths of many seniors during the COVID-19 crisis.
And with Premier Doug Ford's cozy corporate connections, he won't likely be pushing corporations running long-term care to rebuild any time soon – even though it would save lives.