As a Calgary company prepares to take over more long-term care facilities in Western Canada after two years of COVID-19 deaths, advocates are calling for an end to for-profit ownership and operation of long-term care homes in the province.

In January, Revera told residents that 14 of its homes in Alberta and B.C. are set to be sold to another for-profit provider, Calgary-based AgeCare. A letter promised a “seamless” takeover for residents and staff, and continuation of business as usual. Advocates for public long-term care, however, say business as usual is unacceptable—and that a new UCP bill meant to standardize regulations across the sector doesn’t address the underlying problem.

The AgeCare deal would give the company, which has received generous government subsidies from previous PC and NDP governments, control over 17 for-profit long-term care homes in Alberta, including eight in Calgary. Both operators’ Calgary homes were hit hard by the pandemic.

Alberta lacks official data on COVID outbreaks in long-term care. But according to data compiled by independent journalist Nora Loreto on residential-care COVID deaths nationwide, the current death toll at AgeCare’s five Calgary facilities during the pandemic is 80, more than half of which occurred at the company’s Skypointe home in northeast Calgary. The three Revera homes in Calgary AgeCare is purchasing saw 58 deaths.

The takeover must be approved by the Competition Bureau of Canada, which declined comment on the purchase, citing confidentiality.

But Bobby-Joe Borodey, a VP with the Alberta Union of Provincial Employees (AUPE), which represents workers at several AgeCare facilities, says it doesn’t matter who’s in charge of which home so long as the profit motive reigns supreme in long-term care.

“We believe all long-term care within the province needs to be under the public umbrella, so we can do away with the for-profit pitfalls that we see happening,” she told The Sprawl.

The problem, Borodey says, isn’t this or that owner—but the structure of how long-term care operates in Canada, as it exists outside the purview of the public healthcare system.

Alberta’s lack of data makes it difficult to get a clear picture of COVID cases in long-term care. But a study from the Seniors Advocate of B.C. shows a disproportionate number of cases in that province occurred in for-profit long-term care facilities, like those operated by Revera and AgeCare.

A few months prior to the pandemic, the Alberta government eliminated the Seniors Advocate position, which was established in 2014, folding it into the broader Health Advocate’s mandate. The 2019-2020 report from the Health Advocate—the most recent one to date—doesn’t even mention long-term care.

According to the B.C. report, 259 COVID cases per 1,000 beds occurred in for-profit facilities that are contracted out by the government—compared to 219 in non-profits, 106 in public and 79 in fully private facilities (although the report acknowledged a small sample size for the latter category).

Rebecca Graff-McRae, who wrote a report on staffing issues in Alberta’s long-term care industry last year for the Parkland Institute, said these issues pre-date the pandemic.

“They're not new, they're merely more obvious, more tragic, and more urgent now after six waves of pandemic,” Graff-McRae said. “And advocates, workers, unions and researchers have all been pointing to the same basic solutions.”

Her May 2021 report, which was done in collaboration with the Canadian Union of Public Employees, surveyed workers in long-term care in Alberta. It found that although unionized workers were in an advantageous position, workers “across the board'' experienced burnout and overworking. Some had to come in on vacation days due to short-staffing while others had to skip their breaks due to the daily workload demands.

Graff-McRae said there was a “descending correlation” of staffing levels for the various ownership models, with workers at for-profits reporting the worst staff-to-resident ratio and AHS workers reporting the least bad.

She does credit the Alberta government for phasing out multiple-resident rooms, which are by nature prone to more outbreaks, but emphasized this is the bare minimum.

The dire and often deadly conditions faced by residents and workers of these facilities contrasts sharply with the return-on-investment approach of owners.

“Many of these large corporations basically act as real estate speculators,” said Graff-McRae. “They're buying the site, they're buying the land. And that's the investment for them. It's not an investment in people. And that's the part that is really frustrating.”

In 2006, five AgeCare homes in Alberta and one in B.C. were sold to Northern Property Real Estate Investment Trust for $142.9 million, although AgeCare continues to operate the facilities.

In January 2020, 80% of shares in the remaining five AgeCare homes were sold to Axium Infrastructure, a Montreal-based investment firm. Axium also owns 75% of shares in 32 Revera homes across Canada.

AgeCare didn’t respond to an interview request for this story.

In April 2021, The Sprawl spoke to workers at AgeCare homes who outlined the realities of working and living in long-term care while short-staffed and under-paid during the pandemic.

At the time, workers at three Calgary AgeCare facilities and one in Strathmore said they faced a higher workload due to short-staffing and insufficient sick days, which had taken a “physical, emotional and psychological toll” on both workers and residents, according to the union. AUPE called on Alberta Health Services to take over those homes.

“It was not an easy job before COVID and people need to recognize that it’s an undervalued job,” said one worker who spoke to The Sprawl.

According to Borodey, these issues persist two years into the pandemic.

Even before the outset of COVID, Borodey says, long-term care workers had to work multiple jobs to pay the bills—which, given their qualifications, often involved working at other long-term care homes. This became a significant health and safety risk once a highly-infectious virus came into the equation.

“We're not always talking about just someone picking up a second job; we have a number of members who have two and three additional jobs to make ends meet,” Borodey said. “Once the government and the public realized that these members were actually traveling from home to home, it caused an occupational health and safety concern in the middle of a pandemic.”

As a result, the government was pressured into enacting a single-site rule for long-term care workers, which was implemented by fall 2020, but lifted in February 2022—which Borodey says brings the situation back to square one.

The vaccination of residents and workers helps somewhat, but due to the highly-contagious Omicron variant, workers were even more short-staffed than before, which is the reason the government gave for lifting the single-site rule.

With all the uncertainty surrounding the proliferation of new variants, Borodey says it’s wise to err on the side of caution.

“We're still trying to figure out COVID and what the efficacy of being vaccinated or not vaccinated is on your ability to catch different strains,” she said. “It's not like we've truly closed the book and figured anything out yet. It's still very much up in the air.”

Placing long-term care facilities under the public umbrella would also allow workers to bargain with the same employer and ensure universal labour standards across the industry, Borodey said.

One of the Calgary Revera homes included in the sale to AgeCare is McKenzie Towne Continuing Care Centre, which is the target of a $25-million class action suit for allegedly failing to protect its residents from COVID.

About a month after the lawsuit was filed in May 2021, the UCP government passed Bill 70, which shields long-term care operators from legal liability due to COVID outbreaks in their facilities unless their conduct can be proven to be “grossly negligent.”

Mathew Farrell of Guardian Law is representing the plaintiffs in the AgeCare suit. He is also leading a constitutional challenge against Bill 70. Both cases are still in their early stages.

The change of McKenzie Towne’s ownership likely means that AgeCare will take on Revera’s legal liabilities as part of the arrangement.

Bill 70 impacted the initial suit by raising the threshold for culpability, Farrell said.

He added that these kinds of suits go “hand-in-hand with regulations to encourage care homes to do the right thing by making sure that there’s a cost to doing the wrong thing.”

“If nothing else, I do think [Bill 70] is unconstitutional,” he said. “I told them so when they were debating it, but I guess we'll have to get a court to tell them so.”

On March 28, Health Minister Jason Copping introduced the Continuing Care Act, or Bill 11, in the legislature. Copping said the bill will provide a “consistent approach” to regulating long-term care, as well as other forms of residential care such as assisted living and palliative care.

The legislation increases the maximum penalty for homes found violating standards of care to $100,000 a day from $1,000 a day and will allow the government to appoint an administrator to run a home where “a significant risk to the health, safety or wellbeing of residents” is determined.

These were some recommendations from a May 2021 government-commissioned report on facility-based care, which also recommended an increase to the amount of hours of care residents receive by means of an increase to full-time staff. But Copping said the government isn’t so sure about that aspect of the report, citing its $410-million price tag.

“That's the single biggest thing to improve quality of life for residents and support health-care workers, but they're not sure? That makes me uneasy,” Graff-McRae, the Parkland Institute researcher, said.

While many of the changes in the legislation sound good on paper, Graff-McRae is concerned they could be a Trojan Horse for further privatization. She cites the legislation’s reference to “innovative” approaches to the sector and the acknowledgement that it’s the “first stage in a suite of legislative tools.”

Chris Gallaway, executive director of Friends of Medicare, said Bill 11 “leaves more questions than it answers” and doesn’t come anywhere near addressing the root of the problem—patient care taking the back seat to the profit motive.

Gallaway told The Sprawl stronger regulation is a good short-term measure on the road to incorporating long-term care into the public healthcare system, but Bill 11 is insufficient even as a stopgap measure.

“Overall, it’s a strange housekeeping bill that brings a bunch of legislation together and doesn’t really change a lot while ignoring a lot of the major problems we know exist,” he said. “They’re talking out of two sides [of their mouths].”

He called the for-profit motive “toxic” towards prioritizing patient care.

“Unless we move away from this commodity approach to seniors’ care, we’re never going to solve the problem,” Gallaway said.

Jeremy Appel is an independent Calgary-based journalist who writes The Orchard newsletter. He also co-hosts the Forgotten Corner and Big Shiny Takes podcasts.