Long-Term Care Facility Workers’ Perceptions of the Impact of Subcontracting on their Conditions of Work and the Quality of Care

Albert Banerjee, Margaret McGregor, Sage Ponder, Andrew Longhurst
Canadian Journal on Aging
Published online by Cambridge University Press:  28 May 2021

[Excerpts] In the public imagination, LTCFs [Long Term Care Facilities] have long been considered to be places of last resort and are associated with warehousing, waiting to die, and, during the COVID-19 pandemic, death itself. Cost has also been of concern, particularly in the context of an aging population wherein the need for long-term care (LTC) is expected to increase. These concerns have also come at a time of governmental fiscal restraint and greater reliance on market mechanisms to deliver seniors’ care.

One significant consequence of cost concerns has been a turn to the for-profit sector for innovation and investment. In the early 2000s, the province of British Columbia passed several “business-friendly” policies to prepare for increasing for-profit participation in LTCFs. Chief among these were policies permitting the subcontracting of LTCF staff. Subcontracting was a process whereby for-profit companies and non-profit organizations, which had been contracted by the regional public health authority to provide LTCF services, could decide to contract with third-party companies for their staffing needs. In British Columbia, this second layer of contracting was called “subcontracting”. Facility management were able to end these subcontracts with short notice, allowing management to bust unions and reduce labour costs, a process termed “contract flipping”. The governments’ policy decisions to allow subcontracting were legitimated by claims that such arrangements would ensure financial sustainability, while supporting greater flexibility, responsiveness and quality.

Privatization in the LTCF Sector

“Privatization” refers to the transfer of public resources to for-profit providers.

LTC has been particularly susceptible to privatization because the sector is excluded from the Canada Health Act. This exclusion has contributed to the considerable variability in facility ownership across the country and within provinces (e.g., differing public, non-profit, and for-profit ownership mixes). Despite this variability, general trends point towards an increasing reliance on for-profit providers for the construction of new facilities as well as a concentration of for-profit ownership through large corporate chains.

To read more, click on: https://doi.org/10.1017/S071498082100012X