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In defence of for-profit nursing homes | Heather Campbell Pope

Tuesday, April 06, 2021 @ 2:12 PM | By Heather Campbell Pope

Heather Campbell Pope %>
Heather Campbell Pope
Eight years ago, at age 71, Jane Devji climbed Mount Kilimanjaro with her sons to raise money for the Alzheimer Society of B.C. It was her third ascent up Africa’s highest mountain, having first made the trek decades earlier in her 20s, and then for a second time at age 67, also in support of the Vancouver-based dementia charity.

“We who can climb Kilimanjaro can quit any time we want to, if we don’t feel up to going on,” Devji said about hiking the mountain, which sits in northern Tanzania near the Kenyan border.

“People who have dementia cannot quit. They have no options,” she continued. “So, it is important that we do not quit if we want to help them.”

Raised in Tanzania, Devji immigrated to Canada in 1975, along with her husband, Amin, and young son Salim. A registered nurse by trade, she graduated nursing school in Kenya in 1964 and worked at the country’s oldest hospital; but her nursing papers were lost in transit and she could not secure work as a registered nurse in B.C.

The family persevered. Amin, a former BBC employee, found work in television; Devji got a nursing home job. She then heard on the radio that a small care home in Delta, B.C., was for sale.

In 1976, the Devji family and their partnership group bought the business, hoping to provide a new standard of care by owning the home themselves.

Three years later, the family welcomed a second son, Aly, who along with his older brother, grew up in the nursing home, with Salim helping make beds and Aly spending time with residents and staff from just 10 days old.

“I was raised in some cases by residents that had dementia, but back then nobody really knew much about it. So in the late ’80s, my parents, by then the sole owners of the organization, set about designing the Delta View Habilitation Centre,” Aly said. “It was purpose-built for Alzheimer’s disease and related dementias.” The new home opened in 1991.

At Delta View, the Devjis nurtured their “hugs not drugs” policy, an approach that favours freedom of movement over physical restraints. The family continued to own and manage the home until 2018, when it was acquired by Good Samaritan Canada. “Jane and Amin Devji embody the values of compassion, inclusion and innovation and I know everyone in Delta wishes them well in their retirement,” said B.C. Liberal MLA Ian Paton.

Yet if the federal NDP has its way, there would be no family-owned care homes like Delta View. In a motion tabled March 22, party leader Jagmeet Singh urged the federal government to eliminate all for-profit care by 2030, a stance that echoes what many union leaders, academics and advocates have argued for decades.

“[I]t is essential that federal funding for [long-term care] homes be entirely dedicated to not-for-profit and publicly owned service providers,” says a recent legal opinion prepared for the Ontario Health Coalition and its partners on establishing national standards for long-term care.

Understandably focused on the significant issues of chain ownership, the ideological insistence on ending for-profit care devalues the innovations of entrepreneurial families like the Devjis.

Not all independently owned homes are well-run, but profit is not the inherent enemy; in the right conditions, it can be a strong and proper incentive that drives continuous improvement.

Singh’s motion to end for-profit care failed with 305 votes against and 28 in favour. All Liberal, Conservative and Bloc MPs voted against it.

While COVID-19 has put a spotlight on problems in long-term care, holding as absolute that privatization is a menace deflects from the deeper injustice of ageism, the most tolerated form of prejudice that permeates all aspects of society. It is the societal blight that has facilitated the mistreatment and rights violations of nursing home residents, 70 per cent of whom have dementia.

To its credit, the federal government has committed to an action less radical than dismantling the current system of mixed management structures. It promises to develop national standards that would help ensure residents in all types of long-term care are treated with dignity and respect. The ministers of health and seniors have tiptoed around a division of powers battle by pledging to make separate deals with willing provinces and territories. Federal funding would likely be tied to provincial compliance with agreed-upon benchmarks.

Others propose the constitutionally murky approach of establishing national standards in federal legislation, either in a stand-alone statute or an amended Canada Health Act. Relying on the federal government’s spending power, long-term care funding would be released to provinces and territories that meet federally imposed performance measures.

A non-government led initiative is also underway. The Health Standards Organization is revising its long-term care service standard; its affiliate, Accreditation Canada, uses the standard to assess performance of participating homes. Across the country, 58 per cent of long-term care homes are accredited under the current version. Some experts are urging Ottawa to leverage these existing standards and accreditation bodies in its pursuit of national benchmarks.

Several premiers oppose the idea of national standards, instead wanting more cash transfers with no strings attached. Federal Conservative Leader Erin O’Toole agrees with the premiers on jurisdictional grounds, though he welcomes a collaborative approach of sharing best practices.

Views also differ on substance. Academics and others have offered measurable benchmarks. Common themes include improving hours of direct care, staffing ratios and the mix of care providers. Industry stakeholders have proposed principle-based standards, a regulation-lite model that is arguably harder to quantify and enforce.

Many proposals are worthy of consideration, but calls for the outright elimination of for-profits are misguided. In a society that all too easily ignores people with dementia, we need more pioneering families like the Devjis in the long-term care sector.

Heather Campbell Pope (LLB, LLM) is a former B.C. lawyer and founder of Dementia Justice Canada. She worked for the B.C. Care Providers Association in policy and research. Follow her at @SeniorsLaw.
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