Thread by @DrVivianS

Just read this @TorontoStar OPED by @drbobbell.

Points for properly pinpointing key transmission factors.

Points deducted for missing the mark RE: Profit-making process and impact on staffing.

My thoughts below. thestar.com/opinion/contri…

To start. We agree that rising community transmission & ward rooms/improper cohorting were key factors for outbreaks.

You did, however, miss the fact inter-facility movement between homes by precariously employed staff helped set ablaze the wildfire that occurred in wave 1.

Also, ask yourself: Why did for profit (FP) providers buy up old homes and fail to update them over the years?

They knew they had to but didn't.

You don't think that had anything to do with diverting those funds to exorbitant executive salaries and shareholder dividends?

Re: Staffing.

According to you:
"The accusation that infections were caused by privately owned home operators reducing staffing to maximize profits is false. This claim is made by individuals who must not understand how care is funded in Ontario’s LTC homes".

Labour and/or LTC experts never argued the main reason for outbreaks was reduced staffing. What we did do was link the general failure of the FP sector during C19 to the profit making process.

Let me elaborate.

Deadly mistakes made by overburdened and/or improperly trained LTCH staff aggravated the mortality observed.

Add this to the fact many PSWs were precariously employed at multiple homes and we start to understand the corresponding wave 1 disaster.

Now, assuming inter-facility staff movement is not a factor, let's look at staffing conditions.

Overburdened/burnt out workers make mistakes.

Remember, many PWSs were/are working double/triple shifts to make up for staffing collapses that come during outbreaks.

The For Profit (FP) connection?

FP homes tend to have less staff & less properly trained staff which leads to ⬆️ in preventable error. These errors made during a pandemic, with this population, prove deadly.

The military reports (yes, both) confirm this.

Why do we have so many undertrained/poorly paid LTC workers now?

Let's go back in time to the good old Harris days.

The pivotal move came in the 90s when Harris gave the majority of contracts for the creation of 20K beds to FP providers, like Chartwell (incidentally, where he sits on the board & earns 200,000+).

I talked about that here back in July.

https://twitter.com/DrVivianS/status/1283513748897112064?s=20

See @LindaMcQuaig's recent @TorontoStar article on this:
thestar.com/opinion/contri…

His grave mistake set into motion the FP model of market dominance we now have in place (which directly impacted labour conditions in these homes).

ps. Did you know the emerging FP lobbyists argued for the elimination of care standards under Harris?

thestar.com/politics/polit…

The result: Abysmal staffing ratios/absent care standards in an increasingly FP LTC landscape where residents now fail to receive the care they require/deserve.

p.s. It's no coincidence that as the share of FP homes increased, the quality of resident care decreased.

Workers increasingly failing to receive proper pay & training for the very difficult work they provide leads a revolving door of staff (50% of of PSWs leaving the sector within 5 years).

More on this from the Staffing Report released in July:
ontario.ca/page/long-term…

You say operators can't profit from "skimping" on staffing.

Are you aware of the drastic shift in the staffing mix from nurses to PSWs (who are paid far less) over the lasts 20 years since FP homes took over their reign in ON?

Coincidence?!

And THIS is where labour experts prevail.

Flipping the staff mix (effectively on its head) in a bid towards lower-waged labour was a decidedly structural shift to increase profits.

Nurses are more expensive.

In order to pay LTC workers less & to justify the low wages provided, the sector moved to an unregulated (feminized & racialized) workforce that has been shown to be undertrained, overworked and underpaid.

To boot, we're seeing a further de-skilling of this workforce w/ the creation of RCA "Resident Care Aides" (RCAs).

This category has been pushed for by the FP sector and their lobbyists.

And they prevailed.

On Nov 9, @fordnation released their targeted hiring blitz focusing on "recently unemployed workers displaced from the retail & hospitality industries". This spells disaster.
news.ontario.ca/en/release/591…

This further de-skilling has been quietly at play some time & has been corroborated by unions representing frontline staff (@SEIUHealthCan @RNAO @UniforTheUnion).

My thoughts on that recent & targeted hiring blitz: kitchenertoday.com/local-news/ont…

The overall result?

A general degradation to resident care in FP homes, which includes preventable injuries/harm from an increasingly unregulated, undertrained & ill-equipped LTC workforce.

The evidence for the quality of care being lower in FP homes is well documented in the literature.

Some of the evidence:
1. Higher hospitalizations from for-profit chains;
2. Increases in verified complaints;
3. Increased reports of abuse/neglect.
⤵️
amazon.ca/Privatization-…

The Military Reports (both) clearly highlight what we knew re: undertrained/overworked LTCH staffers and how dangerous this was during a pandemic.

Military reporters were quick to point out how many of grave IPAC errors were made by "junior/untrained staff".

So yes, staffing is vitally important (and not merely the # of staff on hand but the skill mix and the organization, remuneration and regulation of that labour).

Oh and ALL of this relates to FOR PROFIT status.

The end.