Tim Hortons emergency care and the nursing home connection
Two popular Canadian institutions, Tim Hortons and universal health care, recently had an awkward partnership. On February 28, doctors at Royal Columbian Hospital in New Westminster were forced to assess patients in the adjacent Tim Hortons store because of emergency room overcrowding. In his public response, minister of health services Colin Hansen said that “this is not a symptom of government inaction, but the reality of the demands of a growing and aging population.”
He went on to describe the recent investments in hospitals and a project to reduce emergency crowding. The “patient-focused funding model,” a pilot project to reduce emergency crowding, gives money to hospitals if they can improve patient flow. In other words, the faster hospitals treat patients, the more money they get. Royal Columbian was one of the hospitals in this pilot project.
Patient-focused funding has had some successes, but it is a narrow response to large problems. According to Marcy Cohen of the Canadian Centre for Policy Alternatives, patients are coming to hospital for treatment that they should be receiving in the community. At a health-care policy conference on March 12 sponsored by Simon Fraser University health science students, Cohen said that people with mental illness and addictions are hospitalized two to three times more often than people with other chronic diseases because of inadequate community services.
Hansen’s remarks suggest that the rising population of seniors is the cause of overflowing emergency rooms. He enumerated the additional nursing home beds that have opened in BC during the Liberal era. Despite Hansen’s assertion, the number of residential care beds per British Columbian 75 years old or older has actually fallen in the past decade. Moreover, government’s policy on financing long-term care expansion may be counterproductive in reducing pressure on hospital beds.
Nursing homes in Canada have traditionally been operated by nonprofit agencies, such as churches or health authorities. Marcy Cohen said that the majority of residential beds in BC are in nonprofit facilities, but since 2000, the government has used the public-private partnership model for creating new residential-care beds. Although nonprofit agencies could bid on proposals for new nursing homes, they seldom have the necessary capital. Corporations have stepped into the breach and as a result, almost all the new beds in BC are in for-profit facilities, while some nonprofit beds have closed.
Two UBC researchers, Margaret McGregor and Lisa Ronald, published a report earlier this year on long-term care in Canada. They examined available research in Canada, the United States, and abroad on the quality of care in nursing homes, both for-profit and nonprofit. The measures of quality include factors such as the staff-to-resident ratio, the occurrence of bedsores, and the rate that elderly residents are sent to hospital for acute problems like urinary infections and pneumonia.
McGregor and Ronald conclude that the “direction of the association between for-profit facility ownership and inferior quality is consistent.” In other words, elderly people who reside in for-profit nursing homes are more likely than residents of nonprofit facilities to develop bedsores, infections, and to require hospitalization. This is likely related to the fact that, compared with residents of for-profit facilities, residents of nonprofit facilities receive on average almost an additional half hour of care per day. This may not seem like much, but according to one study, during one year, 600 residents of for-profit nursing homes in Canada could avoid bedsores if they received this additional staff attention.
The reason for lower staffing in for-profit nursing homes, along with the lower wages they tend to offer employees, is no mystery. Their owners and shareholders expect a return on investment. At the recent Simon Fraser University health policy conference, Dr. Andrew Coates, a New York physician and advocate for universal health care in the United States, described the web of corporate entities surrounding for-profit nursing homes. In many cases, the ultimate control lies in private equity firms, but the owners are far removed from the concerns of residents and their families—and shielded from lawsuits. This is a stark contrast with the model of local control and democratic accountability that has prevailed in Canada. When it comes to caring for the aging BC population, partnering with Tim Hortons may be the least of our worries.