COVID-19 outbreaks more common in for-profit senior residences in B.C.

Private for-profit homes for seniors are over-represented among residences that have experienced COVID-19 outbreaks in B.C., according to an exclusive CBC News analysis.

For-profit facilities saw the largest share of overall outbreaks, as well as a disproportionate share of the worst outbreaks, where more than 40 per cent of residents were infected.

Of the 21 outbreaks where more than 40 per cent of residents were infected between the beginning of March and end of January, 11 were in private for-profit facilities, six were in non-profit run facilities and four were in care homes run by government health authorities.

All but four of these outbreaks were at residences in the Lower Mainland. Three were in the Okanagan, and one was in Prince George.

While the data shows a pattern of for-profit facilities being hardest-hit by COVID-19, it doesn't show why — a pressing question, says B.C.'s seniors advocate, if something is to change to protect vulnerable seniors. An estimated two-thirds of the province's COVID-19 deaths have been in care homes.

Private for-profit homes in B.C. have previously been shown to pay less to employees, and spend less on residents' care, but they also may have had a tougher time accessing supplies and expertise during this unprecedented pandemic.

More deadly outbreaks

CBC News analyzed 218 outbreaks at 155 residential facilities for seniors between the beginning of the pandemic and the end of January. We used the number of beds or units in each facility to calculate approximate infection and death rates. 

Of the 22 outbreaks where more than 10 per cent of residents with COVID-19 died, half were in private for-profit facilities. All but three were in Metro Vancouver.

Outbreaks in B.C. have occurred in assisted and independent living facilities, which are privately operated, but the majority have been in long-term care, which is for seniors who require 24-hour care and supervision.

Long-term care beds in B.C. are roughly evenly distributed between private non-profit, private for-profit, and facilities run by government health authorities, according to the Office of the Seniors Advocate.

Tomorrow, CBC News will name the seniors homes hardest-hit by COVID-19 outbreaks, and speak to family members about the care their loved ones received. 

In Ontario, a CBC analysis found certain chains of privately-operated long-term care homes had higher COVID-19 death rates than municipally or non-profit run residences.

The situation in Quebec, where long-term care facilities experienced the country's highest death rates during the pandemic's first wave, is less clear. 

A national analysis of seniors residences during the first wave of the pandemic did not find significant differences in COVID-19 death rates among different types of facilities.

Unequal access to supplies and expertise 

Back in B.C., Seniors Advocate Isobel Mackenzie said multiple factors likely contributed to why some outbreaks were more widespread and deadly than others. 

"I think ownership is an interesting distinction and a pattern, but the question is, what is it about the owner? What are the practices that we need to to change that are different in for-profit versus not-for-profit? Some of it will be related to the culture." 

A February 2020 report from the Office of the Seniors Advocate found long-term care homes that operated on a not-for-profit basis spent about $10,000, or 24 per cent more per resident, on care than those in the for-profit sector.

Pre-pandemic, the report found non-profit care homes tended to provide more hours of care than they were funded for, while for-profit homes provided less. 

The same report also found "wages paid to care-aide staff in the for-profit sector could be as much as 28 per cent below the industry standard."

But some of the disparity could also be because health-authority run facilities had better access to protective equipment and infection control experts. 

"Long-term care is not accustomed to high-stakes infection control practices," Mackenzie said.  "Health authorities have infection-control experts that deal with Ebola and other high-stakes infections. So the question is, how do we plan for the future and plan for a level of expertise to be available across the board?" 

Facilities that were health-authority owned and operated were supported ... whereas private and affiliate sites felt that they were left to manage independently unless an outbreak occurred.- BC Ministry of Health

A report from the consulting firm Ernst & Young, published in October, suggests privately operated facilities may have been at a disadvantage relative to those run by the government during the first wave of the pandemic, based on interviews with staff.

"There was a consistent perception that the oversight, management, and support available to long-term care providers varied depending on if a facility was health-authority owned and operated versus operated by a private or not-for-profit provider," the report said. 

"Facilities that were health-authority owned and operated were supported in procuring personal protective equipment, managing staffing availability, and infection prevention and control education and training, whereas private and affiliate sites felt that they were left to manage independently unless an outbreak occurred."

'We aren't part of that supply'

These are things Frank Rizzardo, president of the for-profit Florentine seniors residence in Merritt, B.C., has experienced firsthand

The Florentine has not had a COVID-19 outbreak, something Rizzardo attributes to meticulous attention to public health rules and infection control on the part of management and staff.

He said it can be frustrating to hear provincial officials talk in press briefings about all the protective equipment and supplies they have access to.

"They proudly announce we have X number of millions of gloves and masks and et cetera. We aren't part of that supply," he said.

"We don't have the luxury of having the kind of dollars that they have and putting [that] into inventory."

Rizzardo said it's also challenging to find enough staff, especially given the provincial order restricting care-home workers to one facility. He said many nurses and care aides choose to work in the public system due to better compensation and the flexibility to work in both long-term care and acute-care facilities.

This has left him looking out of province, and even out of country, to find enough staff.

Rizzardo said he would prefer to work collaboratively with the government on issues such as equipment procurement and staffing. He cites the successful vaccine rollout in his facility as encouraging example of this.

More for-profit homes in hard-hit Fraser Health region

Another factor, according to the CEO of the B.C. Care Providers Association, which represents independent and assisted living, as well as private-pay care home operators, is which parts of the province have been hardest hit for overall cases.

Terry Lake, who is also a former health minister for B.C., said the Fraser Health region has more private for-profit facilities than other parts of the province — and has seen the most community spread of COVID-19.

"The biggest single factor in studies around North America has been the prevalence of the virus in the community. As the virus goes up, outbreaks go up in care homes... And so certainly in Fraser Health particularly, we have seen that," he said.

Contracted care homes, both private and non-profit, also have higher numbers of residents with dementia, which makes outbreaks more difficult to contain because those patients wander, Lake added.

The Ministry of Health did not respond to a request for comment by deadline.

Methodology

CBC News examined Ministry of Health outbreak data from long-term care, assisted living and independent living facilities between the start of the pandemic in March 2020 and Jan. 27, 2021. This included 218 outbreaks at 155 facilities. We cross-referenced it with data from the Office of the Seniors Advocate on long-term care facilities, which contains the number of beds for all long-term care facilities in B.C. that receive public funding, current as of March 31, 2020. 

Data for facilities where 54 outbreaks occurred is not included in the Office of the Seniors Advocate data because they are classified as assisted or independent living and do not receive public funding. CBC News obtained figures for the number of beds or units in these facilities either from Ministry of Health listings or the websites of the facilities.

Infection rates per outbreak (not per facility) were calculated by dividing the number of residents infected by the number of beds or units. Death rates were calculated by dividing the number of resident deaths by the number of beds or units.

The infection and death rates reported in this story represent an estimate because in most cases the bed count is current as of March 31, 2020, and the number of beds can fluctuate. This methodology underestimates infection rates in facilities that are not at capacity. It overestimates infection rates in assisted or independent-living facilities where there is more than one person per unit, such as couples sharing a suite.